Dear Dr Louise,
As a poz guy who is sexually active, I am pretty savvy about what I do and who I do it with. While I use condoms with partners whose status I don’t know, I sometimes don’t with other poz men. This means STIs[Sexually Transmissible (or Transmitted) Infection] Infections spread by the transfer of organisms from person to person during sexual contact. Also called venereal disease (VD) (an older public health term) or sexually transmitted diseases (STDs). can be an issue and I get regular tests for them. But what about hepatitis C? I have heard it is sexually transmissible. Is this the case or not?
Rick, Sydney
Dr Louise replies:
Thanks for raising this issue, Rick.
Hepatitis C (HCVHepatitis C virus.) is transmitted through exposure to infected blood. In Australia, 70 to 85% of transmissions occur through unsafe injecting practices (i.e. sharing fits, water, spoons or tourniquets). Unsterile tattooing and body piercing is also a risk but rare in reputable studios. Anyone considering a piercing or tattoo should ensure their practitioner adopts strict precautions (with single use needles, gloves and so on). Infection control guidelines designed to prevent the transmission of blood-borne virusesA small infective organism which is incapable of reproducing outside a host cell. and other diseases are adhered to in Australia so transmission in medical settings is extremely rare.
Because levels of the virus found in semen, vaginal secretions and saliva is low, the risk of sexually transmitting hepatitis C is low. But this information comes mainly from observing large populations of serodiscordant heterosexual couples in international studies.
In the last few years there has been a number of HIV positive MSM contracting hepatitis C seemingly without any of the traditional risk factors. These transmissions have most probably occurred in settings where a diverse range of unprotected sexual practices increase the risk of blood and body fluid exchange.
Transmission requires blood from an infected person to enter the blood stream of another person (perhaps through cuts and abrasions) and this could occur during particular sexual activities, especially rough sex play that may cause damage and even microscopic blood loss or cuts.
The natural history of HCV is quite complex. On contact with the virus, some people develop symptoms and an initial illness that may cause lethargy, nausea, vomiting and sometimes jaundice. However, many people experience no symptoms and therefore are unaware that they have been infected at all.
30 to 35% of those infected spontaneously ‘clear’ the virus (i.e. they are no longer infected with HCV). However, for many people the virus remains and they become chronically infected. Ultimately this may result in abnormal liverA large organ, located in the upper right abdomen, which assists in digestion by metabolising carbohydrates, fats and proteins, stores vitamins and minerals, produces amino acids, bile and cholesterol, and removes toxins from the blood. function, fatigue and in some cases cirrhosis of the liver, but most people show no symptoms at all.
People exposed to the hepatitis C virus will develop antibodies and these usually remain for life, even if the virus is cleared. It is therefore important when people have a hepatitis C antibody test and it is positive that a further confirmatory test is requested which confirms whether they still have hepatitis C. This test looks for the virus particles in the blood and is called a PCR test.
HCV is a treatable infection. In some cases it can be cured with antiviralA medication or substance which is active against one or more viruses. May include anti-HIV drugs, but these are more accurately termed antiretrovirals. medications. Treatment advances have improved the outcomes for people with HCV and we recommend anyone who has a positive PCR test discuss treatment options with a specialist. Even if treatment might be a way off, discussing it can offer information and hope for the future.
There are also some important lifestyle issues.
It is recommend that people consume alcohol only in moderation or, ideally, abstain altogether. Alcohol is metabolised by the liver and if the liver is damaged by the virus, alcohol can make it worse. People who have HCV and drink to excess tend to have more severe liver injury, more rapid disease progression, and a higher frequency of cirrhosis and hepatocellular carcinoma.
It is also important to manage your HIV and hepatitis B infections as they can also impact on the virus.
If you are at risk for HCV, you should have regular HCV testing, extend your safe sex practices to protect you from possible transmission of the virus, and ensure your vaccines for hepatitis A and B are up to date. All positive hepatitis C antibody tests should be followed by a PCR test. Some people will find they have cleared the virus and won’t have chronic hep C, which is great news to get.
There are some excellent resources for you to read and you can start with www.hepcvic.org.au
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