Men Need to Protect Themselves From Zika Too

Credit: Statue photos by Daniel Lobo on flickr (CC-by-2.0) Mosquito and Image Modification (on right) by RoseWrites

For most of the year, the CDC has focused on pregnant women who acquire Zika. And I always felt it was ridiculous to advise pregnant women not to travel to Zika-endemic areas and say nothing to men.

It's as though the CDC believes that women – once pregnant – do not engage in any form of sex with their partner again.

So, it's okay if he attends the Olympics or travels to Florida, but not her.

Related: Zika Cases Emerging From the Olympics

And it took an astonishingly long time for the Zika virus to even be recognized as a sexually transmitted disease (STD). On August 1st, 2016 National Geographic published It's official: Zika is a sexually transmitted infection.[1]

William Smith, Executive Director of the National Coalition of STD Directors (NCSD) in Washington, pointed out that CDC-sponsored signs (at airports and other traffic hubs) mentioned mosquitoes and the importance of wearing repellent but they never showed condoms. One example is shown next:

Going to the American Tropics?Credit: Centers for Disease Control and Prevention (CDC) Downloadable Fact Sheet

N.B: The CDC failed to recommend mosquito nets for beds (Culex bite at night) and has lumped Zika together with dengue and chikungunya even though there is 99 percent support for the phylogenetic placement in the clade that includes West Nile virus (WNV) and Saint Louis encephalitis (SLE).

"We have been a little bit frustrated by the lack of focus on Zika as an STD when there has been credible evidence that sexual transmission could be as important a focus for us in preventing Zika as mosquito-borne transmission." ~ William Smith, Executive Director of NCSD

Later that month, on August 26th, 2016, a CNN post mentioned:

"Researchers have known for some time that Zika can be transmitted via semen from men to women, hiding in the testes, where it can avoid the immune system; in fact, there is mounting evidence that it can continue to replicate in the testes – and even increase the viral load – for months after infection."[2]

Backtracking to April 2016

Viral Levels Highest in Testes

In a Futurity post by Caroline Arbanas of Washington University in St. Louis (WUSTL) called Mice With Zika Have Highest Levels in Testicles, Michael Diamond, professor of medicine, molecular microbiology, pathology & immunology at WUSTL, mentioned:

"We looked for evidence of Zika in the mouse testes mostly as an afterthought, due to mounting evidence of sexual transmission and were surprised that viral levels were the highest we saw in any tissue."[3]

May 2016: High Virus Levels Found in

Serum, Spleen, Brain, Spinal Cord, and Testes

In the journal Cell Host & Microbe, Lazear, Diamond, et al. noted in A Mouse Model of Zika Virus Pathogenesis[4] that there were few studies conducted on mice. So, they evaluated Zika infections and disease in wild-type mice and in immune-deficient transgenic mice using different strains of the Zika virus.

The latter group (mice lacking interferon α/β (IFN-α/β) signaling (i.e., Ifnar1−/− or Irf3−/−Irf5−/− Irf7−/− triple knockout [TKO]) became infected with different Zika virus strains.

And high levels of the Zika virus was found in all of the tissues they examined (including blood serum, spleen, brain, spinal cord, and testes).

Related: Zika Virus: Our Tainted Blood Supply

When I read "flaviviruses generally are not associated with persistent infection, but there is evidence of persistent WNV infection in the kidneys and long-term viral shedding in urine (Murray et al., 2010)" it reminded me of what Dr. Fiona Hunter stated:

"If you look at the support for the phylogenetic placement [of Zika virus], there is 99 percent support for that node. The clade includes West Nile virus (WNV), Saint Louis encephalitis, and Zika virus."

Again, as Dr. Ayres mentioned, "Zika is more related to the viruses transmitted by Culex."

It's a bit unsettling that the study titled Persistent Infection With West Nile Virus Years After Initial Infection[5] emphasized the following:

  • Individuals with chronic symptoms following WNV infection may have persistent renal infection over several years.
  • Although we suspected viral persistence in some patients with chronic symptoms, finding one in five urine specimens to be positive was unanticipated.
  • The finding of viral RNA in the urine of these patients is suggestive of ongoing viral replication in renal tissue, consistent with the hamster model. 

It makes sense that Zika is more related to WNV; Zika is not a hemorrhagic disease, yet there are widespread reports (including the CDC) which constantly state "Zika or similar viruses like dengue and chikungunya".[6]

But it's worrisome that WNV can persist in the urinary tract and that hamsters (like mice) were found to have results similar to humans. 

