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Zika virus RNA was detected in urine, but not in serum, by real-time reverse transcription–polymerase chain reaction (rRT-PCR) using a test based on an assay developed at CDC ( 1). Flavivirus and chikungunya virus tests were performed at the Maryland DHMH Laboratories Administration. On day 19 (3 days after symptom onset) she sought medical care the provider suspected Zika virus infection, and serum and urine specimens were collected. On day 16 (2 and 6 days after the episodes of condomless vaginal intercourse) the woman developed symptoms of Zika virus infection, including fever and rash.
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The man also reported that he received fellatio from the woman during their sexual encounter on day 14. The couple reported having had condomless vaginal intercourse twice after the man’s return from the Dominican Republic and before the woman’s symptom onset, approximately 10 days (day 10) and 14 days (day 14) after the man’s return.
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The woman reported no other sex partners during the 14 days before onset of her symptoms and no receipt of blood products or organ transplants. The male partner reported exposure to mosquitoes while traveling, but no symptoms consistent with Zika virus infection either before or after returning to the United States. Case investigation revealed that the woman had not traveled to a region with ongoing transmission of Zika virus, but did have sexual contact with a male partner who had recently traveled to the Dominican Republic. Laboratory testing at the Maryland DHMH Laboratories Administration confirmed Zika virus infection. In June 2016, the Maryland Department of Health and Mental Hygiene (DHMH) was notified of a nonpregnant woman who sought treatment for a subjective fever and an itchy rash, which was described as maculopapular by her provider.