Zika symptoms returned after 3 weeks, says man who documented illness

It began with what felt like apunch in the throat.

I assumed it was irritation from the cigar I'd smoked on mydeck that afternoon in mid-June. But the sensation hung on.Within three days, I had a 102-degree Fahrenheit (38.9 C)fever, chills and bed-drenching night sweats.

For two weeks, symptoms came in waves. A skin rash. Jointpain. Then a dull throbbing behind my eyes. There was pain andredness too, in a certain exclusively male region, whichibuprofen didn't relieve.

Then, I felt better. But a week later, the symptoms staged acomeback, with more eye pain and something new small welts onmy eyelids and temples. I had sporadic headaches, was soexhausted I slept 10 hours a night and even failed to wake upfor a flight.

My mother was the first to suspect I was infected with thevirus that arrived in Puerto Rico in December 2015, four monthsafter I'd begun an assignment as Reuters' San Juan bureau chief.

Initially, I laughed off her internet diagnosis as theoverwrought worries of a long-distance mom. But I agreed to seemy long-time physician during a visit home in late June.

After listening to my symptoms and learning I'd been workingin San Juan, Dr. Kevin Wallace of Murray Hill Medical Groupcalled the New York City Health Department and arranged to havemy blood sent for screening. Eight days later, I got the news.

Mom was right. I had Zika.

Evolving knowledge

Hundreds of thousands of people are estimated to have beeninfected with Zika in the Americas since the virus wasdetected in Brazil early last year. Most have no symptoms or
experience only a mild illness.

But it can penetrate the womb in pregnant women, causing arare but crippling birth defect known as microcephaly. Inadults, it has been linked to Guillain-Barre syndrome, atemporary paralysis. And it can be passed on through sex, aunique characteristic among mosquito-borne viruses. There is novaccine or treatment.

Last month, the U.S. government declared a public healthemergency in Puerto Rico, the hardest hit among states andterritories. More than 17,800 infections have been reported onthe island, including more than 1,500 among pregnant women,and one case of microcephaly in an aborted fetus.

• Public health emergency declared in Puerto Rico over Zika
• Zikaoutbreak: Puerto Rico reports death fromGuillain-Barreparalysis
• U.S. shifts $81M to fight Zika outbreak

As a journalist and a patient, I've had access to some ofthe brightest minds studying Zika. But the virus has confoundedexperts at the highest levels and launched a global race tounderstand its risks.

Each month, new findings have led to changes in how thepublic is advised to stay safe. Compared to what we know aboutother diseases, such as flu and even Ebola, we are in newterritory.

In my case, doctors were hard-pressed to explain why mysymptoms returned about three weeks after the initial infection.Nor could they tell me how long I could be at risk forGuillain-Barre. Another mystery: were condoms enough to protectagainst sexual transmission?

In the weeks since I've recovered, that is proving to be oneof the toughest questions to live with.

• Those exposed to Zika virusshould wait to conceive, CDC says
• Brazil hits 4,000 suspected Zika-linkedcases of birth defects

Both men and women can infect their sexual partners. In onecase, scientists identified Zika virus in semen six months afterthe man's symptoms appeared, though it's not clear how long itcan cause new infections.

Both men and woman can transmit virus

Public health officials have warned couples not to conceivefor at least six months after either a man or woman returns froma Zika outbreak area, even if they show no symptoms.

My wife and I, both in our early 30s, have had to considerhow dangerous my bout with Zika could be to our plans to havechildren some day.

Our most intimate decisions now are affected by theuncertainty surrounding Zika: how long can I infect my partner?

Doubts overcurrent thinkingon transmission

How likely is it that my baby would become sick if I do? Givenhow rapidly the expertise about Zika has evolved so far, howmuch faith should we put in the current thinking?

When I took the one-year post in Puerto Rico, I figured mybiggest health risk would be sunburn.

Even when Zika began circulating on the island, I didn'tworry. My wife Julie, a lawyer and publishing industry pro, haddecided to stay at home in Brooklyn during my assignment, and weweren't planning to have kids for at least a couple of years. Sowe gave Zika little more than a shoulder shrug.

Shrugging off risk factors

I'm not sure when I was infected. I picked up more mosquitobites in San Juan than Twitter followers. I didn't always usebug spray. I worked from home, an apartment in a colonialbuilding without window screens, and kept the deck doors open tosave money on air conditioning.

Locals are used to mosquito-borne illnesses,including dengue and chikungunya. Some, more concerned aboutpesticides than Zika, successfully fought aerial spraying with
Naled. Many also are concerned about Zika's threat totourism, which could compound the island's vast economicchallenges.

One friend grew indignant when I mentioned writing thispiece. "You're a journalist," she said. "You have aresponsibility not to perpetuate hysteria."

When I got sick, I didn't consider going to a doctor inPuerto Rico. The economic crisis has made medical careunpredictable, and the waits are long. When I sought treatment
for allergic reactions earlier in my stay, doctors refused mycorporate health insurance and demanded cash.

