title: Sexual practices in the transmission of hepatitis B virus and prevalence of hepatitis delta virus infection in female prostitutes in the United States.
abstract: OBJECTIVE
  To evaluate heterosexual transmission of hepatitis B virus (HBV) and the prevalence of hepatitis delta virus (HDV) infection in female prostitutes.
  
  
  METHODS
  Survey.
  
  
  METHODS
  Sexually transmitted disease clinics, drug treatment programs, detention centers, and/or outreach efforts in eight areas in the United States.
  
  
  METHODS
  A total of 1368 female prostitutes 18 years of age or older.
  
  
  METHODS
  Seropositivity for HBV and HDV infection.
  
  
  RESULTS
  The overall prevalence of past or present HBV infection was 56%: 74% in women who were injecting-drug users (IDUs), 38% in women reporting no history of injecting-drug use (non-IDUs), 51% in whites, 55% in blacks, and 67% in Hispanics. Of 21 HBV carrier IDUs, 21% had HDV infection; of 18 HBV carrier non-IDUs, 6% had HDV infection. In non-IDUs (49%), risk factors for HBV infection were a history of having penile-anal intercourse (odds ratio [OR], 3.1; 95% confidence limits [CL], 1.3, 7.3) and seropositivity for syphilis and human immunodeficiency virus (HIV) infection. In IDUs, factors associated with an increased risk of infection, in addition to behaviors related to injecting-drug use, were the number of lifetime sexual partners, having sexual partners from groups at high risk for HBV infection, and seropositivity for syphilis and HIV infection; spermicide and/or diaphragm use was associated with a markedly decreased risk of HBV infection among blacks (OR, 0.1; 95% CL, 0.03, 0.4) and Hispanics (OR, 0.2; 95% CL, 0.06, 0.9).
  
  
  CONCLUSIONS
  This is the first study to suggest that having anal intercourse and failing to use vaginal contraceptives may facilitate transmission of HBV to women. Our data support guidelines that recommend hepatitis B vaccination for prostitutes and persons with a history of sexually transmitted diseases or multiple sexual partners.
authors.affiliation: Hepatitis Branch, Centers for Disease Control, Atlanta, Ga. 30333.
authors.forename: L
authors.initials: L
authors.lastname: Rosenblum
authors.forename: W
authors.initials: W
authors.lastname: Darrow
authors.forename: J
authors.initials: J
authors.lastname: Witte
authors.forename: J
authors.initials: J
authors.lastname: Cohen
authors.forename: J
authors.initials: J
authors.lastname: French
authors.forename: P S
authors.initials: PS
authors.lastname: Gill
authors.forename: J
authors.initials: J
authors.lastname: Potterat
authors.forename: K
authors.initials: K
authors.lastname: Sikes
authors.forename: R
authors.initials: R
authors.lastname: Reich
authors.forename: S
authors.initials: S
authors.lastname: Hadler
mesh_terms: D000293:Adolescent; D000328:Adult; D003267:Contraception; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology / Q000635:transmission*; D003699:Hepatitis D / Q000453:epidemiology*; D006801:Humans; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D011477:Sex Work; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous / Q000150:complications; D014481:United States / Q000453:epidemiology