In order for hepatitis C to be transmitted there must be blood to blood contact. This means that the blood from someone with hepatitis C would have to get into the bloodstream (cut or open wound) of someone else.
People with hepatitis C often worry about giving it to others that they live with. However, it would be very hard to transmit hepatitis C unless there is direct blood-to-blood contact. Things like razors, toothbrushes, nail clippers and other personal hygiene items can spread hepatitis C, but it is difficult to do so.
For example, in order for someone to get hepatitis C from a toothbrush there would have to be blood from someone who has hepatitis C on the toothbrush, then someone would have to take that same toothbrush and brush their teeth. Next there would have to be an open cut or wound in the mouth for the hepatitis C infected blood to get into the bloodstream.
Things to consider are:
- Anything that has cut you
- Anything that you drip blood on or has soaked up your blood
- Anything that you have inserted through your skin into your body
In general you need to be aware that if you are infected with hepatitis C a tiny drop of your blood could infect someone else if it gets into their body. So it's obviously better to take precautions and this section examines ways to be really safe. However, it is far from clear that all these precautions are strictly necessary but it's important to be careful rather than paranoid about the risk of infecting others.
You may also feel you would like to warn people so that they can take extra precautions. This would include:
- Phlebotomists (nurses who take your blood), who would be at risk if they accidentally prick themselves
- Body/ear piercers
- Acupuncturists, who might transfer the virus to someone else if they have not taken adequate precautions
Even though the risk is very low it is still important to be careful to make sure that others in the house are protected.
Cover all toothbrushes, razor blades, nail clippers or any item that might have blood on it – even if you can’t see it.
Keep all personal hygiene items away from other people’s hygiene items.
Remember hepatitis C is not spread by casual contact such as hugging, sharing eating utensils, food or water.
The risk of sexual transmission is very low in the absence of any other complicating factors - see research paper below. Although condom use is not suggested between monogamous heterosexual couples, the best way to be absolutely certain that you do not transmit hepatitis C is to use barrier contraception such as a condom or femidom (female condom).
The complicating factors that may increase the risk of transmission are:
- The presence of blood from menstruation or anal sex, particularly fisting (the lining of the anus is thin and prone to tears).
- The presence of ulcers or sores on your genitalia i.e. from a sexually transmitted infection such as gonorrhoea, herpes, genital warts.
- If either partner is co-infected with HIV the risk of sexual transmission of both viruses appears to increase.
- It is important to bear in mind that condoms can break and you may want to consider using a heavy duty variety, particularly if there is a higher risk of transmission. A heavy duty condom is a much safer alternative than using two condoms, one inside the other, as the friction between them can in fact cause them to tear.
You can read the results of a trial on sexual transmission of hepatitis C here
Mother To Baby
The risk of transmission from mother to child is thought to be approximately 5%. The risk is higher in women who are co-infected with HIV. If you are pregnant or planning to have a child and are hepatitis C positive, it is important to discuss this with your consultant. Whether there is anything you can do to lessen the transmission risk is uncertain. There is some evidence that mothers with lower viral loads are less likely to transmit infection. It is not believed that caesarean delivery makes any difference. On the other hand breastfeeding if your nipples are bleeding is also believed to pose a risk.
If you are intravenously injecting drugs and share any injecting equipment, you can expose others to infection with hepatitis C. This applies to the needle and syringe, as well as to water, filters and spoons - even if you are using a new needle. Any needle that has been used before could still have invisible drops of blood attached to it. When this is placed in a spoon the blood can dissolve in the water and be deposited on the spoon or the filter ready for someone else to draw it up.
The best way to avoid transmitting the disease is to use new syringes, new needles, a clean spoon, sterile water and a new filter. If you do not have access to a new syringe and needle, thoroughly clean the ones you have. Hot water by itself will not kill hepatitis C and is not an efficient way of sterilising. Try as a minimum to use bleach, drawing it in and flushing it out several times. Remember, however, to do the same thing with hot water to flush out the bleach.
It is important to dispose of used needles carefully. The best place is a proper sharps bin, which you can get from your local needle exchange and some chemists. The next best thing is to recap the needle and put it in a sealed plastic container.
Snorting Drugs such as Cocaine
If you share a rolled up note or straw for snorting drugs you risk exposing yourself and others to hepatitis C. This is especially true if your nose is bleeding. Cocaine in particular is very alkaline and corrosive to the thin membranes in the nose. If even tiny drops of your blood – often too small to see - get onto the straw or note, it is quite possible that blood to blood contact may take place through the nasal membrane.
If you have hepatitis C and you have an accident that causes bleeding, it is important to be aware of what your blood has come into contact with. Clean all surfaces and implements thoroughly with bleach and rinse. If you have used anything to staunch the flow such as tissues or sticking plasters, ideally dispose of them in a sealed plastic bag. This also applies to used sanitary towels and tampons. Non disposable items should be washed at the highest possible temperature with added bleach.
Personal Hygiene Articles
Razors, hair and nail clippers, scissors and toothbrushes will, at times, come into contact with blood. Even tiny traces of dried blood may be sufficient to cause infection so it's best not to share these articles if you have hepatitis C. Ideally, store them separately so that no one will borrow them by mistake, especially children.
Razor blades and toothbrushes are particularly vulnerable to accumulating specks of dried blood. They should be stored separately and not shared with others.
Medical and Dental Procedures
Hospitals and dental practices are strictly regulated to prevent blood borne virus transmission and in theory it should not be necessary to inform them that you have hepatitis. If you do choose to inform them, however, they should not treat you any differently from any other patient.
Because awareness of infection control varies widely from one practitioner to another, it is advisable to let your acupuncturist know you have hepatitis C.
Body Piercing, Tattoos, Electrolysis
If you have hepatitis C and want to get a tattoo, piercing or have electrolysis, the responsible thing to do is to inform the person carrying out the procedure. They should, anyhow, be taking the following precautions:
- Using new sterile needles each time
- Properly sterilising re-usable equipment
- Using new jewellery
- Using new ink for each person and cleaning the containers between customers.
If you are going to pierce or tattoo at home, use new equipment for each person and dispose of everything with care. To dispose of a piercing needle safely, put a cork over the point and place it in a sharps bin or in a thick plastic container with a top or lid.