You delay having kids. You take a cold shower for months after you've traveled to Brazil. Or you use condoms, even if you're already pregnant.
Such is life with Zika, if you play by the rules.
Safe sex practices have been part of the official Zika prevention guidelines since early this year, when researchers confirmed the virus that can cause severe birth defects could be transmitted by sexual contact as well as mosquito bites.
The current federal Centers for Disease Control precautions advise anywhere from eight weeks up to six months of abstinence or condom use, depending on where you live, where you travel, and if you are pregnant or want to be. While expectant couples are the main target, the guidelines apply to anyone who doesn't want to get Zika.
So are people actually going to live like this?
Some public health experts are doubtful.
"I have talked with quite a few physicians, as well as sexually active patients. And I have not encountered anyone who has changed their sexual behavior. It's the hardest thing in the world is to get people to do," said Dr. Sonjia Kenya, an HIV researcher and sexologist at the University of Miami Miller School of Medicine.
What's the problem? Kenya thinks, in part, the consequences of Zika just aren't scary enough, unless you are a pregnant woman worried about becoming infected.
Most everyone else "has become pretty immune to the Zika media hype," said Kenya, author of "Sex in South Beach," who has been called a multicultural Dr. Ruth. "There is something about the sun and the beach and alcohol that invites people to be more relaxed."
The Sunshine State already is a hotbed for sexually transmitted disease -- and yes, the CDC considers Zika an STD, like gonorrhea and syphillis and HIV.
The CDC's annual HIV Surveillance Report, released this week , found the rate of new infections in South Florida's cities over the past year shot up more than three times the national average.
"If getting HIV doesn't scare you into changing your behavior, I don't think Zika will," Kenya said.
True, being bitten by a Zika-infected mosquito remains by far the most common way humans get the virus. As of Dec. 7, the CDC has confirmed 38 sexually transmitted Zika cases out of 4,575 in the U.S.
That's why the CDC continues to tell people the best prevention practice is to slather on bug spray containing DEET -- even if they are clubbing on South Beach or walking the dog. CDC officials say the products are safe for pregnant women and should be used by those expecting.
Since Aug. 1, there have been three sections of Miami-Dade County that at some point were classified as active transmission zones, placing them under the strict CDC "red" advisory that suggested pregnant women not travel there. The zones included the Wynwood area near downtown Miami, portions of South and North Miami Beach, and Little River.
People who did go there, or were residents, were advised to abstain from sex or "consistently" use condoms if they were pregnant, considering pregnancy or did not want to pass the virus. Women were told to follow these guidelines for eight weeks -- but men needed to do so for six months, as researchers believe Zika can live in seminal fluid for at least that long.
On Friday, Gov. Rick Scott declared the last of those areas, a 1.5-square mile tract in South Miami Beach, free of active transmission, lifting the CDC's no-travel recommendation for pregnant women. But the four former transmission zones, along with all of Miami-Dade County, remain under a "yellow" CDC advisory that includes condom use, abstinence and other precautions for expectant couples or people considering conceiving.
Sexual precautions also are suggested for anyone who has traveled to Zika outbreak countries such as portions of Mexico and Brazil, all of Puerto Rico, and many other countries. For a full list of travel advisories, go to: cdc.gov/travel or call 800-232-4636.
The CDC has drafted guidance for physicians and public health workers regarding Zika and sexual transmission. Officials with the Florida Department of Health said they discuss Zika sex guidelines with their patients and put condoms in the Zika prevention kits distributed to pregnant women.
The AIDS Healthcare Foundation (AHF), a global patient care and education organization, has three three large billboard advertisements -- including one with a giant three-dimensional mosquito -- in Miami-Dade County promoting condom use for Zika prevention.
Michael Kahane, AHF's southern bureau chief, said the organization has been distributing condoms along with Zika fact sheets in South Florida and Jamaica, as well as in Puerto Rico, where public health officials predict one in four residents may become Zika postive.
In the Caribbean countries, "people assume everyone already has it or is going to get it. So getting infected is no big deal unless you're pregnant," Kahane said.
