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Is Transmission Risk of Hepatitis C Related to Sexual Orientation?

Nicole Cutler L.Ac.

February 20, 2013

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Find out about the research evaluating sexual orientation to determine if Hepatitis C can be transmitted sexually. Keep in mind there are other circumstances that appear to raise the risk of Hepatitis C sexual transmission more than the gender of who someone has sex with.

There is considerable fear about not knowing all of the ways a virus capable of causing advanced liver disease can be spread. This gap in understanding likely fuels suspicions that sex may serve as a vehicle for the Hepatitis C virus. Despite the understanding that Hepatitis C is a blood-borne pathogen, there is still a great deal of uncertainty about the potential to spread this virus through sexual activity. To confound matters, most of the research on the sexual transmission of Hepatitis C isolates male homosexual activity from heterosexual sex.

Approximately 30 percent of the estimated four to five million Americans infected with chronic Hepatitis C have not been able to identify how they contracted their infection. Such a substantial unknown tends to breed contagion fears. Understandably, those who don’t know how they acquired Hepatitis C are likely to scrutinize any action known to spread disease – such as sexual activity.

Sexual Transmission of Hepatitis C

The Hepatitis C virus is spread through the blood of someone infected with the virus to the blood of someone else. The documented likelihood of acquiring Hepatitis C through sexual activity is very low. However, medical opinion varies considerably regarding the real life possibility of Hepatitis C transmission through sexual contact. While experts agree that the transfer of blood during sexual activity is needed for viral transmission, they also recognize that the quantity of blood capable of transmitting Hepatitis C is microscopic – far less than what can be visually recognized as a red liquid. In general, the following situations increase the risk that blood could be present – both visibly and invisibly:

  • Sexual activity during menstruation
  • Anal or vaginal intercourse that is rough
  • Sexual aids that could damage genital mucosa – or sharing of contaminated sexual aids
  • Fisting

In addition to the possibilities listed above, research has shown that those with the virus have a higher chance of transmitting Hepatitis C during sex if they:

  • are in the acute stage of Hepatitis C infection
  • have a high viral load
  • inject intravenous drugs
  • have a concurrent infection of HIV

Hetero and Homo

Even with an understanding that the risks listed above are more likely to lead to Hepatitis C sexual transmission, researchers have used sex between certain genders as a tool to further investigate this disease’s infectivity. Over the past decade, researchers have reported several outbreaks of acute Hepatitis C among men who have sex with men that appear to be due to sexual transmission. Such findings conflict with public health guidelines stating that sexual transmission of Hepatitis C is uncommon. Information about heterosexual sex has been affirmed as low risk.

  • According to study results reported at the 2010 Interscience Conference on Antimicrobial Agents and Chemotherapy, sex between women and men does not appear to be a common route of Hepatitis C transmission. While the results reported confirm prior research showing a low rate of heterosexual transmission of Hepatitis C, they contrast with the higher rate reported for gay and bisexual men with other risk factors.

This study may give heterosexuals reason to relax and homosexuals reason to fret; however, it does not tell the whole story. The following studies on Hepatitis C transmission from sex between men contain useful information:

  • As published in the May 2010 Journal of Infection, researchers from the UK investigated if sexual transmission of Hepatitis C in men who have sex with men was elevated in those who are HIV-negative. Based on statistics, there is an increase in sexual transmission of Hepatitis C between HIV-positive men who have sex with men. However, the researchers found that the prevalence of Hepatitis C in HIV-negative men who have sex with men was similar to the general population.
  • As published in the February 2010 edition of Sexually Transmitted Infections, Australian researchers studied if sexual transmission was responsible for Hepatitis C in homosexual men. They found that nearly all of the Hepatitis C cases tracked in men who have sex with men had one or both of the additional risks of intravenous drug use or HIV co-infection.

Both of these studies demonstrate that simply isolating men who have homosexual sex is inadequate in assessing the risk of Hepatitis C sexual transmission. Similarly, evaluating heterosexual sex in HIV-negative, non-drug users as a means for transmitting Hepatitis C is likely to conclude that the virus is rarely transmitted sexually.

A likely consequence of the HIV epidemic first being identified in male homosexuals in the 1980s, we seem to be in the habit of using sexual orientation to determine the sexual transferability of infectious diseases. Although, the facts suggest that a more detail oriented approach is needed to ascertain infectivity. Details such as engaging in sexual activities that injure delicate tissues, HIV co-infection and previous intravenous drug use appear to be especially indicative of Hepatitis C transmission risk. Fully incorporating these risks into further investigations would be more telling of the possibility of sexually transmitting Hepatitis C than differentiating between heterosexuals, bisexuals or homosexuals.

References:

http://www.hepatitis-central.com/mt/archives/2007/07/can_hepatitis_c.html, Can Hepatitis C Be Transmitted Through Sexual Contact?, Nicole Cutler, L.Ac., Retrieved September 26, 2010, Natural Wellness, 2010.

http://www.hivandhepatitis.com/2010_conference/icaac/docs/0921_b.html, Heterosexual Sex Not a Major Risk Factor for Hepatitis C Virus Transmission, Liz Highleyman, Retrieved September 24, 2010, hivandhepatitis.com, 2010.

http://www.ncbi.nlm.nih.gov/pubmed/19841001, Prevalence, incidence and risk factors for hepatitis C in homosexual men: data from two cohorts of HIV-negative and HIV-positive men in Sydney, Australia, Jin F, et al, Retrieved September 26, 2010, Sexually Transmitted Infections, February 2010.

http://www.ncbi.nlm.nih.gov/pubmed/20153770, Unselected hepatitis C screening of men who have sex with men attending sexual health clinics, Scott C, et al, Retrieved September 26, 2010, The Journal of Infection, May 2012.

http://www.ncbi.nlm.nih.gov/pubmed/20231987, Limited evidence of HCV transmission in stable heterosexual couples from Bahia, Brazil, Bessa M, et al, Retrieved September 26, 2010, The Brazilian Journal of Infectious Diseases, August 2009.

http://www.ncbi.nlm.nih.gov/pubmed/20635398, Is sexual contact a major mode of hepatitis C virus transmission?, Tohme RA, et al, Retrieved September 26, 2010, Hepatology, June 2010.

http://www.pegasys.com/basics/hepatitis-c-spread.aspx, Hepatitis C Transmission – How People Get Hepatitis C, Retrieved September 26, 2010, Genentech USA, Inc, 2010.

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Posted by Nicole Cutler L.Ac. on February 20, 2013

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  • Rob

    I’m happy to see that you mention “sharing of contaminated sexual aids” as a risk factor for sexual transmission of hepatitis C. As a hepatitis C educator I believe the messaging around this particular risk factor is salient, but nuanced and under-emphasized.

    Similar to sharing of needles in injection drug users, sharing of sexual aids or penises or fists in the setting of group anal sex is, in my opinion, a major source of new infections. Sexual aids become contaminated with blood from a hep C infected partner which is then passed into the rectum of an uninfected partner. Unfortunately, this does not show up in much of the literature because of the failure of investigators to adequately understand the group sex setting in this population and to then ask the right questions of their study subjects.

    The following is a link to an education campaign on this subject:

    http://checkhimout.ca/blogs/sexual-health/sex-and-hep-c-qampa

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