Screening of genital fluid for Ebola virus
Authors: William A Fischer, Amy J Loftis, David A Wohl
Journal: The Lancet Global Health (2016)

Moses Soka and colleagues (October, 2016)1Soka MJ Choi MJ Baller A et al.Prevention of sexual transmission of Ebola in Liberia through a national semen testing and counselling programme for survivors: an analysis of Ebola virus RNA results and behavioural data.Lancet Glob Health. 2016; 4: 736-743Summary Full Text Full Text PDF PubMed Scopus (74) Google Scholar describe their semen testing programme for survivors of Ebola virus disease. This programme provides an important service to male survivors of this disease in Liberia; however, we are concerned that the real-time RT-PCR assay used might not be validated for the detection of Ebola virus in semen. Although the assay was granted emergency use authorisation by the US Food and Drug Administration for the detection of Ebola virus RNA in blood, plasma, serum, and urine, Soka and colleagues do not include supporting data for the use of this assay with semen. Without establishing the test's parameters for semen, the interpretation of the test results is not clear. In our work2Loftis AJ, Quellie S, Chason K, et al. Validation of the Cepheid GeneXpert for detecting ebola virus in semen. J Infect Dis (in press).Google Scholar validating a different diagnostic platform for the detection of Ebola virus RNA in semen and vaginal fluid, we found that the limits of detection in genital fluid were significantly higher than in blood. Thus, an undetectable result in semen does not necessarily mean that there is no Ebola virus in the sample—a consideration with important implications for sexually active male survivors. Additionally, the programme only offers testing to men. Because Ebola virus has been detected in vaginal fluid, it is important that women should also be given access to validated testing of genital fluid to empower them with the ability to make evidence-based decisions on how best to keep their sexual partners safe. The screening of genital fluid for Ebola virus disease survivors with validated diagnostic platforms is a much-needed service that should be expanded to all men and women who survived Ebola virus disease. WAF and DAW have received grants funding from the US National Institutes of Health (NIH 1K23AI121516 for WAF; and NIH K24DA037101 for DAW), which had no role in the design, data collection, analysis, or interpretation of this work or in the decision to submit for publication. WAF and DAW are scientific investigators on the CRM and PREVAIL IV studies that include semen testing from Ebola virus disease survivors. AJL declares no competing interests. Prevention of sexual transmission of Ebola in Liberia through a national semen testing and counselling programme for survivors: an analysis of Ebola virus RNA results and behavioural dataDuration of detection of Ebola virus RNA by real-time RT-PCR varies by individual and might be associated with age. By combining behavioural counselling and laboratory testing, the Men's Health Screening Program helps male Ebola virus disease survivors understand their individual risk and take appropriate measures to protect their sexual partners. Full-Text PDF Open AccessScreening of genital fluid for Ebola virus – Authors' replyWe welcome the opportunity to respond to the letter by William Fischer and colleagues about our Article.1 The main concern expressed in their letter relates to the qRT-PCR assay of the US Centers for Disease Control and Prevention (CDC) used by the Men's Health Screening Program (MHSP) to test semen samples and appears to be based on their “work validating a different diagnostic platform”. However, Fischer and colleagues do not specify which diagnostic platform and, at the time this response was drafted, they had not published the results of this work. Full-Text PDF Open Access