sexually transmitting HepC

[ram921]

  I've been told from the beginning that HepC is not a sexually transmitted disease, but blood-to blood. My significant other believes otherwise, much because her obgyn and other doctors recoil in horror when she tells them of our unprotected sex. We are long-term monogamous, and do not participate in any high-risk behavior. I've had Hepc for at least 10 years, and haven't given it to her. I respect her feelings, but feel her fear is unfounded.  I believe the whole business has driven a wedge between us, but my feelings are invalid because I am the one with the illness, but that's another issue.

[jslepin]

Hi Ram,
This is a good question and one that we all have to think about.  It seems that every time this question is asked, one gets a different answer.  The CDC says that sexual transmission is NOT COMMON.  Here's a link to their site and what they say about it:   http://www.cdc.gov/hepatitis/Populations/STDs.htm

They also say that HCV can be spread infrequently through sex with an HCV-infected person although it is an inefficient means of transmission.

http://www.cdc.gov/hepatitis/HCV/HCVfaq.htm#section2

I think that in your case, the evidence is already in front of you.  You are in a monogamous relationship and your wife is negative for HCV.

This points out the lack of knowledge so many healthcare providers have about this disease.

Hope this helps.

Jennifer

[eureka254]

It's not unusual for even those in the medical field to lack knowledge about the specifics of hep c -- sorry to hear that you're suffering from the fallout of ignorance.  Perhaps you could encourage her to go with your to your GI/Hep doc visits to alleviate her fears?  Or, maybe printing up some research/data for your spouse would help? (for some, seeing is  believing ...maybe just leave the article 'laying around'...):

http://www.ncbi.nlm.nih.gov/pubmed/15128350

From the Amercian Journal on Gastroenterology, 2005:

"Our data indicate that the risk of sexual transmission of HCV within heterosexual monogamous couples is extremely low or even null. No general recommendations for condom use seem required for individuals in monogamous partnerships with HCV-infected partners."

Hope that helps...
~eureka

[FlGuy]

Dismissing someone's fear of anything by just saying it's unfounded is not dealing with the issue that the person has.  "...obgyn and other doctors recoil in horror " - look at the response that she gets from medical professionals she probably respects. Now, compare those to your response which is basically '"don't worry honey".  Sounds pretty lame in comparison, regardless of the truth.  You need to deal with the entire issue before it gets larger.  Are you really 'respecting her feelings' and dealing with the fears she has which are real to her?

[ram921]

Not "Dismissing". Suggested solutions, sought council from mutually respected sources. Careful about jumping to conclusions, please. My response isn't remotely, "Don't worry , Honey." It's more like, "What would make you comfortable?" But thanks for the 'lame' point of view, speaking of respect.

[Trish77]

I have long found that the Australian sites explain this best, in nice plain language.  Maybe because, as one of my Aussie friends tells me, they're less uptight about sex there, I dunno.
  
http://www.hepatitisaustralia.com/about_hepatitis/relationships.html

This can be a tough issue for some people to sort out for themselves.  Your wife has to feel safe and she doesn't right now.  So maybe you're going to have to put in the time to dig up the *right* information from reputable sources that actually deal with Hepatitis C, not ob-gyn's who don't specialize in it....and be patient...give her time to get informed.  Put in your time and be patient...and hopefully after SHE'S had the same opportunity you've had to get educated, she'll settle out.  

Also try and think if the shoe was on the other foot ... you'd want to be very clear on your risks, I'm thinking and you might opt for "alternatives" until you can sort it out for yourself as well.

Good luck.

Trish

[Odin999]

Has her concern been precipitated by anything in particular? Have you just been diagnosed, or has she developed an extra condition that changes the situation? Either way, a chat with the right kind of expert cannot be a bad thing. Do you have a Hep C support group that can give advice?

I had one partner who was concerned about transmission. A trip to the local sexual health clinic quickly cleared up the fear. I gave all the information that I could and then said now here is where you can go to get independent confirmation if you want to. I said, "don't just believe me, find out for yourself so that you feel really comfortable."

