In clarifying recent guidance, the World Health Organization (WHO) said today it does not recommend that women delay pregnancy in Zika-affected areas. The clarification was prompted by confusion over a recent wording change.

In other developments, three new case studies in Eurosurveillance shed more light on sexual transmission risks and the challenge of detecting the infections, especially given an unusual report of asymptomatic infections in a French couple.

Confusion over pregnancy-delay messaging

Though the threat to unborn babies is the main concern about Zika virus and was the reason the WHO declared a public health emergency of international concern, the group has resisted pressure to advise pregnant women to delay pregnancy. The issue is extremely personal and is affected by religious and cultural undertones as well as limited access to birth control in some of the affected countries.

In a note to the media yesterday that came with its weekly Zika situation update, the WHO pointed out a correction in its sexual transmission guidance, which was updated on Jun 7. The wording of the correction pertained to advice for couples planning a pregnancy in light of the Zika virus threat, providing slightly separate recommendations for those returning from affected areas and those living in affected areas.

Couples or women planning a pregnancy who are returning from Zika-hit countries are advised to wait at least 8 weeks before trying to conceive to make sure any possible Zika infection has cleared, with a waiting period of 6 months if the male partner experienced Zika symptoms.

The WHO added that reproductive-age women and men in affected areas should be informed about the option to consider delaying pregnancy. It said its original guidance was meant to reflect that, but the correction makes it clearer.

In the wake of the correction, many new outlets reported that the WHO had changed its stance toward recommending that people in areas where the virus is spreading delay pregnancy.

Today the WHO acknowledged that the wording of the correction could be misinterpreted and it clarified that it's not recommending that people in Zika countries delay pregnancy, Stat News reported. William Perea, MD, MPH, who coordinates Zika guidance for the WHO, told Stat that the group isn't trying to push people in affected regions toward any one choice. He added that the WHO wanted to clarify that men and women be fully informed about all of their options and risks.

Long-lasting RNA in semen

In other sexual transmission developments, separate reports in Eurosurveillance yesterday documented Zika RNA in the semen of a traveler from the Netherlands 62 days after symptom onset, asymptomatic sexual transmission in a French couple who had been to Martinique, and sexual transmission in a German couple in which the man had been to Puerto Rico.

In the first report, a man in his 50s from the Netherlands sought care at the Erasmus Medical Center travel clinic after getting sick with joint pain and fever 4 days after returning from a business trip to Barbados. Tests on his blood and urine were positive for Zika virus.

He agreed to follow-up Zika tests on his blood, saliva, urine, and semen to see how long the tests remained positive. Zika RNA levels persisted the longest in semen, slowly declining but detectable until 62 days after symptom onset. The investigators also noted that Zika loads were higher than in urine taken at the same time points, which has also been seen in other patients.

The authors concluded that molecular testing on semen might be useful for pinpointing Zika infections in men who are past the window for polymerase chain reaction (PCR) testing but within 2 months of infection. They also said though live virus wasn't detected, condom use or abstinence up to 90 days might be considered until more evidence is known.

Cases of sexual transmission

In the French couple, their Zika virus infections were found only during enhanced testing during the workup for in-vitro fertilization (IVF), given that they had recently returned from a trip to Martinique where local circulation has been reported.

Though both were asymptomatic, Zika blood and urine testing for IVF done 39 days after the couple returned from Martinique found an acute infection in the woman. The man's PCR test was negative for Zika, but his serology tests were positive for Zika Immunoglobulin M. The researchers estimated that sexual transmission occurred 21 to 36 days after they got back from Martinique.

The authors pointed out that the case is notable because earlier reports involved symptomatic illness in index patients.

In the German couple, the 35-year-old man got sick in early April, 1 day after returning from a 1-week stay in Puerto Rico. When he sought care about a week later, serologic tests were positive for Zika virus.

A few days later his 29-year-old female partner, who had not traveled, came down with similar symptoms and was tested when her partner learned of his test results. The woman's PCR test was positive for acute Zika infection.

Testing on the man revealed Zika in urine but not saliva or blood at 13 days after symptom onset. A semen sample taken at day 45 was positive for Zika RNA at a level lower than in previous reports, the team noted.

See also:

Jun 7 WHO interim Zika sexual transmission guidance

Jun 10 Stat story

Jun 9 Eurosurveill report on Zika follow-up in a Netherlands traveler

Jun 9 Eurosurveill report on sexual transmission in asymptomatic travelers

Jun 9 Eurosurveill report on sexual transmission in Germany