Can hepatitis C be transmitted through sexual intercourse?

Can Hepatitis C Be Spread Through Intercourse?

Yes, hepatitis C can be transmitted through sexual intercourse, but the risk is extremely low, particularly among monogamous heterosexual couples, and no changes in sexual practices are recommended for those in stable, long-term relationships. 1

Risk Stratification by Sexual Relationship Type

The risk of sexual HCV transmission varies dramatically based on relationship characteristics:

Monogamous Heterosexual Couples (Lowest Risk)

• The risk of sexual transmission in long-term monogamous heterosexual relationships is essentially negligible (0-0.6% per year). 2, 3
• A 10-year prospective study following 895 monogamous couples (8,060 person-years) found zero confirmed cases of sexual transmission, with an incidence rate of 0.37 per 1,000 person-years—and even those rare cases were ruled out by viral genotype analysis. 2
• No condom use is recommended for persons in stable monogamous partnerships. 1

Multiple Sexual Partners (Moderate Risk)

• Risk increases to 0.4-1.8% per year among persons with multiple sexual partners. 3, 4
• Having multiple sexual partners is associated with a 2.2-2.9-fold increased risk (adjusted odds ratio), though this may be confounded by injection drug use. 5
• For individuals with multiple partners, condom use and partner notification are recommended. 1

High-Risk Groups (Highest Risk)

• HIV-coinfected individuals face substantially higher sexual transmission risk (adjusted OR 3.3-3.9 for women, 4.1-5.7 for men who have sex with men). 5
• Condom use is specifically recommended for promiscuous individuals and homosexual men. 1
• Risk factors that enhance transmission include: traumatic sexual practices (fisting, sex toys), genital ulcerative disease, anal intercourse, sex during menstruation, and concurrent sexually transmitted infections. 4, 5

Mechanism and Viral Load Considerations

• HCV RNA is detectable in genital fluids, though it remains unproven whether this represents infectious virus. 4
• The risk of HCV transmission is related to viral load level—higher HCV RNA levels increase transmission probability. 1
• Sexual transmission is much less efficient than hepatitis B virus (HBV) or HIV transmission. 1

Clinical Counseling Recommendations

For all HCV-positive patients:

• Inform prospective sexual partners of HCV status. 1
• Do not donate blood, organs, tissues, or semen. 1
• Avoid sharing items that may contact blood (razors, toothbrushes, nail clippers). 1

For monogamous couples:

• Testing the sexual partner provides reassurance but is not mandatory given the extremely low risk. 1
• No barrier protection is required, and no changes in sexual practices are recommended. 1

For those with multiple partners or high-risk sexual practices:

• Use latex condoms consistently (though efficacy for HCV prevention is unproven). 1
• Reduce number of sexual partners. 1
• Avoid contact with blood, semen, and other body fluids during sexual activity. 1

Common Pitfalls to Avoid

• Do not overstate the risk to monogamous couples—this causes unnecessary anxiety and relationship strain when the actual transmission risk is near zero. 2
• Do not assume sexual transmission when other risk factors exist—injection drug use, shared razors, or other percutaneous exposures are far more likely culprits. 3
• Do not ignore HIV coinfection status—this dramatically changes the risk profile and counseling approach. 5
• Remember that approximately 20% of HCV cases have no identifiable risk factor, but this does not prove sexual transmission occurred. 4