Free Standard AU & NZ Shipping For All Book Orders Over $80!
Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
REVIEW

Sexual transmission of Zika virus: a literature review

Miranda Sherley A D E and Chong-Wei Ong B C
+ Author Affiliations
- Author Affiliations

A Canberra Sexual Health Centre, Building 5, Level 1, Canberra Hospital, Garran, ACT. PO Box 11, Woden, ACT 2606, Australia.

B Infectious Diseases Unit, Building 10, Level 4, Canberra Hospital, Garran, ACT. PO Box 11, Woden, ACT 2606, Australia.

C Microbiology Unit, Building 10, Level 4, Canberra Hospital, ACT. PO Box 11, Woden. ACT 2606, Australia.

D Medical School, ANU College of Health and Medicine, Australian National University, Acton, ACT 0200, Australia.

E Corresponding author. Email: Miranda.Sherley@act.gov.au

Sexual Health 15(3) 183-199 https://doi.org/10.1071/SH17046
Submitted: 4 March 2017  Accepted: 25 September 2017   Published: 22 December 2017

Abstract

Zika virus is an emerging health threat worldwide. A member of the yellow fever virus family, it is primarily spread by mosquitoes of the Aedes (Stegomyia) genus. Unusually for a mosquito-borne virus, sexual spread has also been reported; with cases of male-to-female, female-to-male and male-to-male sexual transmission all now published in the scientific literature, in both symptomatic and asymptomatic infection. Female-to-female sexual transmission has not yet been reported, but is biologically plausible. The extent of the effect of sexual transmission on the spread of Zika virus around the world is not well-characterised, but has particular relevance to travellers to and from non-endemic regions, and assisted reproduction services.

Additional keywords: microcephaly, prevention, STI.


References

[1]  Wikan N, Smith DR. First published report of Zika virus infection in people: Simpson, not McNamara. Lancet Infect Dis 2017; 17 15–7.
First published report of Zika virus infection in people: Simpson, not McNamara.Crossref | GoogleScholarGoogle Scholar |

[2]  Basu R, Tumban E. Zika virus on a spreading spree: what we now know that was unknown in the 1950s. Virol J 2016; 13 165–73.
Zika virus on a spreading spree: what we now know that was unknown in the 1950s.Crossref | GoogleScholarGoogle Scholar |

[3]  World Health Organization (WHO). WHO statement on the first meeting of the Internatonal Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations. WHO statement: World Health Organisation (WHO); 2016. Available online at: http://www.who.int/mediacentre/news/statements/2016/1st-emergency-committee-zika/en/ [verified 19 February 2017].

[4]  World Health Organization (WHO). Zika virus, microcephaly, Guillain–Barre syndrome. Situation Report: World Health Organisation (WHO); 2017. Available online at: http://www.who.int/emergencies/zika-virus/situation-report/10-march-2017/en/ [verified 6 September 2017].

[5]  Duffy MR, Chen T-H, Hancock WT, Powers AM, Kool JL, Lanciotti RS, Pretrick . Duffy MR, Chen T-H, Hancock WT, Powers AM, Kool JL, Lanciotti RS, Pretrick . Duffy MR, Chen T-H, Hancock WT, Powers AM, Kool JL, Lanciotti RS, Pretrick . Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med 2009; 360 2536–43.
Zika virus outbreak on Yap Island, Federated States of Micronesia.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1MXntVKqtrs%3D&md5=717a52dc2c3312188941ff9c49fa4979CAS |

[6]  Abushouk AI, Negida A, Ahmed H. An updated review of Zika virus. J Clin Virol 2016; 84 53–8.
An updated review of Zika virus.Crossref | GoogleScholarGoogle Scholar |

[7]  European Centre for Disease Prevention and Control (ECDC). Zika virus infection, factsheet for health professionals. Solna: European Centre for Disease Prevention and Control (ECDC); 2016. Available online at: http://ecdc.europa.eu/en/healthtopics/zika_virus_infection/factsheet-health-professionals/Pages/factsheet_health_professionals.aspx [verified 19 February 2017].

