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  • November 29, 2016 8:54 AM | Deleted user

    Written by Honor Whiteman

    Published: Monday 28 November 2016

    There is insufficient evidence to suggest breast cancer screening should be stopped at a specific age. This is the conclusion of the largest study to date of mammography outcomes in the United States.

    Researchers say there is no evidence that women should stop having mammograms after a certain age.

    Study co-author Dr. Cindy Lee, assistant professor in residence at the University of California-San Francisco, and team recently presented their findings at the Radiological Society of North America (RSNA) annual meeting, held in Chicago, IL.

    After skin cancerbreast cancer is the most common form of cancer among American women.

    According to the American Cancer Society, around 246,660 new cases of invasive breast cancer will be diagnosed in the U.S. this year, and more than 40,000 women will die from the disease.

    Despite these grim statistics, breast cancer death rates have been falling in the U.S. since the late 1980s - a trend that has been partly attributed to earlier detection as a result of screening.

    Mammography is considered the gold standard of breast cancer screening. The technique involves the use of X-rays to identify early signs of breast cancer, such as calcifications or tumors in breast tissue.


    Register to Receive More Info on Psoriatic Arthritis

    Guidelines issued by the U.S. Preventive Services Task Force (USPSTF) in 2009 recommend that women aged 40-49 at average risk of breast cancer should make an individual, informed decision as to whether they undergo mammography, while women aged 50-74 should undergo mammography every 2 years.

    For women aged 75 and older, however, the USPSTF state that there is insufficient evidence to "assess the balance of benefits and harms of screening mammography."

    Such guidelines are at odds with those from the American Cancer Society, which recommend that women aged 55 and older should undergo mammography every 2 years, and "screening should continue as long as a woman is in good health and is expected to live 10 more years or longer."

    Assessing the mammography outcomes of more than 2.5 million women

    Dr. Lee notes that the conflicting guidelines surrounding the age at which mammography should be stopped have led to much confusion.

    "There has been a lot of controversy, debate and conversation regarding the different breast cancer screening guidelines, even among major national organizations, over the past few years," she adds.

    Dr. Lee points out that previous randomized, controlled trials assessing mammography outcomes have excluded women aged 75 and older, meaning the available data have been based on results of small, observational studies.

    With this in mind, Dr. Lee and team analyzed data from the National Mammography Database. The researchers assessed more than 5.6 million screening programs that took place at 150 facilities across 31 U.S. states between January 2008 and December 2014.

    All in all, the team gathered data from more than 2.5 million women aged 40 and older. The women were divided into age groups by 5-year intervals up to the age of 90 - aged 40-44, 45-49, 50-54, 55-59, and so on.

    'No evidence for age-based mammography cessation'

    In order to determine mammography outcomes for the women in each age group, the researchers applied four standard performance measures: cancer detection rate, recall rate - the percentage of mammograms that require follow-up testing - and positive predictive value for biopsy recommended (PPV2) and biopsy performed (PPV3).

    Positive predictive value represents the number of cancers identified through mammography that result in biopsy or recommended biopsy.

    According to the researchers, a higher cancer detection rate, higher PPV2 and PPV3, and a low recall rate reflect an optimal mammography performance.

    For every 1,000 patients, the team identified an overall mean cancer detection rate of 3.74, a 10 percent recall rate, a 20 percent PPV2 rate, and a 29 percent PPV3 rate.

    With increasing age, the researchers identified an increase in cancer detection rate, a gradual rise in PPV2 and PPV3 rates, and a fall in recall rates - meeting the criteria for ideal screening performance.

    "The continuing increase of cancer detection rate and positive predictive values in women between the ages of 75 and 90 does not provide evidence for age-based mammography cessation."

    Dr. Cindy Lee

    The researchers conclude that their findings suggest it should be a woman's individual choice - based on health status and personal preferences - as to whether she wants to cease or continue breast cancer screening at the age of 75 or older.

    While further investigation is needed, the new research indicates that the benefits of breast cancer screening after the age of 74 may outweigh the risks.

    Read how digital mammography could help predict heart disease.

