In a letter to the New England Journal of Medicine, a team of French scientists described the case of a 24-year-old woman who had contracted Zika via oral sex. The scientists suggested that the case is strong evidence that Zika might be more easily transmitted through bodily fluids—including perhaps saliva from kissing—than was initially thought.

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According to the NEJM letter, the patient contracted Zika after sexual contact with a 46-year-old man who had recently visited Brazil where he contracted the disease:

We report a case of ZIKV infection in a previously healthy 24-year-old woman (Patient 1) who was living in Paris and in whom acute fever, myalgia, arthralgia, and pruritic rash developed on February 20, 2016. She was not receiving any medication, had not received any blood transfusions, and had never traveled to a region where Zika was epidemic or to tropical or subtropical areas. Her last trip outside France was to Okinawa, Japan, from December 21, 2015, to January 1, 2016. A clinical examination on February 23 showed a maculopapular rash on the patient’s abdomen, arms, and legs and a temperature of 36.6°C. The illness lasted approximately 7 days.

Patient 1 reported sexual contact between February 11 and February 20, 2016, with a man (Patient 2, the index patient) who had stayed in Brazil from December 11, 2015, through February 9, 2016. The sexual contact involved seven episodes of both vaginal sexual intercourse, without ejaculation and without the use of a condom, and oral sex with ejaculation.

The New York Times notes that while one case of Zika from fluid transmission might not seem like a big deal, the discovery is a persistent reminder of how little we know about the disease’s transmission. Before this year, the Times reports, there was only one documented case of Zika transmission from vaginal sex.

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“I don’t think this changes anything, but it shows you how elaborate the number of avenues of possible transmission can be,” William Schaffner, a physician at Vanderbilt University Medical School, told the Times.

In the NEJM letter, the team argues that the case should lead to the reevaluation of recommendations to prevent transmission. The scientists argue:

[...] Guidelines regarding how long men who are returning from an area where active ZIKV transmission is occurring should continue to use condoms during sexual contact with pregnant women and those of child-bearing age are lacking. In addition, recommendations regarding the possibility of oral transmission of the virus through semen are needed.

The Centers for Disease Control and Prevention currently recommends that pregnant women either abstain from sex or use a condom “from start to finish” for vaginal, anal and oral sex. Additionally, the CDC recommends that men who have been exposed or diagnosed with the disease wait six months before having unprotected sex.

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The NEJM letter is sure to cause more unrest about the virus. Already in the United States and its territories 340 pregnant women have the Zika virus; most of the women either contracted Zika abroad or live in Puerto Rico. Last week, the first Zika-infected baby was born in the United State mainland. The girl has microcephaly and “structural abnormalities of the eye.” The mother contracted Zika in Honduras, likely from a mosquito bite.

Image via AP.