Women and Men with Possible Zika Virus Exposure Who Desire Pregnancy

What is considered a “possible exposure” to Zika virus?

Possible exposure to Zika virus is defined as:

• Recent travel to, or living in, an area with active Zika virus transmission; or
• Sex (vaginal, anal, and oral sex, and the sharing of sex toys) without a condom with a partner (male or female) who has traveled to or lives in an area of active Zika transmission.

How should healthcare providers counsel men and women considering becoming pregnant who have been diagnosed with Zika virus disease or have had possible Zika virus exposure?

For women and men who have been diagnosed with Zika virus or had possible Zika virus exposure, even if they have no symptoms, CDC recommends that healthcare providers advise:

• Women to wait at least 8 weeks after their symptoms first appeared or last possible Zika virus exposure before trying to get pregnant.
• Men to wait at least 6 months after their symptoms first appeared or last possible Zika virus exposure before attempting conception with their partner.
• Patients should also be counseled to correctly and consistently use condoms in addition to their chosen method of birth control for vaginal, anal, and oral sex or abstain from sex during this time period if they are concerned about the possibility of transmitting Zika virus to their sex partners.

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 with possible Zika virus exposure and clinical symptoms in the absence of a laboratory-confirmed test?

Persons who had possible Zika virus exposure and display one or more signs or symptoms consistent with Zika virus disease should be referred for laboratory testing. Until they have laboratory testing performed, healthcare providers should follow the same recommendations regarding time periods to wait before pregnancy.

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 could be falsely reassuring. This can happen when

• The blood test is performed after the virus is no longer in the blood but could still be present in other bodily fluids (e.g., semen).
• The antibody test is performed early after infection when the antibody levels are not yet high enough to be detected or later after infection when the antibody levels have fallen to undetectable levels.

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 recommend waiting at least 6 months before attempting conception for men with Zika virus disease or possible Zika virus exposure?

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 sexual transmission from men without symptoms to their partners. Without definitive data showing a difference in sexual transmission risk between men with and without symptoms, 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 symptom onset. Given the limited data available at this time and the potential for severe birth defects from congenital Zika infection, CDC recommends men wait 6 months before considering pregnancy with their partner. This recommendation will be updated as new data become available.

Why recommend at least 8 weeks before attempting conception for women with Zika and those with possible exposure and no symptoms?

Having women wait for at least 8 weeks increases the likelihood that the virus has been cleared from an infected woman’s blood 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.

What guidance should be given to women who followed the previous recommendations to wait at least 8 weeks, but who have now become pregnant with a male partner (who was asymptomatic) who traveled to an area with active transmission within the last 6 months?

CDC recommends that pregnant women who have had possible Zika virus exposure during the periconceptional period (8 weeks before conception and 6 weeks before the last menstrual period) or during pregnancy be offered testing according to CDC’s testing recommendations. Pregnant women who have had unprotected sex during the periconceptional period or during pregnancy with a symptomatic or asymptomatic man who traveled to an area with active transmission within the last 6 months would be considered potentially exposed to Zika virus.