The World Health Organization (WHO) had recommended in May that male Ebola survivors practice safe sex for a minimum of six months after their symptoms began.
Now, two new Ebola virus studies published online in the New England Journal of Medicine have echoed the message that men who have survived the Ebola virus should practice safe sex past the WHO recommendation. The studies further suggest that semen should also be treated as a potential infection source of Ebola.
In the first study, researchers analyzed and matched Ebola genomes from a female Liberian blood sample with the newly attracted virus. A sample of semen had also been taken from the female’s male sex partner, whom she had unprotected vaginal sex with.
The case study had been originally published in the Centers for Disease Control and Prevention (CDC)’s Morbidity and Mortality Weekly Report on May 1, 2015. In that report, it was concluded that the male Ebola survivor’s semen had been the source of the female’s infection; however, they needed a complete genomic sequencing of the Ebola virus from both sex partners to show an association.
Researchers from the current study demonstrated an interesting connection. A molecular analysis revealed that Ebola virus genomes from the male Ebola disease survivor’s semen, as well as blood samples from the female partner, had shown three unique substitutions not seen in the 786 Western Africa Ebola virus genomes. The three sequences were different from the Ebola virus transmission chain previously documented. Also, the 199-day persistence of viral nucleic acids in the semen was over four times greater than WHO recommendations for a country to be free of the disease.
The authors concluded:
“Although the semen sample contained no detectable infectious Ebola virus, the assembly of a nearly complete genome suggested the possible presence of infectious particles. In addition, from the evidence of the sexual transmission between the patient and the survivor, we can infer that infectious Ebola virus was present in the survivor at least 179 days after the onset of disease (155 days after the clearance from blood.”
In the second article published in the New England Journal of Medicine, researchers found that Ebola virus RNA was found nine months after the Ebola disease onset. The pilot study had included 100 Ebola survivors from Sierra Leone. A quantitative reverse transcriptase-PCR assay with target gene sequences of VP40 and NP had been used to measure viral RNA levels in semen samples from 93 of the men, which were taken at different times after their recoveries.
The assay detected Ebola virus viral RNA in 26% of men tested seven to nine months after the Ebola disease onset, 65% of those tested four to six months after the Ebola onset, and 100% in those tested two to three months after onset. One man was tested 10 months after the Ebola onset and the results were indeterminate.
“Persons who survive the Ebola virus disease face myriad challenges. Many survivors have family members and friends who died from Ebola. Many are unemployed, face stigma from their communities, and have lingering sequelae in addition to the risk of persisting virus in semen. Due respect and continuing efforts that have strong sustainable support from within the local communities are crucial in mitigating negative effects in terms of further stigma attached to survivors,” explained Dr. Gibrilla Deen, the lead study author from the Sierra Leone Ministry of Health and Sanitation in Freetown.
Dr. Deen’s team plans to test other bodily fluids in men and women who had survived the Ebola virus disease.
The 2014 Ebola epidemic throughout West African countries is considered the largest outbreak since the virus was first discovered in 1976. There were 11,302 deaths from 28,041 reported Ebola cases—more than any other outbreak combined. The outbreak began in Guinea, and spread to Sierra Leone and Liberia. It also affected travelers by plane from Nigeria and the U.S., and travelers by motorized vehicles from Mali and Senegal.
Sources for Today’s Article:
Mate, S.E., et al., “Molecular Evidence of Sexual Transmission of Ebola Virus,” The New England Journal of Medicine, 2015; doi: 10.1056/NEJMoa1509773.
Deen, G.F., et al., “Ebola RNA Persistence in Semen of Ebola Virus Disease Survivors – Preliminary Report,” The New England Journal of Medicine, 2015; doi: 10.1056/NEJMoa1511410.
Kelly, J.C., “Ebola Sexual Transmission 6 Months After Illness Confirmed,” Medscape Multispecialty web site, October 14, 2015; http://www.medscape.com/viewarticle/852693.
Swift, D., “WHO Issues Interim Advice on Sexual Transmission of Ebola,” Medscape Multispecialty web site, May 12, 2015; http://www.medscape.com/viewarticle/844529.
“The toll of a tragedy,” The Economist, August 27, 2015; http://www.economist.com/blogs/graphicdetail/2015/08/ebola-graphics.