Why Are We Talking About Sexual Transmission Of Hepatitis C Among Gbmsm
Drug use, and injection drug use in particular, is a well-understood pathway for hepatitis C transmission. Sexual transmission of hepatitis C isnt as clear. The evidence suggests that sexual transmission of hepatitis C among heterosexual couples is rare.1 However, as we will discuss below, sexual transmission of hepatitis C can occur among gbMSM. Further, changing sexual practices among gbMSM2 using new HIV prevention approaches may be having an impact on the rates of sexual transmission of hepatitis C.
The Blueprint to inform hepatitis C elimination efforts in Canada indicates that gbMSM are an emerging priority population for efforts to eliminate hepatitis C infection. The Blueprint states that sexual transmission and/or transmission through drug use are the main risk factors for hepatitis C among gbMSM.3 However, hepatitis C infection may not be widely considered a priority for sexual health services and education for gbMSM.
It is challenging to understand the risk of sexual transmission among gbMSM, including separating the risks of transmitting hepatitis C through sex and through drug use. In the studies discussed in this article, where information on drug use is included in the research it is often based on self-reported data, which may be an underestimate because of the stigma that can be associated with drug use.
How Is Hepatitis A Treated
There is currently no cure for hepatitis A. Your healthcare professional will usually recommend rest, good nutrition and plenty of fluids. Painkillers and/or medication to help with itchiness, nausea or vomiting may be prescribed. Most people will recover fully within one to two months.
Whether youve got symptoms or not, dont prepare food for others or have sex until a healthcare professional tells you that youre no longer infectious.
Once youve recovered from hepatitis A youre immune this means you cant get it again. But you can still get other types of hepatitis.
Can Hepatitis C Be Spread During Vaginal Sex
Its rare for the hepatitis C virus to be transmitted through vaginal intercourse. Unless the isnt lubricated or intercourse is very rough and leads to tears in the vaginal walls, theres no opportunity for blood to be exchanged. The risk of transmission with vaginal intercourse is about 1 in 190,000, according to research published in the journal Hepatology.
The U.S. Department of Veteran Affairs, which is the largest care provider for people with hepatitis C, says if one partner in a monogamous, heterosexual relationship has hepatitis C, the risk of transmission is very low, but they do recommend that the other partner get tested. Concerned couples can also discuss using a condom to lower the already very low risk of spreading the virus, says Talal.
Just how safe sex is when a partner has hepatitis C hinges on other factors as well. For example, its important to use a new condom with each sexual act that has the potential to expose the uninfected partner to the infected persons blood, even if youre in a committed relationship, says the Centers for Disease Control and Prevention . Some of these situations include sex when one partner:
- Has an open cut or sore
- Has another sexually transmitted infection , especially one that causes sores or lesions
- Is having a menstrual period
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Hepatitis A B And C: What Is The Difference
A, B, C D and E.
Aside from the letters associated with it, how much do you know about hepatitis? Whats the difference between the types? And if you get a vaccination for hepatitis, which are you protected from?
We spoke with Moises Ilan Nevah, MD, a transplant hepatologist/gastroenterologist and medical director of the Liver Transplant Program at Banner University Medical Center Phoenix, to help better understand the similarities and differences between the various types of hepatitis, who is at risk and when to get vaccinated.
How Are Hepatitis A B And C Transmitted
Hepatitis A is present in the stool of an infected individual. Infected stools can contaminate water, food and various objects. The virus is transmitted by:
- consuming contaminated water or food
- touching contaminated objects
- preparing or consuming drugs under unsanitary conditions
Hepatitis B is transmitted mainly through:
- unprotected sexual intercourse
Mothers can pass the virus on to their babies during pregnancy and delivery.
The main means of transmission of hepatitis C is through blood. It is passed on by:
- sharing drug or steroid injection equipment
- receiving blood, blood products or immunoglobulin
- getting tattoos, piercings or acupuncture with non-sterile equipment
- sharing razors, toothbrushes, nail clippers, etc.
The C virus can also be contracted during sexual intercourse with an infected person. Mothers can pass the virus on to their babies during delivery.
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What If You Test Positive
If a test says you have viral hepatitis, you can take steps to protect the ones you love. For hepatitis A, wash hands frequently. For hepatitis B and C, avoid sharing nail clippers, razors, or toothbrushes. Hepatitis B, and sometimes hepatitis C, can be passed through sexual contact. Make sure everyone in your household gets the hepatitis B vaccine. An important step is to see a specialist to discuss treatment options.
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Can Hepatitis B Be Transmitted Through Water
There is no scientific evidence that hepatitis B can be transmitted through water. However, the virus can be transmitted through contact with blood or other bodily fluids from an infected person. This means that if someone with hepatitis B were to contaminate a water supply with their blood, it is possible that others could become infected if they came into contact with the contaminated water.
