ORIGINAL ARTICLE

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

M A Balogun¹, M E Ramsay¹, J V Parry², L Donovan², N J Andrews³, J A Newham², C McGarrigle⁴, K A Harris² and C G Teo²

¹ Immunisation Division, PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK
² Sexually Transmitted and Bloodborne Virus Laboratory, PHLS Central Public Health, Laboratory, 61 Colindale Avenue, London NW9 5HT, UK
³ PHLS Statistics Unit, 61 Colindale Avenue, London NW9 5EQ, UK
⁴ HIV and STD Division, PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK

Correspondence to:
Correspondence to:
Dr M Adekoyejo Balogun, PHLS CDSC, Immunisation Division, 61 Colindale Avenue, London NW9 5EQ, UK;
kbalogun{at}phls,nhs.uk

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.

Keywords: hepatitis C virus; sexual transmission; genotypes

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