With Zika season here, spread via sex is new danger


With Zika season here, spread via sex is new danger 
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This time last year, an outbreak of the Zika virus was spreading across Florida, creating a potential nightmare scenario for public health officials.

By mid August, cases had been confirmed in 35 counties, hitting Miami-Dade county especially hard. Nearly 250 cases had been registered there, and throughout the state, 70 cases had been confirmed in pregnant women. The outbreak prompted the Centers for Disease Control and Prevention (CDC) to issue a travel advisory for pregnant women who were planning to travel to Florida.

By the end of last summer, Zika had spread across the country with cases documented in every state except Alaska.

This year, Zika is posing another kind of threat in Florida. While the overall number of cases has dropped considerably, the virus has spread in a different and dangerous way.

Earlier this month, the Florida Department of Health confirmed its first case of Zika spread by sexual contact. While doctors and public health officials have long been aware of the risk of sexual transmission, and there have been a handful of documented cases sprinkled throughout the U.S., it’s imperative that we remind the public of this risk.

Here’s why: Zika is most commonly spread by mosquitoes, which affords us certain protections. First, public health officials can take measures to control mosquito populations at the city and country level. Timely and targeted spraying of pesticides can dramatically cut down on the adult population of mosquitoes in a given area.

We can also take personal measures of protection. Avoiding mosquito-prone areas, wearing pants and long sleeves outdoors and using insect repellant consistently can also reduce your risk of infection.

Beyond that, if you are bitten by a mosquito and you do become infected, you may be tipped off to the virus. Symptoms include fever, muscle aches, rash and red eyes and can last up to a week. Symptoms are rarely serious for adults, but can cause severe birth defects in babies.

What makes sexual transmission so concerning is that warning signs may be much more subtle, if there are any at all.

Often, those who are infected with Zika have no discernable symptoms and the incubation period can last up to two weeks. That means if a person contracts the virus and has unprotected sex with multiple partners, the disease could quickly spread even without the presence or personal encounters with mosquitoes.
The situation may be even worse for couples who are trying to have a child. Their risks are especially high for a number of reasons. Either the man or woman may be infected and not know it, their desire to become pregnant, obviously, necessitates unprotected sex and, should they conceive a child, the baby’s wellbeing could be in jeopardy.

For all those reasons, infection through sexual transmission poses a new set of problems for the public.

So, how do you protect yourself? The best way is to avoid areas where the Zika virus is active. If you are traveling within the United States or abroad, the CDC has maps identifying areas of concern.

If you are a woman who is pregnant or trying to become pregnant and have traveled to an area with active transmission of Zika virus or had sex with a partner who lived or traveled to these areas you should be tested if you develop symptoms of Zika or if there are abnormalities in an ultrasound that raises that concern. Routine testing of pregnant women is not recommended although the test is available and some doctors may recommend it on an individual basis.

Men who were infected with Zika or who traveled to an endemic area should use barrier precautions during sexual intercourse with his partner for 6 months or during the entire pregnancy if that is the situation. In the case of a woman that becomes infected or traveled to a Zika-infected area, it is recommended to postpone pregnancy for at least 8 weeks.

As with so many threats of widespread infection, including past outbreaks of diseases like swine and bird flu and the MERS virus, Zika got a lot of attention last year. It was still relatively new to the United States and because we were beginning to see first hand its devastating consequences in babies born with severe birth defects, the threat was taken seriously.

This year, as is often the case, the hype has died down and perhaps we have come a bit complacent when it comes to Zika.

But the diagnosis of cases spread through sexual contact should remind us that we can not let our guard down and assume the risk is gone.

The is message especially important to couples trying to conceive, who may be putting their baby at considerable risk without ever knowing it.

Antonio Crespo, MD is the Chief Quality Officer at Orlando Health Dr. P. Phillips Hospital and a clinical instructor at Florida State University’s College of Medicine. He is a board certified infectious disease specialist focused on helping patients afflicted with a range of illnesses including Zika, MERS, staph, malaria and HIV. 


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