Chikungunya in Puerto Rico: symptoms, dengue look-alike and when to get help

Chikungunya is a viral infection spread by the bite of the Aedes aegypti mosquito, the same mosquito that spreads dengue and Zika in Puerto Rico. According to the CDC, symptoms usually begin 3 to 7 days after the bite. The most common are fever and joint pain.

Most people feel better within a week, but the joint pain can be severe and can last for months. According to Puerto Rico’s Department of Health, the evidence so far suggests that one infection protects you for life.

Puerto Rico reported its first chikungunya case in 2014, followed that same year by a large outbreak. By August 12, 2014, 10,201 suspected cases had been reported, according to a CDC report.

Things are different now. According to the Department of Health’s weekly arboviral report (week 37, published September 23, 2026), no chikungunya cases have been reported in 2026, and 2025 had a single case, imported from travel outside Puerto Rico. Dengue, on the other hand, has 922 cases so far in 2026. So if you have a fever with joint pain on the island, think of dengue and its warning signs first.

You see Dr. Diana Nieves Castro, a Puerto Rico–licensed general practice physician with several years of emergency-department experience, in English or Spanish. We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you.

The doctor asks how long you have had a fever, where it hurts, whether you traveled outside Puerto Rico and what you have taken, and goes over the warning signs with you. If appropriate, the doctor prescribes and we send your prescription to your pharmacy. We do not prescribe controlled substances. This is virtual urgent care for problems that are not emergencies.

We see adults and children of all ages. For patients under 21, a parent or legal guardian stays on camera for the whole visit and shows photo ID. You need to be physically in Puerto Rico during the visit, and visitors are welcome.

Request a visit online 24/7 — we confirm your time by email or text.

A doctor visit costs US$79, the same price for every age, with no membership. Your card is charged when you request the visit, and you get a full refund if the visit can’t take place. A doctor’s note after your visit is included at no extra charge. The lab and the pharmacy charge separately. The service is run by The Health Initiative, a nonprofit. Book your visit.

According to the CDC, the most common symptoms are fever and joint pain. You may also have:

Early on, chikungunya and dengue look alike, and only a lab test tells them apart. That is why the CDC says to manage a suspected case as dengue until dengue is ruled out: use acetaminophen for fever and pain. Don’t take aspirin, ibuprofen or other anti-inflammatory medicines until dengue is ruled out, because with dengue they raise the risk of bleeding. Rest and drink plenty of fluids.

No medicine cures chikungunya; treatment relieves the symptoms. If the doctor thinks a test will help, she gives you a lab order for a lab near you. According to the CDC, during the first 8 days of illness the virus can often be found with a molecular test (RT-PCR), and antibodies usually appear toward the end of the first week. The doctor goes over the result with you.

During the first week, avoid mosquito bites so you don’t pass the virus to mosquitoes around your home: use an EPA-registered repellent (for Puerto Rico, the CDC recommends at least 20% DEET), long sleeves, and screened or air-conditioned rooms.

The CDC warns that chikungunya joint pain can be severe and disabling and can last for months. If your joints hurt and you are not sure it is chikungunya, read joint pain. If you still hurt after the fever is gone, the doctor follows up with you by video: how much it limits you, what helps and, once dengue has been ruled out, whether a change in treatment is appropriate. If you had tests with one of our lab orders, reviewing the results is a follow-up visit.

According to the CDC, people at higher risk of severe disease are newborns infected around the time of birth, adults 65 or older, and people with high blood pressure, diabetes or heart disease.

Because early chikungunya can’t be told apart from dengue, watch for dengue warning signs. They usually start 24 to 48 hours after the fever goes away. With any of these, go to an emergency room or call 911; don’t book a video visit. See when to go to the ER.