Protecting Against STD/STIs: Abstinence/Closed Relationships

Edited for typos, grammar oopsies and stigmatizing language. April 12, 2018.

As should be obvious by now, I am not in any way advocating for any specific relationship style — neither abstinence nor closed relationships would be a comfortable fit for me. There is certainly nothing wrong with open relationships or lots and lots of good sex. But for some people they are valid life choices, so we’re gonna talk about them.

Abstinence-only programs like to say that if you don’t have sex, you can’t get STIs. They are wrong. You can get infected with both forms of herpes, HIV and Hep B without ever touching any genitals in any fashion. These infections are considered STIs because they are often transmitted sexually, they are not only transmitted sexually.

That said, it is true that the best protection available against STIs really is to not have sex outside of sexually exclusive relationships. Really doesn’t matter how many people are in the relationship — whether you have 2 people or 10 people or even 200 people, if all of them join the relationship as virgins (by which I mean, never having touched another person’s genitals, ever), and none of them ever have sex (by which I mean touching another person’s genitals or having their genitals touched any conceivable configuration, including hand jobs, using toys, and other stuff that yes really is sex) with anyone outside the relationship, then the chance of any of them getting and STI are extremely low. The more people in the relationship, the higher the risk of something crazy happening, because statistics is like that. But it is fairly safe to say that is you have a sexually exclusive group of 5 or fewer people (none of whom are drug users), your chances of getting any STI other than (possibly) herpes is damn near incalculable.

Herpes is the real joker in the deck. The blood born stuff (HIV and Hep) you are going to be safe from unless you play with needles (either S&M play or drug use) or just get insanely unlucky. Herpes, compared to most STIs is insanely easy to spread. Partly, this is because herpes (both HSV1 and HSV2) can infect the mouth (and other areas) as well as the genitals. You can get either version of herpes by any form of skin contact with an infected area. Sometimes herpes (especially HSV1) can be spread by sharing sex toys, lipstick or drinks. This means that if your best friend goes down on someone with HSV2, they can get an oral infection of herpes, and the next time you and your friend share a soda, you can get infected. Now your closed polyam quad is exposed to herpes, even though all of you were negative and none of you had sex outside the quad.

Aside from herpes, total abstinence outside of sexually exclusive relationships has a near perfect success rate. If STIs are a real concern, and you can manage it, then establishing a closed relationship with people who have tested negative of STIs you want to be sure you won’t get can be the best way to protect yourselves.

STIs and Cheating

The down side of abstinence or closed relationships as protection against STIs is that staying abstinent or closed just doesn’t work for everyone. Most polyamorists are familiar with the high rate of cheating among monogamous couples. What you may not know is that cheating (defined by the individual) is actually pretty common in polyam relationships.

Now, here’s the kicker when it comes to STIs. A study found that people who cheat are more likely to have sex without condoms, than people who are openly non-monogamous. Now, this study was comparing monogamous cheaters to non-monogamous people, but the results may apply to polyam cheaters. If you can’t deal with a closed relationship, that’s okay. It’s better to have an open relationship and negotiate a safer sex agreement then risk your health and the health of your partners by going behind their backs.

 

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This post is part of the Safer Sex Blog Series.

Preventing STIs: Be a Smart Slut – Open Relationships, Promiscuity and STIs

I’m always happy when I only need to make minimal updates to a post. It means I did it right the first time around. Only real change is that the at-home HIV tests are now “available” instead of “coming soon”. Let’s get a big cheer for that! Updated and reposted April 12, 2018

The past few weeks, talking about ways to prevent STIs, one thing that came up repeatedly was the fewer people you have sex with, and the more closed your sexual circle, the less likely you are to be infected with an STI. Which does not mean you should restrict yourself to just a few sex partners or that closed relationships are in some mystical way ‘better’ than open ones. This is about risk assessment.

The more often you cross a street, the more likely you are to get hit by a car. The more often you have sex, the more chances your birth control will fail. The more you eat, the greater your risk of getting food poisoning. If anyone suggests you restrict yourself to a starvation diet to reduce your risk of getting food poisoning I hope you tell them to take a long walk off a short pier. Seriously.