[Odin999]

One more thing. I wonder why you feel that her fear is unfounded? Not being accusative here. Just wondering because personally I have never felt someone else's fear of catching HCV was unreasonable.

[ram921]

Thank you. Perhaps "unfounded" was an unfortunate choice of words.  The context I  meant is, "in the face of everything we've learned, and after ten years of being aware of the infection without passing it to her..." Jesus. I'm sorry if it sounds as if I am invalidating her feelings!  The original question was directed at gathering more information about the odds of transmission sexually to provide her with even more first-hand information one way or the other.  Not," Hey, Do you think I'm selfish and insensitive?"  Nothing has changed, we've both been aware of the disease for ten or twelve years, I'm preparing to enter treatment in November, so I guess it's academic. But thanks for the  judgment- there's not enough of that from the gen. public.

[Odin999]

Don't think anyone really means to have a go at you for being selfish or insensitive. Maybe we all know from personal experience the strain that chronic illness can put on relationships. Almost every piece of documentation I have ever come across says something similar (already stated above). Perhaps that is why we started asking you other questions. All the evidence points to very low risk -> next questions => why doesn't she feel comfortable, or is there something else affecting her feelings?

Best of luck sorting it out.

[eureka254]

Your post really didn't have an outright question, and really I just took a shot at trying to help in response.  Like Odin, I don't think people where making judgement... rather trying to judge better what exactly you were looking for since your post stated your feelings rather than asking a direct question (which is fine), but it leaves us trying to assess what kind of feedback you were seeking.  

If you're looking for firsthand feedback:  my husband has probably had hep c for almost 40 years, we've been together 22 years, frequent unprotected sex, some 'risky' business, I'm hep c negative.  

It's all about removing wedges, hmm?
~eureka

[ram921]

Thank you. More to the point. No harm done.

[FlGuy]

My earlier reply was to attempt to look from her point of view, not minimize the situation.  From my experience, it's not easy (may be not even possible) for a husband to see a wife's point of view on a lot of stuff. We've been married for more than 20, all of it with me and hcv but diagnosed for only a few of those years. She and the kids were not infected along the way.  But, upon dx, some things were a little weirdly different. Thing is, there is a risk even though it's small. And, if there's a risk, it's not entirely unreasonable to have a fear of it.  If you go through tx or take other measures in the meantime, will things be better?  Didn't mean to be insulting back there.

[Jakied]

Sexual transmission of Hep C is rare.  When sexual transmission does happen, it is

usually male to female.

[Isobella]

Sexual transmission is rare......just like it is  rare for a mother to pass the virus to her baby during birth......like 6%.  As I have said before, the statistics seem small-unless you are one of them.  


I agree with Trish...maybe "opt for alternatives" for a while....because as you said-it's all academic-you are treating soon and on your way to SVR so all this will be a moot point!



I know this is hard on relationships and I do wish you the best.


Take care,

Isobella

[jmjm530]

My significant other believes otherwise, much because her obgyn and other doctors recoil in horror when she tells them of our unprotected sex.
-----------------------------------------
Her doctors are off base compared to the  what the Center Disease Control (CDC) an and most liver specialists would say and advise. This is not surprising since Hepatitis C is not understood very well, even within the medical profession and that's an understatment.

Usual guidelines are that condoms are not recommended for monagamous couples.  Perhaps you could go to the CDC site and printout their guidelines,  or have her talk to a liver specialist,  and not a doctor who probably has no inkling about Hep C. After that, if she is still concerned, condoms are always an option until you get treated.

All the best,

-- Jim

[Isobella]

I will add that my PCP is totally convinced that I got this sexually.  We argue facts and statistics constantly.  I finally told her, if that is what she needs to believe for some reason or to document it in my chart...go for it, but I totally disagree.  

I swear it's like she wants me to admit to sleeping around for some warped reason.

And my ob/gyn is absutely clueless as well.  

