sexual transmission

What would you conclude if you read the following headlines: Man sexually transmits insect-borne disease to wife (Fox News); Zika virus: First insect borne STD? (HuffPo); Scientist gives insect-borne disease to wife during sex (New York Magazine), and A scientist contracts a mosquito-borne virus and gives it to his wife as std (Time). What would be your impression if you read the journal article on which these headlines are based, which does not conclude that the infection was transmitted sexually?

Zika virus was isolated in 1947 from a monkey in Uganda, and subsequently shown to be transmitted by mosquitoes. Zika is classified as a flavivirus, along with well-known human pathogens such as yellow fever virus, dengue virus, and West Nile virus. Infection of humans with Zika virus leads to headache, fever, malaise, myalgia, and formation of  a maculopapular rash on the face, neck, trunk, and arms. The virus is found mainly in African and parts of Asia (see map).

The case that has precipitated incorrect reporting began with two American scientists working in Senegal in 2008, where they were sampling mosquitoes. Between 6-9 days after returning to their homes in Colorado, they developed a variety of symptoms of infection including fatigue, headache, chills, arthralgia, and a maculopapular rash. The wife of one patient, who had not traveled to Africa, developed similar symptoms three days after her husband. Analysis of paired acute and convalescent sera from all three patients revealed antibodies against Zika virus. The two individuals who had traveled to Africa also had antibodies to yellow fever virus, a consequence of immunization with the vaccine.

Here is what the authors conclude from these data:

Evidence suggests that patients 1 and 2 were infected with ZIKV, probably in southeastern Senegal, by bites from infected mosquitoes…Circumstantial evidence suggests direct person-to-person, possibly sexual, transmission of the virus (italics are mine).

The authors do not conclude that transmission from husband to wife was via sexual activity – they suggest it as a possiblity. The authors know that one cannot prove sexual transmission from such a small study. They go on to write:

If sexual transmission could be verified in subsequent studies, this would have major implications toward the epidemiology of ZIKV and possibly other arthropod-borne flaviviruses.

What other ways might the infection have been transmitted from husband to wife? Virus is likely present in the skin of infected individuals, as a rash is a prominent feature. It is possible that virus was transmitted via cuts or abrasions in the skin. Another possibility is that virus is present in saliva or other body fluids, and is transmitted to others by close contact. The authors don’t believe this to be the case because they write that ‘illness did not develop in the 4 children of patients 1 and 3‘. However physical contact between husband and wife is substantially different from the contact between parents and children, which could have a major role in determining virus transmission.

Here is another way to put this puzzling state of affairs into context. In 2009 a group of scientists published a paper in Science indicating that they had found a retrovirus, XMRV, in the blood of 68 of 101 patients with chronic fatigue syndrome. To this day whether or not XMRV causes chronic fatigue syndrome is still being debated, despite studies in hundreds of individuals. In light of this situation, why does the press conclude from a study of three individuals that Zika virus can be sexually transmitted? Could it be that the journalists didn’t read the journal article (poor excuse – it’s quite short), or if they did, they decided that the conclusions were not sufficiently interesting? Or maybe the sex angle – always a good way to get the reader’s attention – was too good to resist, never mind that it might not be correct. Either way, the public is being misinformed about science – again.

Update: There has been discussion in the comments section that the news articles I cite don’t do such a bad job in presenting the science, and it’s the headlines that are the main problem. I don’t agree with that conclusion about the articles – in my opinion they don’t accurately portray the content of the paper. My journalist friends tell me that the headline writers often take liberty with conclusions; but I don’t see why we should use that as an excuse to forgive inaccurate headlines. How many people never get past the headlines? Both the headline and the article need to be consistent and they need to accurately represent the science.

Foy, B.D., Kobylinski, K.C., Foy, J.L.C., Blitvich, B.J., da Rosa, A.T., Haddow, A.D., Lanciotti, R.S., & Tesh, R.B. (2011). Probable non–vector-borne transmission of Zika virus, Colorado, USA. Emerging Infectious Diseases : 10.3201/eid1705.101939

Hayes, E. (2009). Zika Virus Outside Africa Emerging Infectious Diseases, 1347-1350 DOI: 10.3201/eid1509.090442