You Should Know: Sex and Hepatitis C

[Guest guest]

You Should Know: Sex and Hepatitis Cby Cara BruceAccording to the Center for Disease Control, one in fifty Americans, and 200million people worldwide, are infected with the Hepatitis C virus. Thisepidemic is much larger than HIV, and chronic liver disease and cirrhosisnow rank as the tenth leading cause of death.Hepatitis C (HCV) is chronic in about 85% of the people who are exposed toit. It is an RNA virus that attacks and kills liver cells where itmultiplies. The virus is often "silent" -- meaning there are often nosymptoms until the infected person is sick with some type of severe liverproblem. Although, many people do report flu-like symptoms during the acutephase of the illness -- either during the seroconversion period or the first6 months of contracting the virus. Some people are never affected, whileothers develop chronic fatigue or become so sick they are disabled.HCV can lead to cirrhosis, fibrosis or liver cancer. Right now the onlytreatments are Interferon-based medications, which can be just asdebilitating as the disease itself, and aren't guaranteed to completely"clear" the virus. Many people have compared Interferon to chemotherapy andthe most common type of hep C in North American, type 1A, is the leastlikely to respond to treatment. But if you know you have hep C you can takemeasures to protect yourself against developing severe liver disease: youcan stop drinking, doing drugs, and live a healthier lifestyle.Hep C is a scary disease but a manageable one. In fact, it is believed that80% of people outlive the disease. Getting tested is the first step intaking charge of your health. Learning as much as possible about the diseaseis the second.In the industrialized world, the main vectors of hep C transmission arereceiving blood products before 1992 (the blood bank didn't screen for hep Cbefore then), IV drug use (sharing needles, cookers, water and/or ties),sharing straws for snorting drugs, tattooing or body piercing in unsafeand/or unsterile conditions, and sharing a razor, toothbrush or otherhousehold item that could contain infected blood. The HCV virus is believedto be able to live outside the body for up to three months and is very tiny.A small percentage of people may contract the virus through unprotected sexbut contrary to popular belief, hepatitis C is not really a sexuallytransmitted disease. Hepatitis B is sexually transmitted, as it is spreadthrough bodily fluids including blood, semen, vaginal secretions and saliva.Vaccines are available for hep A and hep B. If you engage in any sexuallyactivity that possibly involves feces, such as rimming, you should bevaccinated for hepatitis A, since it is transmitted through the "fecal-oral"route. I encourage all people to be vaccinated for both -- gettingco-infected with hep C and either hep A or hep B can be deadly.Hepatitis C does not distinguish between lesbians, gay men or heterosexuals.The virus doesn't care. It can be passed sexually if you have oral sex withsomeone who is menstruating. Often our gums bleed and we don't realize it.This is also true about our fingers -- we may have tiny cuts on our hands orfingers that we are unaware of. When a woman who is infected with HCV is onher period you should be very careful. Latex gloves and dental dams arerecommended. If you have herpes you are more at risk for contracting hep Csince you may have tiny, open sores on your genitals. Rough anal sex is alsoa potential problem; anal tissue is thin and tears easily, thus increasingthe chance of blood-to-blood contact.Herpes, genital sores, and/or cuts on a penis combined with anal sex arevery dangerous -- condoms should always be used. It is recommended that youuse a condom for all sexual activity, but in the interest of harm-reduction,be especially careful if one of the partners has herpes or any other STD,with anal sex, or if an infected woman is menstruating.One of the biggest problems people with hep C face is talking to potentialsexual partners about their virus. Many people do not understand what hep Cis and may treat the infected person as if they are dirty, diseased andcompletely contagious. I should know -- I am infected with the hep C virus.I have had people refuse to sleep with me and I have had to sit down withpeople and explain the risks to them before they felt comfortable enough tohave sex with me.As you can imagine, this is not fun. It can be scary, demeaning anddepressing. But I choose to live my