[8]  Nayak S, Lei J, Pekosz A, Klein S, Burd I. Pathogenesis and molecular mechanisms of Zika virus. Semin Reprod Med 2016; 34 266–72.
Pathogenesis and molecular mechanisms of Zika virus.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC28XhsV2gs7%2FO&md5=64b24b2ca80172b76b05b3ac4949d2ecCAS |

[9]  Miner JJ, Diamond MS. Zika virus pathogenesis and tropism. Cell Host Microbe 2017; 21 134–42.
Zika virus pathogenesis and tropism.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2sXisVyiu7Y%3D&md5=be81d991ed647f93665f59b5af0bc47cCAS |

[10]  Baca-Carrasco D, Velasco-Hernandez JX. Sex, mosquitoes and epidemics: an evaluation of Zika disease dynamics. Bull Math Biol 2016; 78 2228–42.
Sex, mosquitoes and epidemics: an evaluation of Zika disease dynamics.Crossref | GoogleScholarGoogle Scholar |

[11]  Musso D, Roche C, Robin E, Nhan T, Teissier A, Cor-Lormeau V. Potential sexual transmission of Zika viras. Emerg Infect Dis 2015; 21 359–61.
Potential sexual transmission of Zika viras.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC28XitVKisL7K&md5=f32ce041040ce2f21fe9746fb32ecdc6CAS |

[12]  Besnard M, Lastere S, Teissier A, Cao-Lormeau V, Musso D. Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014. Euro Surveill 2014; 19 1–4.
Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014.Crossref | GoogleScholarGoogle Scholar |

[13]  Foy BD, Kobylinski KC, Foy JLC, Blitvich BJ, da Rosa AT, Haddow AD, Lanciotti RS, Tesh RB. Probable non-vector-borne transmission of Zika virus, Colorado, USA. Emerg Infect Dis 2011; 17 880–2.
Probable non-vector-borne transmission of Zika virus, Colorado, USA.Crossref | GoogleScholarGoogle Scholar |

[14]  Armstrong P, Hennessey M, Adams M, Cherry C, Chiu S, Harrist A, Kwit N, Lewis L, Olzenak-McGuire D, Oduyebo T, Russell K, Talley P, Tanner M, Williams C. Travel-associated Zika virus disease cases among U.S. residents – United States, January 2015- February 2016. MMWR Morb Mortal Wkly Rep 2016; 65 286–9.

[15]  Arsuaga M, Bujalance SG, Diaz-Menendez M, Vazquez A, Arribas JR. Probable sexual transmission of Zika virus from a vasectomised man. Lancet Infect Dis 2016; 16 1107
Probable sexual transmission of Zika virus from a vasectomised man.Crossref | GoogleScholarGoogle Scholar |

[16]  Boggild AK, Geduld J, Libman M, Yansouni CP, McCarthy AE, Hajek J, Ghesquiere W, Mirzanejad Y, Vincelette J, Kuhn S, Plourde PJ, Chakrabarti S, Freedman DO, Kain KC. Surveillance report of Zika virus among Canadian travellers returning from the Americas. CMAJ 2017; 189 E334–40.
Surveillance report of Zika virus among Canadian travellers returning from the Americas.Crossref | GoogleScholarGoogle Scholar |

[17]  D’Ortenzio E, Matheron S, Yazdanpanah Y, de Lamballerie X, Hubert B, Piorkowski G, Maquart M, Descamps D, Damond F, Leparc-Goffart I. Evidence of sexual transmission of Zika virus. N Engl J Med 2016; 374 2195–8.
Evidence of sexual transmission of Zika virus.Crossref | GoogleScholarGoogle Scholar |

[18]  Matheron S, d’Ortenzio E, Leparc-Goffart I, Hubert B, de Lamballerie X, Yazdanpanah Y. Long-lasting persistence of Zika virus in semen. Clin Infect Dis 2016; 63 1264

[19]  Frank C, Cadar D, Schlaphof A, Neddersen N, Gunther S, Schmidt-Chanasit J, Tappe D. Sexual transmission of Zika virus in Germany, April 2016. Euro Surveill 2016; 21 1–4.
Sexual transmission of Zika virus in Germany, April 2016.Crossref | GoogleScholarGoogle Scholar |

[20]  Gulland A. First case of Zika virus spread through sexual contact is detected in UK. BMJ 2016; 355 i6500
First case of Zika virus spread through sexual contact is detected in UK.Crossref | GoogleScholarGoogle Scholar |

[21]  Harrower J, Kiedrzynski T, Baker S, Upton A, Rahnama F, Sherwood J, Huang QS, Todd A, Pulford D. Sexual transmission of Zika virus and persistence in semen, New Zealand, 2016. Emerg Infect Dis 2016; 22 1855–7.
Sexual transmission of Zika virus and persistence in semen, New Zealand, 2016.Crossref | GoogleScholarGoogle Scholar |

[22]  Hills SL, Russell K, Hennessey M, Williams C, Oster AM, Fischer M, Mead P. Transmission of Zika virus through sexual contact with travelers to areas of ongoing transmission - Continental United States, 2016. MMWR Morb Mortal Wkly Rep 2016; 65 215–6.

