The first human Zika virus infection was documented in Nigeria in 1954, with very few documented infections after this initial report, until the virus outbreak in 2007 on Yap Island in the western Pacific Ocean. The infection is usually asymptomatic but symptoms can consist of fever, maculopapular rash, arthralgia, and conjunctivitis.

1 Plourde AR

Bloch EM A literature review of Zika virus. , 2 Miner JJ

Cao B

Govero J

et al. Zika virus infection during pregnancy in mice causes placental damage and fetal demise. 3 Calvet G

Aguiar RS

Melo AS

et al. Detection and sequencing of Zika virus from amniotic fluid of fetuses with microcephaly in Brazil: a case study. 1 Plourde AR

Bloch EM A literature review of Zika virus. 1 Plourde AR

Bloch EM A literature review of Zika virus. , 4 D'Ortenzio E

Matheron S

Yazdanpanah Y

et al. Evidence of sexual transmission of Zika virus. Zika virus infection has been associated with adverse fetal outcomes, including congenital microcephaly, and could lead to pregnancy loss, as was described in a mouse model.Presence of Zika virus has been shown in amniotic fluid, which suggests that the virus can cross the placental barrier.Zika virus has been isolated from several other body fluids, including blood, urine, saliva, breastmilk, and semen.Presence of Zika virus in semen was reported after infection and has been shown to persist even after it is undetectable in blood or urine. Sexual transmission has been described in several publications,as man-to-woman or man-to-man transmission.

However, no data are available on the presence of Zika virus in the female genital tract. Thus, the detection of Zika virus in the female genital tract, its clearance kinetics, and its possible persistence would be of utmost importance in the assessment of woman-to-man sexual transmission of the Zika virus, and it could also help clarify the process of mother-to-child vertical transmission.

We describe the case of a woman (aged 27 years) whose Zika virus infection was identified in May, 2016, at the Pointe à Pitre University Hospital (Guadeloupe, France)—an official area of Zika virus outbreak since late April, 2016.

The patient presented with clinical symptoms of fever, maculopapular rash, and conjunctivitis, typical of an arbovirus infection, and recovered within a few days. Molecular tools were used to rapidly diagnose Zika virus infection (RealStar Zika Virus RT-PCR Kit 1.0; Altona Diagnostics GmbH, Hamburg, Germany), and the patient tested positive for Zika virus in the blood sample and negative in the urinary sample.

5 Agence de la Biomédecine

Recommandations professionnelles pour la prise en charge en AMP, en préservation de la fertilité et en don de gamètes dans les départements français d'Amérique et en métropole dans le contexte de l'épidémie à virus Zika. The patient was monitored for oocyte cryopreservation, because we follow the French Agence de la Biomedecine (ABM) recommendations for infertile patients in Zika virus-infected areas.Her stimulation protocol was then terminated and she agreed to continue with the ABM recommendations of safe sex with systematic condom use.

Table RT-PCR Zika virus results Symptom onset, May 9, 2016 Genital testing, May 12, 2016 Follow-up, May 20, 2016 Blood + .. − Urine − .. − Cervical mucus .. + + Endocervical swab .. + .. Genital swab .. + .. +=positive for Zika virus. –=negative for Zika virus. ..=test not done at the time. A genital swab, an endocervical swab, and a cervical mucus sample were collected for RNA Zika virus analysis 3 days after the onset of symptoms; these samples were all positive for the presence of Zika virus RNA. On day 11 after the onset of symptoms, the patient's blood and urinary samples tested negative, whereas her cervical mucus still tested positive for the presence of Zika virus RNA ( table ).

We report for the first time the presence of Zika virus in the genital tract of a woman who was infected with Zika virus, and its possible genital persistence after its disappearance from blood and urine samples.

Although we have not tested the infectiousness of a locally situated vaginal virus, its very presence in the female genital tract poses notable challenges, implying that sexual transmission from women to men could occur, as is the case for other viral infections. Zika virus presence in the female genital tract also means that vertical transmission from mother to fetus needs to be assessed, since this virus is a member of the Flaviviridae family, which includes hepatitis C, in which vertical transmission from mother to child can occur in up to 10% of pregnancies.

The duration of Zika virus persistence in the female genital tract and its clearance after the disappearance of the symptoms are unknown. Mirroring what was reported in the male genital tract, a possible dissociation between blood and genital samples of RNA results could occur.

Our findings raise the threat of a woman potentially becoming a chronic Zika virus carrier, with the female genital tract persistently expressing the virus RNA. Additional studies are underway to answer those essential questions and to assess what would then be the consequences for women of child-bearing age.

We declare no competing interests.

Article Info Publication History Identification DOI: https://doi.org/10.1016/S1473-3099(16)30193-1 Copyright © 2016 Elsevier Ltd. All rights reserved. ScienceDirect Access this article on ScienceDirect

Linked Articles Zika virus in the female genital tract