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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Unpredictable Zika Transmits Sexually from Female to Male

By Gary Evans, AHC Media Senior Staff Writer

Zika virus is proving nothing if not unpredictable as we now have the first documented case of apparent female-to-male sexual transmission.

This follows a surprising number of male-to-female cases of transmission and the first documented report of Zika infection via needlestick.

“Current guidance to prevent sexual transmission of Zika virus is based on the assumption that transmission occurs from a male partner to a receptive partner . Ongoing surveillance is needed to determine the risk for transmission of Zika virus infection from a female to her sexual partner,” the CDC reported today.

Erring on the side of caution now means taking precautions if either partner has been in a Zika transmission area.

The CDC reports that a routine investigation by New York City public health officials determined that a non-pregnant woman in her 20s apparently transmitted Zika virus to a male sex partner the day she returned from a region with widespread transmission of the virus. The woman reported a single episode of condomless vaginal intercourse.

“She had headache and abdominal cramping while in the airport awaiting return to NYC,” the CDC reported. “The following day [one day after sex] 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 began menses that she described as heavier than usual.”

The following day – day two after intercourse -- she visited her primary care provider who obtained blood and urine specimens. Zika virus RNA was detected in both serum and urine.

“Seven days after sexual intercourse, the woman’s male partner, also in his twenties, developed fever, a maculopapular rash, joint pain, and conjunctivitis,” the CDC reported. [T]hree 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 astute clinician made the connection and reported suspected transmission to NYC health officials. Zika virus was detected in the male sex partner. The man reported he had not traveled outside the United States during the year before his illness.

“The timing and sequence of events support female-to-male Zika virus transmission through condomless vaginal intercourse,’ the CDC concluded. “The woman likely was viremic at the time of sexual intercourse because her serum, collected 3 days later, had evidence of Zika virus RNA by rRT-PCR. Virus present in either vaginal fluids or menstrual blood might have been transmitted during exposure to her male partner’s urethral mucosa or undetected abrasions on his penis. Recent reports document detection of Zika virus in the female genital tract, including vaginal fluid.”

For all the latest AHC Media Zika coverage, please visit