[23]  McCarthy M. Zika virus was transmitted by sexual contact in Texas, health officials report. BMJ 2016; 352 i720
Zika virus was transmitted by sexual contact in Texas, health officials report.Crossref | GoogleScholarGoogle Scholar |

[24]  Ministerio de Salud (MINSAL). MINSAL confirma primer caso de Virus Zika autoctono, transmitido por via sexual en Chile. Gobierno de Chile 2016. Santiago: Ministerio de Salud (MINSAL); 2016. Available online at: http://web.minsal.cl/minsal-confirma-primer-caso-de-virus-zika-autoctono-transmitido-por-via-sexual-en-chile/ [verified 18 January 2017].

[25]  Russell K, Hills SL, Oster AM, Porse CC, Danyluk G, Cone M, Brooks R, Scotland S, Schiffman E, Fredette C, White JL, Ellingson K, Hubbard A, Cohn A, Fischer M, Mead P, Powers AM, Brooks JT. Male-to-female sexual transmission of Zika Virus- United States, January-April 2016. Clin Infect Dis 2017; 64 211–4.
Male-to-female sexual transmission of Zika Virus- United States, January-April 2016.Crossref | GoogleScholarGoogle Scholar |

[26]  Turmel JM, Abgueguen P, Hubert B, Vandamme YM, Maquart M, Le Guillou-Guillemette H, Leparc-Goffart I. Late sexual transmission of Zika virus related to persistence in the semen. Lancet 2016; 387 2501
Late sexual transmission of Zika virus related to persistence in the semen.Crossref | GoogleScholarGoogle Scholar |

[27]  Venturi G, Zammarchi L, Fortuna C, Remoli ME, Benedetti E, Fiorentini C, Trotta M, Rizzo C, Mantella A, Rezza G, Barteloni A. An autochthonous case of Zika due to possible sexual transmission, Florence, Italy, 2014. Euro Surveill 2016; 21 30148
An autochthonous case of Zika due to possible sexual transmission, Florence, Italy, 2014.Crossref | GoogleScholarGoogle Scholar |

[28]  World Health Organization (WHO). Emergencies preparedness, response Zika virus infection – Peru. Disease Outbreak News 2016: World Health Organisation; 2016. Available online at: http://www.who.int/csr/don/21-april-2016-zika-peru/en/ [verified 18 September 2017].

[29]  World Health Organization (WHO). Emergencies preparedness, response Zika virus infection – Chile. Disease Outbreak News 2016. World Health Organisation (WHO); 2016. Available online at: http://www.who.int/csr/don/15-april-2016-zika-chile/en/ [verified 18 September 2017].

[30]  World Health Organisation (WHO). Emergencies preparedness, response Zika virus infection – Argentina and France. Disease Outbreak News 2016: World Health Organisation (WHO); 2016. Available online at: http://www.who.int/csr/don/7-march-2016-zika-argentine-and-france/en/ [verified 18 September 2017].

[31]  Penot P, Balavoine S, Leplatois A, Brichler S, Leparc-Goffart I, Alloui AC, Flusin O, Guilleminot J, Amellou M, Molina JM. Five cases of acute Zika virus infection in French women of reproductive age returning from Central and South America. Rev Med Interne 2017; 38 547–50.
Five cases of acute Zika virus infection in French women of reproductive age returning from Central and South America.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC1c7nsVelsA%3D%3D&md5=5be9c452d76cf1d36109209e16d5ff28CAS |

[32]  Brooks RB, Carlos MP, Myers RA, White MG, Bobo-Lenoci T, Aplan D, Blythe D, Feldman KA. Likely sexual transmission of Zika virus from a man with no symptoms of infection - Maryland, 2016. MMWR Morb Mortal Wkly Rep 2016; 65 915–6.

[33]  Freour T, Mirallie S, Hubert B, Splingart C, Barriere P, Maquart M, Leparc-Goffart I. Sexual transmission of Zika virus in an entirely asymptomatic couple returning from a Zika epidemic area, France, April 2016. Euro Surveill 2016; 21
Sexual transmission of Zika virus in an entirely asymptomatic couple returning from a Zika epidemic area, France, April 2016.Crossref | GoogleScholarGoogle Scholar |

[34]  Davidson A, Slavinski S, Komoto K, Rakeman J, Weiss D. Suspected female-to-male sexual transmission of Zika virus - New York City, 2016. MMWR Morb Mortal Wkly Rep 2016; 65 716–7.

[35]  Deckard DT, Chung WM, Brooks JT, Smith JC, Woldai S, Hennessey M, Kwit N, Mead P. Male-to-male sexual transmission of Zika virus - Texas, January 2016. MMWR Morb Mortal Wkly Rep 2016; 65 372–4.

