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Can Hepatitis C Be Transmitted Through Sexual Contact?

Nicole Cutler L.Ac.

July 30, 2007

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Learn how likely it is to sexually transmit the Hepatitis C virus, as well as what are considered to be high risk sexual transmission factors.

Responsible, sexually active people are educating themselves on safe sex, and this education includes learning about Hepatitis C’s potential for transmission during sexual contact. Creating confusion and instilling mystery, conflicting reports about whether this virus is contracted sexually continues to circulate throughout our society. Although not exclusively considered a sexually transmitted disease, the Hepatitis C virus (HCV) has the potential to be spread through sexual contact.

According to the Centers for Disease Control, HCV is the most common blood borne infection in the United States. Since newly infected individuals rarely demonstrate specific symptoms, Hepatitis C infection is typically detected by routine blood tests. As such, more and more people are surprised to learn that they have been living with this infection, likely for a long time. Presently, an estimated 4 million Americans have Hepatitis C, with new diagnoses occurring every day.

As the number of people realizing they have HCV continues to rise, so does the concern of how they were originally infected with this disease. Since medical experts agree that Hepatitis C is only transmitted through the blood, a majority of cases are contracted through IV drug use or tainted blood transfusions. However, an estimated 10 percent of those infected cannot determine how they contracted Hepatitis C in the first place.
With such a significant percentage of people infected with HCV unsure of how their disease was acquired, just about every possibility becomes suspect. Some physicians reassure their patients that sexual transmission of Hepatitis C is rare, and that their infection likely has other origins. Other doctors flat out assume that sexual activity is the culprit of a person’s Hepatitis C infection.

Truthfully, the evidence indicating HCV is spread through sexual activity is inconclusive. However, researchers have uncovered those at higher risk of transmitting Hepatitis C through sex.

Monogamous Heterosexuals

A majority of published studies about monogamous heterosexuals have concluded an extremely low incidence of sexually transmitting Hepatitis C. While someone in a long-term, monogamous relationship with a partner infected with HCV is at risk, the risk of sexual transmission ranges from 0 to 0.6 percent per year. This risk of transmission is slightly higher — about 1 percent per year — if involved in a short-term sexual relationship with someone who has Hepatitis C. This risk increases if your partner is also infected with HIV.

  1. According to the HCV Partner Study completed by the Centers for Disease Control in 2004, the risk of sexual transmission in the United States is 2.2 percent in monogamous heterosexual relationships where one partner has Hepatitis C.
  2. As reported in the May 2004 American Journal of Gastroenterology, Carmen Vandelli and colleagues concluded that, “the risk of sexual transmission of Hepatitis C within heterosexual monogamous couples is extremely low or even null.”
  3. V. Tahan and colleagues reported in the April 2005 American Journal of Gastroenterology that none of 216 HCV negative individuals with opposite-sex HCV positive spouses seroconverted during an average follow-up period of about three years.

HIV Co-Infection

While the reasons remain unknown, it appears that people already infected with HIV, the virus that causes AIDS, have a higher percentage of sexually transmitting HCV.

  1. Roel Coutinho and Thijs van de Laar reported on a retrospective study of sexual transmission of HCV among 1,836 HIV positive and HIV negative gay men in the Amsterdam Cohort Study. The authors concluded, “HIV infection and/or mucosal trauma caused by extreme sexual techniques and concurrent STD might facilitate sexual transmission of HCV.”
  2. As reported in the November 4, 2005 issue of AIDS, Aureliea Briat and colleagues from Paris analyzed HCV RNA levels in the semen of 82 HIV/HCV co-infected and 38 HCV mono-infected men. They detected HCV genetic material more often in the seminal fluid of co-infected men than men with HCV alone (38 percent vs. 18 percent).
  3. As published in the November 1, 2005 Journal of Infectious Diseases, M.J. Nowicki and colleagues measured HCV RNA levels in the cervicovaginal lavage fluid from 58 HIV/HCV co-infected and 13 HCV mono-infected women. HCV RNA was detected in the genital fluid of 29 percent of the co-infected women, but none of the HCV mono-infected women.

Higher Risk

With all of the research on the sexual transmission of HCV, various factors have been repeatedly recognized as constituting a higher risk. Rates of transmission are higher:

  • When a person has an acute HCV infection
  • When the infected individual has a high viral load
  • Individuals who have frequent sexual encounters and/or multiple sexual partners
  • When mucosa is damaged from potentially vigorous sexual techniques such as anal intercourse, fisting and use of certain sex toys.

While the risk of transmitting HCV through sexual contact is low, it remains a possibility. Factors increasing this risk include concurrent HIV infection, sexual techniques that damage mucosa, acute HCV infection, high HCV viral load and those with multiple sexual partners. Even though studies have yielded conflicting data, there is enough evidence to conclude that sexual transmission of HCV does occur. Until medical researchers provide us with more concrete guidelines, practicing safe sex is the only reliable method of preventing sexual transmission of HCV.

References:

Buffington, J, et al, Low Prevalence of Hepatitis C Antibody in men who have sex with men who do not inject drugs, Public Health Reports, 2007.

www.cdc.gov, Hepatitis C: FAQ, US Department of Health and Human Services, 2007.

www.hcvadvocate.org, HCV Sexual Transmission Revisited: A Look at the Latest Research, Liz Highleyman, HCV Advocate Newsletter, April 2006.

www.hcvadvocate.org, Prevention of Spread of HCV, Miriam J. Alter, PhD, Hepatitis C Support Project, 2007.

www.hcvadvocate.org, Sexual Activity as a Risk Factor for Hepatitis C Infection, Norah A. Terrault, MD, MPH, Hepatitis C Support Project, 2007.

www.mayoclinic.com, Hepatitis C: How Common is Sexual Transmission?, Mayo Foundation for Medical Education and Research, 2007.

www.mysanantonio.com, Cay Crow: Although rare, hepatitis C can be transmitted through sex, KENS 5 and the San Antonio Express-News, July 2007.

Posted by Nicole Cutler L.Ac. on July 30, 2007

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  • samdm87

    Look honestly I’ve had HCV with a high viral load for 7 years. I have been in 4 serious long term relationships averaging around 2 years each. None of my partners contracted HCV except for 1 and they shared razors,toothbrushes,and needles with me knowing that I have HCV. I would not have sex while your partner is on their period protected or unprotected especially if the infected individual is female. If you know that you are HCV infected Do not share toothbrushes, razors, and especially needles, nor would I advise in having unprotected sex if one or both of you have any type of open sore, lesion, or spots where you could be bleeding from on or around your genital area. I have had many doctors tell me not to worry about sexually transmitting it to my partner, but I have had 1 doctor out of the bunch tell me to take proper precautions. I honestly feel that the 10% of people that don’t know how they got it most likely are ex needle users or had tattoos in jail or prison and don’t want the doctor to make them feel like a low life so they are not honest.

  • cherbear

    but cant someone get HCV during sexual intercourse because isnt this virus in the semen as well? or is it just in the blood stream??

  • lovinglife5683

    Cherbear – its only in the blood. samdm87 – i do not agree with you about the 10% hiding being ex or current needle users or having tattoos in prison, the estimated 10% probably comes from studies and or surveys that are anonymous and it seems much more likely they have come to terms with their past to not lie about how they got infected and it seems more likely they had contact with infected blood and didnt know it.. just saying. thumbs up for the rest of your reply tho.

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