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Hepatitis C Transmission

Hepatitis C is transmitted or spread when the blood from a Hepatitis C-infected person enters the bloodstream of someone who is not infected. Today, most people become infected with HCV by sharing needles or other equipment to inject drugs. Before 1992, when screening donated blood and organs for Hepatitis C was not standard in the United States, the disease was commonly spread through blood transfusions and organ transplants.

Hepatitis C can be transmitted through sex between a man and a woman, but the risk is low. Therefore, condoms are not routinely recommended for monogamous, heterosexual couples. The risk of Hepatitis C transmission is higher with unprotected anal sex between two men; using condoms will decrease this risk. All people with multiple sex partners should use condoms to reduce the risk of getting Hepatitis C and/or HIV.

Hepatitis C may be spread if there is a breakdown in the skin or lining of the mouth.  Therefore, sharing of toothbrushes, razor blades and nail clippers is not recommended.

Is hep C contagious?

Hepatitis C transmission happens only through exposure to an infected person’s blood. It is not contagious like the common cold. You cannot get, or give, Hepatitis C by:

  • Kissing
  • Hugging
  • Holding hands
  • Casual contact
  • Sneezing
  • Coughing
  • Sharing eating utensils
  • Sharing food or drink
  • Breastfeeding (unless nipples are cracked and bleeding)

Hepatitis C is believed to be transmitted only by blood. However, unlike many other blood borne viruses (like HIV) virtually any source of blood or blood products seems to be capable of carrying the virus, even if the source is indirect – like a used razor, for example. This makes hepatitis C far more transmissible than most other blood borne viruses – including HIV.

Many hepatitis C victims contracted the disease through blood transfusions in the 1970s and 1980s. Rates of post-transfusion hepatitis during this period were determined to have been between 8% and 10%. Effective bloodscreening for the virus was developed and implemented by 1990, which lowered the rates of post-transfusion hepatitis to less than 5% from 1990-1993. Since then, improved testing has led to drastic reductions in risk, down to less than 1% after 1993. However, anyone who had a blood transfusion prior to that time is at risk for having been infected. Incidence of hepatitis C infection among hemophiliacs remained high through 1993, because plasma used to treat hemophilia is often a mixture from many different donors. However, incidence of new infection among hemophiliacs has rapidly approached zero as better methods have been employed.

Tattooing, as well as many body piercing practices, such as acupuncture and ear-piercing, have contributed significantly to the spread of HCV, even in industrial nations. Needle-stick injuries, contaminated medical equipment, and blood spills in health care

settings are also responsible for many cases of HCV.

The most significant risk behavior for HCV infection is drug use, particularly I.V. drug use, and is responsible for about 30-40% of all identified cases of hepatitis C. As with HIV, the sharing of contaminated needles and other drug paraphernalia increases the chance of infection dramatically. Incidence of infection among I. V. drug users has surpassed 50 percent in many studies, and reached 100 percent in others. Cocaine users have also been shown to transmit the virus by sharing snorting straws. Heterosexual or homosexual activity with multiple sexual partners has been clearly identified as a mode of transmission, but the exact risk is unknown. Because of the lack of

sufficient information, persons in long-term, monogamous relationships are not advised to change sexual practices. Day-to-day contact with another household member that has hepatitis C has also been strongly implicated. Maternal-infant transmission has also been documented as a mode of spread. Certain specialized risks have also been identified – such as manicures, shared toothbrushes, or straight razors in barber shops.

In more than 40% of all cases, the infected individuals cannot identify a source for their infection. It is believed that most of these are due to known risk factors – however, in more than 10% of all cases, no risk factor can be identified. There are clearly other, as yet unidentified modes of transmission.

Is Hepatitis C Sexually Transmitted

Can hepatitis C be spread through sexual contact?

Hepatitis C is a contagious liver disease caused by the hepatitis C virus (HCV). The disease can be passed from person to person.

As with many infections, HCV lives in blood and bodily fluids. You can contract hepatitis C by coming into direct contact with an infected person’s blood. It can also be transmitted by contact with bodily fluids including saliva or semen of an infected person, but this is rare.

 Researchers in one 2013 study found that 1 out of every 190,000 instances of heterosexual sexual contact led to HCV transmission. Participants in the study were in monogamous sexual relationships.

HCV may be more likely to spread through sexual contact if you:

  • have multiple sexual partners
  • participate in rough sex, which is more likely to result in broken skin or bleeding
  • don’t use barrier protection, such as condoms or dental dams
  • don’t use barrier protection properly
  • have a sexually transmitted infection or HIV

Can you get hepatitis C from oral sex?

There’s no evidence that HCV can be spread through oral sex. However, it may still be possible if blood is present from either the person giving or receiving oral sex.

