Sex and Hep C

Sexual Transmission of HCV

Hepatitis C (HCV) is a blood borne virus that can only be passed on if the infected blood of one person gets into the bloodstream of another. HCV is not regarded as a sexually transmissible disease. However, sexual transmission of hepatitis C is definitely possible where blood is present.

The issues surrounding the sexual transmission of HCV are delicate and problematic. The likelihood that somebody with the virus could have passed it on to a sexual partner is worrying for many people with HCV. Should you tell past sexual partners of your HCV status? How should you discuss the topic with your current sexual partner? These are all difficult issues to deal with. Sexual transmission of hepatitis C is very uncommon. However, there are situations during sex where blood may be present and thus there is a chance of this blood infecting your partner.

 

What does research show?

Studies done on the HCV status of the partners of HCV positive people have shown that, on average about 5% were also HCV+. However, it is not known for sure whether the partners contracted the virus from sex with their HCV+ partner, through general household exposure or from a separate incident.

Studies that have looked at sexual transmission within stable monogamous long term relationships, where the partner has no independent non-sexual risk factors, have failed to provide convincing evidence for efficient transmission.

The risk of sexual transmission is thought to be related to a person's viral load and the risk of sexual transmission may be increased during the initial acute phase when the virus is more active.

Other studies have shown that the incidence of HCV in partners increases with each decade of marriage. However, closer scrutiny reveals that the lowest frequencies of HCV infection were documented during the early years of marriage when sexual activity is at its peak and the highest frequencies were documented during later decades.

A consensus is difficult to draw from the many studies on sexual transmission. One cannot ignore the reality that, in some circumstances, there is the potential for HCV infection to be transmitted sexually, even though the risk is low.

 


HCV in other body fluids

While the virus has been found in some sexual fluids, any danger probably lies not so much in the exchange of body fluids but in the passage of blood within them. If there is blood in sexual fluids, (even if it can't be seen) this poses a risk of transmission if your partner has a break in the skin through which the fluid can pass into their bloodstream.

 

  • Although traces of the virus have been found in semen of HCV+ men, there is no risk of an as yet unborn child becoming infected via an infected father or that a partner can be infected by semen alone.
  • The hepatitis C virus is found in breast milk but there are no reports of babies being infected in this way.
  • Mothers can infect their babies at birth but this is rare and is more common if the mother has a high viral load when the baby is born.
  • While traces of the virus have been found in saliva, exchange of saliva is not thought to be a means of transmission.
  • Saliva contains antivirals and the stomach contains acids so it is unlikely that the virus can be transmitted by ingestion. Kissing is therefore OK.

 

However, if blood is present in the mouth (you may have just flossed) there is a possibility that the virus can be transmitted if the recipient has an ulcer or broken skin in their mouth.

The HCV virus is present in menstrual blood and therefore sex should be avoided during this time. Using condoms when having anal sex is also recommended. In order to avoid condom breakage, skin damage or abrasion during sex, a water based lubricant should be used as oil based lubricants can damage condoms.

 

Sexually transmitted disease

It is important for people with HCV to avoid contracting sexually transmitted diseases as the combined effect of two or more diseases operating can compound the rate of damage.

If you have any condition which involved scratches, sores or blisters (especially when these may have come into contact during sexual activity), the possibility of blood to blood contact is increased.

 

Whom should you tell?

You are under no legal obligation to tell others you have HCV but you do have a moral obligation to protect others from contracting the disease from you. It is probably best to tell your partner and together you can both decide whether or not to alter your sexual practices to exclude risk of blood to blood contact.

If you choose to tell a sexual partner, have on hand some information on HCV that explains that while it can be transmitted sexually, the risk is extremely small.

Some partners take the news badly and sometimes an HCV+ diagnosis can affect relations with current sexual partners. It is not always possible to gauge how a friend or partner will take a positive diagnosis.

The question as to whether or not you tell previous sexual partners is again, up to you. Firstly you should assess the sexual relationship you had with this person. If there were incidences where blood may have been present, it may be prudent to advise the person to get a blood test.

However, it is recommended that all sexually active people should consider the benefits of safe sex practices in regard to a whole range of sexually transmitted disease. This is especially recommended if you are beginning a relationship or have had multiple partners.

 

How can I keep from infecting my partner?

  • Avoid sex during menstruation
  • Avoid sex if sores, blisters or breaks in the skin are present, especially in the genital area
  • Use condoms if you are beginning a new relationship or have multiple partners
  • Don’t share toothbrushes, razors or other personal items as even a small amount of blood can spread the virus

 

Information obtained from National Institutes of Health Consensus Development Statement on the Management of Hepatitis C, April 1997 and ‘Hepatitis C and Sexual Partners’ by Wellington Sexual Health Service.

Articles & Studies

Sexual Transmission of Hepatitis C: Practical Recommendations Myung, Patricia; Mallette, Carol; Taylor, Lynn; Allen, Scott; Feller, Edward (2003)

Sex and Hepatitis C Transmission Norah A. Terrault, M.D., The American Journal of Gastroenterology (2005)

Hepatitis C strategy for England Department of Health (2005)

Sexual Transmission of Hepatitis C Edwin J. Bernard. AIDS Treatment Update (2002).

HIV and Hepatitis C Virus Coinfection: 7th Retrovirus Conference Update Michael Marco (2000).

Decline in Male Sexual Desire, Function, and Satisfaction During and After Antiviral Therapy for Chronic Hepatitis C Lorna M. Dove, Raymond C. Rosen, Darmendra Ramcharran, Abdus S. Wahed, Steven H. Belle, Robert S. Brown, Jay H. Hoofnagle (2009)

Sexual Dysfunction is Highly Prevalent Among Men with Chronic Hepatitis C Virus Infection and Negatively Impacts Health-Related Quality of Life Ann Danoff, Oona Khan, David W. Wan, Lainie Hurst, Daniel Cohen, Craig T. Tenner, Edmund J. Bini (2006)

Sexual Transmission of HCV between Spouses Veysel Tahan, Cetin Karaca, Beytullah Yildirim, Aysun Bozbas ... Marmara University School of Medicine, Altunizade; Istanbul University Medical Faculty, Department of Gastroenterohepatology ... Turkey. (2005)

Hepatitis C: Sexual or Intrafamilial Transmission? Cavalheiro Nde P, De La Rosa A, Elagin S, Tengan FM, Araújo ES, Barone AA. Hepatitis Laboratory, Infectious Diseases Departament University of São Paulo, Brazil (2009).

Molecular Evidence of Horizontal Transmission of Hepatitis C Virus Within Couples Isabel Maria Vicente Guedes de Carvalho-Mello, Jose Eymard Medeiros Filho ... Butantan Institute, University of São Paulo, Brazil (2009).

Prevalence and risk factors of hepatitis C in HIV-negative homosexual men ... Fengyi Jin, Garrett P. Prestage, Susan C. Kippax, John M. Kaldor, Greg J. Dore, Andrew E. Grulich. National Centre in HIV Epidemiology and Clinical Research, Wales (2005).

The HCV virus is present in menstrual blood and therefore sex should be avoided during this time. Using condoms when having anal sex is also recommended. In order to avoid condom breakage, skin damage or abrasion during sex, a water based lubricant should be used as oil based lubricants can damage condoms.

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