Zika virus has implications for your male patients (and you)

National Report-The Centers for Disease Control and Prevention recently reported that the mosquito-borne Zika virus can also be transmitted via sexual intercourse. A man whose semen silently harbors the virus is capable of infecting his sexual partner and endangering the outcome of her pregnancy. Urologists, therefore, need to be prepared to deal with men’s questions and recommend preventive steps related to virus transmission.

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The World Health Organization now warns that neonatal microcephaly, as well as other illnesses caused by Zika virus, constitute a “public health emergency of international concern.” Since the first case was reported in Brazil in May 2015, the spread of Zika has escalated “from a mild threat to one of alarming proportions,” WHO Director General Margaret Chan, MD, said in a BBC News article.

In addition to microcephaly and mental retardation, premature birth and serious congenital eye defects are now linked to this virus, according to the CDC. Furthermore, people infected by Zika may later develop Guillain-Barré syndrome, acute demyelinated encephalomyelitis, and other neurologic infections within the brain and spinal cord, recent reports from WHO, the American Academy of Neurology, and other sources indicate.

The most common symptoms are fever, rash, joint pain, or conjunctivitis (red eyes). Other common symptoms include muscle pain and headache. However, most people infected with Zika virus will have no symptoms at all. Even when the Zika virus is present in semen and urine, there are no accompanying signs of prostatitis or other lower urinary tract symptoms. The CDC says it may be possible for a man to be carrying the Zika virus and to transmit it to his partner through sexual contact, without his knowing that he is infected. The virus can stay in semen longer than in blood. Currently, there is no practical screening process for detecting whether or not men are carrying Zika virus in their semen.

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Commercial testing for Zika virus is just now becoming available on a limited basis. Meanwhile, requests for testing still entail a complex, time-consuming application process, mediated through government agencies, which may vary from state to state.

Next: Preventive steps to be taken

Preventive steps to be taken

Because of the link between Zika and serious birth defects, steps should be taken to prevent sexual transmission of infection, especially during pregnancy.

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The CDC has issued the following warning:

• Zika virus can be spread during sex by a man infected with Zika to his partner. The virus has been transmitted from man to woman by vaginal intercourse and man to man via anal intercourse.

• In known cases of sexual transmission, so far the men have ultimately developed Zika symptoms.

• To help prevent spreading Zika through sex, couples at risk during the pregnancy should either use a condom every time they have sex or abstain from sex. Men who have been diagnosed with Zika or who have had symptoms of Zika should use condoms or not have sex for at least 6 months after symptoms begin. Men who have traveled to an area with Zika, but did not develop symptoms, should consider using condoms or not having sex for at least 8 weeks after their return.

The CDC maintains a website with more complete, updated information: Zika and Sexual Transmission.

Next: Unanswered questions

Unanswered questions

These CDC recommendations are preliminary. Answers are based on relatively scant, short-term experience. Many additional critically important questions remain unanswered, and men may soon be asking their urologist:

• How can I know if I am carrying Zika virus?

• How long may I be at risk?

• How much protection do condoms provide?

• Can a woman spread Zika to her sex partner?

• How can a couple determine whether their pregnancy is affected?

• Could there be risk of subsequent neurologic impairment for them or for their baby afterward?

• Should Zika virus be included when screening for other sexually transmitted illnesses?

Anne Schuchat, MD, principal deputy director of the CDC, admits that the type of mosquito in which the virus is carried is present in more U.S. states than was originally estimated-30 states, rather than just 12. Over 500 cases are already present in Puerto Rico. “Everything we look at about the virus is scarier than we initially thought,” she told a White House press briefing.

On a more sanguine note, Congress is now voting on a $1.9 billion package to combat Zika virus here.  Other nations are following suit. A commercially available blood test should be available imminently, and there is hope that an initial anti-Zika vaccine will be available for testing by the end of this year.

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