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May 13, 1992

Sexual Practices in the Transmission of Hepatitis B Virus and Prevalence of Hepatitis Delta Virus Infection in Female Prostitutes in the United States

Author Affiliations

From the Hepatitis Branch, Division of Viral and Rickettsial Diseases (Drs Rosenblum and Hadler), and Division of HIV/AIDS (Dr Darrow), National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Ga; Florida Department of Health and Rehabilitative Services, Tallahassee (Dr Witte); University of California, San Francisco (Dr Cohen); New Jersey Department of Health, Trenton (Mr French); University of Southern California, Los Angeles (Dr Gill); El Paso County Department of Health and Environment, Colorado Springs, Colo (Mr Potterat); Georgia Department of Human Resources, Atlanta (Dr Sikes); and Clark County Health District, Las Vegas, Nev (Mr Reich). Dr Rosenblum is currently with the Surveillance Branch,

JAMA. 1992;267(18):2477-2481. doi:10.1001/jama.1992.03480180063030

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 Measures.  —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).

Conclusion.  —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.(JAMA. 1992;267:2477-2481)