    Written by Honor Whiteman

  • November 29, 2016 8:52 AM | Deleted user

    Statement by Josanne Pagel following NCCPA’s November 18th PANRE Proposal Communication

    On November 18, 2016, NCCPA announced that it had finalized its plans for modifying PA maintenance of certification requirements. It has discarded its proposal to require PAs to take a closed-book, proctored exam in a specialty area, as well as its plans to introduce either several take-home exams or other new requirements during each 10-year recertification cycle.  NCCPA also announced its intention to modify the PANRE exam to focus on “core knowledge.”

    We are grateful to the many PAs who have made and continue to make their voices heard on this issue.  On their behalf, AAPA welcomes NCCPA’s decision to abandon some of the most onerous parts of its recertification proposal. But we continue to oppose high-stakes recertification exams.

    AAPA opposes re-testing because there is no evidence that it improves patient outcomes or safety. We urge NCCPA to conduct research on the impact of PA recertification exams on patients.

    In the meantime, we will redouble our efforts to remove state laws and regulations that require current NCCPA certification for license renewal.  If we can change these provisions, at least PAs will not be at risk of losing their license if they fail NCCPA’s high stakes recertification exam.  We have already contacted the State Chapters in the 20 states where this requirement exists, and we encourage you to join your State Chapter and help us work on this issue.

    We continue to examine the feasibility of starting a new recertifying organization, and we look forward to a robust conversation on this topic with PAs at AAPA’s Leadership and Advocacy Summit (March 4-5) in Washington, D.C.

    NCCPA Revises Potential Changes to the PA Recertification Exam

    September 19, 2016

    NCCPA advised AAPA, PAEA and ARC-PA at our meeting in Atlanta on September 6 that it is considering an alternative to its previous proposal for recertification testing. NCCPA did not ask the organizations present to endorse its proposal, nor did we offer to do so. We – AAPA, PAEA and ARC-PA – agreed to give NCCPA time to make an official announcement to the PA community before reaching out to our respective stakeholders. NCCPA distributed the alternative they are currently considering by email to PAs on September 9. Over the coming weeks, AAPA’s board will evaluate the new NCCPA proposal in light of AAPA policy, the views of our constituent organizations (COs) and those of individual PAs.

    Listening to and being responsive to our membership is at the heart of AAPA. We will continue to provide transparency in our decision-making and actively seek the opinions of PAs and COs. Please continue making your voices heard by posting your views of the NCCPA alternative on our Facebook page, Twitter #PARecert or in Huddle. You can also send us your views by emailing AAPA at this address: We also encourage you to share your views directly with NCCPA.


    Click here for a printable version of the infographic

  • November 28, 2016 8:16 AM | Deleted user
  • November 28, 2016 8:07 AM | Deleted user

    Black Friday and Cyber Monday are here! While you’re surfing around Amazon to find the perfect gifts, please shop under ARHP’s Amazon Smile portal. ARHP’s receives automatic donations from every Amazon purchase that comes through our account—at no cost to you.

    Easy and fast sign-up is here: à

    Please send to your family and friends as well. We actually DO receive a small but helpful check each year from Amazon through the SMILE program. Let’s make this year’s bigger than ever. 

  • November 22, 2016 8:51 AM | Deleted user

    Sexual Health and Your Patients: A Provider’s Guide can help healthcare providers better integrate sexual health conversations and recommended preventive services into routine visits with adolescents and adults. By using this guide, providers can:

    • Streamline their sexual history taking
    • Increase their delivery of recommended preventive sexual health services by using “at a glance” tables

    • Improve their care for LGBT patients 

    • Be better prepared to discuss sexual health topics and answer patient questions 

    • Become more knowledgeable about sexual health

    Explore the guide's sections by clicking on the links below, or download the entire guide by clicking in the box.

    How to Discuss Sexual Health
    Sex can be difficult to discuss, but many patients want to talk about it with you. Get tips for ensuring a productive sexual health conversation with your patients.

    Asking Essential Sexual Health Questions
    Find the essential sexual health questions to ask adults and adolescents at least annually, plus additional questions you can ask to get more information.