But the same way you know not to eat food that smells off, if you are going to have a large number of sex partners, and frequently enough that STI testing is becoming increasingly fallible as a method of self protection, then be a smart slut. Learn the signs and symptoms of those STIs that have obvious signs and symptoms. Check with your local health department about what STIs are common in your area, and which barrier method provides the best protection. Invest in a few of the over-the-counter HIV test kits.

If you want to have an open relationship, be a slut, pick up one night stands, whatever makes you happy, there is nothing wrong with that. But do it knowing your risks. Only you can choose the level of risk you are comfortable with. So educate yourself, make your choice for you, and don’t let any of the sex-negative slut shaming idiots tell you otherwise.

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This post is part of the Safer Sex Blog Series.

Preventing STIs: Testing Agreements

This is one of the few posts so far to need significant updates. I removed a lot of stuff that reinforced stigma against STIs. Facts are the same, presentation is different. Updated March 29, 2018.

Just going to skim this one, cause I’ll be delving into STI testing in some depth later. But since regular testing is one of the main ways polyam folk tend to protect themselves, it deserves a mention here.

The idea behind using STI testing to preventing getting infected, is that if you never have sex with anyone who has STIs you don’t want to risk getting, you are safe. So if you show a STI test to everyone you have sex with, and everyone you have sex with shows STI tests to you, and you don’t have (unprotected) sex with someone who has an STI test you don’t want to get, you’re both safe right? Maybe.

STI tests are good ways to stop the spread of STIs. And they do provide some protection again getting infected. Over all, if you are going to have multiple sex partners in a non-exclusive relationship, getting regular STI tests is a damn good idea. But, it isn’t perfect. (I should make that the theme of this section – “Preventing STIs: Nothing’s Perfect”) There are no hard and fast numbers on what kind of protection getting tested gives you. This is partly because everyone has different testing practices, and partly because every clinic tests for different STIs. That last is another way of saying that STI tests almost never test for every STI. In fact, I have never heard of any clinic or lab testing for every possible STI outside of the rare research study trying to learn about how prevalent STIs are.

Which is one of the big reasons that STI testing doesn’t provide perfect protection against getting ANY STI. If the tests don’t cover every STI, then you can’t know for sure if you or your partners are STI free. Which means you may well be passing around STIs and not know it.

This is one reason why it’s important to learn about STIs yourself and decide which ones you really want to protect yourself against.

The good news is STIs most people want to protect against, like HIV and Hep B do get tested for pretty much everywhere The other hole in the protection STI protection gives you is dormancy. It takes time for an infection to show up on a test. You have probably heard that HIV can take anywhere from 2 weeks to 6 months to show up in a test. (Semi-good news: sexual transmission almost always shows up within a month, 3 months max. It’s actually the method of transmission that shows up the fastest.) However, the dormancy can still leave you unprotected.

Say you get together with partner X for the first time. Partner X has an STI test they got two weeks ago showing they are STI negative. Partner X hasn’t had sex with anyone since the test. But partner X did have sex with someone a week before getting tested. Partner X may have gotten an infection and it would not have shown up in their STI test. But they can pass it on to you.

In general, STI tests provide more protection when you have fewer partners, and your partners have fewer partners, and etc. If you get involved with someone new every month, and they get involved with someone new every month, the protection testing provides drops significantly. If you get involved with one or two new people a year, and they get involved with one or two new people a year, STI testing gives a fair of protection. However there is a flip side, and a very important one. STI testing isn’t just about protecting yourself. STI testing is also about protecting others. Regular STI testing is the best way to find out about an infection before it gets passed on to someone else. So testing actually provides two layers of protection. It gives you some protection against infections and if you get infected, it gives you a chance to prevent the infection from being passed to anyone else.

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This post is part of the Safer Sex Blog Series.

Protecting Against STIs: Barrier Method

Updates today include: updated information based on new research/resources, adding information about dental dams, and changing terms for condoms to the inclusive “external” and “internal” condoms. updated March 7, 2018.

 

Person stuff: I want to say thanks again to everyone who donated to help me fund my visit with my kids and to those who sent prayers/good wishes/thoughts our way. A very great time was had by all, including visiting family, hiking trips, museum trips, and catching a carnival.
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Okay, back to our regular programming.