life as honestly as possible and it'simportant to me to be open about my hep C. I don't live closeted as abisexual and I refuse to live closeted as a woman who has hep C. I havethought of the minimal risk and thought about whether I have to tell peoplethat I believe will be one night stands. And then I think about this: whatif they don't end up being one-night stands? Or what if they find out someother way? I would be pretty angry if someone didn't tell me and give me thechance to make my own decision. In fact, I contracted hep C from someone wholied to me and told me he had tested negative, when he had, in fact, had thevirus for at least three years. It was completely devastating and I seehonesty as my only option.I'm 28 years old, and single. When I received my diagnosis some of the firstthings to cross my mind were: Am I ever going to have sex again? How am Igoing to find someone to love me or want to be with me? These questions arecommon and I'm happy to say that most people have listened to what I havetold them about hep C and not been bothered by it. I have had some badexperiences, and while they were hurtful at the time, I'm now glad I neverslept with someone who was so ignorant and not understanding.New partners are just one issue. Telling a long-term partner when you firstfind out you are infected can be one of the hardest things you ever have todo. They will most likely be just as scared and worried as you are. Beprepared for an emotional conversation. Studies with long-term monogamouspartners have found that only 1 to 3% have contracted the hep C virus froman infected partner.Let your partner know this, and encourage him or her to get tested. If theydo test positive, realize they may not have contracted it from you -- oftenpeople are together because they have similar backgrounds, but in times ofintense fear and uncertainty, accusations can fly. Anger and guilt arecommon reactions.When you find out you have a chronic illness many people go through agrieving process for the loss of their health. This includes the five stagesof grief: denial, anger, bargaining, depression and acceptance. You can gothrough these stages at the same time and over and over. I have heard frommany couples that their doctor told them to keep doing what they have beendoing -- if they haven't been engaging in safer sex they don't have tostart. The risk really is that low. But what if you want to have children?The good news is HCV is rarely passed from mother to child and rarely passedby breast feeding, in fact breastfeeding is usually allowed unless themother has cracked or bleeding nipples.Here are some tips for communicating with your partner:1.) Find a time and place that is comfortable to talk.2.) Be prepared: bring information to back up what you are saying. I havetold people the minimal sexual risks and they have still not believed me.You can bring a book, the number of a hep C hotline, or a pamphlet or printout information from a respected Web site.3.) Know what you want out of the conversation and try not to accuse or bedefensive.4.) Be honest.If someone doesn't want to have sex with you or be in a relationship withyou because of your hep C, they are probably not worth your time. Your hep Cis something that you will most likely have to live with for the rest ofyour life, so find someone supportive. You deserve it. No matter how you gothep C, you deserve happiness, love, and great sex!And for those of you, who may someday come in contact with someone who hashep C, treat him or her with respect, listen to what they have to say, andput yourself in their position. How would you feel if you had to come outand tell someone this? Treat them as you would like to be treated. Many ofus who are queer have already had some sort of coming out process. Rememberhow that was for you. This person, possibly this potential lover, is comingout to you. Be respectful and listen.It's hard to talk to someone you have just met about having hep C. But addtalking about sex on top of that and it can be a very frighteningexperience. Just remember that hep C is a manageable disease. If you arecareful and take care of yourself you can live a long, happy, sexuallyactive life!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Cara Bruce is co-author with Montanarelli of The First Year: HepatitisC (Marlowe & Co., February 2002). She can be reached at carabruce@...and is happy to answer any of your hep C questions. She is also the WebContent Editor at Good Vibrations.

