RESUMO
Hepatitis C virus is a worldwide problem. in Egypt, HCV infection is hyper-endemic, with sero-prevalence rates of 15-20% among volunteer blood donors, and even higher rates reported among segments of the general population. Although the parentral mode of HCV transmission is well established, there remains a high proportion of patients without an identifiable source of infection. The importance of sexual transmission in the epidemiology of HCV infection is still controversial. Better understanding ofroutes of transmission will help to combat the spread of disease. Thus there is a need for studies to define the routes of HCV transmission other than the parentral exposure. The aim of the present study is to investigate the role of sexual transmission in the transmission of HCV infection, and to investigate whether or not the detection of actively replicating HCV in serum coincides with the presence of HCV-RNA in seminal fluid, in an attempt to define one of the main possible routes of HCV infection transmission other than the parentral route. A group of 40 male married patients infected with hepatitis C virus were included in this study and HCV-RNA detection in their semen by nested RT-PCR test was done. We tested for the presence of inhibitors in the seminal plasma by the repetition of negative HCV-RNA seminal plasma samples with an internal control. Fractionation of the semen of five virospermic patients was done on percol gradient into seminal plasma, round cell and motile spermatozoa fractions, and HCV-RNA detection was repeated on each fraction in an attempt to understand which fraction could serve as a reservoir for the virus. The wives of the patients with detectable HCV-RNA in their semen were subjected to serum HCV-RNA detection. Of the forty male patients with HCV-RNA positive sera, ten patients [25%] had detectable HCV-RNA in semen. The test for PCR inhibitors revealed the presence of Taq inhibitors in seminal plasma of 16/30 patients [53.33%] who were considered to be false negative. HCV-blood viral load was significantly higher in virospermic patients, which supports the hypothesis that HCV is "leaked out" from the peripheral circulation. We identified HCV-RNA in serum of four out often wives of virospermic patients. The duration of marriage among HCV infected wives in this study was significantly higher than among the non-infected wives which suggests that a cumulative effect may be required for the sexual transmission of HCV. In the semen could be infectious and the role of sexual transmission in the spread of HCV infection should not be underestimated. Laboratory capability to accurately detect HCV positive semen is an important step in establishing the risk of sexual transmission and in identifing strategies for protecting uninfected partners