Can I Get Hepatitis C by Having Sex?

Sexual Contact and the Spread of Hepatitis C Virus

Man unwrapping condom
Is hepatitis C virus spread by sex?. IAN HOOTON/SPL/Science Photo Library/Getty Images

Can you catch hepatitis C by having sex or through other intimate behavior? Could my partner be a carrier of hepatitis C, and if so, would I know it? What do I need to know about hepatitis C whether or not I have sex?

Can I Get Hepatitis C by Having Sex?

The answer to whether or not you can contract hepatitis C by sex is yes, but there is much more that you should know. In fact, a large number of people who have the disease are not aware they are infected nor do they have any obvious risk factors.

You can get hepatitis C from having sex, but it's very unlikely. Scientists are still somewhat puzzled about this finding. Hepatitis C, like HIV is spread by direct contact with infected blood. Overall, hepatitis C is thought to be ten times more infectious than HIV. Yet the risk of hepatitis C being sexually transmitted is lower than that of HIV. Let's talk a little about hepatitis C and how it is transmitted to make it clearer what the studies looking at sexual transmission of the virus easier to understand.

Hepatitis C Infection

Hepatitis C is a viral infection that was not isolated until the late 1980's. Prior to that time, the symptoms related to the infection were known only as "non-A non-B hepatitis." We've also learned that hepatitis C isn't a single disease, but actually a collection of at least six different strains of hepatitis C. Identifying which strain a person has is important with regard to both treatment and estimating the prognosis.

How Common is Hepatitis C?

Unlike hepatitis B which most often does its damage and leaves (only a small percent of people with the disease go on to become carriers), hepatitis C infection becomes a chronic (lasting) infection in roughly 80 percent of those infected. Worldwide its estimated that 170 million people are carriers of the virus, with at least three million carriers in the United States alone.

How is Hepatitis C Transmitted?

Hepatitis C is spread through infected blood direct contact. There are 7 ways in which hepatitis C is spread.

  • Blood transfusions, organ transplants, and clotting factor infusions - Before an effective hepatitis C test was developed in the early 1990's, hepatitis C (then called non-A non-B hepatitis was transmitted quite often with blood transfusions and especially clotting factor infusions. Now with testing, the risk of contracting the virus through a transfusion is only one in two million.
  • IV drug use.
  • Needlestick injuries.
  • Mother-infant transmission.
  • Sexual contact.
  • Household contact - Transmission is rare with casual contact and usually involves a shared item carrying blood, such as a shared razor or a shared toothbrush.
  • Unknown - In up to 30 percent of those diagnosed there are no discernible risk factors.

Due to the large number of people who develop the disease without any known risk factors, it's now recommended that all adults with birth dates between 1945 and 1965 be tested for the disease regardless of risk factors.

How Often is Hepatitis C Transmitted Sexually?

Looking at the methods of transmission it becomes clear why it is difficult to quantify the number of people who acquire hepatitis sexually vs other means. For example, if both members of a couple received blood transfusions before the early 90's or both used IV drugs it would be hard to determine if the infections were shared infections or if they each developed an infection independently of the other (Keep in mind that hepatitis C if fairly common, affecting over 3 million people in the U.S.)

A 2013 study found a way to address this concern. It was found long term monogamous partners of someone infected with hepatitis C picked up the infection around 4 percent of the time. Scientists next compared the specific strains of virus to see how often both members had the same identical hepatitis C virus. This occurred around 0.6 percent of the time. Based on this study it appears that, statistically, hepatitis C transmission will occur in around 1 out of every 190,000 sexual encounters. In contrast, an earlier study done in 2004 found no evidence of sexual transmission.

What Happens When Someone is Infected?

When the hepatitis C virus enters the body through the blood, it hangs around for around six or seven weeks before causing any problems. In other words, the incubation period is around six to seven weeks. At that time may people may develop a mild flu-like illness or they may have no symptoms at all. Symptoms, if present, may run their course in a few weeks up to five months. The virus may then continue to damage the liver without symptoms. Infections that continue beyond six months are considered chronic.

It can be difficult to understand what happens when the disease becomes chronic because it is most often our immune systems which do the damage rather than the virus itself. Our immune system mounts an attack on the virus which results in chronic inflammation. It is this chronic inflammation which may later lead to fibrosis (cirrhosis) or even liver cancer.

Who Should Be Tested?

It's now recommended that anyone at risk for hepatitis C be tested, especially knowing that effective treatments are available. In addition to those at risk, all adults born between 1945 and 1965 should be tested.

How Does the Risk of Transmission Compare to HIV or Hepatitis B?

As noted earlier, hepatitis C is around ten times more infectious than HIV. In other words, if you had an open cut and were exposed to both hepatitis C and HIV, you would be ten times more likely to contract hepatitis C than HIV. Yet if you were to have sexual intercourse with a person infected with both hepatitis C and HIV you would be more likely to contract HIV. The rate of mother-child transmission is also lower with hepatitis C, with around 90 percent of mothers with HIV (or five percent with treatment) transmitting the infection during childbirth, but only around a four percent mother-child transfer with hepatitis C.

Diagnosing Hepatitis C - How Can You Know if You Have the Virus?

There is a simple blood test that can be done to screen for the virus. Similar to other tests like those for HIV this is a screening test. If the test is positive further testing will need to be done to make sure you are actually infected with the virus. Doctors are also unable to determine on a screening test whether you had the infection in the past (and it is now gone) or if you have a chronic infection.

Decreasing Your Risk of Contracting Hepatitis C  or Other Sexually Transmitted Diseases via Sex

The risk of contracting hepatitis C via sexual intercourse is unclear, but it appears that the risk is increased by having multiple sexual partners, an STD or HIV infection.

If you are asking about the risk of contracting hepatitis C through sex, it's important to note that hepatitis is only one of the organisms that can be acquired in a romantic moment. Some of the other common diseases are hepatitis B, herpes, chlamydia, human papillomavirus, genital warts, HIV, gonorrhea and syphilis. One way to make sex safer is to properly use a condom. For other ways to protect yourself against hepatitis C, here are six protection strategies.

What Happens if You are Have Hepatitis C?

There have been several conditions which have been labeled the "silent killer" but hepatitis C could, at times, make the list. Extensive damage may be caused before any symptoms appear. The complications of hepatitis can include cirrhosis, liver failure, and liver cancer.

Hepatitis C Treatment

Hepatitis C can hide for an extended period of time, but often shows its face. It's thought that around 20 to 30 percent of people with long-standing chronic infections will develop cirrhosis, liver cancer, or liver failure over time. While that is a frightening thought, great progress has been made in hepatitis C treatment in recent years, with cure rates up to 99 percent in some studies.

Sources:

Centers for Disease Control and Prevention. Testing Recommendations for Hepatitis C Virus Infection. Updated 08/15/16. http://www.cdc.gov/hepatitis/hcv/guidelinesc.htm

Terrault, M., Dodge, J., Murphy, E. et al. Sexual Transmission of Hepatitis C Virus Among Monogamous Heterosexual Couples: The HCV Partners Study. Hepatology. 2013. 57(3):881-9.

Vandelli, C., Renzo, F., Romano, L. et al. Lack of Evidence of Sexual Transmission of Hepatitis C Among Monogamous Couples: Results of a 10-Year Prospective Follow-Up Study. American Journal of Gastroenterology. 2004. 99(5):855-9.

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