Yes. No, maybe.

As a health educator hepatitis C, I think it is fair to say that the issue of sexual transmission of HCV is one of the most common that make me. And unlike sexually transmitted infections such as syphilis or gonorrhea, which can definitely say that they are indeed sexually transmitted diseases, the answer to the question of HCV is definitely complicated.

Why is it complicated? We know that HCV is transmitted through blood contact with blood. Hepatitis C virus (HCV) is the pathogen most common blood-borne transmission in official US estimates They are that about 3.2 million people are chronically infected with HCV, but many experts think it is probably much higher. It is widely accepted that certain populations, some might call the “risk groups”, are at greater risk of HCV than others: for example, injecting drug users (PWIDs) and people born between 1945 and 1965 (the “baby-boom “) are two such groups. We have good data to support this, so we can confidently make recommendations for HCV testing. Similarly, we have several studies that support that there is a significant risk for sexual transmission of HCV among HIV positive gay men. We fewer studies looking for gay HIV-negative men, but so far studies have suggested a relatively low rate of HCV in this group. similar rates of HCV among heterosexuals who do not inject found: heterosexual HIV have higher rates of HCV HIV-negative counterparts. Finally, it is complicated because it is difficult to disentangle other risk factors for HCV transmission, including injecting drug use hidden that people not disclosed for fear of negative judgment and stigma.

How is hepatitis C is commonly transmitted?

HCV is transmitted through blood contact with blood. It is transmitted most often in drug users (PWIDs) who share needles and other injection equipment (cotton, cookers, water, etc.) are injected. There are several risks associated with non-injecting drug use, too: sharing straws, drugs or smoking pipes. HCV is a virus that is difficult can live in syringes for up to 63 days on surfaces for up to 16 days, and in the water for up to 21 days. There are other risks of transmission of blood contact with blood may occur: unsterile tattoo, poorly sterilized medical equipment (including dialysis machines), and other procedures in which the contaminated blood can infect you. For a summary of the people who are at risk of being infected with HCV list, see the box on the left: “Who should be tested for HCV?”

When we talk about sex, what we are referring to?

There are many different sexual practices, and sex has many different meanings for different people. For the purposes of this piece, we will be as specific as possible when it comes to sex (eg “vaginal sex” or “anal sex”), but we will focus primarily on sexual practices that have most data: anal sex (insertive and receptive), fisting, and sex toys among HIV-positive gay men. One thing to note is the presence of blood during sex: We HCV is present in the blood, but there is no evidence that is found in semen or vaginal fluids. If a sexual practice can lead to bleeding, there is some risk for HCV transmission. If you minimize the risk of blood contact with blood during sex, the risk of HCV transmission is minimized.

What is the risk for heterosexual men and women?

Although the goal of this piece is the sexual transmission of HCV among HIV-positive gay men, we are to meet the needs of other populations as well. That said, a recurring theme throughout this article is how difficult it will be the answer to questions of sexual transmission, and it is no different here with respect to risk heterosexuals. Complications arise from the wide range of relationships and types of sexual contacts: There are different degrees of risk in monogamous relationships than there are for those who have multiple sexual partners. In addition, the presence of certain risk factors can increase the risk of sexual transmission of HCV including the presence of an STD, or HIV infections.

To monogamous, serodiscordant (ie, a person has HCV and the other does not) heterosexual couples, the risk is extremely low. A recent study of 500 different monogamous couples found that the risk of transmission to be 1 per 190,000 sexual contacts. Couples in this study do not necessarily use condoms or practice other risk reduction methods, nor seem that certain sexual practices increase the risk of transmission. There have been several other long-term studies of this group and do not show an increased risk for socio-HCV negative. This does not mean it can not happen, and there are people in this group who have been infected with HCV through sex. However, the odds are against it. In fact, the authors say that this very low risk of transmission means that the partners remain monogamous need not change their sexual practices.

