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Zika virus and reproduction: facts, questions and current management.
Hum Reprod Update. 2017 11 01; 23(6):629-645.HR

Abstract

BACKGROUND

Zika virus (ZIKV) is an arthropod-borne virus of the family Flaviviridae, genus Flavivirus. ZIKV is currently the focus of an ongoing pandemic and worldwide public health emergency. Although originally isolated in 1947, its pathogenesis was poorly known and very few documented infections were published until recently. Its route of transmission and its impact on reproduction and pregnancy have only recently begun to be disclosed.

OBJECTIVE AND RATIONALE

This review summarizes the most recent knowledge about ZIKV infection and pathogenesis and focuses on its impacts on male and female genital tracts, including the risks of sexual transmission and to pregnancy. The consequences of ZIKV infection for pregnancy planning and ART are also discussed.

SEARCH METHODS

The PubMed and EMBASE databases were inter-rogated using specific terms, such as 'ZIKV', 'transmission', 'male', 'female', fertility', 'pregnancy, 'semen', 'testis', 'ovary' and 'genital tract', up to 17 March 2017.

OUTCOMES

ZIKV has long been considered a harmless virus, but increasing evidence suggests that it has adverse effects on the neurological system and on pregnancy outcomes. In mice, ZIKV slows foetal growth and damages the foetal brain. In humans, the virus is able to cross the placental barrier and to induce foetal death and major anomalies, such as microcephaly, brain defects and long-term neurologic sequelae, i.e. the 'congenital Zika syndrome'. In addition to its transmission by mosquitoes, ZIKV may be transmitted sexually. Currently available data indicate that ZIKV RNA can remain detectable in semen for several months, whereas shedding in the female genital tract appears to be rare and of short duration. Current guidance on preventing the sexual transmission of ZIKV is based on the assumption that transmission occurs from a male partner to a receptive partner. Furthermore, in mouse models, the virus can actively replicate in male genital organs and induce severe orchitis, which raises concerns about its possible impact on human male fertility.

WIDER IMPLICATIONS

These new and relevant findings have led many countries and institutions to release updated and regular guidance for preconception counselling and ART to prevent the sexual transmission of ZIKV. Progress in understanding the sexual transmission of ZIKV and its dissemination to genital systems would also help to better anticipate and control outbreaks of potentially sexually transmissible infectious agents.

Authors+Show Affiliations

Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Gynécologie, Obstétrique et Reproduction, 46 rue Henri Huchard, 75018 Paris, France. Université Paris Diderot, Sorbonne Paris Cité, France.Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Centre d'Etudes et de Conservation des Ovocytes et du Sperme, 27 rue du Faubourg Saint Jacques, 75014 Paris, France. Université Paris Descartes, Sorbonne Paris Cité, France.Hôpital Andrée Rosemon, Avenue des Flamboyants, Cayenne 97300, France. Université de Guyane, Equipe EA 3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Cayenne, Guyane Française.Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Antoine Béclère, Service de Gynécologie-Obstétrique, 147 rue de la Porte de Trivaux, 92140 Clamart, France. Université Paris Sud, Clamart, France.Agence de la Biomédecine, 1 Avenue du Stade de France, 93212 La Plaine Saint Denis, France.Université Paris Diderot, Sorbonne Paris Cité, France. Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Biologie de la Reproduction, 46 rue Henri Huchard, 75018 Paris, France.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28961800

Citation

Epelboin, Sylvie, et al. "Zika Virus and Reproduction: Facts, Questions and Current Management." Human Reproduction Update, vol. 23, no. 6, 2017, pp. 629-645.
Epelboin S, Dulioust E, Epelboin L, et al. Zika virus and reproduction: facts, questions and current management. Hum Reprod Update. 2017;23(6):629-645.
Epelboin, S., Dulioust, E., Epelboin, L., Benachi, A., Merlet, F., & Patrat, C. (2017). Zika virus and reproduction: facts, questions and current management. Human Reproduction Update, 23(6), 629-645. https://doi.org/10.1093/humupd/dmx024
Epelboin S, et al. Zika Virus and Reproduction: Facts, Questions and Current Management. Hum Reprod Update. 2017 11 1;23(6):629-645. PubMed PMID: 28961800.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Zika virus and reproduction: facts, questions and current management. AU - Epelboin,Sylvie, AU - Dulioust,Emmanuel, AU - Epelboin,Loïc, AU - Benachi,Alexandra, AU - Merlet,Françoise, AU - Patrat,Catherine, PY - 2017/04/27/received PY - 2017/08/02/accepted PY - 2017/9/30/pubmed PY - 2018/3/27/medline PY - 2017/9/30/entrez KW - Zika virus KW - assisted reproduction KW - fertility KW - human KW - pregnancy outcome KW - reproduction SP - 629 EP - 645 JF - Human reproduction update JO - Hum. Reprod. Update VL - 23 IS - 6 N2 - BACKGROUND: Zika virus (ZIKV) is an arthropod-borne virus of the family Flaviviridae, genus Flavivirus. ZIKV is currently the focus of an ongoing pandemic and worldwide public health emergency. Although originally isolated in 1947, its pathogenesis was poorly known and very few documented infections were published until recently. Its route of transmission and its impact on reproduction and pregnancy have only recently begun to be disclosed. OBJECTIVE AND RATIONALE: This review summarizes the most recent knowledge about ZIKV infection and pathogenesis and focuses on its impacts on male and female genital tracts, including the risks of sexual transmission and to pregnancy. The consequences of ZIKV infection for pregnancy planning and ART are also discussed. SEARCH METHODS: The PubMed and EMBASE databases were inter-rogated using specific terms, such as 'ZIKV', 'transmission', 'male', 'female', fertility', 'pregnancy, 'semen', 'testis', 'ovary' and 'genital tract', up to 17 March 2017. OUTCOMES: ZIKV has long been considered a harmless virus, but increasing evidence suggests that it has adverse effects on the neurological system and on pregnancy outcomes. In mice, ZIKV slows foetal growth and damages the foetal brain. In humans, the virus is able to cross the placental barrier and to induce foetal death and major anomalies, such as microcephaly, brain defects and long-term neurologic sequelae, i.e. the 'congenital Zika syndrome'. In addition to its transmission by mosquitoes, ZIKV may be transmitted sexually. Currently available data indicate that ZIKV RNA can remain detectable in semen for several months, whereas shedding in the female genital tract appears to be rare and of short duration. Current guidance on preventing the sexual transmission of ZIKV is based on the assumption that transmission occurs from a male partner to a receptive partner. Furthermore, in mouse models, the virus can actively replicate in male genital organs and induce severe orchitis, which raises concerns about its possible impact on human male fertility. WIDER IMPLICATIONS: These new and relevant findings have led many countries and institutions to release updated and regular guidance for preconception counselling and ART to prevent the sexual transmission of ZIKV. Progress in understanding the sexual transmission of ZIKV and its dissemination to genital systems would also help to better anticipate and control outbreaks of potentially sexually transmissible infectious agents. SN - 1460-2369 UR - https://www.unboundmedicine.com/medline/citation/28961800/Zika_virus_and_reproduction:_facts_questions_and_current_management_ L2 - https://academic.oup.com/humupd/article-lookup/doi/10.1093/humupd/dmx024 DB - PRIME DP - Unbound Medicine ER -