    Delivering Recommended Preventive Sexual Health Services
    Preventive services are a key element to improving and protecting sexual health. Find out which your patients should be getting, and which they shouldn't be.

    Responding to Your Patients' Questions
    Not always ready to answer questions about sexual health? See sample responses to common questions so you can include all the important elements in your answers.

    Information About Recommended Screening Tests
    See here for general information about recommended screening tests, including their sensitivity and specificity. 

    Where to Learn More
    Want to learn more about a particular sexual health topic? Visit this list of clinical education and resources.

  • November 21, 2016 2:07 PM | Deleted user

    A new clinical research study seeks to determine whether a rapid molecular diagnostic test can reliably identify gonorrhea infections that may be successfully treated with a single dose of an older antibiotic, ciprofloxacin. The study will enroll up to 381 men and women diagnosed with untreated Neisseria gonorrhoeae. It is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. The study is being conducted by the NIAID-funded Sexually Transmitted Infections Clinical Trials Group at four sites: one each in San Francisco, and Philadelphia, and two in Los Angeles.

    The Centers for Disease Control and Prevention estimates that more than 800,000 new gonococcal infections occur in the United States each year. Fewer than half of these infections are detected, and antibiotic-resistant infections are a growing problem. People treated for gonorrhea must now receive two drugs--one orally (azithromycin) and another as an injection (ceftriaxone)--to hedge against the possibility that they may harbor a strain resistant to one of the two drugs. The availability of a greater variety of treatments for gonorrhea--and a tool to pinpoint the best treatment option for each individual--would benefit patients and also potentially help slow the development of drug resistance, say the study authors.

    In this new trial, scientists will employ a rapid molecular assay using swabbed samples from participants' infection sites to determine whether they are infected with gonorrhea of a specific genetic profile (genotype), gyrA serine 91. Participants with that strain who agree to take part in the study will receive one dose of oral ciprofloxacin (500 mg), and will return for clinical and laboratory assessments within 5 to 9 days to determine if they are cured. Participants who remain infected will be referred for standard treatment.

    If the gyrA serine 91 genotype proves to be a reliable marker of vulnerability to ciprofloxacin, healthcare providers may be able to reintroduce ciprofloxacin as a viable treatment for gonorrhea in some cases.


    NIH/National Institute of Allergy and Infectious Diseases

  • November 18, 2016 9:32 AM | Deleted user

    Teaching a "Martian" how to make a peanut butter and jelly sandwich is part of new curriculum at Northwestern Medicine that aims to eliminate medical errors. Credit: Northwestern University

    Why do physicians accidentally jab themselves in the hand with an EpiPen (epinephrine injection) when they are trying to give another person an injection while holding their breath? 

    How does directing a "Martian" to make a peanut butter and jelly sandwich improve health care communications?  

    The answers are part of the curriculum for the first Ph.D. in health care quality and patient safety program in the country—at Northwestern Medicine — which aims to prevent the annual 440,000 deaths from medical errors in the United States. 

    "You can't stress enough how crazy it is that the third-leading cause of death is medical errors," said Donna Woods, director of the graduate programs in health care quality and patient safety at Northwestern University Feinberg School of Medicine. "How will this ever get fixed if we don't train a work force to do it? We need an army of experts who need to know how to address this. The medical field does not have the skills to do it."

    The first Ph.D. student in health care quality and patient safety graduated this fall with others in the pipeline.

    Senior and mid-career clinicians (physicians, nurses, pharmacists) and health care professionals are trained by engineers, cognitive psychologists and risk assessment and change management specialists, who bring a critical fresh eye to the medical world. The "outsiders" teach students how to spot the vulnerable chinks in the system and figure out how to fix them. The students learn to do research, so they can design fixes based on scientific evidence.

    To build a national health care safety army, Northwestern has provided a template from its master's level health care quality and patient safety program—also the first in the country—to other medical schools to launch their own master's programs. These include George Washington University, Thomas Jefferson University's College of Population Health, University of Illinois and Cornell University. 

    Doctors, nurses and pharmacists are working in a system that has not been designed for safety, and they never got the skills or perspective to help them redesign health care to make it safer. Thus, the problem can't be fixed by insiders without training in health care quality and patient safety, Woods said.