As I mentioned in my last post, the well-known refrain in STI prevention is ‘barrier method’. Barrier method usually means a condom (external or internal), which prevents direct contact between the genitals. For all their problems, condoms are the only effective method for actually stopping several STIs jumping from one person to another. What many people do not realize is that a cervical cap can also be an effective barrier method against certain STIs. Every other method for preventing STIs is basically about making sure no one you are having sex with has currently-infectious STIs. (Exception: PrEP, which is specific to HIV/AIDS and will be covered in another post.)

CONDOMS

Condoms do not protect against all STIs. They do not protect 100% against the STIs they are effective against. However, they are probably the best thing going. External condoms and internal condoms offer different levels of protection against different STIs. The protection offered by external condoms has been more thoroughly studied, so consider the information on internal condoms incomplete pending further research.

External Condoms

External condoms (commonly called ‘male condoms’ or just ‘condoms’) are usually made of latex, though there are non-latex varieties for people with latex allergies. They go on over the penis and trap semen. They also prevent direct contact between the penis or sex toy and the vagina, anus or mouth during intercourse. (Yes, condoms can be used during oral sex as well if there is any chance one of you has an STI. They can also be used on shared sex toys to prevent STI transfer.) Here is a decent step-by-step guide to putting on an external condom.

External condoms provide protection against STIs transmitted through genital fluids, including:

  • HIV
  • chlamydia
  • gonorrhea
  • trichomoniasis
  • HPV

Depending on where the infection is, external condoms may provide protection against:

  • genital herpes
  • syphilis
  • chancroid

The CDC has the following advice for using external condoms:

  • Use a new condom with each sex act (i.e., oral, vaginal, and anal).
  • Carefully handle the condom to avoid damaging it with fingernails, teeth, or other sharp objects.
  • Put the condom on after the penis is erect and before any genital, oral, or anal contact with the partner.
  • Use only water-based lubricants (e.g., K-Y Jelly, Astroglide, AquaLube, and glycerin) with latex condoms. Oil-based lubricants (e.g., petroleum jelly, shortening, mineral oil, massage oils, body lotions, and cooking oil) can weaken latex and should not be used.
  • Ensure adequate lubrication during vaginal and anal sex, which might require the use of exogenous water-based lubricants.
  • To prevent the condom from slipping off, hold the condom firmly against the base of the penis (or sex toy) during withdrawal, and withdraw while the penis is still erect.

Note – natural condoms (those made from natural membranes) are not effective in preventing STIs).

Internal Condoms

Internal condoms (commonly knows as “female condoms”) are made of nitrile and are inserted into the vagina or anus. A ring at the base of the condom is intended to it in place by the cervix. When using internal condoms for anal sex, care needs to taken to keep the condom in place. internal condoms flare at the top, covering part or all of the labia/butt. The best guide I’ve been able to find to using internal condoms is here. If you know of a better one, please let me know. Internal condoms should be used in the same circumstances as external condoms, but internal and external condoms should never be used together – the friction will cause one or both to break.

All the research I have found on internal condoms has been on vaginal use. They are probably just as effective for anal use, but we don’t know for sure.

Current research suggests that internal condoms offer protection against the same STIs that external condoms do. Research into how effective they are is ongoing.

Internal condoms cover a wider area than external condoms, and so may provide better protection against:

  • genital herpes
  • syphilis
  • chancroid

Except for the bit about removing the condom, the guidelines from the CDC above apply equally to internal condoms.

CERVICAL DIAPHRAGMS

Cervical diaphragms are caps that are placed over the cervix, so that semen cannot enter the uterus. Unlike condoms, cervical diaphragms are reusable and can last up to two years. Most information sources will say the diaphragms do not protect against STIs. This is debatable. Diaphragms definitely do not protect against the STIs that most often discussed. Diaphragms MAY protect against some STIs. (Sources: 1, 2, 3) A cervical diaphragm, as the name suggests, can ONLY be used for vaginal intercourse.

Cervical diaphragms may provide some protection against:

  • cervical gonorrhea
  • chlamydia
  • trichomoniasis

Diaphragms may be confused with cervical caps. Cervical caps are smaller than diaphragms, and do not provide protection against STIs.

