The Complex Interpretation and Management of Zika Virus Test Results

Kenneth W. Lin, MD, MPH; John D. Kraemer, JD, MPH; Rachael Piltch-Loeb, MSPH; Michael A. Stoto, PhD


J Am Board Fam Med. 2018;31(6):924-930. 

In This Article

Why Patients Request Testing

Patient requests for Zika virus testing are driven by awareness and knowledge, risk perception based on geography and travel, pregnancy concerns, symptoms, and government and media messages. According to surveys conducted over the course of 2016, women, older adults, non-Hispanic white adults, those with higher incomes, and those with higher education were more likely to be aware of Zika virus risk.[19,20] Awareness did not necessarily equate to knowledge; only 38% of persons aware of Zika virus knew it could be sexually transmitted, cause birth defects, and be asymptomatic. However, knowledge of particular characteristics of Zika virus's effects decreased as the awareness of risk increased.[19] Understanding about Zika virus also varied in specific, targeted populations. Berenson and colleagues[21] reported that women attending prenatal clinics in southern Texas in summer 2016 had low levels of knowledge: 60% were not aware Zika virus can be sexually transmitted. This variation in knowledge and awareness suggests different individuals seek Zika virus tests and engage with their clinician about Zika virus.

Because Zika virus infection increases the risk of microcephaly and other serious neurologic problems in fetuses and neonates of infected women,[22] women who were in an area with active transmission or whose sexual partner may have been exposed and who later learn they are pregnant might desire testing to inform their decisions about undergoing additional fetal surveillance or carrying a pregnancy to term. A woman also might elect to delay pregnancy if her partner tested positive for Zika virus or had a known exposure.

A patient may also seek testing if displaying symptoms, especially after travel. Symptoms of Zika virus infection, such as fever, rash, and joint pain, are relatively nonspecific and could reflect similar mosquito-borne viruses or even flu-like symptoms. Guidelines recommended that testing be ordered in the context of the patient or their sexual partner having traveled to a Zika virus endemic area.

Finally, clinicians confronting a novel disease threat often look to practice guidelines to decide what to do. Guidelines from the CDC and local health departments have changed throughout the course of the US Zika virus epidemic based on prevalence, geography, and clinical concerns.