Sexual Transmission of HCV
The transmission of hepatitis C (HCV) through sexual contact is a common question and concern among those living with Hepatitis C and their partners. Overall, HCV has been considered difficult to acquire through sexual transmission. However, there are various factors which may increase the potential for transmission. Hopefully, this article can help provide a better understanding of the associated risks.
First, it is important to know that hepatitis C is spread from blood to blood contact. Generally this happens when blood from a person living with the hepatitis C virus enters the bloodstream of someone who is not. Today, the most common route of HCV transmission is through intravenous drug use or sharing injection drug equipment. Prior to 1992, many people contracted HCV through blood transfusions or organ transplants.
While HCV can be transmitted through sexual contact; this is often considered an ineffective means of transmission. Last year, in 2015, the Center for Disease Control and Prevention updated guidelines for on the transmission of sexually transmitted infections (STI). Hepatitis C, although not considered an STI, was included in the guidelines as an emerging issue. Here is an overview:
- There is no evidence that kissing, hugging, or casual contact without exposure to blood is associated with HCV transmission.
- Among heterosexual couples who are in a mutually monogamous relationship, meaning the couple only has sex with each other, the risk of HCV transmission is estimated to be low. Based on the low risk of transmission, couples in a monogamous relationship do not need to use condoms, or change their sexual practices.
- Oral sex is also considered unlikely means of HCV transmission.
The risk of HCV sexual transmission increases in the following situations:
- among individuals who have multiple sex partners.
- group sex.
- during a female’s menstrual cycle.
- in the presence of other sexually transmitted infections. HCV is more likely to be transmitted if either partner has another STI, especially one that causes sores or lesions. This should be considered for oral sex as well; it is a possibility that open sores or blood in the mouth or genitalia can promote the transmission of HCV.
- when sexual practices result in blood to blood exposure (ex: rough sex that leads to tearing or cuts.) Anal sex is considered more risky than vaginal sex.
- among individuals who are living with human immunodeficiency virus (HIV) .
- among men who have sex with men (MSM). Important to know: among MSM, the risk of Hepatitis C transmission is increased for those also living with HIV. Recently, there have been increasing rates of acute Hepatitis C infection (HCV that is in the blood stream for less than 6 months) among MSM who are also living with HIV infection. Recent studies involving this cohort of co-infected individuals, found infectious levels of HCV in the semen of the male participants. Therefore, occurrence of HCV infection among this population is primarily a result of unprotected anal intercourse, which may include fisting and/or use of sex toys, which result in abrasions and exposure to infected fluids, usually blood or potentially semen. However, please note: additional research is required.
To minimize the risk of viral transmission, use of condoms is recommended.
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