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article imageCould Ebola become an AIDS-like sexually transmitted disease?

By Stephen Morgan     May 3, 2015 in Health
Scientists have confirmed that Ebola can be transmitted more easily through sexual relations than was previously thought.
Until now, medical experts believed that survivors of the Ebola disease would only remain contagious as sexual partners for 3 months after their recovery. But new evidence tends to show that the infectious period can last almost twice as long.
A female partner of an Ebola survivor died recently in what appears to be a case of infection through sexual contact. What has surprised health experts is that it seems to show that the virus remains alive and transmittable at least 5 months after recovery.
The New York Times says that Ebola genetic material was found in a sample of semen which the man provided 175 days after he developed Ebola symptoms, which makes it 74 days longer than ever before found in a survivor.
The incident involved the death of a 44-year-old Liberian woman who was the sexual partner of a man who suffered Ebola symptoms last September, but survived. The woman became sick in March this year and died just one week after having sex with him.
The disease is transmitted through contact with an infected person's bodily fluids, such as saliva, blood, sweat, semen, breast milk, mucus, vomit and feces. However, it is sufficiently virulent for someone to catch it through infected drinking vessels or contaminated surfaces and other materials.
While scientists are researching further into the incident, all the evidence in this case, points to the woman having been infected with the Ebola infection through sexual relations.
Until now, scientists thought that patients were no longer contagious once they had recovered. The exception was that the virus might remain active in semen for the following three months. Therefore, health officials advised former patients to use condoms or abstain from sex for this period. That limitation now looks to have been overly optimistic.
Until now, medial workers say they can only confirm 10 such cases, but ABC News says that other recent Ebola cases in Liberia, Guinea and Sierra Leone appear to have also been the result of sexual transmission from survivors.
Science Times quotes Dr. Barbara Knust, an epidemiologist and Ebola expert at the CDC (Centers for Disease Control), who said;
"We have suspected that having sexual contact with survivors could be a potential way for people to become infected. Prior to this outbreak we did have messages given to male survivors to abstain from sex for three months and they were provided condoms."
Officials are now telling Ebola survivors to refrain from unprotected sex indefinitely.
"Until more information is known, contact with semen from a male survivor should be avoided. If male survivors have sex (oral, vaginal, or anal), a condom should be used correctly and consistently every time."
At the moment, they are saying that abstinence and protection will not be life-long recommendations, but they can't yet give any precise estimates of how long it should last.
More than 3 800 of the Ebola virus deaths were in Sierra Leone alone  according to World Health Orga...
More than 3,800 of the Ebola virus deaths were in Sierra Leone alone, according to World Health Organization's (WHO) figures
Francisco Leong, AFP/File
On the positive side, they believe that female Ebola survivors cannot transmit the virus because of differences in the reproductive system and immune cells which search out viruses.
Even so, there are lots of "ifs" "coulds" and "maybes" surrounding the medical prognoses and public statements.
The fact is that experts aren't really sure how long the virus remains transmittable, not only through semen, but other bodily fluids, because only a very small number of survivors have been studied.
The World Health Organization, the C.D.C. and the Sierra Leone health ministry are just setting up an investigation to try to get more precise information on how long different bodily fluids remain contagious after a person is cured.
However, if latest evidence proves that it can still be transmitted sexually after recovery, then we could be into an entirely new ball game. The spread of Ebola's could become far more insidious than now, effectively transforming it into a Sexually Transmitted Disease (STD).
Of course, there are many differences between HIV/AIDS and Ebola, which experts can elaborate on, but there are also enough similarities to cause concern.
Superficially, it might be reassuring that, another of the sexual partners of the man who transmitted Ebola to the dead Liberian woman, tested negative to the virus. But, the fact that he actually had two sexual partners in 7 months, shows how sexual habits and promiscuity can become one of Ebola's important transmission belts.
One of the reasons why HIV spread more rapidly after its initial beginnings at the start of the 20th century was the urbanization of African countries. The building of major cities brought millions of people into close contact and that is even more so today.
Cities led to a growth of promiscuity and prostitution and travelers brought HIV across the oceans to other countries.
A typical squatter camp in South Africa  known officially as an  informal settlement.
A typical squatter camp in South Africa, known officially as an "informal settlement."
flickr/hadsie
However, a key reason why HIV was able to eventually become an epidemic, was that it was a silent killer. It spread rapidly, because there was a delay of many years between HIV infection and symptoms of AIDS.
This meant those infected were passing it on to many partners without knowing it and the medical community only became aware of the virus once sufficient numbers of deaths eventually brought it their attention, and by which time it had taken on epidemic proportions.
A key difference between AIDS and Ebola is the time between infection and full-blown symptoms. With Ebola, it is only a matter of days and that reduces the "window of of opportunity" for its spread as a sexually transmitted disease, though not its highly infectious character generally.
Its symptoms are now more easily recognized by trained medical staff, which AIDS wasn't initially. Someone traveling internationally, who is sick, is much more likely to be diagnosed with Ebola than a person with HIV.
However, it isn't those with Ebola symptoms who are principally spreading the virus in an STD form, but those who believe they are cured, and, therefore, don't know or don't believe that they are still infectious.
This the twist; in effect it would be as if someone cured of AIDS could still pass on the illness, but in the case of Ebola, unlike HIV, it could kill within days.
Given human nature, rationalizations and denial of illness is very common, and health warnings are unlikely to have much effect in stopping survivors from having sex, even if it is for only 6 months.
The strict measures taken by health organizations and governments in Africa have succeeded in containing the disease for the moment, but, lets face it, policing sex is a practical impossibility.
Reflecting these difficulties, Pauline Oosterhoff, who is a fellow at the Institute of Development Studies and a member of the Ebola Response Anthropology Platform wrote in the Guardian of her recent experiences in the region;
"When I met members of a women’s secret society in Sierra Leone this February, they proposed drastic measures to stop Ebola from spreading through sexual contact...Male survivors need to be locked up because they cannot control their urge to have sex. Women need to be locked up because they cannot stop their husbands from forcing sex upon them. When I asked them whether using condoms might be easier than quarantine, I was greeted with rolling eyes and hissing. Their men would never accept this. “They would put holes in the condoms as soon as they saw them”. Female condoms? Forget it. “They are disgusting. They get stuck deep into women’s body.”
There can be no doubt that Ebola could spread internationally through sexual contact. It is thought that HIV became a global epidemic after just one individual entered the US from Central Africa and Haiti. In regards to Ebola, some 24,000 people were infected with the disease in the last six months.
In Western cities today, the same conditions are favorable for the spread of Ebola, as they were for HIV. Prostitution, involving multiple partners in a day, can become a fast lane for infection, when their clients then pass it on to the general population.
The incredible speed at which Ebola could grow has been shown recently by the rapid spread of HIV among intravenous drug users in rural Indiana.
While Ebola is not the same as HIV, the potential spread of the virus through sexual contact has apparently been underestimated. This should give us concern for a potential "second wave" of sexually transmitted Ebola infections, not only in Africa, but internationally.
More about Ebola, Virus, Aids, HIV, Sexual