Zika Virus – an update on the latest developments

Mosquito born viruses are nothing new, nor are viruses that harm a fetus if the mother gets infected while pregnant. (chicken pox, rubella)  So what makes a country (El Salvador) tell its women not to get pregnant for 2 years?

What is Zika Virus?

Zika virus is in the same family of viruses such as West Nile, Yellow Fever and Japanese Encephalitis.  It is not a new virus, being first seen in Africa n the 1940s.  With world trade, like other insect borne viruses, it has spread.

Zika virus is contracted when bit by an infected Aedes mosquito.  It generally causes a flu-like illness, and resolves in a week or so.  Most people who contract it do not seek medical attention or realize that they even had Zika, assuming it was a more typical cold or flu.

In the past year, however, Brazil and other countries in Latin America have reported a huge increase in babies born with microcephaly – small skulls and incomplete brain development.  Babies born with microcephaly have developmental issues ranging from mild functional delays to severe birth defects. Infection with Zika virus during pregnancy has been linked to the increase in microcephaly, prompting the World Health Organization to call Zika an epidemic.

Currently, there is no treatment for Zika virus, and there is no vaccine. Efforts are being focused on prevention – avoiding areas with high rates of Zika and controlling the mosquito population/avoiding mosquito bites.

Zika has been shown to be transmitted via sexual contact and blood transfusion, but there have not been any documented cases of microcephaly from these routes of infection. There is no evidence that getting pregnant after recovering from Zika causes harm.

What is currently being done?

  • Vaccines are in development, but it will be at least 3 years before a vaccine is available
  • Research is being done on mosquitoes – giving them infections that make them unable to transmit the virus
  • Research on how to prevent microcephaly from occurring in the setting of an infection is ongoing

Current recommendations

  • El Salvador advised women to avoid pregnancy for 2 years
  • CDC travel advisories have been issued for women of childbearing age and pregnant women to avoid countries with Zika
  • Avoiding mosquitoes – bug spray and protective clothing if traveling in endemic areas
  • Men who have traveled to Zika areas are advised to use condoms with their pregnant partners for the duration of the pregnancy
  • New York’s Department of Health is offering free testing to all women of childbearing age within 2 weeks of travel to an endemic area, with or without symptoms

Take home points

  • Zika virus causes a typical flu like illness in most people
  • It has been linked to microcephaly in infants of women infected during pregnancy
  • Current efforts are aimed at preventing bites/exposure to Zika
  • If you have recently been to an area where Zika has been transmitted, testing is available through the CDC and local Departments of Health

The path to wellness begins with a proper diagnosis

Fertility after the pill

I recently referenced a NY Times article summarizing a study showing a link to stress and fertility problems.   As an Internist and Primary Care Physician, I am often asked fertility questions by my patients that are trying to conceive.  “I’ve been on the pill for years and now I want to get pregnant.  Will it be hard for me to conceive?” is an incredibly common question.  The answer depends on many factors.   The main determinants of fertility are age and the regularity of ovulation before and after oral contraception use.

Does duration of pill use affect fertility?

The amount of time a woman used oral contraceptives prior to attempting conception has little to do with time to recovery of their prior cycle.  Most physicians recommend waiting for a cycle off the pill before attempting conception, however, it is possible to get pregnant right away.  Therefore, if you do not wish to get pregnant right away, an alternative, non-hormonal, method of contraception is recommended.

Oral contraceptives use hormones to suppress ovulation.  If a woman does not ovulate, she can not get pregnant.  Once oral contraceptives are stopped, the hormones from the pill are out of the system in 3-4 days.  After that, the body’s own hormonal rhythm takes over.  So, if a woman had a regular ovulatory cycle before starting the pill, it is reasonable that she will resume that cycle shortly after stopping.  If the pill was being used to regulate an irregular cycle, then the ovulatory issues that existed prior to the pill will need to be addressed after the pill.

Fertility after the pill is mostly determined by fertility prior to the pill.  Duration of oral contraception use is not a major factor.  It takes the average couple about 8 months to conceive, so fertility testing prior to 1 year of attempting conception is not recommended unless there is an underlying issue that may be contributing to infertility.

How does this affect my practice?

A good history about why a person was using the pill, determining any risk factors for fertility issues is most important in answering the question of “will I have fertility issues after the pill?”  Once a sense of how regular a woman was before starting the pill, we can begin to predict what issues, if any, may need to be addressed.  A conversation with your doctor can lead to a plan, alleviate stress and allow you to enjoy the journey to a new part of your life.

The path to wellness begins with a proper diagnosis