Ebola virus RNA is present in the semen of some men for a year or longer after recovery, according to preliminary data from Liberia's Men's Health Screening Program (MHSP). The combination of laboratory semen testing and behavioral counseling appeared to increase the proportion of survivors who reported condom use, according to a report published August 31 in The Lancet Global Health.
The study is the largest to examine the persistence of Ebola virus in male survivors. Although the test identifies virus genetic material, the authors note that it is unclear whether live virus capable of spreading disease is present in the semen.
The median time from Ebola treatment unit discharge to enrollment in the MHSP program was 384 days (range, 7 - 697 days). Of 429 men who survived Ebola, 38 (9%) still had Ebola virus RNA in at least one semen specimen and 24 (6%) still had semen that tested positive for Ebola virus for 12 months or longer after recovery from Ebola.
The longest interval between Ebola recovery and a positive semen sample was 565 days, according to lead authors Moses J. Soka, MD, coordinator, Ebola Virus Disease Survivor Clinical Care, Ministry of Health, Monrovia, Liberia, and first director of the MSPH program, and Mary J. Choi, MD, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, and colleagues.
"Before this outbreak, scientists believed that Ebola virus could be found in semen for three months after recovery. With this study, we now know that virus may persist for a year or longer," Dr Soka explained in a CDC news release. "We now have many more Ebola survivors than ever before. This work demonstrates the importance of providing laboratory testing and behavioral counseling to empower survivors to make informed decisions to protect their intimate partners."
The MHSP is a collaborative effort operated by the Liberian Ministry of Health in collaboration with the CDC, the World Health Organization, and the Academic Consortium Combating Ebola in Liberia. Male Ebola survivors aged 15 years or older can undergo semen testing for Ebola virus RNA by real-time reverse transcriptase polymerase chain reaction and receive counseling about safe sexual practices at enrollment, follow-up, and graduation visits. The newly reported data were obtained between July 2015 and May 2016. Participants graduate from the program after submitting two consecutive semen samples that test negative.
Researchers detected Ebola virus RNA in the initial semen specimen of all 4 participants who enrolled in the program within 90 days of discharge from an Ebola treatment unit, 8 (22%) of 37 enrolled within 181 to 270 days, 10 (8%) of 123 enrolled within 271 to 360 days, 11 (8%) of 133 enrolled within 361 to 450 days, and 5 (7%) of 72 enrolled within 451 to 540 days. (No participants were enrolled in the program 91 to 180 days after discharge.)
Men older than 40 years were more likely to have a positive semen sample 90 days or more after hospital discharged compared with men younger than 40 years (P = .0004).
The program led to a significant increase in men who reported condom use or abstinence; almost 75% of participants who reported nonuse of condoms during enrollment later reported they did use condoms during sexual activity.
"We found that the duration for which Ebola virus is detected in the semen of Ebola virus disease survivors varies by individual," the authors conclude. "As such, semen testing programmes that combine behavioural counselling and laboratory testing can play an important part in educating male survivors of Ebola virus disease of their risk of transmitting Ebola virus through sex and could potentially mitigate future outbreaks associated with sexual transmission."
"This program provides important insights into how long Ebola remains in semen, a key component to preventing flare-ups of the disease and protecting survivors and their loved ones," CDC Director Tom Frieden, MD, MPH, said in the news release. "It also shows how investments in public health capacity can save lives."
The authors have disclosed no relevant financial relationships.
Lancet Global Health. Published online August 31, 2016. Full text
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