A agência da ONU destacou que a via de transmissão primária do vírus zika é através do mosquito Aedes. “No entanto” – diz a OMS – “a transmissão sexual de vírus zika também é uma possibilidade, com evidência limitada registrada em alguns casos”.

Este é um cenário preocupante, diz a Organização, devido à associação entre a infecção pelo vírus zika e complicações potenciais, incluindo a microcefalia e a síndrome de Guillain-Barré.

A atual base de evidências sobre o vírus zika continua extremamente limitada, reforça a OMS. “Esta orientação será revista e as recomendações atualizadas de acordo com o surgimento de novas evidências”, acrescenta a OMS.

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Guia provisórtio em inglês:

Prevention of potential sexual transmission of Zika virus

Interim guidance

18 February 2016

WHO/ZIKV/MOC/16.1

1. Introduction

1.1 Background

This guidance has been developed to provide advice on the

prevention of potential sexual transmission of Zika virus.

The primary transmission route of Zika virus is via the

Aedes mosquito. However, sexual transmission of Zika

virus may also be possible, with limited evidence recorded

in a few cases. This is of concern due to an association

between Zika virus infection and potential complications,

including microcephaly and Guillain-Barré syndrome.

The current evidence base on Zika virus remains extremely

limited. This guidance will be reviewed and the

recommendations updated as new evidence emerges.

1.2 Target audience

This document is intended to inform the general public,

and to be used by health care workers and policy makers to

provide guidance on appropriate sexual practices in the

context of Zika virus.

2. Potential sexual transmission of Zika virus

2.1 Current evidence

Sexual transmission of Zika virus has been described in two

cases, and the presence of the Zika virus in semen in one

additional case.

Zika virus transmission by sexual intercourse has been

suggested by Foy et al. [1], who described a male patient

infected with Zika virus in south-eastern Senegal in 2008.

Four days after the patient returned home to the United

States of America, his wife began to display symptoms of

Zika virus infection. Because she had not travelled out of

the United States during the previous year, and had sexual

intercourse with the patient one day after he returned,

transmission by semen was suggested. In another case on 2

February 2016, the United States Centers for Disease

Control and Prevention announced that a patient with Zika

virus infection in Texas had acquired the virus through

sexual contact, rather than via a mosquito vector – the primary route [2].

Zika virus has been isolated in semen in one documented

case of a man in Tahiti who sought treatment for

hematospermia during a Zika virus outbreak in French

Polynesia in December 2013 [3]. He had previously

experienced symptoms of Zika virus infection twice: two

weeks and ten weeks before presentation with

hematospermia. Zika virus was isolated from semen

samples taken at presentation and also three days later. The

observation of Zika virus in semen supports the possibility

that the virus could be sexually transmitted.

2.2 Interim recommendations

Based on precautionary principles, WHO recommends that:

1. All patients (male and female) with Zika virus infection

and their sexual partners (particularly pregnant women)

should receive information about the potential risks of

sexual transmission of Zika virus, contraceptive

measures and safer sexual practices1, and should be

provided with condoms when feasible. Women who

have had unprotected sex and do not wish to become

pregnant because of concern with infection with Zika

virus should also have ready access to emergency

contraceptive services and counselling [4].

2. Sexual partners of pregnant women, living in or

returning from areas where local transmission of Zika

virus is known to occur, should use safer sexual

practices or abstinence from sexual activity for the

duration of the pregnancy.

3. As most Zika virus infections are asymptomatic2:

a. Men and women living in areas where local

transmission of Zika virus is known to occur should

consider adopting safer sexual practices or

abstaining from sexual activity.

b. Men and women returning from where local

transmission of Zika virus is known to occur should

adopt safer sexual practices or consider abstinence

for at least four weeks3 after return.

1 Safer sexual practices include: postponing sexual debut; non-penetrative sex;

correct and consistent use of male or female condoms; and reducing the

number of sexual partners.

2 All individuals should receive appropriate counselling to make informed

choices on the sexually transmitted infection prevention method(s) they wish to use.

3 Based on estimates of: one week for virus incubation; one week of clinical

symptoms (if any); and two weeks for Zika virus to remain in semen after a

clinical episode (based on evidence from Musso et al.)

Prevention of potential sexual transmission of Zika virus 2

4. Independently of considerations regarding Zika virus,

WHO always recommends the use of safer sexual

practices including correct and consistent use of

condoms to prevent HIV, other sexually transmitted

infections and unwanted pregnancies [5].

WHO does not recommend routine semen testing to detect

Zika virus.

3. Guidance development

3.1 Acknowledgements

This document has been developed by a guideline

development group composed of WHO staff from the

Department of Reproductive Health and Research, WHO

Geneva (Ian Askew, Nathalie Broutet, Bela Ganatra, Metin

Gulmezoglu, Ronnie Johnson, Rajat Khosla and James

Kiarie,), and the Department of Communicable Diseases

and Health Analysis, WHO Regional Office for the

Americas (Sylvain Aldighieri, Maeve Brito de Mello,

Massimo Ghidinelli and Maria del Pilar Ramon Pardo).

3.2 Guidance development methods

This document was developed based on a review of

relevant literature and guideline development group

discussion and consensus. Relevant literature was sourced

from MEDLINE using the following search terms:

flavivirus; sexual transmission; transmission; and Zika. The

guideline development group met face-to-face and via

teleconferences from 5–9 February 2016 and reached

consensus on the recommendations through group

discussion.

3.3 Declaration of interests

Interests have been declared in-line with WHO policy and

no conflicts of interest identified from any of the

contributors.

3.4 Review date

These recommendations have been produced under

emergency procedures and will remain valid until August

2016. The Department of Reproductive Health and

Research at WHO Geneva will be responsible for

reviewing this guideline at that time in light of new and

available evidence, and updating it as appropriate.

4. References

1. Foy BD, Kobylinski KC, Chilson Foy JL, et al. ‘Probable

non-vector-borne transmission of Zika virus’, Colorado,

USA. Emerg Infect Dis. 2011;17(5):880–882.

2. Dallas County Health and Human Services, ‘DCHHS reports

first Zika virus case in Dallas County acquired through

sexual transmission’, 2016. Available online from

http://www.dallascounty.org/department/hhs/press/docu

ments/PR2-2-16DCHHSReportsFirstCaseofZikaVirus

ThroughSexualTransmission.pdf (accessed 7 February 2016).

3. Musso D, Roche C, Robin E, Nhan T, Teissier A, Cao-

Lormeau VM. Potential sexual transmission of Zika virus;

Emerg Infect Dis. 2015, Feb;21(2):359-61.

4. World Health Organization, ‘Women in the context of

microcephaly and Zika virus disease’, 2016. Available online

from http://www.who.int/features/qa/zika-pregnancy/en/

(accessed 12 February 2016).

5. UNFPA, WHO and UNAIDS, ‘Position statement on

condoms and the prevention of HIV, other sexually

transmitted infections and unintended pregnancy’, 2015.

Available online from http://www.unaids.org/en/resources

/presscentre/featurestories/2015/july/20150702_condoms_

prevention (accessed 7 February 2016).