Oropouche Virus and Possible Sexual Transmission

What we know

• There have been no reports of transmission of Oropouche virus through sexual activity to date.
• However, a recent publication describes a patient with Oropouche virus disease who had virus and viral RNA detected in bodily fluids, including semen.
  • Oropouche RNA was detected in semen on days 16, 32, and 58 after symptom onset. Culturable virus was recovered from semen on day 16 but could not be recovered on day 32 (viral culture not attempted on day 58).
• Viruses (e.g., Zika virus, Ebola virus) in semen have been associated with sexual transmission of other infectious diseases.

What CDC is doing

CDC will continue to review all available data, work closely with partners to obtain additional data regarding the likelihood of sexual transmission, and update these interim prevention recommendations as needed.

What we don't know

Currently, we do not know the following about Oropouche virus and possible sexual transmission:

• How often infection results in virus being present in semen, how long virus or viral RNA is present in semen or other bodily fluids following infection, how much virus could be present in semen and if virus can be intermittently shed in semen.
• If the virus can be transmitted through sex, and if so, what factors might increase the risk of transmission (e.g., type of sexual activity, age, symptoms present at time of acute illness) or possible effect on the incubation period.
• If sexual transmission is associated with a risk of vertical transmission or a differential risk of adverse pregnancy outcomes compared to vector-borne transmission.
• If infection has any effect on male fertility.
• If virus might be present in the vaginal fluid of infected people.

How to counsel patients

CDC is providing the following interim recommendations for providers to counsel their patients:

• Biological males who are diagnosed with Oropouche virus disease should use condoms or abstain from sex for at least 6 weeks following the symptom onset date.
• Biological males who traveled to an area with a Level 1 or 2 Travel Health Notice (THN) for Oropouche and experienced symptoms compatible with Oropouche virus disease during or within 2 weeks of returning from travel can consider the use of condoms or abstaining from sex for at least 6 weeks following symptom onset.
  • Oropouche testing should be recommended in suspected cases (contact your state or local health department for assistance).
• Given the limited information on the risk of possible sexual transmission, any travelers (male or female) to an area with a Level 1 or 2 THN for Oropouche and their partners who are concerned about possibly getting or passing Oropouche virus through sex, can consider using condoms or abstaining from sex during travel and for 6 weeks after returning from travel.
• Patients who test negative for evidence of Oropouche virus should still be encouraged to consider using condoms or abstaining from sex during travel and for 6 weeks after returning from travel because the test results might be falsely negative.
• In the absence of more data, advise potential semen donors with confirmed or suspected Oropouche virus disease, or who might have been exposed to Oropouche virus, to defer semen donation for at least 6 weeks after symptom onset and consider deferring donation for at least 6 weeks after return from travel if asymptomatic.
  • Encourage potential semen donors to talk to their donation center about their eligibility.
  • For more information, please see FDA's communication regarding Oropouche virus and considerations for donor eligibility determinations for human cells, tissues, and cellular and tissue-based products (HCT/Ps).

Testing

There are no approved tests available to look for the presence of virus or viral RNA in bodily fluids other than serum or CSF. CDC does not currently recommend testing a person's serum, urine, semen or genital secretions to determine the potential risk of transmitting Oropouche virus through sex for the following reasons:

• A negative test result could be falsely reassuring. This can happen when:
  • Molecular testing is performed after the virus or viral RNA is no longer in the blood but virus could still be present in other bodily fluids (e.g., semen).
  • Antibody testing is performed early after infection when the antibody levels are not yet high enough to be detected.
  • The result is a false negative.
• There is a limited understanding of Oropouche virus shedding in semen. Virus shedding in semen might be intermittent, in which case a person could test negative at one point but still carry the virus and shed it again in the future.