In the event of serious liver damage, you should be vaccinated against hepatitis B. Does waterborne disease like Hepatitis B spread through contaminated water sources?
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Direct Exposure To Blood
Exposure to large amounts of contaminated blood increases the risk for hepatitis C transmission. If you get a cut and need help tending it, whoever helps you should first put on disposable gloves to prevent exposure in case he or she has a cut. You can also help prevent hepatitis C transmission by covering any cuts or sores with bandages until theyre healed and disposing of used bandages properly.
Uninfected people should take steps to avoid getting someone elses blood in their eyes, nose, and mouth. If an uninfected persons skin is exposed to contaminated blood, wash the area with soap and water immediately. If blood gets in the eyes, rinse them with running water right away and call a doctor to find out about further steps that should be taken.
When cleaning blood from surfaces, Dr. Lee recommends using a solution of one part bleach to 10 parts water. Dried blood should also be handled with care because the virus can live for several days outside the body.
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How Is Hepatitis B Treated
Treatment for hepatitis B depends on how long you have had the virus.
There is no specific treatment for acute hepatitis B, and most people recover within one to two months. Usually, you can manage symptoms at home with plenty of rest and painkillers if necessary. Most people make a full recovery from acute hepatitis B.
If you develop chronic hepatitis B, you will be given treatment to help some of the symptoms. This will also reduce the risk of liver damage and liver cancer. Treatment keeps the virus under control but cannot cure chronic hepatitis B. Some people will need lifelong treatment.
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How Its Passed On
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 banknotes that 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 a toothbrush or razor. 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.
You can also potentially get it from medical or dental treatment abroad in countries where hepatitis C is common and infection control is inadequate.
What Are The Rates Of Sexually Acquired Hepatitis C Infection Among Gbmsm
gbMSM living with HIV
In the early 2000s, reports began to appear of hepatitis C outbreaks among populations of gbMSM living with HIV where the vast majority of the men did not report typical blood-related risks for transmission, such as injection drug use or medical/dental care in countries where universal precautions to prevent hepatitis C infection have not been consistently implemented.6,15 These were the first reports to suggest that hepatitis C could be passed through sex. Over time, as more research was published globally on rates of hepatitis C infection among gbMSM living with HIV, it became accepted that sex was a pathway for transmission of hepatitis C among gbMSM living with HIV.6,10,16
Two international systematic reviews reported that the hepatitis C prevalence rate among HIV-positive gbMSM with no history of injection drug use is about seven in 100.17,18 This is higher than the estimated prevalence rate of five in 100 among gbMSM with/without HIV in a survey across five cities in Canada.19
HIV-negative gbMSM have much lower rates of new hepatitis C infections than HIV-positive gbMSM. Rates ranged from 0.4 to 1.5 new hepatitis C infections per 1000 person-years among HIV-negative gbMSM.16
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Do Women Have A Higher Risk Of Getting Infected With Hepatitis Through Sexual Contact
Sex does not determine the risk of being infected with hepatitis through sexual contact. The presence of behavioral and other risk factors may make a person vulnerable to getting hepatitis by sexual contact. Some studies, however, suggest that it is easier for a man to transmit HCV to a woman than vice versa. Furthermore, MSM are 10 to 15 times more at risk of getting infected with hepatitis B than the general population.
How Do You Get It
You can get hepatitis A through contaminated food or water and by not washing hands after the toilet or before touching food.
Hepatitis B is spread:
- from mother to baby
- sharing items that may pierce the skin or have blood on them
- blood transfusion .
You can get hepatitis C through contact with infected blood, sharing needles, syringes and any other equipment and, possibly, through sexual contact. You can also get it with a blood transfusion in countries that do not pre-test blood for transfusion.
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Can You Get Hepatitis C By Having Sex The Sexual Transmission Of Hepatitis C Among Gay And Bisexual Men And Other Men Who Have Sex With Men
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Hepatitis C is not commonly considered a sexually transmitted infection it is usually passed through blood-to-blood contact. However, the sexual transmission of hepatitis C is an increasing concern among some gay and bisexual men and other men who have sex with men . Over the past two decades, sexual transmission of hepatitis C has predominantly occurred among gbMSM living with HIV. Recently a small but increasing number of HIV-negative gbMSM have been getting hepatitis C. This article reviews how hepatitis C is passed sexually, the types of sex where it can be passed and the rates of hepatitis C sexual transmission among gbMSM. It also includes strategies to reduce the likelihood of sexual transmission and recommendations for service providers working with gbMSM.
How Is Hepatitis Treated
Someone who has hepatitis will need to drink enough fluids, eat healthy foods, and get rest. The persons family members may need to get hepatitis vaccines, if they havent already.
