Systematic Review
Sexually acquired Zika virus: a systematic review

https://doi.org/10.1016/j.cmi.2016.12.027Get rights and content
Under an Elsevier user license
open archive

Abstract

Background

Zika virus (ZIKV) is transmitted to humans primarily by Aedes mosquito bites. However, circumstantial evidence points to a sexual transmission route.

Objectives

To assess the sexually acquired ZIKV cases and to investigate the shedding of ZIKV in genital fluids.

Data sources

PubMed, Scopus, Pro-MED-mail and WHO ZIKV notification databases from inception to December 2016.

Selection criteria

Reports describing ZIKV acquisition through sex and studies reporting the detection or isolation of ZIKV in the genital fluids were included.

Risk-of-bias assessment

The risk of bias was assessed using the National Institute of Health Tool.

Results

Eighteen studies reporting on sex-acquired ZIKV and 21 describing the presence of ZIKV in genital fluids were included. The overall risk of bias was moderate. Sexual transmission was male–female (92.5%), female–male (3.7%) and male–male (3.7%). Modes of sexual transmission were unprotected vaginal (96.2%), oral (18.5%) and anal (7.4%) intercourse. The median time between onset of symptoms in the index partner and presumed sexual transmission was 13 days (range 4–44 days). ZIKV RNA was detected in semen as late as 188 days (range 3–188 days) following symptom onset, and infectious virus was isolated in semen up to 69 days after symptom onset. No study reported ZIKV isolation from female genital samples, but detection did occur up to 13 days after symptom onset.

Conclusions

ZIKV is potentially sexually transmitted and persists in male genital secretions for a prolonged period after symptom onset.

PROSPERO systematic review registration number CRD42016041475.

Keywords

Semen
Sex
Zika
Review
Febrile illness

Cited by (0)

4

André Machado de Siqueira and Cristiane C Lamas contributed equally to this article.