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. 2017 Sep 21;13(9):e1006633. doi: 10.1371/journal.ppat.1006633

Fig 1. Women and men are shown in orange and blue, respectively, with squares indicating vector-infected individuals and circles corresponding to infections acquired sexually.

Fig 1

Since most vector-infected individuals typically transmit ZIKV to 0 or 1 sexual partners, a biased estimate of the relevant reproductive number for sexual transmission risk (R0total), will be obtained when considering all infections, thus inaccurately suggesting that ZIKV cannot be a self-sustaining STI (one would correctly determine that R0total1; however, this quantity underestimates the risk of sexual transmission). Considering only transmissions caused by sexually-infected individuals corrects for the bias, but still may not provide a complete assessment of the threat posed by ZIKV as an STI (R0sexual<1). In fact, because of the highly asymmetric sex-dependent probability of transmission of ZIKV, an epidemic is likely to occur in the men-who-have-sex-with-men (MSM) community with some spillover transmission to the population not active in the MSM community, a situation that can only be modeled through a well-suited community-specific reproductive number (e.g., R0MSM>1).