Sexual Transmission of Ebola: Fact or Fear-Mongering?

WHO: Ebola and Sexual Contact

The WHO has come out with a message regarding the potential of sexual transmission of the Ebola Virus. In its statement, titled: “Ebola virus in semen of men who have recovered from Ebola virus disease“, the WHO has categorically stated that though sexual transmission has not been noted, certain precautions need to be adopted by men who are recovering from ebola virus disease. Quoting previous studies the statement clarifies:

In four studies that investigated persistence of Ebola virus in seminal fluid from convalescent patients (a total of 43 patients), three men who had recovered from Ebola virus disease were reported to shed live virus in semen 40 days, 61 days and 82 days after onset of symptoms, respectively.

However, just as the WHO is trying to spread the information about safe sexual practices and abstinence, if possible, without fanning the flames of public panic, there are news reports coming out that are doing just the opposite. Now I have no idea how much truth there is to either camps, but when conflicting communications like these go out, the rumour mongers have a field day making hay while the fear foments. In an article titled “Liberia: Ebola Doctor Alarmed Over Male Survivors Infecting Partners” the All Africa site has brought forward the views of Dr. Omurutu and starts off on a sensational note:

 Dr. Atai Omurutu, head doctor at the Island Clinic Ebola treatment unit, has raised an alarm over the disturbing incidents of male Ebola survivors infecting their partners and putting entire families at risk. Dr. Omurutu said wives of male survivors are being admitted to the facility because they have contracted the disease from their partners.

The fact that there is persistence of the virus in the seminal fluids beyond the period of twice the length of the incubation period of 21 days is well-documented, and it is only logical that if there is viral persistence, then there is likelihood of transmission due to unprotected sex as well. This raises the need to bring in safe sex messages as a part of the communications package as well. However, the fact that there have been no documented cases does not mean that there is no spread through the sexual routes. Absence of evidence is not evidence of absence, as they would say!

In any case, I have always thought that when there is such high stakes on the lines, media needs to play a supporting role. This might be a good example for the role the mass media can play in effectively bridging the communications gap that sometimes the international health agencies leave behind. In the spirit to be true to evidence and prevent widespread panic and irrational behaviour, the WHO is bound to state that there is no evidence of people contracting ebola through the sexual route. However, the emphasis on the fact that the virus may persist in the semen for as long as 90 days after clearing out from the blood stream needs to be stronger. The focus to utilise barrier methods of contraception, if abstinence is not possible, during this phase of possible infectivity, needs to be stressed so that the convalescent survivors do not become foci of outbreaks themselves. This would perpetuate another cycle of outbreaks, causing irreparable damage to the control achieved thus far. And, most importantly, all of this has to be done in a way that does not disenfranchise or outcast the convalescent person, who already has a major burden to carry simply on account of having contracted the disease!

Liberian, not a virus!
Liberian, not a virus!

The media needs to bolster the message that the convalescent men need to use condoms if they are having sex. There needs to be health promotion and health education amongst not just the recovered men, but also amongst their sexual contacts, which makes further propagation of this disease through the sexual means impossible. Taking a page out of the WHO’s twitter stream:

WHO: Ebola and Sexual Contact
WHO: Ebola and Sexual Contact

Interestingly, the Times of India reports that India’s first “patient” who has been shown to have evidence of persistence of Ebola in his seminal fluids, has been quarantined, which is quite against the protocol that has been outlined by the CDC and the WHO!

TOI: Quarantine of India's Patient Zero of Ebola
TOI: Quarantine of India’s Patient Zero of Ebola

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