From the information I have gathered over the years as well as here on your very informative site, the risk of spreading Hep C sexually is minimal if at all (with no trauma). I have it and did not give it to my husband of 15 years, or the following 2 partners I had during the next 10 years. Is it more likely for a man to give it to a woman than it is for a woman to give it to a man during sex? Does it depend on viral load?

As you have nicely pointed out, the risk of sexual transmission of HCV between monogamous couples is extremely low. In the past the risk was quoted as 1 to 3 percent, but more recent studies of even larger number of patients (895 in one study) demonstrate that the risk is even lower, especially if there is no associated trauma.

Most sexually transmittted diseases are transmitted more efficiently from a man to a female. However, with hepatitis C it is not clear since overall sexual transmission is so low.

As for viral load, we know more about the effect of high levels of HCV RNA on perinatal transmission, but not so well on sexual transmission.

And as for men who have sex with men, there are more and more case reports of acute hepatitis C - especially in the context of sexually transmitted diseases and sexual trauma.

Dr. M.