While the traditional paradigm asserted that viral elimination takes place after acute illness, contemporary insights reveals that the male genital tract may act as an independent reservoir, as evidenced by the lasting presence of various viruses associated with emerging epidemics in human semen, even far beyond the initial acute illness. The presence of viral genomes and competent viruses in semen exposes recovered patients to a risk of delayed sexual transmission, sometimes several weeks or months after the infectious episode. This risk has been demonstrated for certain viruses, such as Zika and Ebola, and is suspected for others. Beyond the possible consequences of viral infection on spermatogenesis, the persistence of the virus in semen has implications for natural procreation but also for assisted reproductive technologies, where virologic safety must be ensured. This manuscript reviews the current state of knowledge on this subject and highlights the gaps that exist for certain viruses. Research in this area needs to be developed, in particular to describe the mechanisms involved in this persistence and to better identify periods of prolonged excretion. Public health policies must incorporate the new conceptual framework of possible delayed sexual transmission of certain viruses and therefore consider the presence of the virus in semen as a critical factor in decision-making algorithms designed to counsel and support infected individuals, as well as in formulating individual preventive strategies, recommendations for medically assisted reproduction and collective public health measures.
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