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Can Saliva Transmit Hepatitis C?

Nicole Cutler L.Ac. March 8, 2007

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With over 5 million Americans infected, the Hepatitis C virus is the most common cause of liver disease today. Although it is believed to be primarily transmitted through blood to blood contact, there are indications that other means of contracting Hepatitis C are possible. Of primary interest to those concerned with the number one cause of liver disease is the possibility of transmitting Hepatitis C via saliva.

As the most common chronic blood borne infection in the United States, the concentration of Hepatitis C virus in a drop of infected blood is exponentially higher than the concentration of HIV in a drop of infected blood. This explains why it is important to avoid anything that could possibly be tainted with any amount of blood. While not normally found in urine, semen, vaginal/cervical fluids, feces or saliva, injury or illness may cause some of these substances to be contaminated with blood.

In nearly half the cases of Hepatitis C, the infected individuals cannot identify the source for their infection. While it is believed most cases are due to risk factors involving contaminated blood, there remain unidentified modes of Hepatitis C transmission. Salivary transmission is one potential explanation for many unexplained viral causes.

Tiny and Infectious

Measuring only about 50 nanometers in diameter, Hepatitis C is an extremely small virus. A nanometer is one billionth of a meter; 200,000 Hepatitis C viruses placed end to end would only measure a single centimeter. Smaller than the wavelength of visible light, viral particles have no color. In those who are infected, Hepatitis C may produce approximately one trillion new viral particles every day.

Unlike many other viruses (like HIV), any potential source of blood to blood contact seems capable of carrying the Hepatitis C virus. This is true, even if the source is indirect, such as a used razor, making HCV far more transmissible than most other blood borne viruses. As documented by occupational exposure statistics, Hepatitis C is approximately seven times more infectious than HIV.


People with chronic Hepatitis C are advised not to share toothbrushes, razors, nail clippers or other personal articles that may have potentially been in contact with their blood. While there is very little emphasis on saliva as a vehicle of Hepatitis C transmission, under the right circumstances there is some evidence to the contrary:

  1. As published in the September 2006 issue of Journal of Viral Hepatitis, German researchers investigated the transmission of Hepatitis C via a toothbrush. A team from the University of Regensburg examined 30 patients with Hepatitis C to see whether they had contaminated their toothbrushes with the virus. They collected saliva samples from infected patients both before and after tooth brushing. Figures showed that 30 percent of infected patients tested positive for traces of the virus in their saliva before brushing their teeth, while 38 percent tested positive in their saliva after brushing. Additionally, about 40 percent of the water used to rinse the infected toothbrushes tested positive for the virus. This information confirms the caution against toothbrush sharing, and also sounds a possible Hepatitis C transitory alarm.
  2. In September of 2003, evidence that saliva contains the Hepatitis C virus was disclosed at the Interscience Conference on Antimicrobial Agents and Chemotherapy. Scientists from the University of Washington in Seattle concluded that while saliva may be infectious, the strongest predictor of viral presence in the saliva is serum viral load. Researchers found that Hepatitis C was not found in saliva if the person’s viral load was under one million. Additionally, any risk of acquiring infection through salivary contact existed only in the presence of gum disease. Investigators attribute this risk to microscopic amounts of blood in the saliva and visually undetectable open mouth wounds present in gum disease.

All possibilities must be considered in trying to determine how unknown sources of Hepatitis C infection took place. Although Hepatitis C has been detected in saliva, the necessary conditions render it unlikey—but not impossible—to be transmitted by kissing or through the sharing of a toothbrush. Before anybody panics about these potential risks, remember that there are conditions accompanying these possible modes of transmission:

  • The person with the virus must have a viral load over one million.
  • Both parties involved have gum disease.

While experts view the risk of transmitting this disease through saliva as extremely low, it is recommended to maintain good oral hygiene, and toothbrushes be used solely by their owners.


Jancin, Bruce, Hepatitis C virus may be spread through saliva: avoid toothbrush sharing, OB/GYN News, November 2003.

Hepatitis C – contamination of toothbrushes: myth or reality?, Journal of Viral Hepatitis, September 2006., Hepatitis C FAQ, US Department of Health and Human Services, 2006., The Hepatitis C Virus, Trustees of Dartmouth College, 2006., HCV: Important Study on Dried Blood Stability, Hepatitis C Support Project, January 2004., Saliva may have infectious amounts of HCV in presence of high HCV viral load and gum disease, Michael Carter,, September 2003., Stopping the Spread of the Virus, Molly Colin, Schering Canada Inc., 2006.

www.medicalnewstoday, Kissing Could Spread Hepatitis C, MediLexicon International, Ltd., September 2003., Hepatitis C Virus can Live in Dried Blood, Pennsylvania Academy of Family Physicians, 2003.

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  • Caitlin

    What about potential contaimination throught sharing a cigarette or drinking from another’s cup?

  • Candice Bowen

    Idk I need to know too??

  • Chris

    No, this I know for a fact. Ive been Hep C positive for a few years now, my viral count being pretty high, and I share drinks with my dad all the time. He’s yet to catch it..!