    "Under the current model, when medical students and residents walk into an Emergency Department, their challenge is to survive and adapt to a crazy system, not figure out how to fix it," Woods said. "When they become attending physicians, they are inured to the problems and no longer see the risks. We have to reintroduce them to these risks. If they don't see them, they won't ever do anything to fix them."

    The Ph.D. students learn about physical and cognitive ergonomics, which is the study of predictable errors your mind can make and how to consider these in health care design to make the delivery of health care more reliable.

    In one class session for Ph.D. and graduate students, a faculty member who is a physician and an engineer, brought EpiPen trainers to class. He asked students—most of whom had medical degrees—to hold their breath (to create a sense of urgency) while reading the directions and give another person the injection. In the scenario, the person was having a life-threatening anaphylactic reaction. Every time this session is held, at least one student accidentally sticks himself or herself in the hand with the injector, wasting the life-saving medicine. Students had to figure out why the device's design led to that problem.

    The lesson learned: it's hard to make your eyes focus when you are in a crisis situation.

    The faculty member who taught the EpiPen class subsequently worked with the manufacturer to develop a new design in which the injector gives spoken instructions.

    In another class, students are instructed to write a protocol for a "Martian," who has no earthly cultural knowledge, to make a peanut butter and jelly sandwich. When the instructor attempts to literally follow students' directions, sandwich-making chaos ensues. It illustrates when a person writes a protocol for a health care procedure, they make a lot of cultural assumptions that not everyone shares or understands across medical departments, services and professions. That can lead to errors. 

    Students also learn one of the riskiest moves for a patient is from an intensive care unit (ICU) to the regular-care hospital floor. In the ICU, each nurse cares for two patients and checks them constantly. On the regular floor, a nurse may have seven or eight patients and visits them every four to six hours.

    "In four hours, a patient just transferred from the ICU can quickly deteriorate to the point of death," Woods said. "One opportunity for change is not just recognizing this to be a potentially risky transition but to develop a system of additional monitoring and checking on these patients. Many hospitals have a rapid response system after a patient has deteriorated. Possibly, a system of rapid-response rounding can provide a system so a nurse comes around more frequently. This is the type of intervention our students will develop."

    Woods has a personal interest in this solution; several years ago her mother died within a day after being moved from the ICU to a regular floor.

    The curriculum also targets how to improve teamwork and communication in health care—often disjointed and risky—as a patient moves through the system. A patient's primary care doctor and specialists don't always communicate or know about changes in drugs, which could lead to dangerous interactions or overdoses. Students are tasked with making electronic health records more reliable, including more accurate processes for including all of a patient's current medications. Unreliable information is frequently the cause of medical errors. 
    The first Ph.D. student who graduated in September, Cindy Barnard, is non-traditional in that she is already an executive in the health care world as vice president of quality for Northwestern Memorial Healthcare. In her research, she asks patients how they define quality health care.

    "As surprising as it may seem, nobody has asked them," Barnard said. "We discovered patients have thoughtful and distinctive views of what health care quality should be, and what they want us to improve. Now we need to figure out how we can use their perspective to change what we measure in order to provide what's important to them."

    The medical field thinks patients care most about emotional support and the hotel aspects of the hospital (food quality, cleanliness and parking). But what they really value is a timely, accurate diagnosis and evidence-based care, Barnard said. They also are concerned about medical errors and recognize the most vulnerable time in their care is when they are transitioning from one nurse or doctor to another. Many said they want to make sure all of their doctors are on the same computer system.

    "We've learned the health care industry needs to do a better job of creating quality measures to determine if the patient received a prompt and accurate diagnosis," Barnard said. "There's no way to say this hospital or doctor did or did not do a great job."

    Gayle Kricke, a geriatric social worker who will get her Ph.D. next year, is researching quality end-of-life care for older adults with multiple chronic conditions. They account for two-thirds of the older adult population more than 65 years old, a number on the rise.  