[36]  Gao D, Lou Y, He D, Porco TC, Kuang Y, Chowell G, Ruan S. Prevention and control of Zika as a mosquito-borne and sexually transmitted disease: a mathematical modelling analysis. Sci Rep 2016; 6 28070
Prevention and control of Zika as a mosquito-borne and sexually transmitted disease: a mathematical modelling analysis.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC28XhtVahtrnN&md5=021e2c4d763f49a52bd24ad21c763be4CAS |

[37]  Maxian O, Neufeld A, Talis EJ, Childs LM, Blackwood JC. Zika virus dynamics: when does sexual transmission matter? Epidemics 2017; (in press).
Zika virus dynamics: when does sexual transmission matter?Crossref | GoogleScholarGoogle Scholar |

[38]  Haddow AD, Nalca A, Rossi FD, Miller LJ, Wiley MR, Perez-Sautu U, Washington SC, Norris SL, Wollen-Roberts SE, Shamblin JD, Kimmel AE, Bloomfield HA, Valdez SM, Sprague TR, Principe LM, Bellanca SA, Clinkovich SS, Lugo-Roman L, Cazares LH, Pratt WD, Palacios GF, Bavari S, Pitt ML, Nasar F. High infection rates for adult macaques after intravaginal or intrarectal inoculation with Zika virus. Emerg Infect Dis 2017; 23 1274–81.
High infection rates for adult macaques after intravaginal or intrarectal inoculation with Zika virus.Crossref | GoogleScholarGoogle Scholar |

[39]  Yakob L, Kucharski A, Hue S, Edmunds WJ. Low risk of sexually-transmitted Zika virus outbreak. Lancet Infect Dis 2016; 16 1100–2.
Low risk of sexually-transmitted Zika virus outbreak.Crossref | GoogleScholarGoogle Scholar |

[40]  Althaus CL, Low N. How relevant is sexual transmission of Zika virus. PLoS Med 2016; 13 e1002157
How relevant is sexual transmission of Zika virus.Crossref | GoogleScholarGoogle Scholar |

[41]  Allard A, Althouse BM, Scarpino SV, Hebert-Dufresne L. Asymmetric percolation drives a double transition in sexual contact networks. Proc Natl Acad Sci USA 2017; 114 8969–73.
Asymmetric percolation drives a double transition in sexual contact networks.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2sXht1yrt7zM&md5=03c835ee8d6c03c2b38934b232d58f6aCAS |

[42]  Carroll T, Lo M, Lanteri M, Dutra J, Zarbock K, Silveira P, Rourke T, Ma ZM, Fritts L, O’Connor S, Busch M, Miller CJ. Zika virus preferentially replicates in the female reproductive tract after vaginal inoculation of rhesus macaques. PLoS Pathog 2017; 13 e1006537
Zika virus preferentially replicates in the female reproductive tract after vaginal inoculation of rhesus macaques.Crossref | GoogleScholarGoogle Scholar |

[43]  Rafiei N, Hajkowicz K, Redmond A, Taylor C. First report of Zika virus infection in a returned traveller from the Solomon islands. Med J Aust 2016; 204 186
First report of Zika virus infection in a returned traveller from the Solomon islands.Crossref | GoogleScholarGoogle Scholar |

[44]  Fonseca K, Meatherall B, Zarra D, Drebot M, MacDonald J, Pabbaraju K, Wong S, Webster P, Lindsay R, Tellier R. First case of Zika virus infection in a returning Canadian traveller. Am J Trop Med Hyg 2014; 91 1035–8.
First case of Zika virus infection in a returning Canadian traveller.Crossref | GoogleScholarGoogle Scholar |

[45]  Newman CM, Dudley DM, Aliota MT, Weiler AM, Barry GL, Mohns MS, Breitbach ME, Stewart LM, Buechler CR, Graham ME, Post J, Schultz-Darken N, Peterson E, Newton W, Mohr EL, Capuano S, O’Connor DH, Friedrich TC. Oropharyngeal mucosal transmission of Zika virus in rhesus macaques. Nat Commun 2017; 8 1–7.
Oropharyngeal mucosal transmission of Zika virus in rhesus macaques.Crossref | GoogleScholarGoogle Scholar |

[46]  Atkinson B, Hearn P, Afrough B, Lumley S, Carter D, Aarons EJ, Simpson AJ, Brooks TJ, Hewson R. Detection of Zika virus in semen. Emerg Infect Dis 2016; 22 940
Detection of Zika virus in semen.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2sXjt12js7g%3D&md5=df331255bf198da7a1847b74244d5459CAS |

