Welcome to Strange Medicine – a series of nonfiction articles based on recent journal published, peer-reviewed case studies, review articles, meta-studies, scientific studies, and primary literature. Each relates to events that made the medical community’s eyes widen and scratch their heads, though, please note that all of these cases are significant toward scientific and medical progress because they also forced us to consider the unknown. This week’s featured image is by Greyson Joralemon on Unsplash (Previous article: Injected Mushrooms)

Valentines Day, February 14, 2021, was not the romantic, sexy holiday many of us hoped for as we spent our days isolating and waiting for our turn at a vaccine or waiting for more bizarre news from around the globe. Among that bizarre news came a publication showing that the Guinea 2021 Ebola outbreak had been traced back to a survivor of the 2014-2015 outbreak. The dormant virus had at some point “woken up” and started replicating into the man’s sperm, then transmitted sexually into its first new host after having slept for almost 6 years, approximately quadruple the previous record (500 days) for an individual carrying a filovirus to then shed infectious particles and infect another human. All this because Ebola loves to hang out in testicles.

This is not the first time Ebola went into hiding in a man’s balls to all of a sudden become the Sexually Transmitted Infection/Disease from Hell. Up until 2015 virologists and epidemiologists believed that Ebola remained infectious for up to 21 days “at most.” And then, 30 days after recording the last case, a woman in Sierra Leone tested positive. Having never seen this before, at first scientists assumed this must be a new outbreak. The woman’s only potential exposure to Ebola had been by having sex with a man who tested positive for Ebola in October of the previous year. In 1995, during the Ebola outbreak in the Congo, there were unconfirmed suspicions that a man infected a woman by sexual transmission, but contact tracers count not confirm this suspicion conclusively. Twenty years later, Ebola gave scientists another chance at that confirmation.

Ebola and other viruses like the testicles because they are an immune-privileged organ where the rest of the immune system is kept at bay. While this helps ensure successful reproduction, it does not help ensure the successful destruction of sneaky viruses that take advantage of immune evasion by targeting immune-privileged tissues such as the testicles and eyes.

In 2018, Jean-Pierre Routy decided to take studying viruses like HIV and Ebola by the balls, literally, and arranged for the donations of testicular tissue from Gender Reassignment Surgery (GRS) patients to better understand how this immune evasion worked. Thanks to these heroic tissue donors, he found that the viruses managed to hide asymptomatically in these tissues without triggering an immune reaction that would destroy these tissues due to protein markers on the surfaces of the cells within the tissues. In fact, approximately 20% of semen-related infertility is thought to be related to the loss of immune privilege in these tissues. With these confirmations on mechanisms, additional research proceeded. Other researchers confirmed that Zika and Ebola also took advantage of this immune privilege and could potentially use this as a means to hide within the human population until an unlucky sexual partner becomes the next patient zero.

If these viruses don’t frighten people enough into using barrier methods during sexual encounters while we’re living in a world already subjected to a global pandemic that shut down many borders, perhaps take a moment to reconsider if those encounters are really worth it, or at least ask if your potential partner has traveled to any countries where those viruses are common. If nothing else, it will be a great topic of conversation to start off your evening together in a post-pandemic world.

Further reading: Schindell, B. G., Webb, A. L., & Kindrachuk, J. (2018). Persistence and Sexual Transmission of Filoviruses. Viruses, 10(12), 683.

Featured image by Greyson Joralemon on Unsplash