When people think about sexually transmitted diseases (STDs), hepatitis C (HCV) is not usually among them. But as an HCV health educator, I can easily say that sexual transmission of HCV is one of the questions I get asked most frequently. Unlike syphilis or gonorrhea, which are both definitely STDs, HCV is somewhat more complicated.
What Are the Current Realities of HCV?
HCV is a disease that affects the liver. The Centers for Disease Control and Prevention (CDC) estimates that 2.7 to 3.9 million people in the U.S. are living with HCV. If left untreated, HCV can cause scarring of the liver and increase one's chances of developing liver cancer and other serious health problems. The good news is that HCV can be cured. Today's treatments cure approximately 90-100 percent of people with HCV in just three months.
HCV is primarily transmitted through blood-to-blood contact, and the most common way for transmission to occur is by sharing injection equipment like syringes, cookers, cotton filters and water. Because of this, people who inject drugs, hormones, steroids, and other substances should get tested for HCV at least once per year.
But What About Sex?
Overall, the risk of passing HCV to a sexual partner is relatively low. If blood is present during sex (and often it is, even if we can't see it), then there may be increased risk of transmission. But even when blood doesn't appear to be present, there has been some research to suggest that HCV can also be found in semen and rectal fluids, especially in people living with HIV.
What does this all mean for LGBTQ people, particularly gay and bisexual men? If you and your partner are both HIV-negative, the chances of spreading HCV appear to be very low. It's actually so low that the CDC does not call for routine testing of HCV in HIV-negative individuals where sex is the only risk factor (This testing recommendation may be changing soon in the wake of a few small, studies that have found possible sexual transmission of HCV among HIV-negative gay and bisexual men who have never injected drugs. Some of these men were on PrEP). That said, there may still be times when you may want an HCV test. Be sure to talk to a knowledgeable healthcare provider if you have concerns.
How Does HIV Status Affect HCV Transmission?
If you and/or your partner is living with HIV, then there appears to be a much greater chance of transmitting HCV. We don't fully know why, but through patient interviews and research studies, we've discovered several factors linked to sexual transmission of HCV.
Fortunately, there are many ways to prevent the spread of HCV, many of which are detailed in HRC's Safer Sex and Safer Sex for Trans Bodies guides.
In the end, even if the overall risk of HCV may be low among HIV-negative individuals, it's important to remember that "low" does not mean "zero." That's why it's important to stay up-to-date on HCV-related news and information, especially if you or your partner is a person living with HIV.
As you move forward, remember to have fun, stay safe, and do what you can to maintain your sexual health and the health of others. Consider getting tested for HCV, and consider talking to your partners about it too. For more information about HCV, call HELP-4-HEP, a national hepatitis C helpline at: 1-877-435-7443.
Andrew Reynolds is hepatitis C education manager at Project Inform.
Additional Resources From HRC