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Sexual Transmission of HCVAuthor: Liz HighleymanAuthor Date: 1/1/2002The hepatitis C virus (HCV) often causes liver inflammation. In up to 80% ofpeople initially infected with HCV, the disease becomes chronic, potentiallyleading to long-term liver damage. A small percentage (about 20%) of thosewho are HCV positive will progress to liver cirrhosis, and approximately3-5% of those with chronic HCV infection will develop liver cancer.Experts estimate that at least four million Americans are currentlychronically infected with HCV; the number of new cases of HCV in the U.S. isdecreasing. Fortunately, there are several measures people can take toprotect themselves from this potentially life-threatening disease.How is HCV Spread?HCV is a blood-borne disease, that is, it is transmitted by blood-to-bloodcontact. Any activity that lets one person's blood or body fluids to comeinto contact with another person's blood or mucous membranes can potentiallytransmit HCV. However, some activities are much more likely than others tospread the virus. HCV can be transmitted by sharing equipment for injectionand non-injection drugs (for example, needles, cookers, cocaine straws, andcrack pipes). Needles used for tattooing, body piercing, and acupuncture mayalso spread HCV. Sharing personal items like razors, toothbrushes, or nailfiles is a less likely but still possible transmission route. In the past,many people contracted HCV through blood transfusions, but since 1992 therehas been a reliable HCV blood test and today donated blood is safe. Todaythe likelihood of contracting HCV through infected blood is less than .001%Sex and HCVWe know that blood-borne viruses can be transmitted through certain types ofsexual activity. HCV has rarely been detected in semen and vaginal fluids.However, most studies suggest that the virus is not often found in thesebody fluids, or that it is present in very low amounts and the virusparticles may be noninfectious.Most experts believe that the risk of sexual transmission of HCV is low.Most studies show that only a small percentage of people usually rangingfrom 0-3% contract HCV through unprotected heterosexual intercourse with along-term, monogamous HCV-positive partner. Health Canada estimates the riskthat a person will get HCV from unprotected sex with a steady HCV-infectedpartner at 2.5% over 20 years.Some studies indicate that sexual transmission from men to women is moreefficient than transmission from women to men.Since HCV is spread through blood, the risk of sexual transmission may behigher when a woman is having her menstrual period.According to the most recent (1997) National Institutes of Health consensusstatement, people who have multiple sex partners should practice safer sex.Those in stable, monogamous relationships do not need to change theircurrent sexual practices, although they should discuss safer sex options ifeither partner is concerned about sexual transmission.Among people in so-called "high risk" groups (gay men, prostitutes, peoplewith multiple sex partners, people seen at STD clinics), sexual transmissionof HCV appears to be more common. The fact that people with more sexpartners and other sexual risk factors have higher rates of HCV indicatesthat thedisease is can be sexually transmitted. On the other hand, if sexualtransmission of HCV were common, we would expect to see many more new casesof the disease among people whose partners are HCV positive.Sexual transmission of HCV between men who have sex with men and women whohave sex with women has not been well studied. Many studies show higherrates of HCV infection in gay men, but it is not known whether this isrelated to sexual activity. Anal sex may be a more efficient route oftransmission than vaginal sex because the delicate lining of the rectum ismore prone to damage that allows contact with blood.There are no known cases of HCV being transmitted through oral sex on a man(fellatio) or a woman (cunnilingus). However, it is theoretically possiblethat the virus could be transmitted this way if a person has mouth sores,bleeding gums, or a throat infection.There are no known cases of HCV being spread through kissing, includingdeep, open-mouth, or French kissing. It is theoretically possible that HCVcould be transmitted this way if one partner has mouth sores, bleeding gums,or any other condition that could permit blood-to-blood contact. But thismode of transmission is believed to be very rare.Special ConsiderationsExperts believe that HCV (like HIV) is more likely to be transmitted ifeither the positive or the negative partner has another sexually transmitteddisease (STD), especially one that causes sores or lesions (for example,herpes or syphilis). Always have any suspicious symptoms checked by adoctor,and get prompt treatment for curable STDs such as chlamydia, gonorrhea, andsyphilis.Some studies suggest that people who are co-infected with both HCV and HIVare more likely to transmit HCV; the same may also be true for peopleco-infected with both HCV and hepatitis B virus (HBV). In addition, a personwith HIV whose immune system is compromised may be at higher risk forcontracting HCV.Safer SexSome people feel more secure knowing that they are doing everything they canto prevent sexual transmission of HCV. Safer sex practices can also helpprevent the spread of hepatitis A and B, HIV, and other STDs.Using condoms is the surest way to prevent transmission of HCV and otherSTDs. Latex condoms are best for disease prevention; natural skin condomshave small pores that can let viruses through. Polyurethane (plastic)condoms are also a good choice, especially for people who are sensitive tolatex. Internal or female condoms (brand name Reality) are polyurethanesheaths worn inside the vagina rather than on the penis.Learn how to use condoms correctly. Most condom failure is really caused byincorrect use. Pinch the tip as the condom is rolled on in order to createanair pocket that will leave room for the semen. Hold onto the base of aregular condom or hold an internal condom in place when withdrawing aftersex to keep the semen from spilling. Tie the condom to prevent spills, anddispose of it properly. Condoms (both regular condoms and internal condoms)should be used only once.Some people choose to use condoms for oral sex on a man. For oral sex on awoman, barriers can be used to reduce the risk of disease transmission.Commonly used barriers include latex dental dams, sheets of plastic wrap,and latex sheets sold specifically for sex.To prevent disease transmission through broken skin, some people use latexor nitrile (plastic) gloves or finger cots for manual sex. It is a good ideato cover any cuts or sores with a bandage that will not allow fluids to seepthrough.Use only water-based lubricants with latex condoms or barriers. KY jelly andmost commercial lubricants sold specifically for sex are water-based. Avoidoil-based lubricants (such as Vaseline, coconut oil, or moisturizing lotion)since these damage latex and can cause a condom or barrier to break. Avoidlubricants or pre-lubricated condoms that contain nonoxynol-9. Recentlymanufacturers stopped including this ingredient after it was shown thatnonoxynol-9 caused irritation and damage to mucous membranes of the vagina,rectum, and penis that may actually increase the risk of diseasetransmission.To reduce the risk of HCV transmission during oral sex or deep kissing,practice regular good oral hygiene healthy teeth and gums may be the bestdefense against the spread of diseases through the mouth. Many expertsrecommend that people avoid brushing or flossing their teeth right before orafter oral sex or deep kissing, since these can cause bleeding gums and tinyabrasions.ConclusionWhile sexual transmission of HCV remains somewhat controversial, moststudies indicate that transmission through sexual activity is uncommon, andmost experts believe the risk of sexual transmission is low. According tothe National Institutes of Health, people in stable, monogamousrelationships do not need to change their current sexual practices, althoughthey should discuss safer sex options if either partner is concerned aboutsexual transmission. People with multiple sex partners should practice safersex, in particular the use of latex condoms.DisclaimerThe information in this brochure is designed to help you understand andmanage hepatitis C virus infection. It is not intended as medical advice.People with hepatitis C should consult a medical professional for diagnosisand treatment.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Sex and HCV: Can You Infect Your Partner?