[47]  Atkinson B, Graham V, Miles RW, Lewandowski K, Dowall SD, Pulan ST, Hewson R. Complete genome sequence of Zika virus isolated from semen. Genome Announc 2016; 4 e01116–16.
Complete genome sequence of Zika virus isolated from semen.Crossref | GoogleScholarGoogle Scholar |

[48]  Barzon L, Pacenti M, Franchin E, Lavezzo E, Trevisan M, Sgarabotto D, Palu G. Infection dynamics in a traveller with persistent shedding of Zika virus RNA in semen for six months after returning from Haiti to Italy, January 2016. Euro Surveill 2016; 21 1–4.
Infection dynamics in a traveller with persistent shedding of Zika virus RNA in semen for six months after returning from Haiti to Italy, January 2016.Crossref | GoogleScholarGoogle Scholar |

[49]  de Laval F, Matheus S, Labrousse T, Enfissi A, Rousset D, Briolant S. Kinetics of Zika viral load in semen. N Engl J Med 2017; 377 697–9.
Kinetics of Zika viral load in semen.Crossref | GoogleScholarGoogle Scholar |

[50]  Froeschl G, Huber K, von Sonnenburg F, Northdurft H, Bretzel G, Hoelscher M, Zoeller L, Trottmann M, Pan-Montojo F, Dobler G, Woelfel S. Long-term kinetics of Zika virus RNA and antibodies in body fluids of a vasectomised traveller returning from Martinique: a case report. BMC Infect Dis 2017; 17 55–63.
Long-term kinetics of Zika virus RNA and antibodies in body fluids of a vasectomised traveller returning from Martinique: a case report.Crossref | GoogleScholarGoogle Scholar |

[51]  Gaskell KM, Houlihan C, Nastouli E, Checkley AM. Persistent Zika virus detection in semen in a traveller returning to the United Kingdom from Brazil, 2016. Emerg Infect Dis 2017; 23 137–9.
Persistent Zika virus detection in semen in a traveller returning to the United Kingdom from Brazil, 2016.Crossref | GoogleScholarGoogle Scholar |

[52]  Hashimoto T, Kutsuna S, Tajima S, Nakayama E, Maeki T, Taniguchi S, Lim CK, Katanami Y, Takeshita N, Hayakawa K, Kato Y, Ohmagari N. Importation of Zika virus from Vietnam to Japan, November 2016. Emerg Infect Dis 2017; 23 1223–5.
Importation of Zika virus from Vietnam to Japan, November 2016.Crossref | GoogleScholarGoogle Scholar |

[53]  Huits RMHG, de Smet B, Arien KK, van Esbroeck M, de Jong BC, Bottieu E, Cnops L. Kinetics of Zika virus persistence in Semen. Bull World Health Organ. Epub: 06 Jul 2016. 10.2471/BLT.16.181370

[54]  Jang HC, Park WB, Kim UJ, Chun JY, Choi SJ, Choe PG, Jung SI, Jee Y, Kim NJ, Choi EH, Oh MD. First imported case of Zika virus infection into Korea. J Korean Med Sci 2016; 31 1173–7.
First imported case of Zika virus infection into Korea.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2sXnvVSlu7c%3D&md5=4104920de109aa545d83ac65397d3f00CAS |

[55]  Joguet G, Mansuy JM, Matusali G, Hamdi S, Walschaerts M, Pavili L, Guyomard S, Prisant N, Lamarre P, Dejucq-Rainsford N, Pasquier C, Bujan L. Effect of acute Zika virus infection on sperm and virus clearance in body fluids: a prospective observational study. Lancet Infect Dis 2017; 17 1200–08.
Effect of acute Zika virus infection on sperm and virus clearance in body fluids: a prospective observational study.Crossref | GoogleScholarGoogle Scholar |

[56]  Mansuy JM, Dutertre M, Mengele C, Fourcade C, Marchou B, Delobel P, Izopet J. Zika virus: high infectious viral load in semen, a new sexually transmitted pathogen? Lancet Infect Dis 2016; 16 405
Zika virus: high infectious viral load in semen, a new sexually transmitted pathogen?Crossref | GoogleScholarGoogle Scholar |

[57]  Mansuy JM, Pasquier C, Daudin M, Chapuy-Regaud S, Moinard N, Chevreau C, Izopet J, Mengelle C, Bujan L. Zika virus in semen of a patient returning from a non-epidemic area. Lancet Infect Dis 2016; 16 894–5. [correspondence]
Zika virus in semen of a patient returning from a non-epidemic area.Crossref | GoogleScholarGoogle Scholar |

