Sexual Transmission of HCV

Introduction
The hepatitis C virus (HCV) often causes liver inflammation. In up to 80% of people initially infected with HCV, the disease becomes chronic, potentially leading to long-term liver damage. A small percentage (about 20%) of those who are HCV positive will progress to liver cirrhosis, and approximately 3-5% of those with chronic HCV infection will develop liver cancer. Experts estimate that at least four million Americans are currently chronically infected with HCV; the number of new cases of HCV in the U.S. is decreasing. Fortunately, there are several measures people can take to protect themselves from this potentially life-threatening disease.

How is HCV Spread?

HCV is a blood-borne disease, that is, it is transmitted by blood-to-blood contact. Any activity that lets one person's blood or body fluids to come into contact with another person's blood or mucous membranes can potentially transmit HCV. However, some activities are much more likely than others to spread the virus. HCV can be transmitted by sharing equipment for injection and non-injection drugs (for example, needles, cookers, cocaine straws, and crack pipes). Needles used for tattooing, body piercing, and acupuncture may also spread HCV. Sharing personal items like razors, toothbrushes, or nail files is a less likely – but still possible – transmission route. In the past, many people contracted HCV through blood transfusions, but since 1992 there has been a reliable HCV blood test and today donated blood is safe. Today the likelihood of contracting HCV through infected blood is less than .001%

Sex and HCV

We know that blood-borne viruses can be transmitted through certain types of sexual activity. HCV has rarely been detected in semen and vaginal fluids. However, most studies suggest that the virus is not often found in these body fluids, or that it is present in very low amounts and the virus particles may be noninfectious.

Most experts believe that the risk of sexual transmission of HCV is low. Most studies show that only a small percentage of people – usually ranging from 0-3% – contract HCV through unprotected heterosexual intercourse with a long-term, monogamous HCV-positive partner. Health Canada estimates the risk that a person will get HCV from unprotected sex with a steady HCV-infected partner at 2.5% over 20 years.

Some studies indicate that sexual transmission from men to women is more efficient than transmission from women to men.

Since HCV is spread through blood, the risk of sexual transmission may be higher when a woman is having her menstrual period.

According to the most recent (1997) National Institutes of Health consensus statement, people who have multiple sex partners should practice safer sex. Those in stable, monogamous relationships do not need to change their current sexual practices, although they should discuss safer sex options if either partner is concerned about sexual transmission.

Among people in so-called "high risk" groups (gay men, prostitutes, people with multiple sex partners, people seen at STD clinics), sexual transmission of HCV appears to be more common. The fact that people with more sex partners and other sexual risk factors have higher rates of HCV indicates that the disease is can be sexually transmitted. On the other hand, if sexual transmission of HCV were common, we would expect to see many more new cases of the disease among people whose partners are HCV positive.

Sexual transmission of HCV between men who have sex with men and women who have sex with women has not been well studied. Many studies show higher rates of HCV infection in gay men, but it is not known whether this is related to sexual activity. Anal sex may be a more efficient route of transmission than vaginal sex because the delicate lining of the rectum is more prone to damage that allows contact with blood.

There are no known cases of HCV being transmitted through oral sex on a man (fellatio) or a woman (cunnilingus). However, it is theoretically possible that the virus could be transmitted this way if a person has mouth sores, bleeding gums, or a throat infection.

There are no known cases of HCV being spread through kissing, including deep, open-mouth, or “French” kissing. It is theoretically possible that HCV could be transmitted this way if one partner has mouth sores, bleeding gums, or any other condition that could permit blood-to-blood contact. But this mode of transmission is believed to be very rare.

Special Considerations

Experts believe that HCV (like HIV) is more likely to be transmitted if either the positive or the negative partner has another sexually transmitted disease (STD), especially one that causes sores or lesions (for example, herpes or syphilis). Always have any suspicious symptoms checked by a doctor, and get prompt treatment for curable STDs such as chlamydia, gonorrhea, and syphilis.

Some studies suggest that people who are co-infected with both HCV and HIV are more likely to transmit HCV; the same may also be true for people co-infected with both HCV and hepatitis B virus (HBV). In addition, a person with HIV whose immune system is compromised may be at higher risk for contracting HCV.

Safer Sex

Some people feel more secure knowing that they are doing everything they can to prevent sexual transmission of HCV. Safer sex practices can also help prevent the spread of hepatitis A and B, HIV, and other STDs.

Using condoms is the surest way to prevent transmission of HCV and other STDs. Latex condoms are best for disease prevention; natural skin condoms have small pores that can let viruses through. Polyurethane (plastic) condoms are also a good choice, especially for people who are sensitive to latex. Internal or “female” condoms (brand name “Reality”) are polyurethane sheaths worn inside the vagina rather than on the penis.

Learn how to use condoms correctly. Most “condom failure” is really caused by incorrect use. Pinch the tip as the condom is rolled on in order to create an air pocket that will leave room for the semen. Hold onto the base of a regular condom or hold an internal condom in place when withdrawing after sex to keep the semen from spilling. Tie the condom to prevent spills, and dispose of it properly. Condoms (both regular condoms and internal condoms) should be used only once.

Some people choose to use condoms for oral sex on a man. For oral sex on a woman, barriers can be used to reduce the risk of disease transmission. Commonly used barriers include latex dental dams, sheets of plastic wrap, and latex sheets sold specifically for sex.

To prevent disease transmission through broken skin, some people use latex or nitrile (plastic) gloves or “finger cots” for manual sex. It is a good idea to cover any cuts or sores with a bandage that will not allow fluids to seep through.

Use only water-based lubricants with latex condoms or barriers. KY jelly and most commercial lubricants sold specifically for sex are water-based. Avoid oil-based lubricants (such as Vaseline, coconut oil, or moisturizing lotion) since these damage latex and can cause a condom or barrier to break. Avoid lubricants or pre-lubricated condoms that contain nonoxynol-9. Recently manufacturers stopped including this ingredient after it was shown that nonoxynol-9 caused irritation and damage to mucous membranes of the vagina, rectum, and penis that may actually increase the risk of disease transmission.

To reduce the risk of HCV transmission during oral sex or deep kissing, practice regular good oral hygiene – healthy teeth and gums may be the best defense against the spread of diseases through the mouth. Many experts recommend that people avoid brushing or flossing their teeth right before or after oral sex or deep kissing, since these can cause bleeding gums and tiny abrasions.

Conclusion

While sexual transmission of HCV remains somewhat controversial, most studies indicate that transmission through sexual activity is uncommon, and most experts believe the risk of sexual transmission is low. According to the National Institutes of Health, people in stable, monogamous relationships do not need to change their current sexual practices, although they should discuss safer sex options if either partner is concerned about sexual transmission. People with multiple sex partners should practice safer sex, in particular the use of latex condoms.

This information is provided by the Hepatitis C Support Project. The Hepatitis C Support Project offers support to people affected by hepatitis C. The Project provides information, education, and support groups.

This information is provided by the Hepatitis C Support Project. Reprint permission is granted and encouraged with credit to the Hepatitis C Support Project.

Copyright 2002
Hepatitis C Support Project/HCV Advocate http://www.hcvadvocate.org