the extent to which hcv infection is associated with sexual exposure has been debated extensively . the 2008 egyptian demographic and health survey   estimated that 15% of people aged 1559 years in egypt have anti - hcv antibodies and 10% have chronic hcv infection .
however , this high figure is related to past transmission events and is not representative of the hcv transmission occurring in egypt . sexual transmission of hcv may contribute to the total burden of infection in egypt .
the objectives of this study were to detect the risk for sexual transmission of hcv infection from chronically infected subjects to their long - term monogamous heterosexual partners ( 50 spouses ) and to identify various sexual practices associated with that risk .
spouses were carefully selected to exclude risk factors and participants were hbv ( hbsag , hbcab , and hbsab ) and hiv antibody negative .
all participants were tested for liver enzymes , hcv specific antibodies ( ortho clinical diagnostics , new jersey , usa ) , and hcv rna assay with real - time pcr using qiagen extraction kit and brilliant hcv qrt - pcr for stratagene 's mx3000p .
five spouses showed evidence of hcv infection , two were positive for hcv antibody alone ( 4% ) and three were positive for hcv antibody and hcv pcr ( 6% ) .
no association was found between the hcv infection status and various selected risk factors such as sex , age , duration of marriage , frequency of sexual intercourse , history of sexually transmitted diseases , and other risk factors for hcv .
the only association detected was the age category where both positivity of hcv antibody and hcv pcr were associated with the older age category ( > 60  y ) .
as regards the direction of transmission , an insignificant difference between male and female spouses of chronic hcv-4 infected patients was detected . in this
study the prevalence of hcv in the heterosexual spoused is 10% which may seem to be lower than the general population .
however , our patient population was carefully selected so that sexual intercourse would be the major risk factor .
one possible explanation is that a higher cell - mediated immune response against hcv in repeatedly exposed sexual partners would partially protect them against infection .
the detection of hcv - specific cellular immune responses in seronegative sexual partners of hcv patients has been documented [ 2 , 3 ] .
an important limitation is failure to analyze the sequence of nucleotides of the hcv genome .
the detection of homology in the nucleotide sequences would have been a strong evidence of a common source of infection but it would not clarify the direction of the infection , nor the responsible risk factors . the major limitation of our study may be the relatively small number of participants .
our study results raise the possibility that hcv is sexually transmitted between spouses in egypt .
this confirms the need to screen all people in the so - called high risk groups for hcv infection .
due to the ongoing high incidence of hcv in egypt , further research is needed to identify the exact routes of transmission and the associated risk factors so that preventive measures can be instituted .
 we screened for evidence of hcv infection in healthy heterologous monogamous spouses of chronic hcv patients and studied the relation with various risk factors . 
 a cross - sectional study of fifty healthy monogamous heterosexual spouses of hcv - positive index cases was carried out . 
 all participants were hbv and hiv negative . 
 the association with various risk factors was studied . 
 five spouses ( 10% ) showed evidence of hcv infection . 
 two partners were positive for hcv antibody alone ( 4% ) and 3 for antibody and hcv pcr ( 6% ) . 
 no association was found between hcv infection and various sociodemographic parameters with the exception of older age categories . 
 intraspousal transmission of hcv may be an important source of spread of hcv infection . 
 the reservoir of hcv - infected individuals in egypt is sizable , and sexual transmission of hcv may contribute to the total burden of infection in egypt . 
1. Introduction
2. Conclusion