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CDC updates guidelines to prevent sexual transmission of Zika
Men who have traveled to an area with ongoing Zika virus transmission should consider abstaining from having sex with their pregnant partners or should “consistently and correctly use condoms” for the duration of the pregnancy, researchers cautioned in MMWR.
The recommendations came days after the CDC confirmed the virus had been spread through sexual contact.
In two separate reports, the CDC published interim guidelines for the prevention of sexual transmission of Zika and updated interim guidelines for health care providers caring for pregnant women and women of reproductive age with possible exposure to the primarily mosquito-borne virus.
Thomas R. Frieden
CDC Director Thomas R. Frieden, MD, MPH, said that as more evidence supporting the association between microcephaly and Zika infection becomes available, the priority should be protecting pregnant women.
“With each passing day, the linkage between Zika and microcephaly becomes stronger,” Frieden said during a teleconference. “In addition, the linkage between Zika and Guillain-Barré syndrome also appears stronger the more we learn. And because it’s new and can be so severe, it’s scary, especially for women who are pregnant or considering pregnancy.”
The CDC continues to urge the use of condoms and safe sex practices to protect against the virus.
Men with pregnant sexual partners who are living in areas where Zika is active or who have traveled to those places should either abstain from sexual activity or correctly use condoms during all oral, anal and vaginal sex, according to the recommendations.
Additionally, men who are living in or have recently traveled to an active Zika area who are concerned about transmitting the disease to their nonpregnant partners also should consider the same precautions. Such couples considering sex should take into account that most Zika infections do not have symptoms and any illness is usually mild.
The CDC noted that Zika might persist in semen even after it is no longer detectable in blood. Zika testing in men is recommended to establish diagnosis of infection in groups including pregnant women. However, testing for men for the purposes of assessing their risk for sexual transmission is not recommended.
“As we learn more about the incidence and duration of seminal shedding from infected men and the utility and availability of testing in this context, recommendations to prevent sexual transmission of Zika virus will be updated,” researchers wrote in MMWR.
Serologic testing is recommended within 2 to 12 weeks for pregnant women without symptoms who have returned from traveling to areas with ongoing Zika transmission. Testing is recommended within the first week for pregnant women with clinical illness consistent with Zika.
Further, the CDC has expanded guidance for women who reside in areas with ongoing Zika virus transmission, including recommendations for screening, testing and management of pregnant women and recommendations for counseling women of reproductive age (15 to 44 years).
Zika discovered in urine, saliva samples
According to Brazilian health authorities, active Zika has been discovered in urine and saliva samples. However, experts urged caution about the new finding and stressed that the virus is primarily spread by mosquitoes.
Stephen Gluckman
“It’s hard to interpret what that means,” Stephen Gluckman, MD, professor of infectious diseases at the University of Pennsylvania and medical director of Penn Global Medicine, told Infectious Disease News.
Gluckman noted that HIV is also present in urine and saliva but is not transmissible through either means. “Zika may not be transmissible that way. Nobody knows,” he said.
The CDC has not issued warnings about acquiring Zika through kissing, nor should it at this point, Gluckman said.
An evolving situation
Gluckman said the more speculation about Zika, the more the public will feel angst over the virus. He said the risk for acquiring Zika through insertive sex is still unknown and that it has not been conclusively established that the virus causes microcephaly.
“There’s a probable association, but it’s not clear that it does,” he said. “I’m not saying it doesn’t, don’t get me wrong, but even that hasn’t been established and people are going way beyond that. The disease itself is pretty trivial. … Even if it is associated with microcephaly, nobody has the foggiest idea of what the risk is. Is there risk in every pregnancy? Is there risk in one in 10? Or is there risk in one in 100,000?”
Gluckman said Zika is concerning for pregnant women, but the general population should not be alarmed.
“No one else should be worried,” he said. “And until it’s clearer what the risks are for pregnant women, that’s an unquestionable priority.” – by Gerard Gallagher
Disclosures: The researchers, Frieden and Gluckman report no relevant financial disclosures.