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Re: Hepatitis C testingFrom: Ronald E. Ainsworth (ainsron@msn.com)Fri Aug 27 16:31:30 1999
>Hepatitis C is not an 'STD' - not very often is it spread sexually. There >is little to support hepatitis C testing because: >1. You can't offer any useful treatment. >2. It doesn't alter your management > >In high-risk patients there may be some benefit to yourself so as not to >give it to yourself. The risk categories you mention are appropriate. >Peter Wein I disagree with the comment that Hepatitis C is not a STD. It may not be transmitted "efficiently," but as this excerpt from the CDC website it is transmitted that way, and more effeciently from men to women than the other way. Sexual Activity. Case-control studies have reported an association between exposure to a sex contact with a history of hepatitis or exposure to multiple sex partners and acquiring hepatitis C (40,41). In addition, 15%-20% of patients with acute hepatitis C who have been reported to CDC's sentinel counties surveillance system, have a history of sexual exposure in the absence of other risk factors. Two thirds of these have an anti-HCV-positive sex partner, and one third reported greater than 2 partners in the 6 months before illness (2). In contrast, a low prevalence of HCV infection has been reported by studies of long-term spouses of patients with chronic HCV infection who had no other risk factors for infection. Five of these studies have been conducted in the United States, involving 30-85 partners each, in which average prevalence of HCV infection was 1.5% (range: 0% to 4.4%) (56,82-85). Among partners of persons with hemophilia coinfected with HCV and HIV, two studies have reported an average prevalence of HCV infection of 3% (83,86). One additional study evaluated potential transmission of HCV between sexually transmitted disease (STD) clinic patients, who denied percutaneous risk factors, and their steady partners (28). Prevalence of HCV infection among male patients with an anti-HCV-positive female partner (7%) was no different than that among males with a negative female partner (8%). However, female patients with an anti-HCV-positive partner were almost fourfold more likely to have HCV infection than females with a negative male partner (10% versus 3%, respectively). These data indicate that, similar to other bloodborne viruses, sexual transmission of HCV from males to females might be more efficient than from females to males. Among persons with evidence of high-risk sexual practices (e.g., patients attending STD clinics and female prostitutes) who denied a history of injecting-drug use, prevalence of anti-HCV has been found to average 6% (range: 1%-10%) (24-28,87). Specific factors associated with anti-HCV positivity for both heterosexuals and men who have sex with men (MSM) included greater numbers of sex partners, a history of prior STDs, and failure to use a condom. However, the number of partners associated with infection risk varied among studies, ranging from greater than 1 partner in the previous month to greater than 50 in the previous year. In studies of other populations, the number of partners associated with HCV infection also varied, ranging from greater than 2 partners in the 6 months before illness for persons with acute hepatitis C (41), to greater than or equal to 5 partners/year for HCV-infected volunteer blood donors (56), to greater than or equal to 10 lifetime partners for HCV-infected persons in the general population (3). Only one study has documented an association between HCV infection and MSM activity (28), and at least in STD clinic settings, the prevalence rate of HCV infection among MSM generally has been similar to that of heterosexuals. Because sexual transmission of bloodborne viruses is recognized to be more efficient among MSM compared with heterosexual men and women, why HCV infection rates are not substantially higher among MSM compared with heterosexuals is unclear. This observation and the low prevalence of HCV infection observed among long-term spouses of persons with chronic HCV infection have raised doubts regarding the importance of sexual activity in transmission of HCV. Unacknowledged percutaneous risk factors (i.e., illegal injecting-drug use) might contribute to increased risk for HCV infection among persons with high-risk sexual practices. Although considerable inconsistencies exist among studies, data indicate overall that sexual transmission of HCV appears to occur, but that the virus is inefficiently spread through this manner. More data are needed to determine the risk for, and factors related to, transmission of HCV between long-term steady partners as well as among persons with high-risk sexual practices, including whether other STDs promote transmission of HCV by influencing viral load or modifying mucosal barriers.
-- Ronald E. Ainsworth, MD, FACOG Paradise, CA, Private Practice 20 yrs.
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