    "These patients tend to be on a roller coaster of sickness and relative health, so you don't really know when they are approaching the end of their lives," Kricke said. She's investigating how to improve care for them, moving them into palliative care sooner and hospice at the appropriate time. Many spend only a few days in hospice care, which means they aren't getting the full benefit, including a focus on comfort and holistic care to meet the spiritual and emotional needs of the patient and family.

    "These students are the future of safer and higher quality medical care," said Neil Jordan, director of Northwestern's Health Sciences Integrated Ph.D. Program, which includes the Ph.D. degree in health care quality and patient safety.

  • November 17, 2016 9:22 AM | Deleted user

    Be the change. The nccPA Health Foundation challenges PAs to take responsibility for making a change to improve health and offers a funding opportunity to support PA efforts. This grant is for PAs to lead, design, and execute activities that expand access to care as a strategy for promoting more equitable care. These grants are intended to encourage, facilitate, and support volunteerism and service-learning, mechanisms that allow PAs to leverage their unique skills and training to support patient education and care in their communities. 

    This program is for certified PAs, PA organizations (educational programs or constituent organizations), and PA students. Grants are considered on a rolling basis and awarded based on merit, in amounts up to $1,000 until all funds are expended. Applicants should be a certified PA or PA student (working with a PA faculty member at an accredited PA program). (Co-applicants may be interprofessional colleagues.) Funds are generally disbursed to the organization sponsoring the project. Individuals coordinating outreach activities are also welcome to apply.

    For more information and to apply, click here

  • November 17, 2016 9:00 AM | Deleted user

    The Food and Drug Administration (FDA) has approved Bonjesta (doxylamine succinate and pyridoxine HCl extended-release tablets; Duchesnay), a fixed-dose combination drug product for the treatment of nausea and vomiting of pregnancy in women who do not respond to conservative management. This product has not been studied in women with hyperemesis gravidarum.

    Each tablet of Bonjesta contains 20mg of doxylamine succinate, an antihistamine, and 20mg of pyridoxine HCl, a vitamin B6 analog. The combination of doxylamine succinate and pyridoxine HCl has been the subject of many epidemiological studies designed to detect possible teratogenicity. No increased risk for congenital malformations has been reported based on these studies.

    Bonjesta will be available in extended-release tablets in 100-count bottles. The tablet should be taken on an empty stomach as food may delay the onset of action.

    Duchesnay also markets Diclegis, which contains doxylamine succinate 10mg and pyridoxine HCl 10mg, for a similar indication.

    For more information visit

  • November 15, 2016 9:57 AM | Deleted user

    On September 30, 2016, this report was posted online as an MMWR Early Release.

    Emily E. Petersen, MD1; Dana Meaney-Delman, MD1; Robyn Neblett-Fanfair, MD1; Fiona Havers, MD1; Titilope Oduyebo, MD1; Susan L. Hills, MBBS1; Ingrid B. Rabe, MBChB1; Amy Lambert, PhD1; Julia Abercrombie, MPH1; Stacey W. Martin, MSc1; Carolyn V. Gould, MD1; Nadia Oussayef, JD1; Kara N.D. Polen, MPH1; Matthew J. Kuehnert, MD1; Satish K. Pillai, MD1; Lyle R. Petersen, MD1; Margaret A. Honein, PhD1; Denise J. Jamieson, MD1; John T. Brooks, MD1 (View author affiliations)

    View suggested citation

    CDC has updated its interim guidance for persons with possible Zika virus exposure who are planning to conceive (1) and interim guidance to prevent transmission of Zika virus through sexual contact (2), now combined into a single document. Guidance for care for pregnant women with possible Zika virus exposure was previously published (3). Possible Zika virus exposure is defined as travel to or residence in an area of active Zika virus transmission (, or sex* without a condom† with a partner who traveled to or lived in an area of active transmission. Based on new though limited data, CDC now recommends that all men with possible Zika virus exposure who are considering attempting conception with their partner, regardless of symptom status,§ wait to conceive until at least 6 months after symptom onset (if symptomatic) or last possible Zika virus exposure (if asymptomatic). Recommendations for women planning to conceive remain unchanged: women with possible Zika virus exposure are recommended to wait to conceive until at least 8 weeks after symptom onset (if symptomatic) or last possible Zika virus exposure (if asymptomatic). Couples with possible Zika virus exposure, who are not pregnant and do not plan to become pregnant, who want to minimize their risk for sexual transmission of Zika virus should use a condom or abstain from sex for the same periods for men and women described above. Women of reproductive age who have had or anticipate future Zika virus exposure who do not want to become pregnant should use the most effective contraceptive method that can be used correctly and consistently. These recommendations will be further updated when additional data become available.