Whatever the information about the risk of sexual transmission of HCV in monogamous heterosexual couples may be, ultimately decides your comfort level about risk: You (and your partner) must decide sexual practices and level risk you feel comfortable, and take it from there.

While the risk for monogamous couples may be low, people with multiple sexual partners appear to be at greater risk of sexual transmission of HCV. In a review article published in 2010 by two researchers from the CDC, found that people with multiple sexual partners who have more than twice the risk of sexual transmission of HCV. Presence of coexisting diseases sexually transmitted diseases, especially those that cause an increased risk of pain, men and women alike.

Finally, although we have almost as many studies in men or heterosexual women with HIV, HIV infection significantly increases the risk of sexual transmission of HCV, as it does with gay men. One study found that women with HIV were twice as likely to achieve HCV as well as HIV-negative, and another looking at HIV positive men attending a clinic in Baltimore STD found women the risk was four times higher their HIV-negative counterparts.

What is the risk for HIV-negative gay men?

This is a very interesting question and one for which the answer may be changing. Until recently, we thought the risk was relatively low. Although we do not have the number of studies or data compared to HIV-positive gay men, when they have, showing no relationship between HCV sexually transmitted diseases and HIV-negative gay men.

A recent review of the awareness of HCV presented at ICAAC 2014 summarizes the prevalence of HCV (the amount of HCV in the community) in homosexual men in several countries (see box on the right, “HCV rates by country”).

As the review shows, rates of HCV in HIV-negative gay men are much lower than in HIV-positive gay men. In a general review article, researchers provide additional confirmation that gay men are HIV-negative have a low risk of HCV, and as HIV-negative heterosexuals who do not inject drugs, routine screening is not justified HCV.

This research goes against what many people assume: Gay men have anal sex, anal sex and can lead to bleeding. Since blood can transmit HCV, it makes sense that anal sex transmit the virus. Again, as a health educator, I hear all the time. And while the data suggest little risk, worry and anxiety about the risks remain high.

This anxiety can be validated by the results of another test, also presented at ICAAC. It is not a conclusive opinion that changes the game, but certainly serves as a warning that people should be aware of the risk of HCV in HIV-negative gay men. The numbers of this review were quite small: 44 HIV-negative gay men who were diagnosed with acute HCV infection (acute HCV is defined as the first six months of infection). The author of the study and revised the sex and practices that these men engaged in, and found several high-risk activities that we have been associated with sexual transmission of HCV in HIV-positive gay men in drug use: anal sex without a condom , group sex, fisting, drug use with sex, the presence of a sexually transmitted disease, and limited knowledge of the status of partner. While it is true that some of these men may have acquired HCV drug (either intranasally or injection), 42% of them reported that it is useless, suggesting sexual transmission as the source infection. Finally, a key point made by the author is that we do not offer detection of HCV to HIV-negative gay men, so perhaps we need asymptomatic HCV infections in this group.

Therefore, what is our takeaways? HCV rates among HIV-negative gay men may be low, but should be aware of the risks. Even if sex could not be the direct mode of transmission, we know that the risk factors that can lead to HCV infection, as we know those who facilitate the sexual transmission. gay HIV-negative men who have anal sex without a condom with partners of unknown HIV status, fist, and / or use drugs, particularly in combination with gender, must take into account the detection of HCV as part of their practice of awareness sexual health.

What is the risk for HIV-positive gay men?

This is the area where we have most of the evidence and the area where we have the greatest confidence: gay men with HIV are at increased risk of sexually acquired HCV are other groups. That said, it can still be a bit tricky when you start to break down. For example, we know that HCV is transmitted through blood contact with blood, but what about sexual fluids? The truth is we do not know. Some studies have found HCV in semen, while others have not. In the end, either in the semen or not, we know that is in the blood, and sexual practices that can lead to bleeding risk transport for HCV transmission.

