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The hepatitis C virus is most often transmitted by blood. In certain cases, it is possible for the virus to be transmitted vertically or sexually.

HCV can survive more than six weeks in the open air. To ensure that the HCV virus is fully eradicated, only autoclave sterilization or ionizing radiation machines are reliable.

Transmission by blood

HCV is majoritarily transmitted by exposure to blood. Transmission requires a port of exit from a person who is a carrier of the virus, a mode of transmission and a port of entry to an uninfected person.

In Egypt, for example, 15% of the population were carriers of HCV antibodies in 2008. The causes of this epidemic are associated with campaigns for treating parasitic bilharzia (schistosomiasis) between 1950 and 1980. The use of reusable needles and other insufficiently sterilized materials led to a vast transmission of HCV. Since 1992 in Canada, the use of blood products, tissue and other medical materials has been highly controlled and safe..

Sharing personal hygiene tools such as nail clippers, toothbrushes or razors may also be a mode of transmission for HCV. Certain practices involving piercing or cutting skin–such as tattooing, acupuncture, wet cupping therapy or BDSM – are also risks for transmission if they are not performed with sterile and single-use equipment.

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Sexual transmission

Sexual transmission of HCV is rare; it is even rarer in the context of heterosexual sex. According to a 2013 study, transmission only occurs at a rate of 0.07% of serodiscordant monogamous heterosexual couples per year. This is considered an insignificant risk.¹

Nevertheless, it is important to note that gay and bisexual men who have sex with other men (GBMSM) face an increased risk of HCV transmission. Seropositive GBMSM who consume drugs (often by injection) in a sexual context are the most at risk of contracting HCV.² Lastly, an increasing number of sexually transmitted HCV outbreaks has been reported recently–some of which are associated with drug use–which particularly impacts those living with HIV. According to a study, the prevalence of HCV is slightly higher among GBMSM who are HIV-negative (1.58%) and much higher among HIV-positive GBMSM without a history of drug use via injection (7%). This data is in comparison to the general population. A 2017 study estimates that, in wealthier countries, the incidence rate of HCV among HIV-positive GBMSM Is 19 times higher than those who are HIV-negative.³

There are sexual practices that pose a higher risk to HCV exposure in the GBMSM community. The same is true for drug use within a sexual context.⁶ These risk can include:

• The presence of another STBBI;
• Anal sex without a condom;
• Anal penetration with a fist (fisting) without protective gloves;
• Sharing sex toys;
• Multiple sexual partners;
• Group sex;
• Anal cleaning or douching;
• Practices involving cutting or piercing skin (e.g.: BDSM);
• Drug use prior to or during sex (Party’n Play or Chemsex).⁷

Oral sex is considered a very low risk for HCV transmission. There are no known cases of HCV transmission by oral sex, but the risk still theoretically exists.⁸

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Vertical transmission

A large scale meta-analysis reported the risk of vertical transmission of HCV to be at 5.8%. Data suggests both intra uterine and perinatal transmission.⁹

For pregnant people with HIV/HCV coinfection, the risk of vertical transmission is much greater. Some stakes estimate it being from 10% to 30%.^{10–11–12–13}

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Others modes of transmission

Contrary to HBV, there is no documented transmission of HCV by household contact.¹⁴

The risk of percutaneous HCV transmission in a professional context is estimated at 0.5%.

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References

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