Later on, the person will get follow-up blood tests. Often the blood tests will show that the person no longer has hepatitis. Sometimes, the blood tests may show that someone is now a carrier of hepatitis he or she wont have hepatitis symptoms, but could pass the infection to other people.
Sometimes, blood tests will continue to show that some people still have hep B or C, which means they may have chronic hepatitis. If so, they will need to eat healthy foods and take very good care of themselves by getting rest and visiting the doctor regularly. In some cases, someone with chronic hepatitis may get special medicine for the condition.
We hope that this heads-up on hepatitis will help you stay safe. It may sound funny, but you can love your liver by washing your hands and making smart choices!
What If Im Pregnant And Have Hepatitis B
Pregnant woman with hepatitis B can pass the virus on to their unborn baby. This is why women are tested for hepatitis B as part of prenatal care. In almost all cases, an infection can be prevented if the infant receives the recommended vaccinations in time.
Infants infected at birth are more likely to develop chronic hepatitis B and go on to develop liver complications. Its important to talk to your doctor if you have any questions and follow any advice they give.
Who Should Be Vaccinated For Hepatitis B
All newborns should be vaccinated. Also, people who are under 18 who were not vaccinated at birth should also get the vaccine. Other groups who should be sure to be vaccinated are those in certain high-risk categories, such as:
- People who have more than one sexual partner.
- Men who have sex with men.
- Adults with diabetes.
- Sexual partners of infected people and people who share households with infected individuals.
- People who are exposed to blood and other bodily fluids, including healthcare and public safety professionals, and people who work in jails and other places taking care of people who cant take care of themselves.
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What Laboratory Tests Are Available For Hepatitis B
Tests are available to detect the types of antigens used to identify the hepatitis B virus. The tests determine if the virus is present in the body tissue or blood. The amount of each type of antigen present indicates how advanced the disease is and how infective the individual has become.
Other tests are available to detect the bodys reaction to the viral infection or the bodys reaction to vaccination against the virus. These tests work by measuring the number of antibodies present in the blood.
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What Are Clinical Trials For Hepatitis B
Clinical trialsand other types of clinical studiesare part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future.
Researchers are studying many aspects of hepatitis B, such as
- progression of hepatitis B and long-term outcomes
- new treatments for hepatitis B
- prevention of reactivated or worsening hepatitis B in people receiving cancer treatment
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How Does Viral Hepatitis Affect Pregnancy
Hepatitis B and C can cause problems during pregnancy and can be passed to your baby. The risk of passing the virus to your baby is higher with hepatitis B than C.
Research shows that pregnant women with hepatitis B or C may have a higher risk for certain pregnancy complications:2
- Gestational diabetes
- Low-birth-weight baby
- Premature birth . Premature birth is the leading cause of infant death and raises the risk of health and developmental problems at birth and later in life.
Talk to your doctor if you think you may be pregnant or plan to become pregnant. Some antiviral medicines that treat hepatitis C, such as ribavirin, can cause serious birth defects if taken during pregnancy.
Although hepatitis is most commonly the result of an infection, other factors can cause the condition.
Alcohol and other toxins
The alcohol directly injures the cells of your liver. Over time, it can cause permanent damage and lead to thickening or scarring of liver tissue and liver failure.
Other toxic causes of hepatitis include misuse of medications and exposure to toxins.
Autoimmune system response
In some cases, the immune system mistakes the liver as harmful and attacks it. This causes ongoing inflammation that can range from mild to severe, often hindering liver function. Itâs three times more common in women than in men.
Sexual Transmission Of Hepatitis C: A Rare Event Among Heterosexual Couples
Transmission of hepatitis C virus is primarily attributed to percutaneous exposure to infected blood. Methods to prevent percutaneous transmission are well defined and clear counselling messages exist to reduce person-to-person transmission of virus . While studies suggest that sexual transmission of HCV occurs infrequently, few studies thoroughly investigated sexual risk factors and potential confounding transmission modes within the household . These ambiguities hampered development of clear counselling messages for sexual practices among HCV-infected persons.
While the HCV Partners Study provides much-needed reassurance for the millions living with HCV and in long-term partnerships, these results do not apply to all patient populations. Particularly, HIV-infected men who have sex with men represent a different demographic and recent publications emphasise the role of sex in HCV transmission . This represents a different clinical scenario with other factors that are likely to be important.
Household exposures from sharing blood-contaminated objects provide a plausible alternative route for HCV transmission among partners that may be erroneously ascribed to sex contact . The HCV Partners Study carefully evaluated household practices to account for potential non-sexual HCV transmission. Although partners frequently shared personal grooming items, we found no association between sharing these items and HCV concordance among couples.
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