It is worth noting that diaphragms definitely do NOT provide protection against HIV.

Dental Dams

Dental dams are squares of polyurethane or latex that are placed over the vulva or anus prior to oral sex. Use of a dental dam protects against STIs that can be transmitted through oral sex, including

  • herpes
  • genital warts
  • HIV

Dental dams should only be used once. If you don’t have or don’t have access to dental dams, you can make one out a latex external condom. DO NOT make a dental dam out of a non-latex condom, including all internal condoms, which are made of nitrile. (Saliva is a digestive fluid, it requires different types of barriers than genital fluids.) The CDC has a guide for making a dental dam out of an external condom.

Do you use a barrier method for STI protection? Please leave a comment on how your polycule uses barrier methods and your thoughts/feelings.

More on Polyamory, Safe Sex, and STIs

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STIs Protection (Introduction)

Minimal changes here. Mostly just changed STD/STI to STI. The biggest change is the last sentence of the post, which wasn’t there in any form in the original. I intend to spend a bit more time directly addressing STI stigma this time around, starting with a new post inserted into the series next week.

The bit at the end about a trip is from when this post was first written. I’m leaving it there bc it’s part of the history of the blog and why the hell not? updated 11/16/17

Protection against STIs

If you grew up in the 80s and 90s you likely heard the refrain of ‘barrier method’ (a euphemism for ‘condom’) as the only way to have sex without risk of STI. Like many simplistic answers to complex problems it is partly accurate, but leaves out a whole lot.
In theory, the best way to avoid STI is to not have sex with anyone who has an STI. If you and all your sexual partners are regularly tested for STIs, you shouldn’t need to worry, right? Unfortunately, this only works in theory.
The truth is that while STI testing is available at reasonable cost or free in most areas of the US, Canada and Europe (can’t comment on the rest of the world) that it is rare for STI testing to cover all possible infections. For instance, most don’t bother testing for herpes unless you have visible lesions. (Why? Because the test is notoriously unreliable otherwise. More on that another week.)
In addition, as mentioned last week, there are STIs that can infect you without any sexual contact. So even not having sex at all doesn’t provide 100% protection. The most important thing you can do, for yourself and your sexual partners is get it through your heads that there is no such thing as fully protecting yourself from STIs. All you can do is manage your risks.
The second most important thing you can do is understand that most of the time, getting an STI is not the end of the world. Or even your sex life. (More on this next week.)
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Sorry for the late (and short) post. Getting ready for this trip has cut unto my time and sanity, I’m afraid. So rather than write a shitty post, I’m stopping here and I’ll continue the topic next time.
Be well all, I’ll be back in two weeks.

What are STIs?

Expanded the “what are STIs” bit to make it clearer that there are infections which aren’t considered STIs that you can still get from sex, because language is weird that way. Other than that mostly cleaned up typos and grammar. Updated October 20, 2017
If I’m going to spend the next couple months discussing STIs, it seems like a good idea to start with what exactly they are, but first let’s take a look at terminology.

STD or STI?

STD stands for sexually transmitted disease. STI for sexually transmitted infection. STD is an old term, that many doctors no longer consider accurate. Basically, in medico-speak, a disease is something that causes symptoms which affect your health and well being. If you get hit with a virus, bacteria or fungus that doesn’t cause any symptoms, it’s an infection, not a disease. A lot of sexually transmitted stuff doesn’t cause symptoms, so many doctors now use STI instead.

Since this kind of change in medical terminology doesn’t make the headlines, non-medical websites, books and pamphlets that discuss sexually transmitted infections sometimes use STD, sometimes use STI and sometimes use both.

When I first write this blog series I used the slashy version ‘STD/STI’ on this blog, so that people who come into the series in the middle and might not have come across ‘STI’ would still know what I was talking about. Now that ‘STI’ has become more familiar, I’ll be changing the series to use just ‘STI’.

What Are STIs? And Why Do We Care?

STIs are pretty much just what the name says: infections that are transmitted sexually. Some viruses and bacteria really like the genitals. They are moist and warm and perfect breeding grounds for bacteria. They have mucus membranes, making them good places for viruses to invade cells.

And unlike the inside of the nose, other warm, moist mucusy areas come into contact with our genitals, making it possible for infections to jump from one person the another.

