The Liberian government recommended on
Saturday that survivors of Ebola practice safe
sex indefinitely, until more information can be
collected on the length of time the virus might
remain present in body fluids including semen.
Previously, male survivors were advised to
abstain from sexual intercourse or to use
condoms for three months, reflecting that the
active virus had been detected for up to 82 days
in semen.
Acting on new developments, all countries
affected by the Ebola outbreak need to consider
applying similar recommendations, said Dr. David
Nabarro, the United Nations secretary general’s
special envoy for Ebola.
Agencies involved in the response were urgently
reviewing the issue. “Yet again the Ebola-
affected communities are asked to deal carefully
with an unknown,” Dr. Nabarro wrote in an email,
adding that survivors “should not be stigmatized
as they take actions for the public good. They
are the heroes.”
The new guidelines came one day after the
death of Liberia ’s single confirmed patient with
Ebola, Ruth Tugbah. Before her illness, the
country had gone three weeks without a new
Ebola diagnosis, and hopes had risen that Liberia
was nearing the end of a yearlong epidemic that
killed more than 4,000 people there. Ms.
Tugbah’s only known risk factor was having a
boyfriend who was an Ebola survivor.
Graphic | Ending the Ebola Outbreak Months of
declining cases have fed hopes that the Ebola
outbreak might finally be ending.
Scientists detected the genetic material of Ebola
from a semen sample the boyfriend provided to
infectious disease investigators, officials from
two Ebola response agencies said, speaking on
background because they were not authorized to
speak publicly.
In a potentially worrying development, officials
learned that the man, whose name is not being
released, was treated for Ebola last September.
A blood sample from his girlfriend, who tested
positive for Ebola, was collected on March 19.
Given a maximum incubation period of 21 days,
the earliest she could have been infected was
Feb. 26, well over three months after the man
was cured of Ebola.
Even though traces of the virus were detected in
the man’s semen, that does not prove that the
fluid contained active virus particles, or that Ms.
Tugbah was infected from it, the officials said.
To help determine that, the sample will be sent
to scientists outside Liberia who have the
facilities to try to grow the virus in a culture.
Scientists in Monrovia, Liberia’s capital, were
working to determine whether the virus carried
by Ms. Tugbah matched the sequence of that
from her boyfriend. The national laboratory
gained the capacity to sequence the Ebola virus
just last month with support from the United
States Army Medical Research Institute for
Infectious Diseases.
Officials from Liberia, the United States Centers
for Disease Control and Prevention and the World
Health Organization scrambled on Friday to come
up with the new recommendations given the
developments and their sensitivity.
“For now we are encouraging survivors to have
safe sex,” said Tolbert Nyenswah, Liberia’s top
Ebola official. He said the country planned to
enroll survivors in a study to determine the
maximum length of time the virus remains
detectable. Condoms have not been tested with
Ebola, but are thought to be effective because
they block transmission of much smaller viruses,
bacteriophages, which are 27 nanomillimeters
compared with Ebola’s 80 nanomillimeters, said
Nathalie Jeanne Nicole Broutet, a medical officer
with the World Health Organization’s Department
of Reproductive Health and Research in Geneva.
“In theory the Ebola virus wouldn’t pass the
condom,” she said, while noting that condoms
“are not perfect for sexually transmitted
illnesses. They have a 95 percent efficacy if you
use them constantly and correctly.”
Dr. Broutet said that research protocols had
been developed to test a range of body fluids for
the virus — such as tears, sweat, semen, vaginal
secretions and even breast milk — but that the
studies had not yet started and were still
awaiting ethical approvals. Certain parts of the
body, including the testes, may harbor the virus
longer than the blood because those areas are
not well accessed by immune cells.
The research was sensitive, Dr. Broutet said.
Some survivors accused of infecting their sexual
partners have been incarcerated in Sierra Leone.
Dr. Broutet said research had been delayed
because of competing priorities during the height
of the epidemic. “Now that it’s quieter, it’s the
right time,” she said. “The question is urgent.”
Dr. Philderald E. Pratt, assistant representative
in Liberia of the United Nations Population Fund,
known as UNFPA, a reproductive health agency,
said there needed to be a campaign to inform
the public about the uncertainties, while at the
same time avoiding further stigmatizing
survivors.
“We’ve thought about it, we’re planning it, but
we hadn’t kick-started it,” he said.

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The question now is what effect will an "infected semen" be to a woman? hm