Friday, July 15, 2016

MMWR: 1st Female-to-Male Sexual Transmission of the Zika Virus - NYC


Given the Lancet report earlier this week of Zika virus in the female genital tract, no one should be terribly surprised by the news that the CDC has documented the first ever female-to-male transmission of the Zika virus in an Early Release MMWR published today.
First the statement from the CDC, followed by a link to, and excerpts from, the MMWR report.

The New York City report of female-to-male sexual transmission of Zika virus infection is the first documented case of sexual transmission of Zika from a woman to her sex partner and adds to the growing body of knowledge about the sexual transmission of Zika. All previously reported cases of sexually transmitted Zika virus infection have been spread from men to their sex partners.

CDC recommends that all pregnant women who have a sex partner who has traveled to or resides in an area with Zika use barrier methods every time they have sex or they should not have sex during the pregnancy. Although no cases of woman-to-woman Zika transmission have been reported, these recommendations now also apply to female sex partners of pregnant women.

CDC is currently updating recommendations for sexually active people in which the couple is not pregnant or concerned about pregnancy and for people who want to reduce personal risk of Zika infection through sex.

July 15, 2016 / Vol. 65 / Early Release
Suspected Female-to-Male Sexual Transmission of Zika Virus — New York City, 2016 Alexander Davidson, MPH1; Sally Slavinski, DVM1; Kendra Komoto1; Jennifer Rakeman, PhD1; Don Weiss, MD1 (View author affiliations)
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A routine investigation by the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) identified a nonpregnant woman in her twenties who reported she had engaged in a single event of condomless vaginal intercourse with a male partner the day she returned to NYC (day 0) from travel to an area with ongoing Zika virus transmission. She had headache and abdominal cramping while in the airport awaiting return to NYC. The following day (day 1) she developed fever, fatigue, a maculopapular rash, myalgia, arthralgia, back pain, swelling of the extremities, and numbness and tingling in her hands and feet. In addition, on day 1, the woman began menses that she described as heavier than usual. On day 3 she visited her primary care provider who obtained blood and urine specimens. Zika virus RNA was detected in both serum and urine by real-time reverse transcription–polymerase chain reaction (rRT-PCR) performed at the DOHMH Public Health Laboratory using a test based on an assay developed at CDC (1). The results of serum testing for anti-Zika virus immunoglobulin M (IgM) antibody performed by the New York State Department of Health Wadsworth Center laboratory was negative using the CDC Zika IgM antibody capture enzyme-linked immunosorbent assay (Zika MAC-ELISA) (2).

Seven days after sexual intercourse (day 6), the woman’s male partner, also in his twenties, developed fever, a maculopapular rash, joint pain, and conjunctivitis. On day 9, three days after the onset of his symptoms, the man sought care from the same primary care provider who had diagnosed Zika virus infection in his female partner. The provider suspected sexual transmission of Zika virus and contacted DOHMH to seek testing for the male partner. That same day, day 9, urine and serum specimens were collected from the man. Zika virus RNA was detected in urine but not serum by rRT-PCR testing at the DOHMH Public Health Laboratory. Zika virus IgM antibodies were not detectable by the CDC Zika MAC-ELISA assay performed at the New York State Department of Health Wadsworth Center. The CDC Arbovirus Disease Branch confirmed all rRT-PCR results for urine and serum specimens from both partners.

During an interview with DOHMH on day 17, the man confirmed that he had not traveled outside the United States during the year before his illness. He also confirmed a single encounter of condomless vaginal intercourse with his female partner (the patient) after her return to NYC and reported that he did not engage in oral or anal intercourse with her. The man reported that he noticed no blood on his uncircumcised penis immediately after intercourse that could have been associated either with vaginal bleeding or with any open lesions on his genitals. He also reported that he did not have any other recent sexual partners or receive a mosquito bite within the week preceding his illness.
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