    Review of Evidence

    Zika virus infection during pregnancy is a cause of congenital microcephaly and serious brain abnormalities (4). The risk for adverse pregnancy outcomes associated with maternal Zika virus infection around the time of conception is unknown. To date, there have been no published reports of adverse pregnancy outcomes after periconceptional Zika virus infection. Infections with other viruses (e.g., cytomegalovirus, rubella, parvovirus) around the time of conception have been associated with congenital infection and adverse pregnancy outcomes, although the exact timing of infection relative to conception was sometimes uncertain (59).

    Zika virus is transmitted primarily through the bite of Aedes aegypti mosquitoes. Zika virus can also be transmitted through sex without a condom. The risk for sexual transmission of Zika virus from a person infected with Zika virus remains unknown. Most reported sexual transmissions have been from persons with symptomatic Zika virus infections, including from men to female sex partners (1012), from a man to his male sex partner (13), and from a woman to her male sex partner (14). Two new reports describe one presumed and one more definitive case of sexual transmission from men with asymptomatic Zika virus infection to female sex partners (15,16). Sexual transmission of Zika virus has been associated with condomless anal sex and vaginal sex and possibly also with fellatio (17). Among reported cases of sexually transmitted Zika virus infection, the longest reported period between sexual contact that might have transmitted Zika virus and symptom onset was 32–41 days (based on an incubation period of 3–12 days) (18).

    Data on the detection of Zika virus RNA in semen can inform estimates of the periods during which sexual transmission might occur. However, detection of Zika virus RNA in semen might not indicate the presence of infectious virus and thus the potential for sexual transmission. Reports indicate that concentrations of detectable Zika virus RNA in semen decrease after infection (17,1928). Zika virus RNA was detected in semen of five men more than 90 days after symptom onset, with the longest period of reported detection 188 days after symptom onset (20,26,29,30). Culture is considered the gold standard for demonstrating the presence of replicative and thus infectious virus, and among four published reports of Zika virus cultured from semen, virus was reported in semen up to 69 days after symptom onset (17,19,21,31). Culture methods varied in these studies and additional studies are needed to confirm the presence of infectious virus in semen.

    New data on the persistence of Zika virus RNA in serum and whole blood might have implications, both for sexual transmission of Zika virus and for fetal exposure to Zika virus. Zika virus RNA has been detected in the serum of nonpregnant persons up to 11–13 days after symptom onset (32); in the serum of pregnant women, Zika virus RNA has been detected up to 10 weeks after symptom onset (33,34). Zika virus RNA was detected in whole blood of a nonpregnant person up to 58 days after symptom onset followed by a negative result at 79 days; however, Zika virus could not be cultured at 58 days (35). Experience with other flaviviruses suggests that if a person’s immune system has activated an antibody response, viral transmission (i.e., through blood transfusion) is unlikely (36). Detection of Zika virus RNA in blood might not indicate the presence of infectious virus, and thus the potential risk for maternal-fetal Zika virus transmission periconceptionally is unknown.


    Guidance for Preconception Counseling and Prevention of Sexual Transmission

    CDC is updating its guidance on timing of conception after possible Zika virus exposure and prevention of sexual transmission of Zika virus. CDC continues to evaluate all available evidence and update recommendations as new data become available. Most of the recommendations for preconception counseling and prevention of sexual transmission are dependent on whether persons live in or travel to areas of active Zika virus transmission.¶ As of September 26, 2016, 59 countries and U.S. territories reported active Zika virus transmission. The Florida Department of Health identified two areas of Miami-Dade County with active local mosquito-borne Zika virus transmission; as of September 20, 2016, only one remains an area of active transmission (37). Updates on areas with active Zika virus transmission are available online at

    For Couples Planning to Conceive Who Do Not Live in Areas with Active Zika Virus Transmission. Health care providers should discuss couples’ travel plans in preconception counseling. Women and men who are planning to conceive in the near future should consider avoiding nonessential travel to areas with active Zika virus transmission.