For example, a slight risk may exist if any of the following are present:

  • menstrual blood
  • bleeding gums
  • throat infection
  • cold sores
  • canker sores
  • genital warts
  • any other breaks in the skin in the involved areas

Though sexual transmission is rare overall, HCV may be more likely to spread through anal sex than oral sex. This is because rectal tissue is more likely to tear during intercourse.

Intravenous drug use

 The dominant way of Hepatitis C transmission comes from reused infectious needles in illegal drug use.  In developed countries, more than 60% of Hepatitis C transmission is done in such way. The frequency of Hep C patient in illegal drug users is very high.Similar is seen in prisoner population, where there are 10 to 20 times as many Hep C patients as in the rest of population, primarily because of intravenous drug use and tattoos made with non-sterile needles.

Blood transfusion

Second most common way of Hepatitis C transmission is by blood transfusion or organ transplant. Before 1990, when testing donor blood for Hep C was non-existent the probability of transmission was 1 again 200 units of blood. Nowadays all the blood is tested for Hepatitis C and the likelihood of getting Hep C with blood transfusion is 1 against 10.000. The test takes from 11 to 70 days. It is, however, important to not that because of the high cost of Hep C testing some countries choose not to test donor blood for Hepatitis C.

How else is hepatitis C spread?

According to the U.S. Department of Health and Human Services, sharing needles is the most common way somebody contracts hepatitis C.

Less common ways include using personal hygiene products from an infected person, such as:

  • razors
  • toothbrushes
  • nail clippers

The virus can’t be transmitted through casual contact, such as sharing a cup or eating utensils with an infected person. Hugging, holding hands, and kissing also won’t spread it. You can’t catch the virus from someone with hepatitis C sneezing or coughing on you.

Breastfeeding

Breastfeeding doesn’t transmit the virus to a baby, but babies born to women infected with the virus are more likely to have the virus. If a mother is infected with hepatitis C, there is a 1 in 25 chance she will pass the virus to her baby.

If a father has hepatitis C, but the mother isn’t infected, he won’t transmit the virus to the baby. It’s possible that a father could transmit the virus to the mother, which could infect the baby.

Whether the baby is delivered vaginally or via cesarean delivery doesn’t affect the risk for getting the virus.

Who’s at risk for hepatitis C?

People who’ve injected illicit drugs are at the greatest risk.

HIV and hepatitis C coinfection can be common. Anywhere from 50 to 90 percent of people who use IV drugs and have HIV also have hepatitis C. This is because both conditions have similar risk factors, including needle sharing and unprotected sex.

If you received a blood transfusion, blood products, or an organ transplant before June 1992, you may be at risk for HCV. Prior to this time, blood tests weren’t as sensitive to HCV, so it’s possible to have received infected blood or tissue. Those who received clotting factors before 1987 are also at risk.

How to reduce your risk for hepatitis C

A vaccine to protect against HCV doesn’t currently exist. But there are ways to prevent infection.

General tips for prevention

Refrain from engaging in IV drug use and be cautious with all procedures that involve needles.

For example, you shouldn’t share needles used for tattooing, piercing, or acupuncture. The equipment should always be carefully sterilized for safety. If you’re undergoing any of these procedures in another country, always make sure the equipment is sterilized.

Sterile equipment should also be used in a medical or dental setting.

Tips for preventing transmission through sex

If you’re sexually active with a person who has hepatitis C, there are ways that you can prevent contracting the virus. Likewise, if you have the virus, you can avoid infecting others.

A few steps you can take to reduce the likelihood of sexual transmission include:

  • using a condom during every sexual contact, including oral sex
  • learning to use all barrier devices correctly to prevent ripping or tearing during intercourse
  • resisting engaging in sexual contact when either partner has an open cut or wound in their genitals
  • being tested for STIs and asking sexual partners to be tested too
  • practicing sexual monogamy
  • using extra precautions if you’re HIV-positive, as your chance of contracting HCV is much higher if you have HIV

If you have hepatitis C, you should be honest with all sexual partners about your status. This ensures that you’re both taking the proper precautions to prevent transmission.

Getting tested

If you think you’ve been exposed to HCV, it’s important to get tested. The hepatitis C antibody test, also known as the anti-HCV test, measures a person’s blood to see if they’ve ever had the virus. If a person has ever been infected with HCV, their body will make antibodies to fight against the virus. The anti-HCV test looks for these antibodies.

If a person tests positive for antibodies, doctors usually recommend more tests to see if that person has active hepatitis C. The test is called an RNA or PCR test.

You should visit your doctor regularly to have an STI screening if you’re sexually active. Some viruses and infections, including hepatitis C, may not cause symptoms for several weeks after exposure. In the time it takes for the virus to be symptomatic, you may spread it to a sexual partner without knowing it.

