Introduction
Hepatitis C (also called hep C) is not classified as an STI (sexually transmissible infection) although people, unable to identify any other risk factors, may believe they may have contracted hep C sexually.
General transmission of hep C
Hep C is most commonly transmitted through blood-to-blood contact, i.e. when the blood of someone with the virus enters the bloodstream of someone else. This can occur through:
- Sharing needles or syringes or any other drug injecting equipment
- Unsafe tattooing or body piercing
- Less common means are from mother to baby at birth (vertical transmission), household transmissions (e.g. sharing razors and toothbrushes) and occupational transmission (e.g. through needle-stick or sharps injuries).
- There is no documented evidence that breastfeeding spreads hep C. If a nursing mother’s nipples are cracked and bleeding, she should stop nursing temporarily until her nipples are healed.
- Before hep C tests were introduced in Australia (in 1990), some people received contaminated blood transfusions or blood products. All blood donations in Australia are now screened for hepatitis C.
- Being hep C positive (also called “having chronic hep C”) means that you have tested positive with the hep C PCR blood test. Antibody tests can’t confirm whether or not you actually have hep C.
HCV transmission during sex: is it possible?
Some research suggests that a small percentage of people do contract hep C through blood-to-blood contact that may occur during sexual contact. Thus, transmission of hep C during sex is seen as possible but is believed to be rare.
If hep C is transmitted during sex, it is likely to be through blood-to-blood contact. This emphasises the need for safe sex practices where there is a risk of blood-to-blood contact, e.g. sex when you have cuts or lesions on or close to the genitals, during anal sex (because the anus lining is easily broken), during menstruation, and during sexual practices that may involve bleeding or broken skin.
Some studies suggest a slightly increased rate of hep C transmission in people with multiple sexual partners and high levels of sexual activity. These studies, though, have usually found it difficult to exclude other possible routes of transmission, e.g. injecting drug use.
Research increasingly suggests the risk of transmission of hep C through sexual contact among heterosexual people is minimal.
Sex and relationships
Because hep C is not classified as an STI, people with chronic hep C do not need to consider making dramatic changes within their sexual relationships.
It is currently believed that a decision to use safe sex practices depends on the nature of the sexual relationship.
With new or casual sexual partners, or any instances where there may be blood-to-blood contact during sex, safe sex practices should always be used to protect against the wide range of STIs.
Within monogamous sexual relationships where one or both partners is hep C positive and there is little risk of blood-to-blood contact, there is no need to adopt safe sex practices.
Safe sex and sexually transmitted diseases
All sexually active people should consider safe sex because of the risk of contracting a sexually transmissible infection. STIs include conditions such as genital herpes, HIV, hepatitis B, gonorrhoea, syphilis, chlamydia, crabs and genital warts.
If you have any condition that involves scratching, sores or blisters (especially when these may come into contact during sexual activity) the possibility of blood-to-blood contact and transmission of STIs is increased.
Men who have sex with men
In a nutshell, there is an increased risk of sexual transmission for men who have sex with men (if one or more partners has HIV).
It is estimated that up to 5 per cent of gay men and men who have sex with other men have hep C, compared with 1 per cent of the general population. Around 13 per cent of people with HIV in Australia also have hep C.
Among men who have sex with men, the risk of hep C being transmitted is higher if one or more partners has HIV, or if the sex involves blood-to-blood contact, of if they have other STIs, or if recreational drugs are used.
To reduce the risks:
- use condoms and lots of lube for anal sex
- wear gloves and use lots of lube for fisting
- use condoms on toys and change them between partners, or wash toys with hot soapy water and dry them between partners
- if affected by alcohol or recreational drugs, your judgement around risks will be impaired and you’ll have decreased inhibitions so take special care to avoid blood-to-blood contact.
Some men choose not to use condoms when having sex with other men who believe they have the same HIV status. This is called sero-sorting and can further increase people’s risk of contracting hep C.
For more information about anything in this factsheet, phone the Hepatitis Infoline on 1800 803 990.
This factsheet was developed by Hepatitis NSW. It was produced with assistance from NSW Health, Drs Ingrid van Beek, Alex Wodak and Leena Gupta, and Profs Geoff McCaughan, Geoff Farrell, Michael Kidd, Sue Kippax and Bob Batey. “Men who have sex with men and hep C transmission” section based on information provided by Positive Life NSW.