    Women who have had possible Zika virus exposure through travel or sexual contact and do not have ongoing risks for exposure should wait at least 8 weeks from symptom onset (if symptomatic) or last possible exposure (if asymptomatic) to attempt conception. Women who wait at least 8 weeks to conceive might have an increased likelihood that Zika virus no longer presents a risk for maternal-fetal transmission.

    CDC now recommends that men with possible Zika virus exposure, regardless of symptom status, wait at least 6 months from symptom onset (if symptomatic) or last possible exposure (if asymptomatic) before attempting conception with their partner. CDC previously recommended that men with possible Zika virus exposure who were asymptomatic wait at least 8 weeks from last possible exposure. The updated recommendation minimizes the likelihood that periconceptional sexual transmission will result in fetal exposure to Zika virus. The recommendation to wait at least 6 months for asymptomatic men is based on the range of time after symptom onset that Zika virus RNA has been detected in semen of symptomatic men and the absence of definitive data that the risk for sexual transmission differs between symptomatic and asymptomatic men. Zika virus has not been definitively cultured from semen more than 3 months after symptom onset. It is unknown whether detection of Zika virus RNA in semen indicates presence of infectious virus and the potential for transmission. Current recommendations provide couples planning to conceive with periods that, based on existing data, are expected to minimize risk for Zika virus transmission to an uninfected partner. Studies are underway to better understand the persistence of infectious Zika virus in semen and the associated risk for sexual transmission of the virus. Given that limited data are available, some couples in whom a partner had possible Zika virus exposure might choose to wait longer or shorter than the recommended period to conceive, depending on individual circumstances (e.g., age, fertility, details of possible exposure) and risk tolerance. For example, after consultation with their health care provider, symptomatic persons with negative test results who received testing in the appropriate time window and in accordance with the testing algorithm (38) might choose not to wait to conceive.

    For Couples Who Want to Conceive, in Which One or Both Partners Live in Areas with Active Zika Virus Transmission. Women and men who reside in areas with active Zika virus transmission and who experience symptoms of Zika virus disease should be tested for Zika virus infection (38). Men with results that indicate recent Zika virus or unspecified flavivirus infection should wait at least 6 months from symptom onset to attempt conception with their partner; women with results that indicate recent Zika virus or unspecified flavivirus infection should wait at least 8 weeks from symptom onset to attempt conception. Persons who have had symptoms of Zika virus disease with negative Zika virus test results should talk with their health care provider about timing of conception in the setting of ongoing risk for possible exposure.

    Persons living in an area with active Zika virus transmission should be counseled on the possible risk for Zika virus infection during the periconception period. CDC has developed tools to assist health care providers with preconception counseling (39). Health care providers should provide counseling about the potential consequences to the fetus associated with Zika virus infection during pregnancy, such as microcephaly and other serious brain abnormalities. Women and men should discuss their reproductive life plans** with their health care provider, in the context of potential and ongoing Zika virus exposure. Health care providers should review factors that might influence pregnancy timing (e.g., unknown duration of Zika virus outbreak, fertility, age, reproductive history, medical history, personal values and preferences). For couples who choose to conceive, health care providers should stress use of mosquito bite prevention strategies†† while attempting pregnancy and during pregnancy. Health care providers should counsel couples who decide to wait to attempt conception about strategies to prevent unintended pregnancy, including the most effective contraceptive methods (i.e., long-acting reversible contraception) and provide contraception or referral to appropriate providers for contraception care (40).

    Special Considerations for Women Undergoing Fertility Treatment. Zika virus transmission through assisted reproductive technology has not been reported. However, transmission through gametes or embryos is theoretically possible. Recommendations for sexually intimate couples with Zika virus infection or possible Zika virus exposure undergoing fertility treatment with their own gametes and embryos should follow the testing and timing recommendations as described above; recommendations might need to be adjusted depending on individual circumstances. The Food and Drug Administration has issued guidance to reduce the risk for Zika virus transmission by donated human cells, tissues, and cellular and tissue-based products, including reproductive tissues (41).