The bottom line

About 3.2 million people in the United States have HCV. A large number of them don’t know they have it, because they don’t experience symptoms. During this time, they can pass the virus on to their partners. And although sexual contact isn’t the most common way a person gets hepatitis C, it can happen. It’s important that you ask your sexual partners to be tested regularly and to practice safe sex by properly using protection, such as condoms. Regular testing and practicing safe sex will help keep you and your sexual partners safe and healthy.

Sexual Transmission

The topic of sexual transmission of HCV has been controversial. It is believed that HCV can be transmitted sexually, but that it is inefficient — meaning, it is not easy or likely to pass the virus during sex. On the other hand, HCV infection is very efficient when it is passed from the blood of one person to the blood of another person, such as when people share needles for drug use. The frequency of HCV transmission between monogamous sex partners is very low according to most studies. However, the likelihood of sexual transmission of HCV is increased under any of the following circumstances:

 Having multiple lifetime sex partners

  • Engaging in rough sex such as anal sex
  • Having a history of a sexually transmitted disease
  • Having HIV
  • Having sex with a prostitute or intravenous drug user
  • Having sex during menstruation or whenever blood is present

When counseling patients regarding sexual transmission, the following issues may be relevant:

  • For discordant couples, with one HCV-positive partner and one HCV-negative partner, the negative partner should be regularly screened for HCV infection.
  • For discordant couples in long-term monogamous relationships, a change in sexual practices is not necessary (e.g., if they have not been using condoms, they do not have to start using condoms).
  • For patients who have new or multiple partners, HIV infection, or high-risk sexual behaviors, it is recommended that they use condoms and exercise caution regarding potential blood exposure to help reduce the chance of HCV infection.
  • For HCV-negative patients who have a new HCV-positive partner or engage in high-risk behaviors with a partner of unknown HCV status, regular screening is recommended.

Household Transmission

The prevalence of HCV among household contacts of people with HCV infection is low. Care providers need only advise patients to take “common sense” precautions such as not sharing items that may have blood on them (e.g., razorblades, toothbrushes) and properly covering open cuts or wounds.

The study of HCV transmission among household contacts is complicated by the difficulty of ruling out other possible modes of acquisition.

Occupational Exposures

Health care workers who have exposure to blood are at risk of infection with HCV and other bloodborne pathogens. The prevalence of HCV infection, however, is no greater in health care workers, including surgeons, than for the general population. According to the CDC, the average rate of anti-HCV seroconversion after unintentional needlesticks or sharps exposure from an HCV-positive source is 1.8% (range 0%-7%). An Italian study of 4,403 needlesticks among healthcare workers found 14 seroconversions (0.31%). There is an emerging body of literature, however, that close follow-up of health care workers after a needlestick from a patient with chronic HCV, with early interferon and ribavirin therapy for the healthcare worker if they develop HCV viremia but fail to clear within 3-6 months, can be a beneficial management strategy.

How is hepatitis C transmitted?

Hepatitis C is a blood-borne virus, which means that a person must come in contact with infected blood to contract it.

According to the WHO, the most common ways of transmitting hepatitis C are:

  • Injecting drugs using an infected needle.
  • Using or reusing medical equipment, such as syringes and needles, that have not been properly sterilized.
  • Receiving a blood transfusion from blood or blood products that were not adequately screened.

Before 1992, the United States’ blood supply was not as widely or heavily screened for diseases, such as hepatitis C, as it is today. As a result, people who received blood or organ transplants were at greater risk of getting hepatitis C.

Today’s screening methods are much more stringent. However, it is possible that someone may have received infected blood a long time ago, and they may not know they have the hepatitis C infection.

Less common methods of transmitting hepatitis C include:

  • having sex with an infected person
  • passing the virus between mother and baby
  • using personal care items, such as toothbrush or razor, that were in contact with an infected person’s blood,

The WHO estimated that 1.75 million people were newly infected with hepatitis C in 2015. Once a person has the virus, it will typically start to spread among cells after 2 weeks to 6 months time.

Many people, particularly those that have chronic hepatitis C, may not experience symptoms until much later.

Risk factors

Because chronic hepatitis C often does not cause immediate symptoms, a person might not discover that they have the infection until they have already experienced significant liver damage.

For this reason, it is important that people know in advance how hepatitis C is transmitted. This critical knowledge can help people avoid spreading or contracting hepatitis C.

The following groups may be at risk of contracting hepatitis C:

  • people who inject drugs
  • people who have received infected blood products or blood products from healthcare facilities with inadequate infection control processes, usually before 1992
  • people who have a sexual partner with hepatitis C
  • people with HIV
  • people who have tattoos or piercings, particularly those done in unregulated facilities
  • healthcare workers, who can become accidentally infected by a needle

A person who has had hepatitis C previously or another type of hepatitis may still be at risk of developing a hepatitis C infection.

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