Testing positive back in New York

Instead, I waited a few days to see Dr. Wallace during myvisit to New York. I was his second potential Zika patient,though the first ultimately tested negative for the virus.

Eight days after my blood sample was submitted, a woman fromthe city health department called.

Have you heard from your doctor? she asked.

"No."

"Oh?" she said. "You haven't spoken to your doctor at all?"

I broke a long pause, saying, "Feel free to let the cat outof the bag."

"Well," she said, "you tested positive for Zika."

The way it is supposed to work, the results are sent to thepatient's doctor in time to break the news before the city"interviewer" calls to address public health concerns. But Dr.
Jay Varma, deputy commissioner of the New York City HealthDepartment, acknowledged that doesn't always happen.

Puerto Rico friends not overly concerned

Some friends in Puerto Rico teased me when they learned Ihad Zika. Many of them had experienced chikungunya or dengue,and had stories about months of muscle pain or weeks in bed.Friends from the states, on the other hand, showed graveconcern, offering thoughts, prayers and condolences. Some kepttheir distance for weeks. A few questioned whether it was safefor me to be around babies.

The evidence shows Zika clears the bloodstream quickly, andthe virus doesn't spread through casual interactions.

Julie and I weren't quite sure how to react. We didn't takeit too seriously at first. I posted a glamour-shot selfie onFacebook with the caption: "This is the face of a man with
Zika."

As the weeks passed, it became clear that Julie and I werealso a little rattled and not fully on the same page. Shecancelled a planned long weekend visit to Puerto Rico. Shewanted to minimize her exposure to Zika and arranged instead forus to meet in Florida.

Wife cancels trip

This disappointed me. I had hoped to show her my newfavourite places on the island. I clung stubbornly to the viewthat Zika fears were largely overblown. She reminded me that,given the unknowns about Zika's impact on pregnancy, I was in noposition to call the shots.

"Try to see it from a woman's perspective," she said.

We have heard a lot of different things about Zika, evenfrom doctors, and she doesn't totally trust the idea that thevirus is manageable with the current medical advice.

What if Zika poses a threat for months or years afterinfection? If so, could that jeopardize our future plans tostart a family? What if we got pregnant before we planned to?

We've had to manage our different anxieties over the "whatifs" of Zika.

Shifting opinions from experts

There's plenty the experts are still figuring out, and thathas been reflected in the shifting opinions about my case.

• WHO updates Zika virus warning to wait at least 8 weeks before trying to conceive
• WHO advises 6 months of safe sex or abstinence after return from Zika-hit zones

Ingrid Rabe, an epidemiologist with the U.S. Centers forDisease Control and Prevention, told me Zika generally lasts afew days. While she couldn't address my specific case, shespeculated that a return of symptoms like mine could indicatethe presence of a second virus.

A few weeks later, Dr. Varma told me it was possible, insevere cases, for symptoms to last longer or recur.

Lingering health problems

Of three acquaintances in Puerto Rico who developedZika, all have complained, like me, of lingering healthproblems, in one case for longer than a month.

Two weeks into my infection, Dr. Wallace couldn't tell mewhether I remained at risk for Guillain-Barre. The city healthinterviewer, after consulting with doctors, told me the
paralyzing condition would most likely have set in within daysof Zika infection, so I was probably out of the woods.

Again, the information shifted over time. The CDC's Rabelater told me it could take "a few weeks" for Guillain-Barre toappear. So far, I haven't had any symptoms consistent withGuillain-Barre, and here's hoping it stays that way.

Guidance on sex lacked precision as well. The city healthinterviewer recommended we "use condoms every time" for sixmonths, reflecting CDC guidelines.

When I asked whether Zika can spread via saliva or oralsex, the city health interviewer didn't answer directly. Shesaid it can spread via "sexual activity," and that saliva is
"currently not being tested." Rabe later told me "there's beenno evidence" that saliva can spread Zika.

Testing forCDC study

The city health interviewer asked if I would join a CDCstudy gauging how long Zika can be spread through semen andurine. I'm one of 140 participants, though protocol calls for upto 250.

The study is a bit awkward. But, as a writer always lookingfor a good story, I could not pass it up.

• Zikainfection found in newborns withoutmicrocephaly
• Zikaremains global emergency, virus still spreading, says WHO

Every two weeks, a study test kit arrives by FedEx in a boxwith dauntingly detailed instructions on how to produce andpackage my samples, then overnight them back to the centre'sColorado lab. I also answer a somewhatblush-inducing questionnaire about my recent sexual activity.

The CDC staffer assigned to my case sends cheery emails tolet me know she has received my samples and sex report, aninteraction that feels slightly too intimate. But I endure it inexchange for a $50 Visa gift card for each sample, and, moreimportantly, for the chance to learn and to contribute toscience.

The downside: I don't learn my results until the study endsin December.