    • usingthatexamplethen..

      i have been hep c positive for over 25 years.. married to same person for 28 years.. do all the things that married people do.. and he still to this day does not have it.. that surprises me.. but it is true.. so i think it is really hard to get unless you use needles or get it thru a transfusion or something like that.. i just know we have had plenty of years to try to spread it to him and he still does not have it.. we had been sleeping together for several years before i found out i had it.. and he did not have it then.. when i was positive, we tested him and he was negative.. so we never considered using protection.. out of habit of not doing it before probably.. but .. ..we both have gum disease.. years of dipping tobacco.. nice habit.. and we still do not have it passing thru kissing…after brushing teeth lol… i brush teeth after any dip.. cant stand smoking.. wont buy nicotine stickers or gum.. so i dip… after almost 30 years of marriage and dating it has not been passed between us.. so.. go figure.. i think i got it after donating blood and plasma.. it was after i went there that i tested positive.. and i had donated blood many times before no problem at college and at blood drives at church and at plasma place then.. all of a sudden i was unable to donate anymore.. told i had this thing i had never heard of.. it was back in late 1980’s..I wondered if the blood banks were not testing for it yet as it was newly discovered back then..and they tested for aids but not hep c..anyway, after they told me that, I went to doctor.. did liver enzyme tests and other blood tests.. etc.. sure enough high liver enzymes and tested positive…. and still I do enzyme tests periodically to check the virus level.. it stays high.. treatments are off the charts too expensive and only very small percentage of people get any benefit after doing the treatments that are horrid on the body..and cost thousands and take weeks and weeks to go through making patients super sick during.. so doctor said to use ibuprofen and never drink alcohol again.. so, ibuprofen helps with pain/body aches etc.. but not too often or flu like symptoms get way worse.. I cannot drink any alcohol.. it makes me horridly feverish and diarrhea for several days.. even just a little.. so no drinking ever! so i am sick.. but ironically still he is not. I find that weird.. and he does not worry and wont use precautions.. does not like them.. and we still kiss and share nail clippers.. have every kind of sex possible that married people have.. so go figure.. are some people immune to it or something? that is what i wonder..

    • sb

      when your viral load is over 1 million, you CAN pass HEP C along through saliva. THAT is what the experts are saying.

  • panicked

    smoking a joint after someone with hep c

    • Breah Olczak

      What about it? Can it really be transmitted that wa?

  • Paul

    Sharing a rolled up one hundred dollar bill,……sharing a toot straw is another way that HepC is passed around.

  • Sum guy

    What about touching a bloody tissue of someone infected and then eating something with out washing your hands

  • Etznab87

    I just got tested and found out I have hepatitis c no real information was giving to me … I live in Atlanta GA just got out of prison and don’t know where to go . I’m freaking out , specially googling the price on the medication .. Is their any available free help I can get in my city ? Please help

    • becca

      hello. I am not sure with your area for sure but check with your local health district so Atlanta city health online, they should have discount medication programs at the very least. go to your community health clinic tell them you have low income and need health assistance. I hope his helps

    • Abbviefan1

      Hey Etznab87,
      After over 40 years since my only blood transfusion, two failed attempts at a cure using Alpha Interferon and then Alpha Interferon plus Ribaviron, I found a CLINICAL TRIAL on CLINICALTRIALS.GOV. There I found a clinical trial in my area and was enrolled within about 6 weeks. The study was on the “3D” , 3 pills twice a day combo from a company called Abbvie. My viral load went from over 1.5 million down to UNDETECTABLE within 2 weeks with NO SIDE EFFECTS.
      I would suggest you check this site out. The treatment is very expensive still but coming down soon Ive been told. As a side note, I suffer from fibromyalgia which I would describe as muscle and joint pain all over, but this began when I was on the interferon treatments over 15 years ago and never left, not the current regimen. It keeps me from sleeping at night which is problematic to say the least. I am just relieved that the virus is no longer attacking my liver after all of these years.

    • good sam

      atlanta harm reduction coalition

  • Worried

    So my friend has hep C ive obviously never swapped blood but we smoke together and get drunk together frequently. Im not going to catch hep c from this right ?

  • Vee

    Can u get it from kissing, ?from saliva?

  • potnot

    it is a blood to blood virus I had it for 45 years got treatments and got rid of it.also have been married 35 years still have a healthy sex life and my wife never contracted the virus it is very had to spread I got infected from a blood transfusion

    • Abbviefan1

      potnot, my experience has been the same as yours. I’ve been with 3 different women partners for over 10 years each and none of them got HCV even though we took little precaution in the early days as I had no idea I had the disease – there was no test for it yet.

  • Britt

    I have a question about the likelihood of contacting hepatitis c that I am going this group can help answer. My sister is an active IV drug user – no longer “illegal” drugs, but shooting up various prescription medications. She appears to regularly have fresh looking puncture/needle markes on her hands and arms, even though she swears they are just scars, and that she isn’t injecting anything anymore. I did see blood running down her arms last time I saw her. She said she couldn’t explain why. My sister was diagnosed with hepatitis c a few years ago and was hospitalized once for liver complications.

    To my question… I have a 11 month infant son who I am very reluctant to allow my sister to hold, all of this considered. I just don’t feel I can trust her, that there isn’t dried up blood underneath her clothes or on her hands, which my son could possibly touch, put directly in his mouth, etc. I have told her that until I understand any potential for harm a little better, that I am not comfortable with her holding him (they tend to go outside and walk/play, snuggle throughout the house, etc.)

    Is this overkill on my part? Couldn’t my son contract something if perhaps I flipped his nails, for example, and he had an open wound, touched her dry blood, and put his fingers directly in his mouth? I just want to protect my son as best as I can while, ideally, maintaining my relationship with my sister who is currently furious with me because of all of this. I’d love everyones feedback! Thank you.

  • sarah

    I just found out my 5 month old has hep c am I going to loose him

  • Tammy

    What happenif I’m a dental assistant and my patient has Hepsie and water splashes in both my eyes from patient

  • Tammy

    I have been exposed by saliva from a hep C patient