by C.

Article Date: 06-09-04

The risk of sexually transmitting the hepatitis C virus is rare among monogamous couples, say doctors in Italy who set out to answer questions about the topic.

Transmitting HCV in Monogamous RelationshipsIn a study published in May,1 the physicians at Universita di Modena e Reggio Emilia in Modena, Italy followed nearly 900 monogamous couples with at least one partner infected with the hepatitis C virus to find out whether the risk of sexually transmitting HCV between partners was high or not.

The couples were followed for a total of 8,060 person-years; that is, the total number of years that the patients, collectively, had been affected by hepatitis C. For example, 776 spouses were followed for 10 years, corresponding to 7,760 person-years. An additional 119 spouses contributed an additional 300 person-years. In the latter group, their partners had either cleared the virus, ended the relationship or were no longer a part of the study at the time of follow-up.

All couples denied practicing anal intercourse or vaginal intercourse during menstruation, thought to be higher risk factors for HCV transmission.2 None of the couples acknowledged using condoms during sex. The average frequency of sexual intercourse was 1.8 times per week.

Differences in Viral Types FoundDuring the follow-up period, the investigators learned that three of the patients had become infected with hepatitis C. However, the investigators report that the infecting HCV genotype in one spouse was different than that of the partner, "clearly excluding sexual transmission," they wrote.

The remaining two couples were infected with the same genotype, but additional genetic testing showed that there were more minute, but significant, differences between the viruses in each partner, proving again that the virus was not transmitted sexually, the Italian study team noted.

Still, the authors found that in 3.4% of the couples initially investigated, both partners had tested positive for HCV antibodies, suggesting that the virus could have been transmitted earlier in their relationship.

