That doesn’t mean you should throw caution to the wind: Although treatable, hepatitis C is a serious illness that can harm the liver and lead to cirrhosis, liver failure, liver cancer, and other health complications. What’s more, it usually doesn’t cause symptoms and can go undetected for years — even decades. “The risk [of transmission] comes down to whether sex results in mucosal tears in body tissues, such as to the vagina or the rectum,” says Andrew H. Talal, MD, MPH, a hepatologist and professor in the department of medicine at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, part of The State University of New York. Even the smallest tear in the skin or tissue gives the hepatitis C virus a way to travel from one body and enter the other. “You need to always think about blood being exchanged; that’s where you need to be careful,” Dr. Talal adds.
Can Hepatitis C Be Spread During Vaginal Sex?
It’s rare for the hepatitis C virus to be transmitted through vaginal intercourse. Unless the vagina isn’t lubricated or intercourse is very rough and leads to tears in the vaginal walls, there’s no opportunity for blood to be exchanged. The risk of transmission with vaginal intercourse is about 1 in 190,000, according to research published in the journal Hepatology. The U.S. Department of Veteran Affairs, which is the largest care provider for people with hepatitis C, says if one partner in a monogamous, heterosexual relationship has hepatitis C, the risk of transmission is very low, but they do recommend that the other partner get tested. Concerned couples can also discuss using a condom to lower the already very low risk of spreading the virus, says Talal. Just how safe sex is when a partner has hepatitis C hinges on other factors as well. For example, it’s important to use a new condom with each sexual act that has the potential to expose the uninfected partner to the infected person’s blood, even if you’re in a committed relationship, says the Centers for Disease Control and Prevention (CDC). Some of these situations include sex when one partner:
Has an open cut or soreHas another sexually transmitted infection (STI), especially one that causes sores or lesionsIs having a menstrual period
Keep in mind that if you have more than one sex partner, the CDC recommends always using a male latex condom. (This is especially true if you’ve been diagnosed with HIV.) If you have multiple partners, the odds increase that you’ll either infect others or become infected yourself.
What to Know About Hepatitis C During Oral and Anal Sex
Oral sex does not pose an increased risk of transmitting the hepatitis C virus unless there are open sores or cuts in the mouth, according to the American Liver Foundation. To be safe, though, the CDC recommends using a latex (or, if you’re allergic to latex, polyurethane) condom whenever you have oral sex to reduce the risk of transmitting hepatitis and STIs. Anal sex is high risk, because rectal tissue is fragile and can easily tear when manipulated or pushed to expand. If the tissue tears and bleeds, there’s a chance for blood-to-blood contact. For this reason, it’s best to always use a condom during anal sex. It’s also important to liberally apply water- or silicone-based lubricant to keep anal tissue and condoms from tearing. If you use sex toys, it may be safest to avoid sharing them. If you’re engaging in rough sex that results in skin tears, even tiny traces of infected blood that remain on a toy can pass through openings in the skin, although the risk of spreading bloodborne diseases remains very low. What’s more, the human papilloma virus (HPV) has been transmitted via sex toys, even after cleaning.
For Safer Sex, Treat Hepatitis C
If you have chronic hepatitis C, you can lower your odds of spreading the virus by seeking medical treatment. Direct-acting antiviral medications can cure more than 90 percent of hepatitis C cases with eight to 12 weeks of treatment, according to the CDC. These newer hepatitis C treatments are not only effective but also generally have fewer, much less severe side effects than previous drugs. Just be aware that during treatment, transmission can still occur. And a cure doesn’t grant you protection against the virus for life. “If you continue to engage in high-risk behavior, you can get reinfected,” warns Kenneth Sherman, MD, PhD, a professor of medicine and the director of the division of digestive diseases at the University of Cincinnati College of Medicine.
More Ways to Reduce the Risk of Infection
If you aren’t sure whether you have hepatitis C, get tested. Testing is especially important if you are having sex with more than one person or if you have other risk factors for hepatitis C, including having had a blood transfusion prior to 1992 or injecting drugs (even if you’ve only done it once). Talk to your partner about getting tested as well, for hepatitis C and other STIs, so you know the risks before having sex. “People who are at risk for hepatitis C are also at risk for HIV and other STIs,” notes Talal.
Building Healthy Sexual Relationships
Rule number one for a healthy sexual relationship: Be open and honest. “I believe in transparency,” says Talal. This conversation can be difficult, but it’s important to have. Part of discussing your status is talking about what exposure you may have had to hepatitis C, even in the distant past. It’s a good opportunity for you to share both your sexual history and your past experiences with other ways the virus can be transmitted, such as injecting drugs or being exposed to items that may have infected blood on them, including needles, razors, and toothbrushes. Dr. Sherman explains that even if you consistently use condoms during sex, other activities, such as sharing needles or straws to inject or snort drugs, increase your risk of spreading (or getting) hepatitis C. “People do not want to hear about this,” he says. “It’s difficult to get the word out about risk.” If you and your partner find that hepatitis C is disrupting your relationship or sex life, you might also want to consider working with a marriage and family therapist or sex therapist.
