Detection of Hepatitis Delta virus in seminal fluid and cervical/vaginal secretion

Abstract

Background: Mongolia has the highest prevalence of the hepatitis D virus (HDV), leading to high morbidity and mortality from liver diseases and HCC. HDV causes the most severe form of chronic viral hepatitis. In a recent study, it was estimated that anti-HDV prevalence is 67.5% among HBsAg positive population in Mongolia. The prevalence of HDV infection is relatively high among sexually active and young people, thus, the virus might be transmitted during sexual intercourse. Aim: Therefore, it is important to confirm the possibility of sexual transmission of HDV by detecting HDV-RNA in the semen and vaginal secretions of patients with chronic hepatitis Delta. Materials and Methods: From October 2022 to January 2023, patients from Liver Center, Ulaanbaatar, Mongolia were asked to enroll in this study. A total of 61 patients, (male 31, female 30, aged 23-48 years old) participated in the study. The average age of all participants is 36.3 years and 83.3% of them are married. The males and females were to refrain from sexual activity for at least 48 hours prior to the test. Females also were recommended not to use any intravaginal products for at least 48 hours prior to the collection of vaginal/cervical swab specimens. The seminal fluids were collected in a sterile container by masturbation. Vaginal/cervical specimens were collected by rubbing with a swab dedicated to a molecular biology test. Viral RNA was extracted, and the presence of HDV-RNA was detected subsequently by real-time RT-PCR analysis. Results: In the male group, 51.6% (16/31) of seminal fluid samples were positive; in the female group, 83.3% (25/30) of vaginal/cervical swab samples were positive. This result indicates that HDV is more likely present in the genital secretion of female patients than in the seminal fluid of male patients. For the male group, a correlation between HDV RNA existence in seminal fluid and serum RNA level was weakly observed. In contrast, the female group has a correlation between HDV RNA existence in the genital tract and serum RNA level. HDV-RNA was not detected in the sample from only one woman, who had a low number of HDV RNA in her serum sample (197IU/ml). Conclusion: HDV RNA can be detected in the seminal fluid of male patients and in the genital tract of female patients. This result is solid evidence to indicate the possible risk of sexual transmission of HDV. In the future, we need to study this in more detail.