HCV is called a lot of things.  We know that Hepatitis C is classified as a communicable disease.   It is transmitted when the blood of an infected person enters the blood-stream of another person.

We know that mother-to-child transmission can occur before or shortly after birth (called vertical transmission).

We know that Hepatitis C can be a healthcare-associated infection (HAI).  It can live on environmental surfaces and hands so it’s an environmental-associated infection.

We also know that Hepatitis C can be a sexually transmitted disease (STD).   First, the good news for many people:  An Italian 2004 study of 895 monogamous heterosexual couples, who denied anal intercourse, sex during menstruation and condom use, found the HCV transmission was low or null.   “No general recommendations for condom use seem required for individuals in monogamous partnerships with HCV-infected partners.”  A small 1994 American study found that “HCV RNA was present in the menstrual blood of all chronically infected patients tested.”  But even if the female is the infected person, and the couple has unprotected non-rough sex, they appear to be pretty safe.

Things get risky when a person has unprotected sex with a sex worker.

A 2012 large study of HCV in Vietnam found that 8.7% of commercial sex workers (CSWs; 8.7%, n=87/1000) in certain regions were infected.

Genotype 1 was the most prevalent HCV genotype in our study, although this varied between regions as follows: Ha Noi (54%, n=47/87), Hai Phong (72.1%, n=31/43), Da Nang (81.4%, n=35/43), Khanh Hoa (47.2, n=25/53) and Can Tho (55.4%, n=31/56).

Analysis of the different risk groups revealed that genotype 1 viruses accounted for a significantly higher proportion of HCV infections in both IDUs (70.1%, n=87) and CSWs (63.7% n=21), compared to dialysis (51%, n=50) and multi-transfused (36.4% n=8) patients, p<0.001 (Figure 3).

Discussion

“Sexual transmission of HCV is still relatively rare and, to date, HCV transmission within CSW cohorts in Vietnam has not been well studied. Although the prevalence described in CSWs in this study (8.7%) is higher than estimates from other Asian countries, this is likely confounded by the effect of injecting drug use practices as almost 60% of the HCV positive CSW cohort reported such activity. Evidence exists to support sexual transmission of HCV, although available data suggest the efficiency of transmission by the sexual route is low. Despite this, a number of studies have reported a higher seroprevalence of HCV infection in CSWs compared to the general population.”

However, the authors of the Vietnam study think that there is a low transmission of HCV from sexual intercourse based on a study of middle-aged spouses–a very different demographic from sex workers.

Nod has posted some cases about STDs.  In one, a veteran had documentation that he was treated for a STD in service but received SC for HCV after being denied due to willful misconduct.  In the award letter, the VA wrote, “…your hepatitis C is due to or the result of high risk sexual activity while in the Army.  The examiner stated that sexual intercourse with persons who may be infected with hepatitis C (prostitutes, IV drug users) is a documented risk factor for this infection.  The transmission of this infection if (s) often associated with the transmission of other sexually transmitted diseases.  Due to the high risk sexually activity documented in your service treatment records, it is likely that your Hepatitis C had its onset and was acquired while you were in the Army.”

My question is, “What if a veteran thinks that his/her main risk factor for HCV was sexual contact with a sex worker during military service and HCV was the only STD they became infected with?”  The government knows that military personnel didn’t use condoms as often as they should, having fathered thousands of children in Asia.  But what evidence of risky sexual activity can one offer, other than the HCV itself, if you didn’t also get, say, gonorrhea, and the general condition of your liver?  In my opinion, the HCV is proof enough.  Would the VA say, no you have to have at least 2 STDs HCV AND one more of your choosing.  

The CDC doesn’t provide much guidance.  They have a very hard time communicating clearly about HCV and sex.

In their recent MMWR Report (8/17/12):

Introduction, paragraph 3.

“Although HCV is inefficiently transmitted through sexual activity, the prevalence of HCV antibodies among persons who report having had ≥20 sex partners is 4.5 times greater compared with the general population (1).”

Why can’t they just spit it out?:  “…HCV is sometimes transmitted through sexual activity…”

Background, paragraph 2–they provide hints about oral sex etc..:

“Persons with unapparent percutaneous or mucosal exposures, including those with high-risk sexual behaviors, sexual and household contacts of persons with chronic HCV infection (1%–10%), and persons with sporadic percutaneous exposures (e.g., health-care workers [1%–2%]), had lower rates.”

Meanwhile, an online Medline article about youth with HCV states (section 5): ”

“Adolescents should be educated about the risk of transmission of the infection to their sexual partners.”

WHO classifies adolescents as 10-19 years old.  They’re mature enough for the facts. Their parents and grandparents aren’t.

The way our well-paid public health officials have been dealing with the HCV health crisis is  crazy.