STI | Cytomegalovirus

Cytomegalovirus is found throughout the world with an estimated global seroprevalence of 83 percent in the general population.

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Overview

Cytomegalovirus, also referred to as CMV, is a member of the herpesvirus group, which also includes: 

 

  • Herpes simplex virus types 1 and 2 

  • Varicella-zoster virus (which causes chickenpox)

  • Epstein-Barr virus (which causes infectious mononucleosis) 

 

CMV is found universally throughout all major geographic locations and socioeconomic groups, although it is more widespread in developing countries and in areas of lower socioeconomic conditions. 

A 2019 study by Zuhair et al. estimated a global cytomegalovirus seroprevalence of 83 percent in the general population, 86 percent in women of childbearing age and 86 percent in donors of blood or organs.

Once a person becomes infected, the virus remains alive, but usually dormant within that person’s body for life. For most healthy people who acquire CMV after birth there are few symptoms and no long-term health consequences. Therefore, for most people, CMV infection is not a serious problem. However, CMV infection may be of concern to certain high-risk groups. 

Cytomegalovirus is the most common congenital viral infection transmitted to a developing child before birth. Infection to the unborn baby during pregnancy – called congenital CMV – can include symptoms at birth and long-term, such as:

 

  • Jaundice

  • Enlarged liver and spleen 

  • Rash

  • Pneumonitis 

  • Microcephaly 

  • Damaged retina 

  • Psychomotor retardation

  • Vision loss 

  • Hearing loss

 

There is also a risk of symptomatic infection to women of childbearing age who work with children and previously have not been infected with CMV, as well as those who are immunocompromised, such as organ, bone marrow or stem cell transplant recipients and persons infected with HIV. For those at higher risk, the virus may cause serious issues affecting their:

 

  • Brain

  • Eyes 

  • Esophagus

  • Lungs 

  • Stomach

  • Intestines 

  • Liver


Some healthy people will experience mononucleosis-like syndrome with fatigue, achy muscles and a prolonged fever. Recurrent disease rarely occurs unless the person's immune system is suppressed due to therapeutic drugs or disease.  

Infectious cytomegalovirus may be shed in the bodily fluids of any previously infected person, and thus may be transmitted through:

  • Urine

  • Saliva

  • Blood 

  • Tears

  • Semen

  • Breast milk 

  • Blood transfusions or organ transplants 

Babies can acquire CMV perinatal at the time of delivery by contact with the virus in the birth canal or by breastfeeding. A baby can also acquire CMV postnatal by contact with individuals who are shedding virus. The shedding of virus may take place intermittently, without any detectable signs, and without causing symptoms; however, it is still transmissible.

Cytomegalovirus is prevalent in the general population; therefore, total prevention may not be possible. There are some measures that can be taken to reduce the spread of CMV including:

  • Wash hands often with soap and water for 20 seconds

  • Practicing safer sex including properly use latex condoms or polyurethane dental dams to avoid contact with sexual fluids

  • Avoid sharing utensils, cups or glasses

  • Avoid their tears and saliva when kissing a baby  

  • Clean areas that come in contact with body fluids including baby’s toys, changing tables, etc.

High-risk individuals may be prescribed antiviral medication to prevent cytomegalovirus. Currently, there is no preventative vaccine for CMV; however, researchers are testing vaccines in pregnant women to protect them from acquiring CMV and passing the virus to their babies in utero.

There are laboratory tests that can detect CMV; however, most people will not be tested for cytomegalovirus. For those who have symptoms, an active virus or previous CMV infection or are immunocompromised or pregnant, test options include:

  • Blood, saliva or urine tests

  • Virus culture

  • Molecular testing (PCR)

  • Amniocentesis 

Antiviral medications are available to treat CMV. Based on the presentation of CMV symptoms, doctors will prescribe medications for the areas of the body affected. 

Babies born with congenital CMV that require treatment are commonly prescribed ganciclovir or valganciclovir to help improve hearing and developmental outcomes.