WHO Issues Interim Advice on Sexual Transmission of Ebola

Diana Swift

May 12, 2015

With sexual contact emerging as a possible route of Ebola virus transmission, especially from men to women, the World Health Organization (WHO) has issued interim precautionary recommendations for sexually active survivors.

Male Ebola survivors and their sexual partners should be counseled on practicing safe sex or abstinence until semen has twice tested negative. Survivors should be given condoms, which should be used consistently and correctly and then carefully disposed of to avoid contact with seminal fluid. Hands should be washed after any contact with survivors' semen.

Male survivors should have their semen tested at 3 months after disease onset. Those positive for the virus should be tested every month until their seminal fluid twice tests negative for the virus in week-apart tests, at which point they can resume normal sexual practices. Untested men should practice safe sex for at least 6 months after symptom onset.

According to the WHO, a recent case investigation identified Ebola RNA in semen 199 days after symptom onset, which is well beyond the period of virus detectability in survivors' blood, and long after recovery.

In another recent case, a Liberian woman is thought to have contracted Ebola through unprotected sexual relations with a male survivor some 5 months after his blood tested negative for the virus.

As further evidence of possible sexual transmission, the WHO referred to a reported case of heterosexual transmission of Marburg virus, Ebola's sister filovirus, from a male survivor to his female partner during an outbreak in 1967.

Although Ebola virus RNA has been detected in the vaginal fluid of a woman 33 days after disease symptom onset, live virus has never been isolated from vaginal fluids. It is not known how long virus typically persists in vaginal fluids or whether it can be sexually transmitted from women to men.

The WHO cited the need for more surveillance data and research on the risks of sexual transmission, and particularly on the prevalence of transmissible virus in semen over time.

"Interim Advice on the Sexual Transmission of the Ebola Virus Disease." WHO. Published online May 8, 2015. Full text

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