[58]  Mansuy JM, Suberbeille E, Chapuy-Regaud S, Mengelle C, Bujan L, Marchou B, Delobel P, Gonzalez-Dunia D, Malnou CE, Izopet J, Martin-Blondel G . Zika virus in semen and spermatozoa. Lancet Infect Dis 2016; 16 1106-1107 [correspondence]
Zika virus in semen and spermatozoa.Crossref | GoogleScholarGoogle Scholar |

[59]  Nicastri E, Castilletti C, Liuzzi G, Iannetta M, Capobianchi MR, Ippolito G. Persistent detection of Zika virus RNA in semen for six months after symptom onset in a traveller returning from Haiti to Italy, February 2016. Euro Surveill 2016; 21 30314
Persistent detection of Zika virus RNA in semen for six months after symptom onset in a traveller returning from Haiti to Italy, February 2016.Crossref | GoogleScholarGoogle Scholar |

[60]  Oliviera Souto I, Alejo-Cancho I, Gasco Brustenga J, Peiro Mestres A, Munoz Gutierrez J, Martinez Yoldi MJ. Persistence of Zika virus in semen 93 days after the onset of symptoms. Enferm Infecc Micrbiol Clin 2016; [Epub ahead of print; verified 17 September 2017].
Persistence of Zika virus in semen 93 days after the onset of symptoms.Crossref | GoogleScholarGoogle Scholar |

[61]  Percivalle E, Zavattoni M, Fausto F, Rovida F. Zika virus isolation from semen. New Microbiol 2017; 40 197–198. [Epub; verified 17 September 2017].

[62]  Reusken C, Pas S, GuertsvanKessel C, Mögling R, van Kampen J, Langerak T, Koopmans M, van der Eijk A, van Gorp E. Longitudinal follow-up of Zika virus RNA in semen of a traveller returning from Barbados to the Netherlands with Zika virus disease, March 2016. Euro Surveill 2016; 21
Longitudinal follow-up of Zika virus RNA in semen of a traveller returning from Barbados to the Netherlands with Zika virus disease, March 2016.Crossref | GoogleScholarGoogle Scholar |

[63]  Barzon L, Pacenti M, Berto A, Sinigaglia A, Franchin E, Lavezzo E, Brugnaro P, Palu G. Isolation of infectious Zika virus from saliva and prolonged viral RNA shedding in a traveller returning from the Dominican Republic to Italy, January 2016. Euro Surveill 2016; 21 30159
Isolation of infectious Zika virus from saliva and prolonged viral RNA shedding in a traveller returning from the Dominican Republic to Italy, January 2016.Crossref | GoogleScholarGoogle Scholar |

[64]  Murray KO, Gorchakov R, Carlson AR, Berry R, Lai L, Natrajan M, Garcia MN, Correa A, Patel SM, Aagaard K, Mulligan MJ. Prolonged detection of Zika virus in vaginal secretions and whole blood. Emerg Infect Dis 2017; 23 99–101.
Prolonged detection of Zika virus in vaginal secretions and whole blood.Crossref | GoogleScholarGoogle Scholar |

[65]  Nicastri E, Castilletti C, Balestra P, Galgani S, Ippoloto G. Zika virus infection in the central nervous system and female genital tract. Emerg Infect Dis 2016; 22 2228–30.
Zika virus infection in the central nervous system and female genital tract.Crossref | GoogleScholarGoogle Scholar |

[66]  Prisant N, Bujan L, Benichou H, Hayot P, Pavili L, Lurel S, Herrmann C, Janky E, Joguet G. Zika virus in the female genital tract. Lancet Infect Dis 2016; 16 1000–1.
Zika virus in the female genital tract.Crossref | GoogleScholarGoogle Scholar |

[67]  Prisant N, Breurec S, Moriniere C, Bujan L, Joguet G. Zika virus genital tract shedding in infected women of child-bearing age. Clin Infect Dis 2017; 64 107–9.
Zika virus genital tract shedding in infected women of child-bearing age.Crossref | GoogleScholarGoogle Scholar |

[68]  Penot P, Brichler S, Guilleminot J, Lascoux-Combe C, Taulera O, Gordien E, Leparc-Goffart I, Molina JM. Infectious Zika virus in vaginal secretions from an HIV-infected woman, France, August 2016. Euro Surveill 2017; 22 30444
Infectious Zika virus in vaginal secretions from an HIV-infected woman, France, August 2016.Crossref | GoogleScholarGoogle Scholar |

[69]  Visseaux B, Mortier E, Houhou-Fidouh N, Brichler S, Collin G, Larrouy L, Charpentier C, Descamps D. Zika virus in the female genital tract. Lancet Infect Dis 2016; 16 1220
Zika virus in the female genital tract.Crossref | GoogleScholarGoogle Scholar |

[70]  Bingham AM, Cone M, Mock V, Heberlein-Larson L, Stanek D, Blackmore C, Likos A. Comparison of test results for Zika virus RNA in urine, serum and saliva specimens from persons with travel-associated Zika virus disease – Florida, 2016. MMRW Morb Mortal Wkly Rep 2016; 65 475–8.