A 'Null' Risk"Our data indicate that the risk of sexual transmission of HCV within heterosexual monogamous couples is extremely low or even null," they wrote. "No general recommendations for condom use seem required for individuals in monogamous partnerships with HCV-infected partners."

The risk of transmitting hepatitis C through sexual intercourse is lower than the risk associated with hepatitis B or HIV, the virus that causes AIDS, the researchers stressed. While sexual transmission of HCV is possible in monogamous heterosexual relationships, it isn't likely. Still, experts suggest condom use for couples who are concerned that transmitting the virus in such a relationship might still be possible. Long-term partners of people with hepatitis C should get tested for the virus, but if the results are negative, doctors say it's unlikely another test will have to be taken.

Other Warnings to HeedThe authors of the Italian study stress that, based on evidence in other studies, couples should avoid sharing personal hygiene items like toothbrushes, razors or nail clippers.

It isn't known whether the hepatitis C virus can be spread through oral or anal sex, however. While there's no proof that anyone has spread the virus through oral sex, it may be possible. Anal sex may damage the lining of the rectum, and make it easier to pass the virus into the bloodstream.3

On the other hand, there have been reports of increasing incidents of sexual transmission among HIV-positive men who engage in high-risk, unprotected sex with other men.4

Doctors have also reported that transmitting HCV in heterosexual contact is "5 times higher when HIV is also transmitted, suggesting the HIV may be a cofactor for the sexual transmission of HCV."5

1. Vandelli C, Renzo F, Romano L et al. Lack of evidence of sexual transmission of hepatitis C among monogamous couples: Results of a 10-year prospective follow-up study. Am J Gastroenterology 2004 May;99(5):855-9.2. University Health System. University of Virginia.3. Veterans Administration National Hepatitis C Program. Sex and Hepatitis C Virus.4. Fletcher S. Sexual transmission of hepatitis C and early intervention. J Assoc Nurses AIDS Care. 2003 Sep-Oct;14(5 Suppl):87S-94S.5. Eyster ME, Alter HJ, Aledort LM et al. Heterosexual co-transmission of hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Ann Intern Med 1991 Nov 15;115(10):764-8. is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.

http://www.hepatitisneighborhood.com/content/in_the_news/archive_1923.aspx

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Hepatitis C Can Be Sexually Transmitted

Mon Apr 25, 2005 04:02 PM ET

NEW YORK (Reuters Health) - The virus that causes hepatitis C (HCV) can be sexually transmitted and the risk is directly related to the frequency of intercourse, the findings from a new study suggest. However, the association does not seem to be very strong. Contact with infected blood is the main route by which HCV is transmitted, lead author Dr. Veysel Tahan, from Marmara University in Istanbul, Turkey, and colleagues note. However, in up to 50 percent of cases, a transmission route is never identified. Researchers have hypothesized that some of these unknown cases may be caused by sexual transmission. To investigate this controversial topic, Tahan's team assessed HCV transmission between 600 patients with chronic hepatitis C and their spouses. In a subgroup of 216 spouses who were HCV-negative at the start of the study, the authors assessed transmission rates over an average period of 36 months. The findings appear in the current issue of the American Journal of Gastroenterology. Antibodies against HCV, indicating exposure to the virus, were detected in two percent of the spouses, the researchers note. The average age and duration of marriage were not associated with the likelihood of detecting HCV antibodies. In contrast, an association between the frequency of sexual intercourse and HCV transmission risk was observed. However, this relationship was not statistically significant, indicating the association was. In the subgroup of 216 spouses, none of the HCV-negative subjects became positive during follow-up, the investigators note. "The risk of HCV transmission between monogamous sex partners may be related to the number of sexual intercourse" events, the authors state. "The absence of any evidence of transmission in the three-year follow-up period suggests that this relation is not very strong." In a related editorial, Dr. Norah A. Terrault, from the University of California at San Francisco, comments that the "low incidence of new infections among monogamous couples supports the clinical practice of not recommending that such couples change their sexual practices." SOURCE: American Journal of Gastroenterology, April 2005.

http://www.reuters.com/newsArticle.jhtml?type=healthNews & storyID=8287010

(What a very misleading article!)