Case report
Acute hepatitis C infection with evidence of heterosexual transmission

https://doi.org/10.1016/j.jcv.2010.06.008Get rights and content

Abstract

A 62-year-old woman acquired acute hepatitis C virus (HCV) infection after heterosexual contact with a known HCV positive former injecting drug user. There were no known sexual or other risk factors for HCV acquisition. Phylogenetic analysis confirmed the case and index were infected with identical genotype 3a strains, consistent with heterosexual transmission in the absence of specific risk factors.

Section snippets

Why this case is important

Hepatitis C virus (HCV) is a blood-borne pathogen and estimated to affect 170 million people worldwide.1 Transmission of HCV occurs via blood-to-blood contact and is commonly associated with injecting drug use, blood transfusions and health-care procedures; while the risk of sexual transmission of HCV is considered to be extremely low.2 We provide a case report with evidence of sexual transmission as a source of HCV infection after heterosexual contact.

Case description

In October 2008, Sydney West Public Health Unit received a laboratory notification for the woman who had positive antibodies for HCV with clinical and laboratory evidence of acute viral hepatitis. A public health investigation was undertaken, according to State Health Guidelines.3

A 62-year-old woman presented to a general practitioner with onset of illness on 13 October 2008 complaining of severe tiredness, nausea and dark urine but no jaundice. Her liver function tests (LFT) on 24 October 2008

Other similar and contrasting cases in the literature

HCV is recognised as being sexually transmissible; reviews of other cases have indicated that sexual transmission of HCV is more likely in prolonged sexual relationships (perhaps with transmission via other parenteral routes such as sharing razors or toothbrushes), or where there is some mucosal damage associated with sexual activity (more commonly anal intercourse or menstruation).2, 8, 9, 10 Amongst groups with high-risk sexual behaviour, a higher prevalence of HCV was associated with HBV

Discussion

Molecular sequencing and cluster analysis are established methods used for molecular epidemiological investigations to provide rapid determination of the consensus sequence of a heterogeneous population and evolutionary history of HCVs.6, 12, 13, 14, 15

To determine the genetic relatedness of the source and case, two genetic regions of the HCV genome were analysed, as commonly employed to establish transmission of virus and geographical distribution of genotypes6, 16, 17: the hypervariable

Funding

None.

Competing interests

None declared.

Ethical approval

Not required.

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  • Cited by (16)

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    • Should HCV discordant couples with a seropositive male partner be treated with assisted reproduction techniques (ART)?

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      Sexual transmission of the hepatitis C virus is a controversial issue. Most data indicate that the risk of heterosexual transmission is extremely low but not impossible [2]. Recent data suggest an increasing incidence of acute HCV infection in HIV-1 infected men who have sex with men [3], but for HCV-discordant monogamous couples the rate of seroconversion, after 10 years of sexual unprotected intercourse, is only 2.5% [4,5].

    • Diagnosis and Treatment of Acute Hepatitis C Virus Infection

      2012, Infectious Disease Clinics of North America
      Citation Excerpt :

      Although a history of intravenous drug abuse was still the most frequent cause for HCV infection in 48% of cases, 42% of the participants reported more than one sex partner and 10% revealed their sexual preference as MSM. The broader availability of lifestyle drugs, such as sildenafil, and use of noninjecting drugs has influenced sexual culture and has been shown to significantly increase the risk for HIV and other sexually transmitted diseases, not only in MSM but also in other populations.20–23 Nevertheless, most sexually transmitted acute HCV infections worldwide have been reported among HIV-positive MSM (Fig. 1).16,24–51

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