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Patient Counseling

It is important for women and their partners to plan their pregnancies in the context of the risk of Zika. Healthcare providers should counsel couples considering pregnancy about plans for travel to or those living in areas with risk of Zika. Read more below for CDC’s guidance.

People Planning to Conceive

Before Travel to Areas with Risk of Zika

Healthcare providers should counsel women and men considering or planning for pregnancy about travel to areas with risk of Zika virus infection. Consideration should be given to the health risks and potential consequences of Zika virus infection around the time of conception and during pregnancy as well as a discussion of the patient’s individual circumstances, level of risk tolerance, and plans for having children.

Following Travel to Areas with Risk of Zika

Remind patients that most people infected with Zika remain asymptomatic.

  • If a couple has a female partner and only she travels to an area with risk of Zika: before trying to get pregnant, the couple should wait at least 2 months after the date of her last possible Zika virus exposure (if asymptomatic) or 2 months after the start of her symptoms of Zika virus disease (if symptomatic).
  • If a couple has a male partner and only he travels to an area with risk of Zika: before trying to conceive, the couple should wait at least 3 months after the date of his last possible Zika virus exposure (if asymptomatic) or 3 months after the start of his symptoms of Zika virus disease (if symptomatic).
  • If a female and male couple travel together to an area with risk of Zika: before trying to conceive, the couple should wait at least 3 months after the date of their last possible Zika virus exposure (if asymptomatic) or 3 months after the start of his symptoms of Zika virus disease (if symptomatic).
  • In addition to a discussion about waiting to conceive, couples should also be counseled about correctly and consistently using condoms to prevent the sexual spread of Zika virus during the waiting period. Condoms should be used during vaginal, anal, oral sex, and the sharing of sex toys. Condoms may be used as a method of birth control alone or in addition to a couple’s chosen method of birth control. Couples may also choose not to have sex during the waiting period.

Zika virus testing is indicated for all travelers to areas with risk of Zika who experience symptoms of Zika virus disease. This includes non-pregnant women and men.

Patients with Ongoing Exposure to Areas in the US with Risk of Zika

Ongoing exposure means living in or frequently traveling to (e.g., daily or weekly) an area with risk of Zika. Given the ongoing possible exposure to Zika, healthcare providers should counsel women and men about how they can protect themselves against Zika, the potential consequences of becoming infected with Zika around the time of conception and during pregnancy, and their individual circumstances.

  • Symptomatic non-pregnant women and men: Zika virus testing is indicated for non-pregnant women and men who live in or frequently travel to areas with risk of Zika and who have symptoms of Zika. Those who test positive for Zika should follow the suggested timeframes above before trying to conceive.
  • Asymptomatic non-pregnant women planning to conceive: CDC previously issued a recommendation to consider Zika virus IgM testing as part of preconception counseling to establish baseline IgM results for asymptomatic women with ongoing possible exposure who are planning to conceive (HAN, May 5, 2017). However, testing for such a purpose is no longer warranted given that Zika virus IgM is no longer routinely recommended for asymptomatic pregnant women.

People Not Planning to Conceive

Men and women should use condoms correctly and consistently for vaginal, anal, and oral sex and while using sex toys in addition to their chosen birth control method, or abstain from sex if they are concerned about the possibility of transmitting Zika virus to their sex partners. People who live in or travel to areas with risk of Zika should be informed that Zika can be passed through sex, even if the infected person does not have symptoms at the time. The virus may also be passed through sex by a person who has been infected with the virus but never develops symptoms.

Couples can follow the designated timeframes below to minimize their risk for sexual transmission of Zika virus.

  • If a couple has a male partner and only he travels to an area with risk of Zika, the couple should consider using condoms or not having sex for at least 3 months after the male partner returns (even if he doesn’t have symptoms) or from the start of the male partner’s symptoms or date of diagnosis.
  • If a couple has a female partner and only she travels to an area with risk of Zika, the couple should consider using condoms or not having sex for at least 2 months after the female partner returns (even if she doesn’t have symptoms) or from the start of the female partner’s symptoms or date of diagnosis.
  • If a couple has both a male and female partner and they both travel to an area with risk of Zika, they should consider using condoms or not having sex for at least 3 months after their return or from the start of symptoms or date of diagnosis.

Patients should be counseled about contraceptive methods, including the availability and effectiveness of different contraceptive methods and how to use these methods. The decision about what type of contraceptive method to use is a personal decision and should be made by the person or couple in consultation with their healthcare provider.

Persistence of Zika in Semen

A focused review of the literature to date can be found in CDC’s guidance for preconception counseling and prevention of sexual transmission of Zika virus.

  • Evidence of sexual transmission: Briefly, among the currently available reports of sexual transmission of Zika virus, the longest period from symptom onset in the index case to potential sexual transmission to a partner was between 32–41 days.
  • Potentially infectious Zika virus in semen: The longest reported period after symptom onset at which potentially infectious virus has been detected in semen by culture or cytopathic effect was 69 days. No other studies reported potentially infectious Zika virus in semen specimens obtained more than 40 days after symptom onset.
  • Detection of Zika virus RNA in semen: A large number of publications have also reported on detection of Zika virus RNA in semen, which might not indicate presence of infectious virus at the time of sampling or correlate with the potential for sexual transmission of infectious virus. In the largest cohort study to date, Zika virus RNA shedding declined during the 3 months after symptom onset. At >90 after illness onset, semen of ≤7% of participants had detectable Zika virus RNA. The estimated mean time to clearance of Zika virus RNA from semen was 54 days. Similar findings have been observed in smaller cohort studies.

Limited data suggest the incidence of Zika virus RNA shedding in semen and its persistence after infection are likely similar for symptomatic and asymptomatic men infected with Zika virus.

Clinician Resources

Preconception Counseling Guide for Men and Women Living in Areas with a CDC Zika Travel Notice Who are Interested in Conceiving

Counseling Travelers: Women and Men of Reproductive Age

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