How to Be Smart About Sex and Hep C

To tell or not to tell?

If you have hep C, that is the question. But the answer isn’t the same for everyone.

Paul Bolter, community outreach and education manager at the Greater New York Division of the American Liver Foundation, says a lot depends on the people and the setting.

“If you’re in a loving, committed relationship and know you will be supported, then we suggest you tell your partner because you’re going to need support,” he says.

But he adds that if you’re in an abusive relationship, don’t feel safe, or worry that other people might find out, telling might not be the right choice.

What’s more, even a loving partner may need some time to absorb the news.

Be patient and stay open to any questions your partner may have, advises Lynn Wang, MD, a gynecologist and sexuality counselor in Philadelphia.

For instance, they might want to know how you got hep C and whether they could have it, too.

Bolter says those are hard questions to answer because there’s still a lot of stigma around the disease.

“When people hear hep C, they think of drug use -- one of the main risk factors,” he says.

But hep C can spread in other ways, too. You might have been exposed if you had a blood transfusion or organ transplant before 1992. Or if your body piercer or tattoo artist didn’t use clean tools. Also, health care workers can get hep C from needle sticks.

If you don’t feel comfortable saying how you got it, just say you don’t know. Many people aren’t 100% sure how they got hep C.

What to Say to Your Partner

Assure your partner that hep C isn’t spread through kissing, touching, or sharing dishes. The chance of getting it through sex is very low -- less than 1% per year if you and your partner only have sex with each other. Unlike an STD, hep C can only spread through blood.

“Two pools of blood have to come together,” Bolter says. “For most people, if there’s no blood, there’s no infection.”

He says your odds are even lower if you have less of the virus is your blood.

“The amount of virus that a person has -- called the viral load -- can be really high or really low. The nature of hep C is that it goes up and down. But if someone has a steady low viral load, they’re less likely to spread the virus. So it’s important to know your status,” he explains.

Your partner may also wonder if you need to change the way you have sex. For some couples, the answer is no. For instance, most people who are married or partnered for a long time don’t use condoms. But you may want to discuss safer sex options if you make love during a woman’s period or have rough or anal sex, when tissue is more likely to tear and bleed.

The chance of spreading hep C is higher if you have sex with more than one partner or have an STD or HIV. Using a latex condom every time can help lower the risk.

“These are very intimate, personal conversations,” Bolter says. “You can’t tell people what to do. You can only suggest.”

Living Safely With the Virus

Once you learn you have hep C, your doctor should talk to you about ways to keep your household safe. The most important is not to share razors, toothbrushes, nail clippers, or other personal care items that might come in contact with your blood. Bolter says asking family members not to use these items might be a good way to start the conversation about hep C.

Even if you don’t tell them you have the virus, keep the children you live with safe. Make sure they know never to use your personal care items.

And don’t reuse them yourself after treatment.

“When you’re cured, throw away all your old grooming products, because you could become infected again,” Bolter says. “The same goes for manicures and pedicures. Make sure the technician doesn’t cut your skin and sterilizes all the instruments in front of you. Better yet, bring your own.”

He says one thing to keep in mind when you talk to your family is that hep C doesn’t make you a different person.

“You’re the same person; now they just know one more thing about you.”

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