Hepatitis C is found in infected blood. It is also rarely found in semen (cum) and vaginal fluids.
Hepatitis C is mainly passed on through using contaminated needles and syringes or sharing other items with infected blood on them. It’s also a sexually transmitted infection (STI) that can be passed on through unprotected sex, especially when blood it present.
You can prevent hepatitis C by never sharing needles and syringes, practising safer sex, and avoiding unlicensed tattoo parlours and acupuncturists.
A simple blood test carried out by a healthcare professional will show whether you have hepatitis C.
For some people, hepatitis C will clear up on its own, but many people will develop chronic infection and need treatment and care.
What is hepatitis C?
Hepatitis C (also known as hep C or HCV) is part of a group of hepatitis viruses that attack the liver.
It’s mainly passed on through contaminated needles, either from injecting drugs or from needle stick injuries in healthcare settings. It can also be transmitted sexually, especially during anal sex or other types of sex that may involve blood.
Some groups are more at risk of getting hepatitis C than others, including people who use drugs, people in prisons, men who have sex with men, health workers and people living with HIV.
Chronic hepatitis C can be serious and without appropriate treatment and care, can cause liver disease and liver cancer leading to death. Treatment, where available, can cure hepatitis C in most cases.
How do you get and prevent hepatitis C?
Hepatitis C is passed on when infected blood gets into another person’s body. It is very infectious and the virus can stay alive outside the body for up to several weeks.
Contaminated needles and infected blood
You can get hepatitis C from sharing contaminated needles, syringes and other injecting equipment during recreational drug use. Banknotes and straws used for snorting may also pass the virus on.
Being exposed to unsterilised tattoo and body piercing equipment can also pass hepatitis C on. Occasionally, you can get it from sharing a towel, razor blades or a toothbrush if there is infected blood on them.
Hepatitis C infection is also passed on in healthcare settings, from needle stick injuries or from medical and dental equipment that has not been properly sterilised. In countries where blood products are not routinely screened, you can also get hepatitis C by receiving a transfusion of unscreened blood and blood products.
You can prevent hepatitis C by:
Never sharing needles and syringes or other items that may be contaminated with infected blood, such as razors, toothbrushes, towels or manicure tools (even old or dried blood can contain the virus).
Only have tattoos, body piercings or acupuncture in a professional setting, and ensure that new, sterile needles are used.
If you are a healthcare worker, following standard infection control precautions.
Hepatitis C can be passed on via sex without a condom or dental dam with someone who has the virus, even if they don’t have symptoms. Hepatitis C has been detected in semen and vaginal fluids, but infection via these routes is thought to be unlikely.
Sex which leads to blood exposure is the main way hepatitis C is passed on sexually. These types of sexual activities include anal sex, fisting, when a woman is on her period and rough sex which leads to tearing or cuts. Sharing of uncovered or unwashed sex toys can also pass it on.
Because of this, sexual transmission of hepatitis C is more common among populations that practise anal sex, such as men who have sex with men. Sexual transmission during vaginal sex is thought to be very rare.
The risk of hepatitis C infection is increased when you have another STI – especially one that causes sores. People living with HIV are also more likely to get hepatitis C.
You can protect yourself by:
Knowing the status of any sexual partner.
For men who have sex with men, using condoms, dental dams and latex gloves for anal sex, rimming, fingering and fisting, and during any other rough sex.
If you are a woman, using condoms when on your period, during anal sex and during rough sex. If you are having sex with a new partner or if you have multiple partners, it’s also a good idea to use condoms.
Testing regularly for STIs.
For people living with HIV, using condoms, dental dams and latex gloves during sex, and taking your antiretroviral treatment for HIV.
Apart from condoms, other types of contraception such as the contraceptive pill and pre-exposure prophylaxis (PrEP) for HIV offer no protection against sexually transmitted infections.
Mother to child
Hepatitis C can be passed on from a pregnant woman to her child during pregnancy and birth, although this is rare. This risk is slightly higher among women living with both HIV and hepatitis C (called co-infection).
There are currently no treatments available to stop you passing hepatitis C onto your unborn baby. But because the risk is low, listen to your doctor and they will support you to remain healthy during your pregnancy.
If you have hepatitis C and are planning on getting pregnant, your doctor may recommend treating hepatitis C before you get pregnant. Hepatitis treatment using antivirals is currently not recommended for pregnant women because there isn’t enough information to know if the drugs used are safe for your unborn baby.
Breastfeeding with hepatitis C is considered safe. But if you have cracked nipples or bleeding, it’s generally recommended to stop until they have healed.
What do hepatitis C symptoms look like?
Hepatitis C infection can go through two stages: acute and chronic. In the early, or ‘acute’ stage, most people don't have symptoms. If they do develop symptoms, these can include:
flu-like symptoms, tiredness, high temperature and aches and pains
loss of appetite
tummy (abdominal) pain
jaundice, meaning your skin and the whites of your eyes turn yellow
While for some people, the infection will clear without treatment, in most cases, acute infection will develop into long-term ‘chronic’ infection. Chronic infection may not become apparent for a number of years until the liver displays signs of damage. These symptoms can include:
mental confusion (often called ‘brain fog’) and depression – these are specific to hepatitis C
constantly feeling tired
nausea, vomiting or tummy pain
dark urine (pee)
pale faeces (poo)
joint and muscle pain
Without treatment, chronic hepatitis C can cause scarring of the liver (cirrhosis), which can cause the liver to stop working properly. A small number of people with cirrhosis develop liver cancer and these complications can lead to death. Other than a liver transplant, there’s no cure for cirrhosis. However, treatments can help relieve some of the symptoms.
How do you test for hepatitis C?
A simple blood test carried out by a healthcare professional will show whether you have the virus. You may also be given an extra test to see if your liver is damaged.
If you’ve got hepatitis C you should be tested for other STIs. It's important that you tell your recent sexual partner/s so they can also get tested and treated. Many people who have hepatitis C do not notice anything wrong, and by telling them you can help to stop the virus being passed on. It can also stop you from getting the infection again.
How do you treat hepatitis C?
People with acute infection do not always need treatment, because their immune system may clear hepatitis C on its own. If you test positive during the acute stage, your doctor may ask you to come back after a few months to re-test and to see if you need any treatment.
If people develop chronic infection, they will need treatment to help clear the virus. Where available, treatment with drugs called direct-acting antivirals (DAAs) can cure hepatitis in most cases. These are usually taken for 8-12 weeks. Your doctor will also check your liver for any damage.
If you’ve had hepatitis C in the past, you’re not immune to future infections – which means you can get it again. You can also still get other types of hepatitis, and having hepatitis C together with another type is more serious.
If you’ve already had hepatitis C, it’s advisable to have the vaccination against hepatitis A and B to protect your liver from further damage.
Whether you have symptoms or not, don’t have sex until your healthcare professional says you can.
Hepatitis C and HIV
Co-infection with hepatitis C and HIV is common because they are both transmitted in similar ways. While both infections can be treated, it can complicate things, so it’s important that your doctor is fully aware of your infections.
That’s because if you’re living with HIV and become infected with hepatitis C, you’re more likely to develop chronic hepatitis C. The infection is also more likely to progress quickly and become serious. This is even true when you are taking your antiretroviral treatment for HIV and your viral load is low.
If you think you’ve been exposed to hepatitis C, it’s important to get tested and treated with DAAs if necessary. In some cases, your doctor may make changes to your antiretroviral treatment while they are treating your hepatitis C infection.