Hepatitis C virus (HCV) can be transmitted sexually, although the efficiency of this mode of transmission is generally considered low compared to other routes such as injection drug use
Sexual transmission in different populations
- Monogamous heterosexual couples: The risk of HCV transmission among monogamous heterosexual couples is extremely low. A study involving 500 anti-HCV-positive, HIV-negative index subjects and their long-term heterosexual partners found that the maximum incidence rate of HCV transmission by sex was 0.07% per year, or approximately one per 190,000 sexual contacts
- Men who have sex with men (MSM): Sexual transmission of HCV is more commonly documented among MSM, particularly those with HIV. The prevalence of HCV antibodies among MSM, regardless of HIV status, is relatively high. For instance, a study found that nearly 1 in 5 MSM screened had been infected with HCV . The AASLD/IDSA 2020 guidelines recommend annual HCV testing in sexually active MSM with HIV and at least annual testing in MSM without HIV who are on pre-exposure prophylaxis
Factors influencing sexual transmission
- High-risk sexual behavior: High-risk sexual behavior, such as having multiple sexual partners, is associated with an increased risk of HCV transmission. This risk is further increased in the presence of practices that lead to mucosal trauma and the presence of genital ulcerative disease
- Coinfection with other sexually transmitted infections: Coinfection with other sexually transmitted infections, including HIV, is associated with an increased risk of HCV transmission
Counseling and education
- The AASLD/IDSA 2020 guidelines recommend counseling all MSM about the risk of sexual HCV transmission with high-risk sexual and drug use practices and educating them about measures to prevent HCV infection or transmission
In conclusion, while sexual transmission of HCV is possible, it is generally less efficient than other modes of transmission. The risk is higher in certain populations, such as MSM, particularly those with HIV, and in individuals engaging in high-risk sexual behaviors. Regular testing and counseling are recommended for these populations to prevent transmission and manage infection