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Women and Men with Possible Zika Virus Exposure Who Desire Pregnancy

World map of areas with CDC Zika travel notice and areas with zika risk but no CDC Zika travel notice

	pink rectangleAreas with a CDC Zika travel notice: Areas where the virus has been newly introduced or reintroduced and mosquitoes in the area are infected with Zika virus and are spreading it to people.

	orange rectangleAreas with Zika risk but no CDC Zika travel notice: Areas where the virus was present before 2015 and there is no evidence transmission has stopped, and areas where the virus is likely to be circulating but has not been documented. Travel notices would be considered if the number of cases rises to the level of an outbreak.

	blue rectangleFor exposure* in the United States, please visit this webpage for current maps and guidance.

* Exposure means living in or traveling to this area or having sex without a condom with someone who lives in or has traveled to this area.

How should healthcare providers counsel men and women who are trying to conceive and who have been diagnosed with Zika virus disease or have had exposure to an area with a CDC Zika travel notice?

For women and men who have been diagnosed with Zika virus or had exposure to an area with a CDC Zika travel notice, even if they have no symptoms, CDC recommends that healthcare providers advise:

  • If a woman is exposed, the couple should wait at least 8 weeks after her symptoms started or last possible Zika virus exposure before trying to get pregnant.
  • If a man is exposed, the couple should wait at least 6 months after his symptoms started or last possible Zika virus exposure before trying to conceive.
    • During the waiting periods after their possible exposure, couples should also be counseled to correctly and consistently use condoms for vaginal, anal, and oral sex, in addition to their chosen method of birth control, or to not have sex.

Given the limited data available, men and women with possible Zika virus exposure might choose to wait longer than the recommended time period to conceive, depending on individual circumstances and risk tolerance.

How should healthcare providers counsel men and women who are trying to conceive and who have had exposure to an area with Zika risk but NO CDC Zika travel notice?

Decisions about pregnancy are personal and complex, and the circumstances for women and their partners will vary. The level of risk for Zika virus infection in these areas is unknown. For this reason and because information is limited about the risk of infection around the time of conception, healthcare providers should counsel women and men who are trying to conceive about travel to these areas and their risk of Zika virus infection. This conversation should address the potential consequences of becoming infected with Zika around the time of conception in the context of the couple’s plans to have children, their individual circumstances, and risk tolerance.

Zika virus testing is indicated for non-pregnant women and men who have exposure to these areas and who experience symptoms of Zika virus disease. Those who test positive for Zika should follow the suggested timeframes above before trying to conceive.

How should healthcare providers counsel men and women considering becoming pregnant who have ongoing exposure (e.g., live in or frequently travel) to any area with Zika risk (with or without a travel notice)?

Given the ongoing possible exposure to Zika, healthcare providers should counsel couples about how they can protect themselves against Zika, the potential consequences of becoming infected with Zika around the time of conception (in the context of the couple’s plans to have children), and their individual circumstances.

Zika virus testing is indicated for non-pregnant women and men who live in or frequently travel to any area with Zika risk and who have symptoms of Zika. Those who test positive for Zika should follow the suggested timeframes above before trying to conceive.

Why is Zika virus testing not recommended for asymptomatic couples interested in attempting conception in which one or both partner has had possible exposure to Zika virus?

No test is 100% accurate. A test result can sometimes be negative in the setting of true infection, and the results could be falsely reassuring. For example:

  • If the serum or blood PCR is performed after the virus is no longer in the blood, Zika could still be present in other bodily fluids (e.g., semen). In those situations the blood test would be negative but the person could still be carrying the virus in other bodily fluids.
  • If the IgM test is performed too early after infection when the antibody levels are not yet high enough, the results could be negative.
  • If the antibody test is performed after the IgM has waned, the results could be negative.

We currently have limited understanding of Zika virus shedding in genital secretions or of how to interpret the results of tests of semen or vaginal fluids. Zika shedding in these secretions may be intermittent, in which case a person could test negative at one point but still carry the virus and shed it again in the future.

Why are men with Zika virus disease - or exposure to areas with a CDC Zika travel notice- recommended to wait at least 6 months before attempting to conceive with their partner?

CDC is aware of reports of Zika virus RNA detected in semen more than 90 days after symptoms began, with the longest report at 188 days. However, it’s unknown whether Zika virus RNA in the semen represents infectious virus. There have also been reports of men without symptoms who are infected with Zika transmitting Zika virus to their partners through sex. Without definitive data showing a difference in the risk for men with and without symptoms to spread Zika through sex, the recommendations are the same for both groups.

To date, Zika virus has been cultured (shown to be infectious) from semen collected within 3 months after symptoms started. Given the limited information available at this time and the potential for severe birth defects from congenital Zika infection, CDC recommends men wait 6 months before attempting pregnancy with their partner. This recommendation will be updated as new data become available.

Why are women with Zika - or possible exposure to areas with a CDC Zika travel notice- recommended to wait at least 8 weeks before attempting conception?

Having women wait for at least 8 weeks increases the likelihood that the virus has been cleared from an infected woman’s body and reduces the likelihood that she will transmit the virus to her fetus if she becomes pregnant.

Where can I find more information about preconception health care?

Preconception health care aims to promote the health of women of reproductive age before conception and to improve pregnancy-related outcomes. Preconception health care for women who may be exposed to Zika virus should include a discussion of the risks of Zika virus infection to the mother and her fetus. Visit Preconception Health Care for more information.

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