Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Colarado, USA.
Curr Opin Infect Dis. 2018 Feb;31(1):39-44. doi: 10.1097/QCO.0000000000000414.
Zika virus has recently emerged from an obscure mosquito-borne pathogen to an international public health concern. It is the first viral agent newly demonstrated to cause birth defects in several decades, and it is the only arbovirus now known to be transmitted sexually. The purpose of this review is to provide an overview of current understanding of sexual transmission of Zika virus and its possible clinical and public health consequences.
Sexual transmission of Zika virus has been reported from at least 13 countries without simultaneous mosquito-borne transmission; it is undoubtedly also occurring in countries with active arthropod transmission. Most published cases involve transmission from symptomatically infected men to women partners. Nevertheless, transmission from a symptomatic man to another man, from a symptomatic woman to a man, and from an asymptomatic man to a woman has also been reported. Sexual transmission has occurred before symptom onset, during illness, and after resolution of the source partner's symptoms. With the exception of a woman who developed symptomatic infection 44 days after onset of her husband's illness, nearly all instances reported to date have occurred within 20 days of the source partner's illness. Zika virus RNA has been detected in semen, saliva, blood, urine, and vaginal and cervical secretions; the length of time during which RNA can be detected varies widely across different body fluids but is especially lengthy in semen. Although semen has been found to contain ZIKV RNA for more than 180 days after illness onset, only a small proportion of samples with detectable RNA yield replicative virus whenever cultured.
Public health agencies have promulgated interim recommendations to prevent sexual transmission of Zika virus; however, much remains unknown regarding the duration of contagiousness and risk factors for transmission. Given the risk for birth defects, the greatest concern is for transmission of the virus to women who are pregnant or attempting to become pregnant. To prevent sexual transmission in general, couples are advised to use condoms or not have sex for at least 6 months from the start of the male partner's symptoms or the date he was diagnosed with Zika or after he has returned from an area with risk of ZIKV infection. Women who have symptomatic ZIKV infection or have traveled to an area of risk are advised to use condoms or avoid sex for 8 weeks from the start of the woman's symptoms or the date she was diagnosed with Zika or after the woman returns from the area of risk.
寨卡病毒已由一种鲜为人知的蚊媒病原体演变为国际公共卫生关注的焦点。它是近几十年来首个被证实可导致出生缺陷的病毒病原体，也是目前唯一已知可经性传播的虫媒病毒。本文旨在概述寨卡病毒性传播的现有认识及其可能的临床和公共卫生后果。
至少 13 个国家有寨卡病毒性传播的报告，而这些国家并无蚊媒传播；在有节肢动物传播的国家，这种传播无疑也在发生。大多数已发表的病例涉及有症状的男性传染给女性伴侣。然而，也有从有症状的男性传染给另一名男性、从有症状的女性传染给男性、以及从无症状的男性传染给女性的报道。性传播发生在症状出现之前、发病期间和源患者症状消退之后。除了一名女性在其丈夫发病后 44 天出现症状性感染外，迄今为止报告的几乎所有病例均发生在源患者发病后 20 天内。寨卡病毒 RNA 已在精液、唾液、血液、尿液以及阴道和宫颈分泌物中检出；不同体液中 RNA 可检出的时间长短差异很大，但在精液中尤其长。尽管在发病后超过 180 天的精液中仍发现有 ZIKV RNA，但只有一小部分有可检测 RNA 的样本经培养后能产生复制性病毒。
公共卫生机构已发布预防寨卡病毒性传播的临时建议；然而，关于传染性持续时间和传播风险因素，仍有许多未知。鉴于存在出生缺陷风险，最大的担忧是病毒传播给怀孕或试图怀孕的女性。为了一般性预防性传播，建议伴侣在男性伴侣出现症状或被诊断患有寨卡病毒或从寨卡病毒感染风险地区返回后至少 6 个月内使用避孕套或避免性行为；有症状的寨卡病毒感染或曾前往感染风险地区的女性，建议在女性出现症状或被诊断患有寨卡病毒或女性从感染风险地区返回后 8 周内使用避孕套或避免性行为。