[71]  Bonaldo MC, Ribeiro IP, Lima NS, Dos Santos AA, Menezes LS, da Cruz SO, de Mello IS, Furtado ND, de Moura EE, Damasceno L, da Silva KA, de Castro MG, Gerber AL, de Almeida LG, Lourenco-de-Oliveira R, Vasconcelos AT, Brasil P. Isolation of infective Zika virus from urine and saliva of patients in Brazil. PLoS Negl Trop Dis 2016; 10 e0004816
Isolation of infective Zika virus from urine and saliva of patients in Brazil.Crossref | GoogleScholarGoogle Scholar |

[72]  de Laval F, Matheus S, Maquart M, Yvrard E, Barthes N, Combes C, Rousset D, Leparc-Goffart I, Briolant S. Prospective Zika virus disease cohort: systematic screening. Lancet 2016; 388 868
Prospective Zika virus disease cohort: systematic screening.Crossref | GoogleScholarGoogle Scholar |

[73]  Fourcade C, Mansuy JM, Dutertre M, Delpech M, Marchou B, Delobel P, Izopet J, Martin-Blondel G. Viral load kinetics of Zika virus in plasma, urine and saliva in a couple returning from Martinique, French West Indies. J Clin Virol 2016; 82 1–4.
Viral load kinetics of Zika virus in plasma, urine and saliva in a couple returning from Martinique, French West Indies.Crossref | GoogleScholarGoogle Scholar |

[74]  Hamer DH, Barbre KA, Chen LH, Grobusch MP, Schlagenhauf P, Goorhuis A, van Genderen PJJ, Molin I, Asgeirsson H, Kozarsky PE, Caumes E, Hagmann SH, Mockenhaupt FP, Eperon G, Barnett ED, Bottieau E, Boggild AK, Gautret P, Hynes NA, Kuhn S, Lash RR, Leder K, Libman M, Malvy DJM, Perret C, Rothe C, Schwartz E, Wilder-Smith A, Cetron MS, Esposito DH. Travel-associated Zika virus disease acquired through in the Americas through February 2016. Ann Intern Med 2017; 166 99–108.

[75]  Hearn PT, Atkinson B, Hewson R, Brooks T. Identification of the first case of imported Zika fever to the UK: a novel sample type for diagnostic purposes and support for a potential non-vector-borne route of transmission. ASTMH (American Society of Tropical Medicine and Hygiene) 63rd Annual Meeting Abstract book, Abstract 211. Available in Am J Tro Med Hyg 2014; 91(5 suppl 1): 62–63.

[76]  Musso D, Roche C, Nhan TX, Robin E, Teissier A, Cao-Lormeau VM. Detection of Zika virus in saliva. J Clin Virol 2015; 68 53–5.
Detection of Zika virus in saliva.Crossref | GoogleScholarGoogle Scholar |

[77]  Paz-Bailey G, Rosenberg ES, Doyle K, Munoz-Jordan J, Santiago GA, Klein L, Perez-Padilla J, Medina FA, Waterman SH, Gubern CG, Alvarado LI. Persistence of Zika virus in body fluids – preliminary report. N Engl J Med 2017; [Epub ahead of print].
Persistence of Zika virus in body fluids – preliminary report.Crossref | GoogleScholarGoogle Scholar |

[78]  Musso D, Richard V, Teissier A, Stone M, Lanteri MC, Latoni G, Alsina J, Reik R, Busch MP. Detection of Zika virus RNA in semen of asymptomatic blood donors. Clin Microbiol Infect 2017; [Epub ahead of print.]
Detection of Zika virus RNA in semen of asymptomatic blood donors.Crossref | GoogleScholarGoogle Scholar |

[79]  Sun J, Wu D, Zhong H, Guan D, Zhang H, Tan Q, Zhou H, Zhang M, Ning D, Zhang B, Ke C, Song T, Lin J, Zhang Y, Koopmans M, Gao GF. Returning ex-patriot Chinese to Guandong, China, increase the risk for local transmission of Zika virus. J Infect 2017; 75 356–367.
Returning ex-patriot Chinese to Guandong, China, increase the risk for local transmission of Zika virus.Crossref | GoogleScholarGoogle Scholar |

