Cervicovaginal shedding of hepatitis C viral RNA is associated with the presence of menstrual or other blood in cervicovaginal fluids |
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| Authors: | Chia C. Wang Linda Cook Kenneth A. Tapia Sarah Holte Meighan Krows Arthur Bagabag Anna Santos Lawrence Corey Keith R. Jerome |
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| Affiliation: | 1. Department of Medicine, University of Washington, Seattle, WA, United States;2. Department of Laboratory Medicine, University of Washington, Seattle, WA, United States;3. The Vaccine and Infectious Disease Institute, Fred Hutchinson Cancer Research Center, United States;1. Department of Kinesiology, University of Waterloo, Waterloo, Canada;2. School of Psychology, Queen’s University Belfast, Northern Ireland, UK;3. Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Ireland;1. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India;2. Kalawati Saran Children''s Hospital, Lady Hardinge Medical College, New Delhi 110001, India;3. Department of Biotechnology, Faculty of Science, Jamia Hamdard, Hamdard Nagar New Delhi 110062, India;1. Department of Microbiology, Medical College of Soochow University, No. 199, Ren Ai Road, Suzhou, Jiangsu, 215123, PR China;2. Fengcheng Hospital of Shanghai, No. 9983, Chuan Nan Feng Road, Fengxian, Shanghai, 201411, PR China;1. University of Colorado Denver, Division of Gastroenterology and Hepatology, United States;2. Baylor University Medical Center Dallas, United States;3. University of Colorado Denver, Department of Pediatrics, United States;4. University of Colorado Denver, Department of Biostatistics and Informatics, United States;5. University of California San Francisco, Department of Surgery, United States;6. University of Colorado Boulder, Department of Integrative Physiology, United States;7. Oregon Health and Sciences University, Division of Gastroenterology, United States;8. University of Colorado Denver, Department of Surgery, United States;9. University of Colorado Denver, Department Pediatrics and Human Medical Genetics and Genomics Program, United States |
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| Abstract: | BackgroundThe role of sexual activity in hepatitis C virus (HCV) transmission remains controversial. Studies to date have not explored the relationship between HCV shedding in cervicovaginal fluids and the presence of menstrual or other blood.ObjectivesSince cross-sectional studies may underestimate the prevalence of viral shedding, we performed a 56-day longitudinal study of cervical HCV shedding.Study designWomen self-collected cervicovaginal swabs for 56 consecutive days, while keeping a diary of menses and genital symptoms. Swabs were tested for HCV RNA and cellular DNA by quantitative PCR, and hemoglobin by spectrophotometry.ResultsSixteen women contributed a total of 701 cervicovaginal swabs (mean collection period 48 days, range 18–56). Detection of HCV RNA was associated with detection of hemoglobin. Premenopausal women were more likely than post-menopausal women to have HCV RNA detected in cervicovaginal fluids. For premenopausal women, detection of HCV RNA was more likely during menstruation (OR = 56.4) or when hemoglobin was detected in cervicovaginal fluids, even if menstruation was not occurring (OR = 35.4). No woman post-hysterectomy had HCV RNA detected in cervicovaginal fluids on any day, regardless of whether hemoglobin was detected.ConclusionsOur findings are consistent with a low likelihood of sexual transmission of HCV. The results suggest that shedding of HCV RNA in the female genital tract is associated with the presence of blood, and requires the presence of a cervix. Clinicians should consider advising premenopausal women who are concerned about transmitting infection that infectivity may increase during menstruation. |
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