A national survey of genitourinary medicine clinic attenders provides little evidence of sexual transmission of hepatitis C virus infection

Abstract

Objective: To determine the prevalence and genetic diversity of hepatitis C virus in genitourinary medicine clinic attenders and to assess the extent of sexual transmission of the virus. Methods: A cross sectional, unlinked, anonymous survey in 14 genitourinary medicine clinics situated in England, Wales, and Northern Ireland. Serum specimens from genitourinary medicine clinic attenders, retained as part of the Unlinked Anonymous Prevalence Monitoring Programme (UAPMP) serum archive, were tested in small pools, for the presence of antibody to hepatitis C virus (anti-HCV). The main outcome measures were prevalence of antibodies to hepatitis C virus and identification of hepatitis C virus genotypes. Results: Testing of 17 586 specimens from 1995 showed an adjusted prevalence of anti-HCV in genitourinary medicine clinic attenders of 1.03% (95% CI: 0.89 to 1.16) overall and 0.65% (95% CI: 0.51 to 0.78) among those who did not report injecting drug use. Prevalence in injecting drug users attending genitourinary medicine clinics was 36.9% in both 1995 and 1996. Heterosexual injecting drug users had a higher prevalence of anti-HCV than homosexual/bisexual injectors. The most common hepatitis C genotypes were types 3a and 1a. There was a high degree of concordance between genotype and serotype. Conclusions: The low prevalence of anti-HCV in genitourinary medicine clinic attenders who deny injecting drugs suggests that the majority of hepatitis C infections have been acquired in adult life, mostly by injecting drug use, and that the hepatitis C virus is rarely transmitted sexually. The use of needle exchanges may explain the relatively low prevalence observed in the injecting drug users.

Hepatitis C testing in sexual health services in England, 2002-7: results from sentinel surveillance

“…The incidence among those tested was also low, and was comparable with recent estimates of hepatitis C incidence in low-risk populations 11 12. The characteristics of anti-HCV-positive individuals described here confirm previous reports that suggest anti-HCV positivity is higher in males and in IDU 13 14. One limitation of this study was the paucity of information on risk factors, with our sources limited to a freetext clinical details field.…”

Low Prevalence of Hepatitis C Virus Antibody in Men Who Have Sex with Men Who Do Not Inject Drugs

“…18 A larger, more recent study in genitourinary clinics in the United Kingdom, using similar methods, found a low prevalence of anti-HCV among non-IDU, with the anti-HCV prevalence in MSM not significantly different from non-MSM (0.92% vs. 0.75%, PR 1.23; 95% CI 0.76, 1.98). 19 The prevalence of HCV infection among MSM in STD clinics has generally been found to be no higher than among heterosexuals. [6][7][8] Only one study of STD clinic clients found male homosexual activity to be an independent risk factor for HCV infection, but this association became nonsignificant when HIV infection was included in the multivariate model.…”

Increase in diagnosed newly acquired hepatitis C in HIV-positive men who have sex with men across London and Brighton, 2002-2006: is this an outbreak?

“…The efficacy for most genotypes remains low, however, with specific problems in HIV-positive individuals 6 – 8. The main risk factor in the United Kingdom is injecting drug use 9 10. Historically, using data from heterosexual HCV discordant couples, the risk of sexual transmission was considered to be low.…”