The Liberian government recommended on Saturday that survivors of 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 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 ’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.
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 and the 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 — 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.