While Kahane said that while there has been public health education about Zika, "a lot of people in the U.S. have told me they had no idea it could be sexually transmitted," Kahane said. "I think the general public just isn't aware."
A stroll though Fort Lauderdale's Himmarshee Village entertainment district on an early December night, where diners and drinkers filled outdoor tables, suggested Kahane might be right.
"SIX MONTHS?" cried Adrienne Airhart, 32, when asked how long she thought Zika might live in semen. Airhart, a Los Angeles visitor who had just finished a guided bike trip of the area's bars with pals, had guessed 22 months.
"That's really terrifying," said Airhart, who used to live in Coral Springs. "I am totally not going to Miami."
Her also surprised boyfriend, Aristotle Georgeson, 28, said he didn't know having sex could spread Zika. "So I would definitely let my partner know if I felt sick," he said.
But did he know that there was only a 20 percent chance he would even know he had a Zika infection? That's a problem, he agreed. "And it's not like I can look at a mosquito and know it had Zika," he said.
Dr. Aaron Elkin, a Hollywood obstetrician-gynecologist and past president of the Broward County Medical Association, said the majority of his patients "absolutely" are changing their health and sexual practices due to Zika.
"We are seeing more and more people living in our area afraid of becoming pregnant," said Elkin, who has been involved with federal Zika policy as a John McCain Fellow with the American College of Obstetricians and Gynecologists. "A lot of them are asking me, 'What should I do?' They are very receptive when we talk about steps they can take."
Elkin now does Zika counseling during every prenatal visit, as recommended by the CDC, and patients can pick up free condoms at the office's front desk. His practice is one of the few that, at this point, can run and process Zika tests, cutting wait times for results. So far, Elkin has screened over 200 patients for the virus and predicts, in the future, Zika testing will become a prenatal care standard, as it has for HIV.
Some couples are opting to hold off conception until a Zika vaccine is available, Elkin said, which could be within two years. If the biological clock is ticking, others are willing to move out of the area until their baby arrives.
The majority of South Floridians determined to conceive, however, stay here and wrestle with Zika.
"You can't stop mosquitoes, you can't stop travel and you can't stop sex," Elkin said. "We need to think about how we deal with patients who live here. We can't just say nobody who lives in Miami-Dade can get pregnant until there's a vaccine."
The number of in-vitro fertilizations performed at the Fertility & IVF Center of Miami has been slightly lower this year over last, said medical director Dr. Michael Jacobs, although he is not sure that is due to Zika. A few couples, before Miami-Dade County came under the CDC advisory, earlier this year froze sperm because the male partner was traveling repeatedly to Zika hot zone countries, Jacobs said.
He suspects that some people, including pregnant couples, aren't following all of the CDC Zika prevention recommendations, from applying bug repellent to using condoms. Jacobs said when Miami Beach still had active transmission zones, he spotted a very pregnant woman picnicking outdoors.
"It's all over the news, you are about to give birth, and you are standing next to water with a bunch of mosquitoes in it. I don't understand it," Jacobs said.
dlade@sunsentinel.com and 954-356-4295
SEX AND ZIKA
The federal Centers for Disease Control and Prevention suggest expectant couples or those considering conceiving in the near future take these sexual precautions. Pregnant women are those most at risk, as the Zika virus can cause severe fetal abnormalities, but anyone can get Zika through sex. Common Zika symptoms include: fever, rash, joint pain and red eyes.
Women who live in Miami-Dade County or frequently travel there should wait eight weeks before trying to become pregnant. They should abstain from sex or consistently use condoms during this time.
Men who live in Miami-Dade County or frequently travel there should wait six months before trying to get their partner pregnant. They should abstain from sex or consistently use condoms during this time.
Expectant couples where one or both partners either live or have traveled to Miami-Dade County should consistently use condoms, or abstain from sex, until after delivery.
The above guidelines also apply to couples in which one partner has traveled to a country with active Zika transmision.
For more information on Zika prevention: cdc.gov or 800-232-4636√.