Furthermore, the study by Iwasaki et al. published August 26th, 2016 called Vaginal Exposure to Zika Virus during Pregnancy Leads to Fetal Brain Infection states:

"Therefore, humans are naturally more susceptible to ZIKV [Zika virus] infection than mice because infected cells can no longer respond to IFNs [interferons]. Consequently, we speculate that ZIKV introduced into the human vagina is likely to replicate more robustly than in the vaginal cavity of wild-type mice."[7]

So while we need to be mindful that mice are not men, I think it's important to be aware that there are plenty of similarities drawn between the reproductive systems of mice and humans in study literature. 

Addendum: November 8th, 2016

I wrote to Michael Diamond, M.D., Ph.D. and asked him:

In May 2016, your study "A Mouse Model of Zika Virus Pathogenesis" showed high levels of the Zika virus in: serum, spleen, brain, spinal cord, and testes. My question is: could the Zika virus also be "hiding and replicating" in the spleen?

And I cited two studies that found viral Zika RNA in whole blood for two months and for 81 days.

He responded: 

"I don't think it is hiding in the spleen — we have seen titers and RNA drop rapidly between day 7 and 14 … at least in mice. Not sure where it is in whole blood — they should fractionate the cells."

Just to Compare Our Gonads to Other Species

The Rhesus Macaque is Ideal, But Not Easily Obtained

Proposed model of CTCF and BORIS evolution in amniotes
Credit: Phylogeny Figures on flickr (CC-by-2.0)

The ancestral expression pattern of BORIS is wide, including multiple somatic tissues (reptiles and monotremes), but becomes progressively restricted in therian mammals with gonad specific expression in marsupials and cattle and testis-specific expression in humans and mice.

October 31st, 2016: Irreparable Damage

Zika Replicates Continuously and Kills Sperm Cells

CNN's Sandee LaMotte reported on the latest study by Dr. Michael Diamond, associate director of Washington University's Center for Human Immunology and Immunotherapy Programs: "Not only did male mice infected with the Zika virus have a tougher time getting females pregnant, their levels of sex hormones crashed, and their testicles shrunk by 90 percent, possibly permanently."[8]

And Sujan Shresta, associate professor at La Jolla Institute for Allergy and Immunization, added:

"The last thing I want to do is scare people, but I can imagine as a scientist if the virus is always replicating, then chances are that it is destroying your sperm. Eventually, that person will be infertile, right? And we don't know right now. We don't have the data."

High Viral Levels: Spermatogonia & Sertoli Cells

Significant Damage to the Blood-Testes Barrier

In a brilliant Q&A: Zika Damages Mouse Testes, Reduces Fertility[9] by Ben Andrew Henry, I learned more details about the study by Diamond et al. called Zika Virus Infection Damages the Testes in Mice.[10]

After two weeks, the following damage had occurred:WalnutsCredit: U.S. Department of Agriculture (USDA) on flickr (CC-by-2.0)

-Testicles were smaller
-Seminiferous tubules were damaged
-High viral levels were found in other cells
-Sperm were infected 
-Inflammation was still present
-Breakdown of the blood-testes barrier began

Photo: Walnuts by U.S. Department of Agriculture (USDA) on flickr (CC-by-2.0)

PeanutsCredit: uacescomm on flickr (CC-by-2.0)After another week (day 21), observations included:

-Testicles were much smaller
-Enormous amounts of microscopic damage
-Virus still present
-Significant damage to the blood-testes barrier

Photo: Peanuts by uacescomm on flickr (CC-by-2.0) 

Sperm counts (and therefore fertility) and hormone levels all plummeted. Eventually mice became sterile.

The Huffington Post report by Julie Steenhuysen called Zika Virus May Affect Male Fertility, According To Study On Mice[11] made me realize how permanent this damage could be to men's reproductive systems.

"We saw significant evidence of destruction of the seminiferous tubules, which are important for generating new sperm. The [Zika] virus is infecting a site which doesn’t really renew if it gets damaged. That is the problem." ~ Dr. Michael Diamond of Washington University in St. Louis

Sertoli cells do not regenerate.

