Cervicovaginal shedding of hepatitis C viral RNA is associated with the presence of menstrual or other blood in cervicovaginal fluids.
BACKGROUND
The 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.


OBJECTIVE
Since cross-sectional studies may underestimate the prevalence of viral shedding, we performed a 56-day longitudinal study of cervical HCV shedding.


METHODS
Women 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.


RESULTS
Sixteen 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.


CONCLUSIONS
Our 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.
Department of Medicine, University of Washington, Seattle, WA, United States. chiaw@u.washington.edu
Chia C
CC
Wang
Linda
L
Cook
Kenneth A
KA
Tapia
Sarah
S
Holte
Meighan
M
Krows
Arthur
A
Bagabag
Anna
A
Santos
Lawrence
L
Corey
Keith R
KR
Jerome
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001826:Body Fluids / Q000737:chemistry / Q000821:virology; D002584:Cervix Uteri / Q000821:virology; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics / Q000502:physiology*; D006526:Hepatitis C / Q000821:virology*; D006801:Humans; D008137:Longitudinal Studies; D008598:Menstruation; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D014621:Vagina / Q000821:virology; D019562:Viral Load / Q000235:genetics; D017201:Virus Shedding; D055815:Young Adult
D012367:RNA, Viral