An infection whose primary means of moving from person to person is genital contact is caused an STI. That means there are many infections (mononucleosis, for instance) which you can get from sex but are not considered STIs, becuase usually people are infected some other way. And there are some STIs that have other means of jumping from person-to-person.

It is a basic fact: a person who never lets anyone else touch their genitals will probably not get an STI. Similarly, if people (of what ever number) who have no STIs are sexually exclusive for their entire lives, it is unlikely that any of them will ever get an STI.

Please note ‘probably’ and ‘unlikely’. As mentioned above, there are several STIs that can infect a person through other avenues. Blood borne STIs are the classic example of this.

It is, however, a reality of non-monogamy that having multiple sex partners makes STI infection easier. Thankfully, openly non-monogamous folks are pretty good at taking precautions against STIs.

Next week I’ll be taking a look at ways you can protect yourself and your partners against STD/STI infection.

Read excerpts from the upcoming Safer Sex for the Non-Monogamous

STIs

Biggest change here is removing references to “safer sex” where ever possible. As I discussed Sunday, I’ve recently come to the realization that by equating “protecting against STIs” with “safer sex” we’re missing a big part of the safer sex discussion. So I am no long referring to discussing STIs as discussing safer sex, etc etc. Probably when I’m done with the Finances blog series I’ll start writing about the wider aspects of the safer sex discussion that are usually forgotten or ignored. YOu may notice that I’ve also stopped doing “STD/STI”. When I started this blog series “STI” was a relatively new and unknown term and I felt I needed to use both to be everyone understood. These days STI is well known and the most used term in the polyam communities I am part of. So I can stop using STD and just go with STI, which is the term I prefer. I’ll note here that the medical community is not in agreement about which term to use and both terms are perfectly acceptable. Updated oct 20, 2018.

If you’ve been involved in polyamory for any length of time, participated on any forums, read any blogs or books, eventually you will have come across topic of STIs. It is a medical fact that by having more than one sexual partner, you increase your risk of getting a sexually transmitted infection. If by some chance you haven’t already run across a good discussion of the hows and whys of discussing STIs, I suggest you take a brief detour to More Than Two’s Negotiating Safe Sex. It’s on the short side, but hits the basics of discussing STIs very well. You might also find some other good info there on dealing with jealousy and other relationship-related polyam stuff (as opposed to practical-type stuff I try to focus on here).

Still, even most polyam folk who know and follow standard s and staying healthy. Just as a for instance, I had a first meeting with a potential partner once, who when we discussed safer sex said he had no objection to getting regular STI testing if I could pay for it – since it cost over $100 a person. What he didn’t know, and I turned up in a 5 minute web search, is that the local health department offers STI testing for $10 a person.

I’ve also run across a frightful amount of misinformation over the years on polyam forums about STIs, how they are prevented, how common they are, and, oh, lots of stuff.

So, next week I’m beginning a new series on STIs. I’ll be covering what STIs are, finding places to get tested in your area, and brief introduction to the various STIs, how they are treated, and just how much of a concern they are. Along with some other semi-random stuff.

In the meantime, if you want to do some research of your own, the American Sexual Health Association is a decent place to start.

Read excerpts from the upcoming Safer Sex for the Non-Monogamous

Defining Safe Sex

Last week I said safe sex means different things to different people. On a personal level, that means each of us needs to define safe sex for ourselves. Today we’re going to walk through defining safe sex. What is means to you, and how you can take steps to keep yourself safe while enjoying the sex life that suits you.

How Safe Do You Want to Be?

An Indie driver and a commuter both try to be safe when they drive–but what an Indie drive considers “safe” most commuters would consider suicidal. Race car drivers wear fire-proof undies for a reason.

Do you want to be completely protected from any risk of STIs? Are you comfortable with maybe getting herpes but want to be sure you are safe from HIV? Maybe you know your statistics and just want to get tested once in a while so you can get treated for anything early.

In addition to STIs, there is also pregnancy. Unlike STIs, how protected you want to be when it comes to pregnancy may vary from partner to partner.

As far as pregnancy goes you can opt entirely by never putting penis and vulva together. Or (slightly less extreme) never have PIV and except the infinitesimal risk that sometimes comes with getting semen on the outside of the vulva.

