Health : What You Need To Know About Hepatitis C
July 28 is World Hepatitis Day—A nice chance to learn more about the disease. Hepatitis C (HCV) is a curable disease, but awareness of it remains pretty low. We can do a better job of getting the word out. One area that leads to much confusion around HCV is sexual transmission of the virus. Here’s some information to help you understand it and prevent it.
As a hepatitis C health educator, I can easily say that the question of sexual transmission of HCV is one of the more common ones I’m asked. And unlike sexually transmitted infections like syphilis or gonorrhea, where we can say definitively that they are indeed STIs, the answer to the HCV question is definitely complicated.
We know the main way that HCV is transmitted is through blood to blood contact, that is, when someone’s HCV-infected blood gets into you. Sharing of injecting equipment—syringes, cookers, cotton and water—where HCV-infected blood is introduced, is the most common way HCV is transmitted today.
But what about sex? Overall, the risk of sexual transmission of HCV is relatively low. If blood is present during sex (and it often is, even if we can’t see it), then there is some risk. But even when there’s no blood, there has been some research to show that it can be found in semen and rectal fluids.
There are no studies, but we can assume it’s not efficiently transmitted from oral sex.
If you’re HIV- negative, the risk appears to be very low for both tops and bottoms. If you’re HIV-positive, then there appears to be greater risk of transmission: We definitely see more people living with HIV who have never injected drugs but are still HCV co-infected. We don’t fully know why, but through patient interviews and studies, the following risk factors have been linked to sexual transmission of HCV:
- Condomless receptive anal sex
- Fisting
- Sharing of sex toys
- Group sex
- Presence of other ulcerative STIs (like herpes or primary syphilis)
- Use of non-injectable drugs with sex
Here are some tips for preventing sexual transmission of HCV:
- Wearing a condom for anal sex can create a barrier to prevent semen, rectal fluids and blood contact.
- Use lots of lube (water-based or silicone-based) to minimize friction and tearing of the anal cavity.
- Check the condom and switch it out if sex is going on for awhile to prevent it from slipping off or breaking.
- In group sex, each partner should wear their own condom and change them with each new partner.
- Using the FC2 female condom is widely used for anal sex can reduce risk of semen and blood transmission.
- In group sex, when using the female condom, change them with each new partner.
For condomless sex: Using lots of lube before and during sex (and fisting or sex toy play) to prevent tearing and bleeding, maintaining blood awareness, and checking for blood during sex may reduce your risk of getting HCV. Remain mindful of the potential risk of HCV transmission from semen or rectal fluids, too.
In the end, even if the overall risk of HCV may be low in HIV negative MSM, low does not mean zero and it can happen. You should do what you feel most comfortable with when it comes to protecting your health and the health of others.
For more information, call HELP-4-HEP, a national hepatitis C helpline at: 1-877-435-7443.
Be well
Andrew
Project Inform
Sexual contact is “relatively low” for infection vector, my ass. I contracted HCV in the ’90s from an INFECTED TOP. Eating pussy or rimming hole are VERY GOOD VECTORS for getting HPV, and so’s anal intercourse for the bottom….JUST like HIV. You don’t need “blood to blood” contact to get it it through the colon wall, OR the tissues around the eye. This article is a lie and the “educator” should be sanctioned. The stats and the personal experience in the gay community tell the tale well…the ones most likely to have HCV are ANAL BOTTOMS AND RIMMERS. Get a clue, A4A….AGAIN. Fortunately I was cured of HCV when Sovaldi first came out for frials and I had a less virulent genotype (2B) and was cured in 12 weeks…but the treatment included ribavirin, which causes very serious side effects…blotching and frecking of skin, cognitive issues (JUST like Truvada), skyrocketing albumin counts and VERY low red blood cell counts, as well as a general feeling of malaise. You have been warned.
Hi TiredOfIt, I asked Andrew the author of this blog post to answer your comment. He will be in touch tomorrow here on the blog. He is a professional in Hep C, so he will be able to answer better than I can.
Dave
Hi Tiredofit. Thanks for your comment, and for taking the time to write it. I like to get feedback—even critical ones—as it helps me clarify my messaging and be a better writer.
First: I’m really sorry about your bad experience with HCV treatment. While everybody’s experience with side effects is different, and there are people who do well on ribavirin, it can still be very hard on some: The side effects of fatigue and anemia can be debilitating. This won’t help you (thankfully you’re cured!) but I want other readers to know: There are ribavirin-free HCV treatments available now and they tend to have mild, manageable side effects.
As to the sexual transmission of HCV: I’m glad for your note as it will help me clear up any misconceptions. First, everything I write is based on current research, conversations with doctors and other HCV researchers, and people living with HCV. It’s the nature of a blog that I don’t cite the research by name. Blogs also tend to be short, so you can’t write as much as you’d like and that risks not getting your point across clearly. I hope to rectify that here.
The risk of sexual transmission of HCV is low, as the CDC states: “…the risk of transmission from sexual contact is believed to be low. The risk increases for those who have multiple sex partners, have a sexually transmitted disease, engage in rough sex, or are infected with HIV.” When you look at the CDC’s most recent STD Treatment Guidelines, published in 2015, they state: “HCV is not efficiently transmitted through sex. Studies of HCV transmission between heterosexual or homosexual couples have yielded mixed results, but generally have found either no or very minimally increased rates of HCV infection in partners of persons with HCV infection compared with those whose partners are not HCV-infected. However, data indicate that sexual transmission of HCV can occur, especially among persons with HIV infection.”
That was the message I was hoping to get across. When I use the term relatively, I in no way wanted to suggest that there was no risk. The research shows that HIV-negative MSM (and heterosexual men and women, for that matter) have low rates of sexually transmitted hepatitis C, and it also shows that HIV-infected men have higher rates. There has never been a documented case of HCV transmission from oral sex. In addition to blood-to-blood contact, I also mention that recent research has found it in semen and rectal fluids. I do list receptive anal sex as a potential risk, and provide a list of ways to minimize the risk of sexual transmission.
That said I can still be clearer in my writing and update the blog. For example, I’m going to re-write my bullet point about condoms as follows: “Wearing a condom for anal sex can create a barrier to prevent semen, rectal fluid and blood contact.” Additionally, I will add a line to clarify that even though the research says the risk may be low, sexual transmission can and does happen, and you should do what you feel most comfortable with when it comes to protecting your health and preventing HCV.
Again, thanks for the feedback and the opportunity to clarify the risks and highlight the ways we can protect ourselves from getting (or transmitting) HCV.
Best
Andrew