Hepatitis C is the most common type of viral hepatitis. It’s caused by a blood-borne virus that attacks the liver and is easily spread by sharing drug injecting equipment. It can also be spread through sex.
There is no vaccine against hepatitis C.
Without treatment the virus can cause liver disease that can be fatal. However there are now new treatments for hepatitis C without giving injections of interferon.
Most people will be offered 12 weeks of tablets with few side effects and these give a high cure rate of 90-95%.
Stages of hepatitis C infection
- The first six months of infection with hepatitis C is called the ‘acute’ phase. Around 20-25% of people will clear the virus naturally during this time. (This percentage is lower for people co-infected with HIV.)
- People who don’t clear the infection will enter the ‘chronic’ (or long-term) phase and can pass on hepatitis C to others.
Symptoms of hepatitis C:
Most people who get hepatitis C don't notice any symptoms when they are first infected. It can take years before you feel ill, with symptoms often not easily identified as being due to hepatitis C.
The symptoms can include:
- mild flu-like symptoms
- extreme tiredness
- itchy skin
- stomach pain
- jaundice, meaning your skin and the whites of your eyes turn yellow, your urine is dark and your faeces (poo) are pale
- mental confusion (often called ‘brain fog’) and depression - these are specific to hepatitis C.
The hepatitis C virus is found in blood and is passed on when infected blood gets into another person’s bloodstream. It’s seen as unlikely (but not impossible) that it can be passed on in semen.
Most people get the virus from sharing drug injecting equipment such as needles, syringes, water cups, tourniquets, spoons, filters and swabs. Sharing things like straws and bank notes which are used for snorting drugs might pass the virus on, as can sharing pipes.
In the UK piercing and tattooing should be safe - but unsterilised equipment abroad can spread the virus.
An infected person risks infecting others if they share anything that might have blood on it like toothbrushes or razors.
A pregnant woman with the virus can give it to her baby during pregnancy or childbirth. Blood transfusions in the UK are safe as blood is screened.
A further transmission route can be from receiving medical or dental treatment abroad (including blood transfusions) in countries where hepatitis C is common and infection control is inadequate.
Hepatitis C and sex
Hepatitis C is rarely passed on during sex between a man and a woman. There’s also no significant spread of hepatitis C among HIV negative gay men. But the infection has spread sexually among gay men with HIV and is much more common among them.
Gay men, chemsex and hep C
Group sex and chemsex parties provide the perfect storm for hepatitis C transmission. If you’re taking drugs and having sex for longer your inhibitions are likely to be lowered and the delicate skin lining the anus can be damaged, causing bleeding. Hep C is very infectious and is easily passed on through group sex, it can even be passed from one person to another on fingers.
The virus spreads through anal sex and fisting when condoms and gloves are not used. It’s also passed on during group sex, on objects such as sex toys, fingers, enema equipment, condoms, latex gloves or in contaminated lubricant.
The iBase guide Safer HCV sex for gay men is a useful reminder of what to avoid and what steps to take to protect yourself.
The Hepatitis C Trust has some useful information about transmission. They also provide an advocacy service for MSM who have been re-infected with hepatitis C after previously being successfully treated.
How can I protect myself and others?
- Never share injecting drug equipment (eg, needles, syringes, swabs, spoons, filters) or things that may have blood on them such as toothbrushes and razors. Also avoid sharing straws or rolled up banknotes if snorting drugs with others.
- Use condoms for anal and vaginal sex and latex gloves for fisting.
- During group sex, cover anything which goes from one partner to another with a fresh condom or fresh latex glove for each new person it enters. Clean objects with warm water and anti-bacterial soap before using on a new partner.
- Don’t share enema equipment or pots of lubricant.
If you have hep C you may want to tell a partner and explain that you’re infectious. They can then decide if they are happy to take any risks and whether they want to take precautions. That way they cannot accuse you of infecting them without them knowing that the risk was there.
Giving blood and organ donation
If you have hepatitis C you cannot give blood.
In terms of organ donation, in a recent research study in America (the THINKER trial at the University of Pennsylvania) kidneys from people with hepatitis C who had died were transplanted into patients who did not have the virus. All of the recipients subsequently contracted hepatitis C but were treated for it and all were cured – the risk of not clearing hepatitis C outweighed the benefit of receiving a kidney.
What can I do if I think I have hepatitis C?
A doctor or sexual health clinician can test you to see if you have hepatitis C. If you do, effective treatment with fewer side effects than the older medicine is available and you can discuss how to avoid infecting your sexual partners or people you live with.
It can take three to six months before the blood test for hepatitis C will be able to detect signs of infection in your blood. For people with HIV who may be immunocomprised the antibody may not be detectable and it may be necessary to request an RNA test which detects the virus.
Is there a vaccination against hep C?
No, there is no vaccination against hep C, however you can be vaccinated against hepatitis A and B.
If you already have hep C, it’s recommended to have the vaccination against hep A and B to protect your liver from further damage.
Treatment for hep C:
Drug treatment is available and has recently improved, with a better success rate and fewer side effects. In fact, 90-95% of people can be cured by the new medications, known as direct acting antivirals (DAAs). These are taken in tablet form once or twice a day for typically 12 weeks.
You can find out more detailed information about treatment for hepatitis C on the Hepatitis C Trust website.
If you’re cured of hepatitis C, you’re not immune - you can get hep C again. You can also still get other types of hepatitis, and having hepatitis C and another type is more serious.
Why should I get treated?
Because hepatitis C can be fatal when left untreated.
Untreated hepatitis C can lead to scarring of the liver known as ‘cirrhosis’. A small number of people with cirrhosis will go on to get liver failure, the only treatment for which is a liver transplant. A small proportion of people with cirrhosis develop liver cancer.
What else can I do to stay healthy?
NHS Choices recommends:
- avoid alcohol
- liver disease can make you more vulnerable to infection - smoking is best avoided as it can increase the seriousness of liver damage
- recreational drugs should be avoided to allow your liver to get better
- eat a healthy balanced diet.
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