March 3rd, 2013

It’s Not Safe Sex If You’ve Just Had the Smallpox Vaccine

One of my more memorable teachers used to love warning us about the hazards of sex.

No, this wasn’t in my 8th grade health class — this was during my first year of Infectious Diseases fellowship, and the teacher was one of our highly experienced attending physicians, now retired.

To him, sex carried limitless infectious risks. He demonstrated these hazards in lectures that featured an endless series of grisly Kodachromes projected in a dark classroom, explicit images that were not for the faint of heart. Think driver’s ed films, only substitute still shots of diseased genitalia.

Now, mind you, this man was married, and had three children. We ID fellows wondered how — literally — those children found their way to planet Earth given his obvious fear of procreation. We envisioned that they were most likely conceived by two people in hazmat suits, communicating via crackly intercom, with requisite background loud breathing.

Imagine the following verbal (and other) exchange, the voices similar to Darth Vader’s in Star Wars.

Him:  Requesting permission for exchange of bodily fluids. Over.
Her:  Permission granted. Place liquid in sterile receptacle, and evacuate area immediately. Over.
Him:  Objective completed. Evacuating area. Over.
Her:  Sperm transport initiated. Over

Then, nine months later, voila, a baby!

All of this came rushing back to me when I read this case report of sexual transmission — twice, no less! — of the vaccinia virus from the small pox vaccine. From the summary in Physician’s First Watch:

One man received smallpox vaccine through the U.S. Department of Defense, but he did not cover the vaccine site as instructed. After intercourse with the vaccinee, a second man was hospitalized for painful perianal rash and upper-lip sore, as well as fever and emesis; he reported having had contact with “moisture” on the vaccinee’s arm. The second man then had intercourse with a third, who was also hospitalized with genital and arm lesions.

Yet another infectious risk of unprotected sex — one not even considered by my fearful ex-attending. And here is an interesting comment from a colleague of mine, someone who specializes in HIV prevention:

What surprised me was that transmission was from an enlisted man to another man who presented with anal lesions and had contacted someone who then got penile lesions. Oh dear! Not what I expected as I began reading these case reports. And what’s with the contact with “moisture” on the arm (that could be anything). Did this rather unusual chain of transmission in these three cases occur among immunocompetent hosts, or was it an outlier series of events related to greater susceptibility conferred by underlying HIV infection?

Good question — the HIV status of only one of these men is reported (he was negative). Regardless, is it time to add vaccinia to the (long) list of potentially sexually transmitted infections? Might be enough to get my former attending back out on the lecture circuit.


2 Responses to “It’s Not Safe Sex If You’ve Just Had the Smallpox Vaccine”

  1. Sarah Albee says:

    Oh my. You ID docs must hear some pretty sordid, out-there tales from your patients. So much story bulges out between the lines of these case reports.

  2. Steven says:

    Maybe your teacher’s kids were adopted…

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

Biography | Disclosures | Summaries

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