Hepatitis C and sex: Transmission, symptoms, and treatment

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Hepatitis C is a liver disease caused by a viral infection. This common blood-borne viral infection often spreads through sexual practices that expose people to blood.

The hepatitis C virus (HCV) causes the liver infection hepatitis C. The infection can be short-lived (acute) or long-term (chronic).

The World Health Organization (WHO) estimates that nearly 71 million people have chronic hepatitis C. The Centers for Disease Control and Prevention (CDC) estimate that there were 50,300 acute hepatitis C infections in the United States in 2018.

This article will explore the sexual transmission of hepatitis C. It will also cover other modes of transmission, hepatitis C diagnosis, and the current treatment options.

Scientists have identified seven strains, or genotypes, of HCV that can cause hepatitis C. The HCV strain a person has can dictate the treatment type that is most appropriate for them.

Genotype 1 is the most common HCV genotype in the United States. The next two most common genotypes are genotypes 2 and 3.

The virus causes acute and chronic infections. Acute infections are shorter while chronic infections can be life-long.

The infection causes liver damage and inflammation. In the long term, it can lead to cirrhosis and liver cancer.

HCV is a bloodborne virus. People can transmit it through blood that carries HCV or body fluids that contain blood.

Someone without HCV can contract the virus through sex without a condom or other barrier method if they come into contact with blood that contains HCV. However, the risk through this mode of transmission is low.

A 2014 study found that the likelihood of sexual transmission of HCV among heterosexual couples was low and that the risk per sexual contact was 1 per 380,000.

According to the CDC, out of 1,350 cases of acute hepatitis C reported in 2018 in the United States, 105 people reported sexual contact as a risk behavior.

Men who have sex with men are at a higher risk of transmitting HCV. A 2019 study found that the incidence of sexually transmitted acute hepatitis C virus infection in both HIV-positive and HIV-negative men who have sex with men was higher.

Some sexual practices, such as anal sex, can increase the risk of transmitting HCV. The risk is higher as the tissue of the rectum can be torn and lead to blood exposure. Similarly, sex during menstruation can also increase the risk of transmitting HCV.

Oral sex has a low risk of transmitting HCV, and there is currently no evidence this practice spreads hepatitis C.

However, the virus may spread if a person has cuts or breaks in the lining of the mouth or if a person has open sores or bleeding gums.

Certain practices can transmit hepatitis C, including:

  • drug use through injection (also known as injection drug use or IDU) and sharing needles
  • improper sterilization and reusing of medical equipment
  • use of unscreened blood and blood products in transfusions
  • sexual practices that increase the likelihood of blood exposure

In the United States, the most common mode of HCV transmission is injection drug use. According to the CDC, 72% of cases of acute hepatitis C in 2018 reported IDU.

Other modes of transmission also exist, but these are low risk or rare. These include:

  • sharing items that have traces of blood, such as toothbrushes or razors
  • needlestick injuries in hospital or healthcare settings
  • unregulated tattooing

Certain risk factors can increase the chance of HCV transmission. These include:

  • having sex without a condom or other barrier method with a person that has hepatitis C
  • sharing needles or injecting drugs
  • living with HIV, thalassemia, or hemophilia
  • being a man who has sex with men
  • having had a blood transfusion or organ transplant before July 1992
  • working in a healthcare environment where there is an increased risk of blood exposure
  • sharing personal items such as toothbrushes and razors
  • receiving hemodialysis
  • being born to a mother with hepatitis C
  • having multiple sexual partners

According to the World Health Organization, 80% of people who contract HCV initially do not show symptoms. However, a person may not experience symptoms until 2 weeks after they contract the virus, or even up to 6 months later.

Symptomatic people may experience:

  • fatigue
  • fever
  • decreased appetite
  • nausea
  • vomiting
  • abdominal pain
  • dark urine
  • gray-colored stool
  • pain in the joints
  • yellowing of the skin and whites of the eyes, known as jaundice

Generally, people with long-term, or chronic, HCV do not have any specific symptoms other than depression and fatigue.

Early diagnosis can help prevent transmission of the virus to others. Anyone who feels they could have contracted HCV should see a medical professional. A doctor may order a blood test to detect the presence of HCV.

The blood test will look for anti-HCV antibodies. Antibodies are a type of protein produced by the body in response to a foreign substance, namely, the virus. The presence of anti-HCV antibodies in a blood test suggests a person has had an exposure to HCV.

If this test is positive, the doctor may order a nucleic acid test for HCV ribonucleic acid (RNA). They use this test to confirm their diagnosis, as 30% of people with HCV spontaneously clear the infection but can still test positive for anti-HCV antibodies.

Tests can detect HCV RNA levels as early as 1–2 weeks after exposure to HCV.

People can get a test for HCV at their local general practitioner, hospital, or dedicated sexual health clinic.

If a person thinks they may have contracted HCV from sexual intercourse, they can also get tested for other sexually transmitted infections (STIs).

The CDC recommends that universal hepatitis C screening be offered to:

  • all adults over the age of 18 at least once in a lifetime
  • all pregnant women during each pregnancy

Doctors use antiviral medication to treat hepatitis C. Some people may not require treatment if their immune system can clear the infection.

According to the CDC, 90% of people with an acute HCV infection can clear it if they receive oral antiviral medication for 8–12 weeks.

The World Health Organization recommends pan-genotypic direct-acting antivirals (DAAs) for people over age 12 with chronic HCV infections.

Examples of medications that doctors may prescribe to treat hepatitis C include:

  • daclatasvir
  • ribavirin
  • peginterferon alfa-2a
  • simeprevir
  • sofosbuvir
  • elbasvir
  • ledipasvir

According to the World Health Organization, approximately 30% of people with HCV spontaneously clear the virus within 6 months and without the need for treatment.

Furthermore, antiviral medication can cure over 95% of people with hepatitis C infection.

The outlook for acute HCV infection is generally good. While some may spontaneously clear the infection, most people can clear the infection with antiviral medication.

However, in people with untreated chronic hepatitis C, the outlook may differ. They may develop cirrhosis or liver scarring, or liver cancer.

According to the CDC, of every 100 people who contract HCV, 5–25 people will develop cirrhosis within 10–20 years.

There is currently no vaccine for hepatitis C. One of the main challenges of developing a vaccine is the presence of different genotypes and subtypes of HCV.

The most effective methods of prevention are avoiding practices that increase the risk of transmitting or contracting hepatitis C. These include:

The WHO also recommends these secondary prevention steps for people with HCV:

  • education and counseling on treatment options
  • immunization with hepatitis A and B vaccines
  • regular monitoring for early detection of chronic liver disease
  • early medical management

Hepatitis C is an infection of the liver caused by the hepatitis C virus. It causes liver damage and inflammation and can lead to cirrhosis and liver cancer.

The risk of transmitting and contracting hepatitis C during sexual intercourse or oral sex is low. However, certain sexual practices can increase the risk.

Data has shown a higher risk of HCV transmission in men who have sex with men. The risk is also higher in people who use injected drugs.

Doctors can treat and potentially cure hepatitis C. People should see a medical professional for diagnosis and appropriate treatment. As there is no vaccine for hepatitis C, prevention methods and education are the most effective methods to reduce the risk of transmission.



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