Possible Sexual Transmission of Ebola Reported

Diana Swift

May 01, 2015

Thirty days after the most recent confirmed case of Ebola in Liberia, a woman likely contracted the disease through unprotected vaginal sex with an Ebola survivor, investigators write in an article published online May 1 in the Morbidity and Mortality Weekly Report.

The investigators note that the Ebola virus appears to persist in the seminal fluid of convalescent men much longer than previously recognized. "Until more information is known, contact with semen from a male survivor should be avoided," write Athalia Christie, MIA, the Centers for Disease Control and Prevention's deputy of global health, and colleagues. "If male survivors have sex (oral, vaginal, or anal), a condom should be used correctly and consistently every time."

Ebola virus has previously been isolated from semen as long as 82 days after symptom onset, and viral RNA has been detected in semen up to 101 days after symptom onset, the authors note. But in the recent case, a male Ebola survivor appears to have sexually transmitted the infection 5 months after testing negative for the virus.

Christie and colleagues outlined the case of a 44-year-old woman (patient A) from Monrovia, Liberia, who contracted Ebola seemingly inexplicably. Going to the hospital on March 19, 2015, for symptoms that started on March 14, she reported no history of travel, no interaction with visitors from Sierra Leone or Guinea, no contact with a person with symptoms consistent with Ebola, and no recent funeral attendance (which in West Africa can involve direct contact such as kissing or eating a meal in the presence of the deceased).

The woman did, however, report having unprotected vaginal intercourse a couple of weeks earlier with an Ebola survivor (survivor A). He had been discharged from an Ebola treatment unit in October 2014 after testing negative for the virus and reported no subsequent symptoms. Several of his family members had confirmed or suspected Ebola during his symptomatic period, and three of them died.

Researchers subsequently found Ebola virus RNA in survivor A's semen in March 2015, but that does not prove the presence of infectious virus. Nor is it possible to definitively ascribe patient A's infection to their sexual contact, the researchers caution. "However, the timing of intercourse between survivor A and patient A, the subsequent illness in patient A, the presence of viral RNA in survivor A's semen, matching genetic sequences (where coverage has been obtained) in isolates from survivor A and patient A, and the lack of other known exposures suggest possible sexual transmission," they write.

Previously, the CDC and the World Health Organization recommended abstinence or condom use for at least 3 months after recovery from Ebola. "However, to prevent transmission of Ebola, contact with semen from male survivors should be avoided," the report states. Used condoms should be handled and disposed of safely to avoid contact with semen. After handling of condoms, or after any physical contact with semen, skin should be washed thoroughly with soap and water.

Several other recent Ebola cases in West Africa have suggested sexual transmission from survivors but have not been confirmed. Additional studies are planned to determine clearance, persistence, and shedding of Ebola virus in the body fluids of survivors and to evaluate possible sexual transmission of infection.

Morb Mortal Wkly Rep. Published online May 1, 2015. Full text


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