    For Couples Who Are Not Pregnant and Are Not Planning to Become Pregnant in the Near Future. Couples in whom the man or woman has had possible Zika virus exposure who want to maximally reduce their risk for sexually transmitting Zika virus to the uninfected partner should use condoms consistently and correctly or abstain from sex for at least 6 months for men or 8 weeks for women after symptom onset (if symptomatic) or last possible Zika virus exposure (if asymptomatic). Some couples might choose to use condoms or abstain from sex for a shorter or longer period than recommended depending on individual circumstances and risk tolerance. Couples should be advised that correct and consistent use of condoms reduces the risk for other sexually transmitted infections.

    Health care providers should discuss strategies to prevent unintended pregnancy with couples who do not want to become pregnant. Safety, effectiveness, availability, and acceptability should be considered when choosing a contraceptive method (42). Patients should be counseled to use the most effective contraceptive method that can be used correctly and consistently. Long-acting reversible contraception, including contraceptive implants and intrauterine devices, provide highly effective reversible options.

    For Pregnant Women and Their Partners. Pregnant women living in areas without active Zika virus transmission should be advised to avoid nonessential travel to areas with active transmission. Persons who have traveled to or live in an area with active Zika virus transmission and whose partner is pregnant should be advised to consistently and correctly use condoms during sex or abstain from sex for the duration of the pregnancy. These actions reduce the risk for sexual transmission of Zika virus during pregnancy. Health care providers should ask pregnant women about their own and their sex partner’s history of travel to areas with active Zika virus transmission. Pregnant women with possible Zika virus exposure, either through sex or through traveling to or living in an area with active Zika virus transmission, should be tested for Zika virus infection in accordance with CDC’s “Updated Interim Pregnancy Guidance: Testing and Interpretation Recommendations for a Pregnant Women with Possible Exposure to Zika Virus” ( ), including pregnant women with possible sexual exposure whose sex partner has had no symptoms of Zika virus disease. Further guidance for care of pregnant women with possible Zika virus exposure has been published (3).


    Zika Virus Testing

    Persons with possible Zika virus exposure who have symptoms of Zika virus disease should receive testing in accordance with CDC interim guidance: “Algorithm for U.S. Testing of Symptomatic Individuals” (38). CDC does not recommend Zika virus testing of nonpregnant persons with possible Zika virus exposure who do not have symptoms of Zika virus disease, including persons who are planning to attempt conception, or to assess the risk for sexual transmission of Zika virus. Zika virus testing for this purpose remains of uncertain value, because current understanding of the duration and pattern of shedding of Zika virus in reproductive tissues is limited. Information on the performance of serologic Zika virus testing remains limited, with falsely positive tests resulting in avoidable stress and expense and falsely negative tests providing false reassurance and possibly leading to inadvertent fetal exposure to Zika virus.


    Corresponding author: Emily E. Petersen;; 770-488-7100.


    1Zika Response, CDC.



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    * For the purpose of this guidance, sex is specifically defined as vaginal sex (penis-to-vagina sex), anal sex (penis-to-anus sex), oral sex (mouth-to-penis sex or mouth-to-vagina sex), and the sharing of sex toys.

    † Condoms include the use of male or female condoms for vaginal or anal sex, male condoms for oral sex (mouth-to-penis), and male condoms cut to create a flat barrier or dental dams for oral sex (mouth-to-vagina).

    § A person is considered symptomatic if one or more signs or symptoms (acute onset of fever, rash, arthralgia, or conjunctivitis) consistent with Zika virus disease is reported. A person is considered asymptomatic if these symptoms are not reported.





    Petersen EE, Meaney-Delman D, Neblett-Fanfair R, et al. Update: Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika Virus for Persons with Possible Zika Virus Exposure — United States, September 2016. MMWR Morb Mortal Wkly Rep 2016;65:1077-1081. DOI: .

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