"This is the only virus I know of that causes such severe symptoms of infertility." ~ Co-author Dr. Kelle Moley, a fertility specialist at Washington University  

Structure and Signaling Mechanisms of the

Putative Mouse Testicular Germline Stem Cells Niche

Sertoli cells (green-specialized domain contacting and supporting GSCs), blood vessel and perhaps other cellular and non-cellular components including myoid cells and basal membrane
Credit: By Xie T., Germline stem cell niches (September 30, 2008), StemBook, ed. The Stem Cell Research Community, StemBook, doi/10.3824/stembook.1.23.1, [CC BY 3.0 (], via Wikimedia Commons

A Must-See: Zika Infection Reduces Fertility, Lowers Testosterone in Male Mice

By Washington University School of Medicine

Addendum: January 20th, 2017

An Unpublicized Study I Found Confirms the Worst

I cannot understand why there are no media reports about this. The WHO, CDC, or Health Canada have not made any announcements either (that I am aware of).

And every source I looked up required me to pay to access this study. I took a screenshot (shown next) just in case the text gets removed (as it did with the PubMed study I mentioned in a previous article of mine). 

In Nature Reviews Urology, the study called Infection: A new threat on the horizon — Zika virus and male fertility[14] by Andreas Meinhardt (published January 10th, 2017) states:

"Amongst the many causes of male-factor infertility, a diagnosed viral cause is a rather infrequent aetiological factor. However, a recent study has illustrated that Zika virus infections affect not only developing fetuses in pregnant women, but are also a threat to fertility in men. Whether this threat could be managed or mitigated remains uncertain." 

Zika in Men Causes Infertility Unpublicized StudyCredit: Screenshot taken January 20th, 2017 by RoseWrites of unpublicized study (hidden behind paywalls) [Fair Use]

Prostatitis and Hematospermia (Blood in Semen)

While working in Senegal in 2008, microbiologist Brian Foy, experienced 
common symptoms of Zika virus infection and symptoms of prostatitis (after returning home to Colorado).

Four days later, he observed signs of hematospermia [blood in his semen]. On the same day, his wife had symptoms of a Zika virus infection.[15]


Please Ask Your Doctor About Azithromycin

It Treats STDs and Babesiosis, a Tick-Borne Disease

UC San Francisco researchers have identified fetal brain tissue cells that are targeted by the Zika virus and determined that azithromycin, a common antibiotic regarded as safe for use during pregnancy, can prevent the virus from infecting these cells.[16]

Azithromycin is used to treat certain bacterial infections, such as bronchitis; pneumonia; sexually transmitted diseases (STD); and infections of the ears, lungs, sinuses, skin, throat, and reproductive organs.[17]

Until more is learned about how the Zika virus affects men, my sense is that azithromycin might be worth a try (but be sure to ask your doctor first). 

Azithromycin is also used sometimes to treat babesiosis (an infectious disease carried by ticks).[17]

Important to Tell Your Doctor: 

If you are allergic to azithromycin, clarithromycin (Biaxin, in Prevpac), dirithromycin (not available in the United States), erythromycin (E.E.S., E-Mycin, Erythrocin), telithromycin (Ketek), or any other medications (or any of the ingredients in azithromycin).[17]

Other prescription and nonprescription medications, nutritional supplements, vitamins, and herbal products you are taking (or plan to take).

Make sure your doctor knows of the following before s/he prescribes azithromycin: anticoagulants such as warfarin (Coumadin, Jantoven); cyclosporine (Neoral, Sandimmune); digoxin (Lanoxin); dihydroergotamine (D.H.E. 45, Migranal); ergotamine (Ergomar); medications for irregular heartbeat such as amiodarone (Cordarone, Pacerone), dofetilide (Tikosyn), procainamide (Procanbid), quinidine, and sotalol (Betapace, Sorine); nelfinavir (Viracept); phenytoin (Dilantin); and terfenadine (not available in the United States). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.[17]

Note: If you are taking antacids containing magnesium hydroxide or aluminum hydroxide (Maalox, Mylanta, Tums, or others), you will need to allow some time to pass between when you take a dose of these antacids and when you take a dose of azithromycin. Ask your doctor how many hours before or after you take azithromycin you may take these medications. The extended-release suspension may be taken at any time with antacids.

More Related Articles About the Zika Virus

A Crime Against Humanity: How the CDC and WHO Are Promoting the Global Spread of Zika

Zika and Its Path: What Our Public Health Authorities Are Hiding

Safe Mosquito Eradication That Works: Using Coffee, Bti, Rubbing Alcohol, and a Cat

Want to Help?

Spread the word. Share this article (especially with your doctor). Ask questions.

I designed serious (and some humorous) products on Zazzle to help raise funds for Zika research. My Zazzle collection and my devoted Facebook page are both called: Zika: Let's Stop a Global Pandemic.[12][13]

Author's note: All of my citations have a clickable link to their source. The list is found in the bibliography at the end of this page.