Objective. To identify the risk factors for HCV infection within married couples in Egypt. Methods. In 2008 Egypt conducted its first nationally representative survey of HCV prevalence. 11126 of the 12780 individuals aged 15–59 year who were sampled agreed to participate and provided information via a questionnaire about demographic and behavioural characteristics and blood for HCV antibody and RNA analysis. We assessed the risk factors for HCV infection in a subsample of 5182 married individuals via multivariate logistic regression. Results. Overall HCV antibody prevalence in the married couples was 18.2% (95% CI, 16.8–19.6). HCV antibody prevalence was higher in the husbands (23.7%) than the wives (12.1%; ). Having a spouse who was infected with HCV was an independent risk factor for HCV infection with odds ratios of 2.1 (95% CI, 1.6–2.9) and 2.2 (95% CI, 1.6–3.1) for women and men, respectively. Husbands whose wives had experienced female genital cutting (FGC) had a higher prevalence of HCV and this relationship was driven by a strong association in urban areas. Amongst the women there was no association between FGC and HCV overall but in urban areas only women who had experienced FGC were HCV infected. Conclusions. This study provides additional evidence of the importance of intrafamilial transmission of HCV in Egypt. 1. Introduction With 14.7% of 15–59-year-olds testing anti-HCV positive, Egypt has the highest HCV prevalence in the world [1]. Although parenteral antischistosomiasis therapy (PAT) was important in the genesis of Egypt’s HCV epidemic this was stopped over 25 years ago and HCV incidence remains high estimated between 150？000 and 500？000 new infections per year [2–4]. Infection from inadequate sterility of dental and medical devices has been shown to play a role in this regard [1, 2, 5–12]. Intrafamilial transmission is an alternative explanation [6]. Support for this theory comes from studies such as a longitudinal study of incidence in two villages in Egypt, which found that the strongest predictor of incident of HCV was having an anti-HCV positive family member [13]. Among those that did and did not have a family member infected with HCV, HCV incidence was 5.8 and 1.0/1000 person years, respectively. Parenteral exposure increased the risk of HCV but was not statistically significant. This elevated risk of incident of HCV of family members could be due to sharing of implements such as razors or toothbrushes or due to sexual transmission between family members [14, 15]. Alternatively, the elevated risk may be due to shared risk factors
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