Sexual practices in the transmission of hepatitis B virus and prevalence of hepatitis delta virus infection in female prostitutes in the United States
Rosenblum, L.; Darrow, W.; Witte, J.; Cohen, J.; French, J.; Gill, P.S.; Potterat, J.; Sikes, K.; Reich, R.; Hadler, S.
JAMA 267(18): 2477-2481
1992
ISSN/ISBN: 0098-7484 PMID: 1573724 DOI: 10.1001/jama.1992.03480180063030Document Number: 318304
Objective: To evaluate heterosexual transmission of hepatitis B virus (HBV) and the prevalence of hepatitis delta virus (HDV) infection in female prostitutes. Design: Survey. Setting: Sexually transmitted disease clinics, drug treatment programs, detention centers, and/or outreach efforts in eight areas in the United States. Participants: A total of 1368 female prostitutes 18 years of age or older. Outcome Measure: 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 HBVF carriers IDUs, 21% had HDV infection; of 18 HBV carrier non-IDUs, 6% had HDV infection. In non-IDUs (49%), risk factors of 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 syphillis 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 syphillis 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). Conclusion: This is the first study to suggest 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.