You can use various forms of birth control, which has more risk that not having PIV sex at all, but way less risk than going without birth control.

Or you can say fuck it, I don’t care about starting a pregnancy (or fuck it I WANT to start a pregnancy) and go for all the PIV sex with no birth control.

STIs are complicated–maybe there are some STIs you are willing to risk (Personally, I don’t give a fuck about herpes) but others you want to be protected from. What protects against some STIs won’t offer protection against others.

In general terms, you can choose not to have genital contact at all, and that will reduce your chance of getting STIs to almost nothing. (Sexually transmitted infections can be transmitted other ways–they aren’t exclusive to sex. For most STIs however, non-sexual transmission is rare.)

You can only have genital contact with people who get tested regularly and weren’t infected at the time they got tested. This offers significant protection, but not perfect protection. The more frequently you and your sex partners connect with new sex partners, the less protection it gives.

You can use barrier methods such as condoms and dental dams. This provides some protection against some STIs. It provides significant protection against HIV and Hep B, two of the STIs that are the most worrisome in terms of treatment and long-term impact.

You can combine STI tests and barrier method for more protection than either alone.

You and your partners can do visual checks of each other for outward signs of infection, which provides some protection against a few STIs.

You can not worry about protection for most STIs ahead of time. Truvada will protect you against HIV.

You can just get tested yourself regularly so you can catch and treat any infections early.

Which of these options sounds like “safe sex” to you?

Once you have a general idea of how you would define safe sex, it’s time to do some research. Learn about the different STIs and how they are transmitted. Learn about different birth control options. As you learn, you are further defining safe sex for yourself.

Maybe you started with wanting the protection that comes from only having sex with partners who test regularly and test STI negative. But as you learn more you decide that you really aren’t concerned about herpes and genital warts, so you’re comfortable being with a sexual partner who has either one of those STIs. Maybe you aren’t worried about barrier methods as protection from STIs, but as you learn about birth control options you decide that you definitely want to use condoms in addition to any hormonal birth control. That extra protection is reassuring.

Make sure you take the time to talk with your partner(s) about how they define safe sex. You don’t need to agree, you do need to respect each other’s definitions. Always remember that people need to be able to consent to risks. Don’t put your partner at risk in ways they don’t consent to, and if a partner puts you at risk without your consent, it’s time to get out of that relationship.

This post is part of the Safe SEx and Polyamory blog series.

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Zika Virus: A New STI?

Over the past several months, new reports in the US have focused on a “new” threat: the zika virus. Until recently, zika was believed to be transmitted only by mosquitoes, but there is now new evidence for sexual transmission.

Some History

The zika virus has been around at least since the 1950s. It was originally found in rhesus monkeys in the equatorial regions of Africa and Asia. Very rarely it was spread to humans in the region. Sometime in the early 2000s it made the jump to humans as a preferred host and began spreading. Between 2007 and 2014 the virus spread through Micronesia and Oceania before appearing in the South America in 2014. From South America it spread north, and the first cases appeared in the US in 2015.

Symptoms

Zika fever, caused by the virus is usually very mild. Headache, rash and fever are common symptoms. It is estimated that 1 in 5 people infected with the zika virus develop zika fever.

Long Term Complications

Since the zika virus appeared in Brazil there has been spike in cases of microcephaly. Microcephaly is defined as a skull that is within less than 2 standard deviations of normal for size and age. In other words, a skull that is too small for the brain to develop properly. Children with microcephaly frequently suffer from neurological disorders and shorter lifespan.

We do not know if zika causes microcephaly. At this time, scientists have proven that it is possible for zika to be transmitted from mother to fetus. This means that zika may be the cause of these birth defects. Other possible causes have been proposed. It is notable that increases in microcephaly are not being reported in other areas with the zika virus. For the time being, governments in South American countries with zika infections are advising their people to avoid pregnancies until the epidemic is under control.

Zika fever also appears to be connected to the development of Guillain–Barré syndrome in adults.

TransmissionUpdate May 12, 2016

Scientists have recently determined how the zika virus causes birth defects. We can now say with certainty that zika causes birth defects, and is most damaging during the early stages of pregnancy.