Zika is working its way around the United States. It’s spreading across Florida, and is before long expected to reach Texas, Louisiana and other Southern states. It is a dizzying trip, and one that isn’t going to end anytime soon.
The virus spreads from a type of mosquito that has now officially been confirmed to carry Zika in Miami Beach. A massive effort to kill them in South Carolina produced a disaster for the bee population there.
But while mosquitoes are a key menace when it comes to Zika, the media and public officials are too focused on them. They also need to pay attention to sex: If we are going to stop the spread of this disease, we are going to need better access to Zika testing for anyone who is sexually active in a Zika zone.
At the moment, the Centers for Disease Control and Prevention recommends testing for pregnant women at risk of Zika transmission, people who exhibit symptoms of being infected with Zika, and people who have had sex with a partner who might have been exposed to the virus.
The CDC explicitly states that men, women who are not pregnant and children who are not symptomatic do not need to be tested. That, however, is not the best way to manage Zika.
Zika testing isn’t being offered as an essential preventive health service to every American right now. Nor should it be, at least not yet. It would be a waste of medical resources to include a Zika test with every sexually transmitted disease panel, especially for people outside areas of active transmission.
But it seems like more than just an oversight that the CDC is not yet recommending that sexually active men seek out testing in areas where active Zika transmission is confirmed. Recent studies show the Zika virus is detectable in semen for up to six months after infection.
Zika isn’t the only virus that can be found in semen for months after infection: Another recent study of 429 men infected with Ebola in Liberia showed that 38 of them tested positively for it more than one year after having symptoms of the disease. Primary literature on this study: And, of course, we have known for some time that men can transmit HIV and HPV to a male or female partner.
If men can be carriers of Zika, why aren’t they being recommended for testing in active Zika zones, too? Despite the fact that Zika is becoming a public health crisis for the general population, pregnant women and their doctors are being asked to bear the burden of preventing its spread. And if we are going to prevent the outbreak from spreading further, shouldn’t testing and counseling be offered to anyone who might be at risk as part of a panel of tests for sexually transmitted infections?
US government agencies at both local and federal levels are recommending more precautions, but skirt around addressing Zika as an STD.
The Food and Drug Administration recently called for universal testing for Zika in blood donations. The CDC continues to issue advisories for pregnant women not to travel to places with established, active Zika transmission. The FDA knows that testing is important. The agency continues to grant emergency use authorizations, or EUA, to various Zika diagnostic tests, with the provision that the permission can be revoked if the emergency subsides. So far, none of these tests has been granted FDA approval for standard use in clinical care anywhere.
Another problem with testing is that not all brands of tests are created equal, which makes it difficult for patients to know if they even have Zika. While some use a well-established technique, the same one used for a rapid HIV test, some on the EUA list use newer technologies. For those tests, only labs with the equipment manufactured by the company marketing the test can get accurate results. So, without a standard test being offered in Zika zones, combined with the fact that we know a person with Zika is able to infect another person for at least six months, we are creating a perfect storm for the spread to continue.
This information is clear if you read the EUA authorization information — and here’s the link to Roche’s press release that says you have to have their analyzer for their test, which was recently granted an EUA.
But a lack of accurate testing isn’t the only issue preventing easy access to testing. A lack of money to pay for testing is also problematic.
Who is footing the bill for Zika infection tests, which run an average of $500 apiece?
It is unclear whether most private insurance companies cover the cost of testing.
The bottom line is that we need a Zika policy for the current outbreak and for the long run. Zika virus infection isn’t always a mild illness that will go away on its own. It can cause serious neurological problems in adults, like Guillain-Barré syndrome, a severe condition in which the immune system destroys nerve cells that control movement.
Zika isn’t the first STD that we’ve been squeamish around, and our puritanical history makes it likely that it won’t be the last. STDs and their resulting epidemics make for tumultuous and often ineffective public health policy in the United States.
Before the transmission of HIV through a blood transfusion, AIDS was known as GRID, or “gay-related immune disorder.” There is public outrage over the recommendation that boys, as well as girls, be vaccinated for HPV. A look back at recent history reveals that we want to marginalize STDs, make them specific to one group of people while ignoring the fact that viruses don’t discriminate. It’s easy to make Zika an issue for pregnant women exclusively. But we can’t ignore the role that men and unsafe sex play in trying to prevent the spread of Zika.
No matter the epidemic, there are always a limited amount of medical resources to go around. Tough decisions have to be made and those who are most affected by Zika surely ought to get attention first. But Zika is an STD, one that can be passed on to partners and developing infants just like HIV, chlamydia and syphilis.
All who might carry it should know their carrier status. State, local and federal agencies need to push testing availability and coverage. Battling mosquitoes is only part of the response that Zika demands.