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UPDATE ON ZIKA VIRUS: What Do I Need to Know in the Urgent Care Setting?

You walk into the exam room and introduce yourself to your next patient. She tells you that she and her husband returned one week ago from Puerto Rico. This morning she woke up feeling achy and feverish with pains in “her joints and muscles” and noticed that her eyes were red and irritated. They are thinking about getting pregnant, and even though her husband does 

not have any symptoms, they both want to be tested for the Zika Virus, and ask if you think they have it. How would you proceed?

Zika virus is a mosquito-borne illness transmitted primarily by the Aedes aegypti mosquito. More than one million people have been infected since the appearance of the virus in Brazil in 2015. The virus has gained international attention due to concerns for infection in pregnant women potentially causing fetal microcephaly. Urgent care providers must be prepared to address concerns from patients presenting symptoms consistent with acute Zika virus infection, especially those who are pregnant or planning travel to Zika-endemic regions, as well as women planning to become pregnant and their partners.


Zika infection is asymptomatic in 80% of cases. When infected, after an incubation period of 2–7 days, symptomatic patients develop rapid onset fever, maculopapular rash, arthralgia, and conjunctivitis, often associated with headache and myalgias. Male to female sexual transmission has been reported. To entertain a clinical diagnosis of Zika, two or more symptoms should be present in addition to an appropriate exposure history.

Urgent Care Evaluation

Generally, testing is not recommended for asymptomatic persons, with the exception of pregnant women 2 to 12 weeks after travel to areas with ongoing Zika virus transmission. Patients should be assessed for pregnancy. The good news is that there are no mosquito borne cases reported yet in the continental United States. Local health departments and many commercial labs now offer testing for Zika virus, but because these are rapidly evolving, you will need to contact them to learn what the current protocols are in your state. Some public health departments may decline to test if the clinical scenario is not suggestive of Zika virus. 


Treatment for Zika virus infection is entirely supportive as no specific antiviral therapy is yet available. Management consists of rest and symptomatic treatment, including drinking fluids to prevent dehydration and administration of acetaminophen to relieve fever and pain. Aspirin and nonsteroidal anti-inflammatory drugs should be avoided until dengue fever can be ruled out, to reduce the risk of hemorrhage. Most patients have self-limited illnesses, with symptom resolution within seven days. Complications of Zika include congenital microcephaly and fetal loss, as well as neurologic complications such as Guillian-Barre. Pregnant women who test positive for Zika virus should be referred to an OB-GYN, and offered ultrasound to assess for microcephaly.

So back to your patient- after examining the patient and discussing her concerns, you agree that Zika testing is a good idea. You consult your local health department and they approve testing for her. Since her husband is asymptomatic, they do not approve him for testing. You send off urine and blood samples from your patient, and advise her that it will likely be 7-14 days for results, but that she shouldn’t worry as most people experience only mild, self-limited symptoms. Based on the available evidence, you tell her that we believe that Zika virus infection in a woman who is not pregnant would not pose a risk for birth defects in future pregnancies after the virus has cleared from her blood. From what we know about similar infections, once a person has been infected with Zika virus, he or she is likely to be protected from a future Zika infection. You recommend fluids and Tylenol, have a discussion with her and her husband regarding sexual transmission of the virus, and suggest they use condoms for contraception. The patient asks how long she has to wait before she could try to get pregnant. You inform her that while some studies have shown the virus to be present in semen for up to 6 months, you recommend that she discuss this further with her OB/GYN physician prior to attempting to conceive. The patient is feeling much better after some fluids and Tylenol, and you discharge her home.


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