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Interim Guidelines for Px of Sexual Transmission of Zika Virus

Nurse Practitioner

by Mimi Secor, DNP, FNP-BC, FAANP

Can you accurately answer your patients’ questions about the Zika virus and the possible sexual transmission of this virus? Your patients’ lives may depend on your knowing the facts!
According to CDC, Zika virus may be sexually transmitted. This is of great concern for pregnant women and their partners because of a possible association between maternal Zika virus infection and congenital microcephaly. Based on three reports, new interim recommendations for the prevention of sexual transmission of the Zika virus have been released by the Center for Disease Control (CDC) (1).
The Zika virus is transmitted by the Aedes aegpti mosquitoes (2, 3). An estimated 80% of patients (3, 4) are asymptomatic when infected with the Zika virus. When illness occurs, symptoms are usually mild and resolve without treatment. However, possible complications secondary to Zika infection include congenital microcephaly (5, 6) and Guillian-Barre syndrome (5, 6). Unfortunately, there is no treatment for Zika infections nor is there a vaccination to prevent Zika infection. CDC recommends that persons traveling to, or residing in areas of active Zika transmission, take measures to prevent infection by preventing mosquito bites (http://www.cdc.gov/zika/prevention/) (1).
Based on three cases, it appears that the Zika virus may be sexually transmitted. The first of the three cases involved possible heterosexual transmission because the clinical symptoms developed soon after sexual activity. The second case is under investigation in Dallas, Texas, so limited details are available at the time of this writing. The third case involves isolation of the Zita virus in semen 2-10 weeks after onset of symptoms.
Symptomatic illness occurred in these three cases. It is not known if asymptomatic infected patients, who never develop illness, are able to transmit the Zika virus. To date, no cases have been reported of sexual transmission from infected women to their sex partners. Use of latex condoms is known to reduce sexual transmission of a host of STIs (1).
Recommendations for men and their pregnant partners
According to CDC, “Men who reside in or have traveled to an area of active Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex (i.e., vaginal intercourse, anal intercourse, or fellatio) for the duration of the pregnancy. Pregnant women should dis¬cuss their male partner’s potential exposures to mosquitoes and history of Zika-like illness (http://www.cdc.gov/zika/symptoms) with their health care. Providers can consult CDC’s guidelines for evaluation and testing of pregnant women (1, 9).
Zika virus testing in men has been recommended to estab¬lish a diagnosis of infection in some groups, such as male partners of pregnant women (9). At present, Zika virus testing for the assessment of risk for sexual transmission is of uncertain value, because current understanding of the incidence and duration of shed¬ding in the male genitourinary tract is limited to one case report in which Zika virus persisted longer than in blood (8). At this time, testing of men for the purpose of assessing risk for sexual transmission is not recommended.” (1, p.1).
CDC will update these recommendations, as more is known about semen shedding of Zika virus from infected men.

By Mimi Secor, DNP, FNP-BC, NCMP, FAANP, Send correspondence to [email protected]

1. Oster AM, Brooks JT, Stryker JE et al. Interim Guidelines for Prevention of Sexual Transmission of Zika Virus — United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65(Early Release):1-2.
2. Hayes EB. Zika virus outside Africa. Emerg Infect Dis 2009;15:1347–50. http://dx.doi.org/10.3201/eid1509.090442.
3. CDC. Zika virus. Atlanta, GA: US Department of Health and Human Services, CDC; 2016. http://www.cdc.gov/zika/index.html.
4. Duffy MR, Chen TH, Hancock WT, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med 2009;360:2536–43. http://dx.doi.org/10.1056/NEJMoa0805715.
5. European Centre for Disease Prevention and Control. Rapid risk assessment: Zika virus epidemic in the Americas: potential association with microcephaly and Guillain-Barré syndrome. Stockholm, Sweden: European Centre for Disease Prevention and Control; 2015. http://ecdc. europa.eu/en/publications/Publications/zika-virus-americas-association-with-microcephaly-rapid-risk-assessment.pdf.
6. Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 2016;47:6–7. http://dx.doi.org/10.1002/uog.15831.
7. Foy BD, Kobylinski KC, Foy JLC, et al. Probable non-vector-borne transmission of Zika virus, Colorado, USA. Emerg Infect Dis 2011;17:880–2. http://dx.doi.org/10.3201/eid1705.101939.
8. Musso D, Roche C, Robin E, Nhan T, Teissier A, Cao-Lormeau VM. Potential sexual transmission of Zika virus. Emerg Infect Dis 2015;21:359–61. http://dx.doi.org/10.3201/eid2102.141363.
9. Oduyebo T, Petersen EE, Rasmussen SA, et al. Update: interim guidelines for health care providers caring for pregnant women and women of reproductive age with possible Zika virus exposure—United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65(5).