As we saw in the picture, “HCV rates by country”, compared the prevalence of HCV in HIV-negative gay men HIV-positive gay men, there are much higher rates of HCV in people living with HIV . HIV-positive within the group, we see similar behaviors: unprotected anal sex, group sex, fisting, and so on. So what accounts for the highest rates in this population? One possible explanation is serosorting, or practice of only having sex with someone who has the same HIV status. Many gay men have carried this practice to prevent transmission of HIV to the negative sexual partners. Gay men can become aware of their HIV status of your partner, but not their HCV status, and if you engage in anal sex without a condom (or fisting) risk for HCV is higher.

What is the role of HIV itself and the risk of transmission of HCV from sex? It certainly makes sense that a weaker immune system may make it more vulnerable to HCV infection. Although data on this are not great, we have an excellent overview showing a relationship between low CD4 counts and increased risk of HCV. In addition, HCV rates were higher in HIV-positive gay men with CD4 counts below even when they had fewer risk factors for HCV. We do not know what protection factor taking anti-HIV drugs could be against sexual transmission of HCV, but we know that all the health benefits that otherwise, so it can not hurt. Regardless of CD4 count, you want to minimize the risk of contact with blood to minimize the risk of transmission of HCV. In the next section the risk factors of sexual transmission of HCV have been identified in a variety of studies for HIV-positive gay men are examined.

What factors increase the risk of sexual transmission for HIV-positive gay men?

As mentioned briefly above in the previous section, there are several activities and behaviors that increase the risk of sexual transmission of HCV. Check out the box at the bottom of this page, “What activities increase the risk of sexual transmission of HCV?” For a review of the risk factors that are associated with sexual transmission of HCV.

How is tested for hepatitis C?

Testing for HCV can be a bit confusing, especially if you are accustomed to HIV testing. HIV testing in a positive antibody test means you have been infected with HIV. In HCV tests, two tests to confirm that you are infected, and that 20-25% of people who contract HCV virus naturally be cleared in the first six months they are needed. These people always put a positive antibody test, but has no real virus damage the liver. Therefore, it is possible to obtain an antibody test positive HCV, but are not infected with HCV. Because of this, testing positive HCV antibody should be followed with a viral load test confirmation. The picture on the left shows the range of tests for HCV and its meaning.

If you are at risk of HCV infection, talk to your doctor about taking a test. There may also be organizations based in the community or other drop-in clinics where you can get a test for HCV antibodies (including a rapid test), but always want to make sure that there is a viral load test confirmation available in case a positive result.

How often should I get tested for hepatitis C?

There are no clear guidelines for how often a person should be tested for HCV, especially for those who are at risk of sexual transmission. In fact, the sexual transmission of HCV is not included in any of the guidelines or risk-based birth cohort CDC. recent recommendations from the AASLD / IDSA call for “proof of annual VHC people who inject drugs and for HIV positive men who have unprotected intercourse with other men. Periodic testing must be offered to other people with factors ongoing risk for exposure to HCV. “There are other national and international, that we can take to give us an idea of ​​how often a person at risk for HCV should detect its presence recommendations and guidelines.

How I can reduce my risk for hepatitis C?

Knowledge of risks for HCV is the first step to reduce it. Hopefully this article has given you enough information about sexual transmission of HCV can make their own informed decisions to reduce the risk of it. Increasing awareness of the blood and reduce the risk of blood contact with blood during sex will reduce the risk of sexual transmission of HCV. Check out the information sheet on this page for tips and techniques to reduce the risk of sexually transmitted HCV.


hope this helps to clarify the confusing issue of sexual transmission of HCV. There’s a lot to it and is a topic that continues to evolve. If you are HIV negative, the risk of sexual transmission is relatively low. If you are living with HIV, the risk is higher, especially among gay men who have anal sex without a condom, engage in fisting or use non-injecting drugs during sex (among other risk factors). The take-home message is to increase awareness of hepatitis C as a disease potentially sexually transmitted diseases, and to carry out risk reduction practices to minimize the risk. And, of course, talk to your health care provider and the screen for at least annually, and perhaps more often if their risk factors justify

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