[80]  Yin Y, Xu Y, Su L, Zhu X, Chen M, Zhu W, Xia H, Huang X, Gong S. Epidemiologic investigation of a family cluster of imported Zika cases in Guandong, China: probable human-to-human transmission. Emerg Microbes Infect 2016; 5 1–12.
Epidemiologic investigation of a family cluster of imported Zika cases in Guandong, China: probable human-to-human transmission.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC28XosFWhsro%3D&md5=27c2a383c8e3e1f7f46d1f5d91f52c4cCAS |

[81]  Wu D, Sun J, Zhong H, Guan D, Zhang H, Tan Q, Zhou H, Ning D, Ke C, Song T, Lin J, Zhang Y. A family cluster of imported ZIKV cases: viraemia period may be longer than previously reported. J Infect 2016; 73 300–3.
A family cluster of imported ZIKV cases: viraemia period may be longer than previously reported.Crossref | GoogleScholarGoogle Scholar |

[82]  Zambrano H, Waggoner J, Leon K, Pinsky B, Vera K, Scinetto M, Rivera L, Landivar J, Granda M, Lee A, Mor G. High incidence of Zika virus infection detected in plasma and cervical cytology specimens from pregnant women in Guayaquil, Ecuador. Am J Reprod Immunol 2017; 77 e12630
High incidence of Zika virus infection detected in plasma and cervical cytology specimens from pregnant women in Guayaquil, Ecuador.Crossref | GoogleScholarGoogle Scholar |

[83]  Atkinson B, Thorburn F, Petridou C, Bailey D, Hewson R, Simpson AJ, Brooks TJ, Aarons EJ. Presence and persistence of Zika virus RNA in semen, United Kingdom 2016. Emerg Infect Dis 2017; 23 611–5.
Presence and persistence of Zika virus RNA in semen, United Kingdom 2016.Crossref | GoogleScholarGoogle Scholar |

[84]  Duggal NK, Ritter JM, Pestorius SE, Zaki SR, Davis BS, Cang GJ, Bowen RA, Brault AC. Frequent Zika virus sexual transmission and prolonged viral RNA shedding in an immunodeficient mouse model. Cell Reports 2017; 18 1751–60.
Frequent Zika virus sexual transmission and prolonged viral RNA shedding in an immunodeficient mouse model.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2sXislOlsLg%3D&md5=160513d777697aa58b45e27578945bebCAS |

[85]  Chan JF, Yip CC, Tsang JO, Tee K, Cai J, Chik KK, Zhu Z, Chan CC, Choi GK, Sridhar S, Zhang AJ, Lu G, Chiu K, Lo AC, Tsao S, Kok K, Jin D, Chan K, Yuen K. Differential cell line susceptibility to the emerging Zika virus: implications for disease pathogenesis, non-vector-borne human transmission and animal reservoirs. Emerg Microbes Infect 2016; 5 1–12.
Differential cell line susceptibility to the emerging Zika virus: implications for disease pathogenesis, non-vector-borne human transmission and animal reservoirs.Crossref | GoogleScholarGoogle Scholar |

[86]  Osuna CE, Lim SY, Deleage C, Griffin BD, Stein D, Schroeder LT, Omange R, Best K, Luo M, Hraber PT, Andersen-Elyard H, Ojeda EF, Huang S, Vanlandingham DL, Higgs S, Perelson AS, Estes JD, Safronetz D, Lewis MG, Whitney JB. Zika viral dynamics and shedding in rhesus and cynomolgus macaques. Nat Med 2016; 22 1448–55.
Zika viral dynamics and shedding in rhesus and cynomolgus macaques.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC28Xhs1SltLrM&md5=e95efe9df26fbee03692f006a41bbe3aCAS |

[87]  Chen JC, Wang Z, Huang H, Weitz SH, Wang A, Qiu X, Baumeister MA, Uzgiris A. Infection of human uterine fibroblasts by Zika virus in vitro: implications for viral transmission in women. Int J Infect Dis 2016; 51 139–40.
Infection of human uterine fibroblasts by Zika virus in vitro: implications for viral transmission in women.Crossref | GoogleScholarGoogle Scholar |

[88]  Coelho FC, Durovni B, Saraceni V, Lemos C, Codeco CT, Camargo S, de Carvalho LM, Bartos L, Arduini D, Villela DA, Armstrong M. Higher incidence of Zika in adult women than adult men in Rio de Janeiro suggests a significant contribution of sexual transmission from men to women. Int J Infect Dis 2016; 51 128–32.