The first female-to-male sexual transmission of Zika virus infection has been reported in New York City. Previously reported cases have always been men spreading Zika virus infection to their sex partners.
New York City’s Department of Health and Mental Hygiene (DOHMH) described a non-pregnant female in her 20’s who reported a single event of vaginal intercourse with a male partner without a condom. This happened the day she returned to New York City (Day 0) after traveling to an area with active Zika virus transmission. She reported headache and abdominal cramping in the airport waiting to return to New York City.
The next 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; she also started menses that was heavier than normal. After collecting blood and urine specimens, Zika virus RNA was detected in both samples. Serum testing for anti-Zika virus immunoglobulin M (IgM) antibody was negative.
On Day 6, the woman’s male partner developed fever, a maculopapular rash, joint pain, and conjunctivitis. Three days later, the man visited the same primary care provider who had diagnosed Zika virus infection in his female partner. The man’s urine and serum specimens showed Zika virus RNA in urine but not in serum; Zika virus IgM antibodies were not detectable. The male partner denied having traveled outside the country during the year before his illness, having any other recent sexual partners or being bit by a mosquito the week before his illness.
The evidence supported female-to-male Zika transmission through condomless vaginal intercourse. The report described the transmission of virus present in either vaginal fluids or menstrual blood during exposure to her male partner’s urethral mucosa or undetected abrasions on his penis.
The Centers for Disease Control and Prevention (CDC) recommends all pregnant women to use barrier methods with every intercourse or abstain from sex during pregnancy if they have a sex partner who has traveled to or lives in an area with Zika virus. These recommendations also apply to female sex partners of pregnant women though no cases of female-to-female Zika transmission have been reported. Also, the CDC is updating recommendations for people who are sexually active but the couple is not pregnant or not concerned about pregnancy, and for people who want to reduce risk of sexual transmission of Zika infection.
Healthcare providers are urged to report any patients with illness compatible with Zika virus disease without a history of travel to an area with ongoing Zika virus transmission but who had sexual exposure to a partner who did travel.
For more information visit CDC.gov.