My point is-she may have a hard time convincing her docs otherwise.  It is possible she cannot convince them at all.  She may need to hear it from a good hepatologist/GI doc.

Once again...soon to be a moot point, as you are on your way to SVR :-)

[nygirl7]

Usual guidelines are that condoms are not recommended for monagamous couples.  
---------

I asked my doctor why - why is it any different for a monagmous relationship or if someone is 'dating' (just curiousity).  

He said that it's a rather archaic tool to use - that they figured that if someone has had multiple partners in a few years that the chance of transmission is higher because they would have less saferR sex practices than an old married couple. I found that to be the most ridiculous thing but there you go. I guess you know for non-married couples they are all just sexually crazed deviants hahaha.

But that is the explanation that he gave me.   So, I think the whole "monogamous" thing means if you are practicing safe'R' sex practices you are relatively safe and that the low low number of possibility is just covering their butts in case you are doing things not considered safeR sex.

[mremeet]

I don't remember all of the intricate details concerning the risk of sexual transmission, but I recall HR discussing this some time back. Hopefully someone can find the post, because my complete and accurate recollection of it is hazy (partially because I didn't understand all of it). But from memory he said there is a sort of localized partial immunity to HCV at the tissue level. By that apparently there is a first line of defense in our immune system that starts in the actual tissues that may come into contact with an infected person's microdroplets of blood (as occurs in sexual contact). He always refers to all these different immune response "pathways", and this was one of those pathways - a first line of defense, entry level pathway. There was some kind of test he referred to that could detect if certain cells in tissues had been exposed to the HCV virus (in those who were not infected and had never had HCV in the past). And that testing showed that those who had contact with someone with HCV actually "lit up" (i.e they luminesced) indicating that those cells recognized the HCV virus revealing they had in fact been exposed to the HCV virus in the past, even though the person themselves had never contracted the disease.

I recall he said these immune pathway cells are "educated" in recognizing low level contact with the virus, and once they are educated they serve as first line defenders. These "defenders" were thought to probably be responsible for protecting a spouse from becoming infected by an HCV+ partner, and may be why transmission rates are so low (and even seemingly non-existent) in monogamous couples. If I remember correctly he said these first line defenders can lose their memory of HCV in a relatively short period of time (compared to antibody decay rates etc), so it was thought that if a monogamous couple stopped having intimate contact for a prolonged period of time, the uninfected partner's protection may decrease to a point where they may not carry as much protection as they normally would. In other words, having sex more frequently with their infected partner would keep the primary pathways "refreshed" with ongoing contact with the HCV virus. If intimate contact stopped over a relatively long period of time, the primary pathway's may lose their effectiveness at stopping the virus from a successful invasion (should there be a significant contact to initiate an actual infection). If this described (and theoretical) mechansism is accurate, it would also help explain why monogamous couples have such an ultra low transmission rate when compared to those that were sleeping around with multiple partners and happened to encounter an HCV+ person without the "educated" primary immune pathways as described above.

[R Glass]

I never really quite understood this 6% chance for monogamous couples.
How could the 6% chance apply the same to a monogamous couple that has been together 3 years versus one that has been together 30 years? Or if it is 6% chance every time they have intercourse? If this is the case, after 16 times the rate jumps to .96% chance. Personally, I think the whole study is Cr@pola

[jmjm530]

I think it might have something to do with more incidences of STDs with non-monagamous couples. Less STDs translate into less chance of virus penetrating tissues, i.e. less sores, etc. Also, don't people stop having "rough sex" by the time they are married :)

[R Glass]

Thanks Jim, it all makes since to me now.
The chances of having rough sex drops 94% for monogamous couples, thus leaving the 6%.

[jmjm530]

That's been my experience

[HCA]

The sex part stops when they are married but the rough is only just starting.

[Isobella]

You guys crack me up!!


That whole 6% per incidence arguement is what my PCP uses with me. Making it a pretty sure thing that my hubby would be positive after 23 years of marriage.  She drives me nuts with it.