Female-to-Male Transmission of Zika Virus

Summary and Comment |
July 25, 2016

Female-to-Male Transmission of Zika Virus

  1. Stephen G. Baum, MD

The first description of probable sexual transmission from a female to a male.

  1. Stephen G. Baum, MD

Since the first descriptions of mosquito-borne Zika virus in South America and the Caribbean in 2015, evidence has been mounting that the infection can be spread through unprotected sexual intercourse from males to females who have not traveled to endemic areas. Now the Centers for Disease Control and Prevention and the New York City Department of Health and Mental Hygiene provide evidence that a female traveler to an unidentified endemic area has transmitted Zika virus to a male sexual contact, presumably as the result of condomless vaginal sexual intercourse occurring on the day of her return from the endemic area.

A female in her 20s developed headache and abdominal pain the day before she returned to New York City. Her symptoms on the day of her return (day 1) included fever, fatigue, maculopapular rash, myalgia, arthralgia, back pain, swelling of her extremities, numbness and tingling in her hands and feet, and heavier-than-usual menses. On day 3, she sought medical attention. Blood and urine specimens were both positive for Zika virus RNA, as tested by real-time reverse transcriptase polymerase chain reaction. On day 6, her male sexual partner, who had not traveled to an endemic area, developed fever, maculopapular rash, joint pain, and conjunctivitis. He denied sexual intercourse with any other person during this period. Three days after his illness onset, Zika RNA was detected in his urine, but not in his serum. Tests for Zika-related IgM antibodies were negative in both patients.


It seems highly likely that infection of the male was due to transmission from the female via passage of either vaginal fluid or menstrual blood. Based on this case, healthcare providers caring for patients with Zika-compatible symptoms should obtain appropriate sexual histories and testing.

Editor Disclosures at Time of Publication

  • Disclosures for Stephen G. Baum, MD at time of publication Consultant / Advisory board Clinical Infectious Diseases (Editorial Advisory Board) Speaker’s bureau UpToDate (author) Editorial boards Medical Letter (Board of Directors, Chairman)


Reader Comments (1)

Matthew Collins Fellow-In-Training, Infectious Disease

I think saliva-borne transmission cannot be discounted. IgM more reliable after a few more days of symptoms.

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