MSM long-term sexual relationship and HCV.

[Joseebus]

Dear doctor,

I am a gay male and my partner of 3 years was diagnosed with HCV back in October as a "recent exposure". I have read that sexual transmission is very rare, yet MSM relationships are in a "high risk" group. This confuses me because I understand the risk is higher because of the higher risk of causing trauma to the lining of the rectum (I am the "receiver" by the way) which could make blood-to-blood contact easier through unprotected anal sex so of course condoms are recommended. But is there any other factor (other than this and HIV coinfection) that makes us a higher risk group? Reading some of these things can be torture on the nerves and ultimately only confuses me.

I was tested in November and came back negative (for both HCV and HBV) and my doctor (who is familiar with my lifestyle) informed me that the HCV is not an STD and the risk just really isn't there. My main purpose of this "letter" is that I just want some general information and a second opinion to finally reassure myself that it is okay for us to remain sexually active because there is limited information available to us MSMers.

About 80% of our sex life is oral, me performing it on him, unprotected, with him ejaculating into my mouth and sometimes some of it will get into my eye. Is this exposure generally safe as far as HCV is concerned? And of course any anal sex will be with protection just to be safe.

Any and all information or reassurance to any of the above will be GREATLY appreciated. I apologize if it appears that I have rambled on a bit. I just wanted to get all of my concerns out in the open.

Thank you in advance.

[Edward W Hook, MD]

Glads we could help.  Take care.  EWH

[Joseebus]

Thank you so much, doctor. I think a huge part of dealing with this disease is learning how to LIVE with it as normally as possible. Sex is a large part of a relationship and I think if we can learn how to protect ourselves with this infection, then we can have a healthy sex life with less fear. It makes it seem less like some sort of "spectre of death" if that makes sense.

You are greatly appreciated.

[Edward W Hook, MD]

I don't think you are being neurotic.  Your asking questions for which there are no good data.  In my opinion, there should be no risk of hepatitis C transmission from oral sex.  As for rectal sex, there is a risk.  It is probably low.  I would urge you to use condoms in rectal sex to protect yourself against HIV and Hepatitis C.  I think your risk of HIV acquisition is higher than your risk for hepatitis C.  EWH

[Joseebus]

I guess I'm just a neurotic kind of person and sometimes the difference of opinion on sexual risk of HCV can be very confusing.

My real questions are:

Is unprotected oral sex a realistic risk factor for HCV?

and

As long as we are protected and use caution, can we continue to have anal sex with little to no risk?

[Joseebus]

So what is your suggestion that we do? Protection? Also, what about my oral sex question?

[Edward W Hook, MD]

You ask a question which is a topic of hot debate amongst specialists.  In the past the two sides of the argument was whether or not hepatitis C was sexually transmitted or not.  Today the argument has evolved to the point where all agree that the infection is transmitted sexually and the argument is now, how often?  The current beliefs on the subject, based on recent published research are as follows:
1.  Hepatitis C IS sexually transmitted
2.  Hepatitis C is much more easily transmitted with exchange of blood than genital secretions.
3.  MSM are at higher risk than heterosexuals, probably because of the "trauma" associated with rectal sex.
4.  Even among MSM, hepatitis is not as efficiently transmitted as other STDs such as hepatitis B, gonorrhea or chlamydia.   (I am not aware of comparisons of HIV vs hepatitis C).

With regard to your own post, two other comments.  First if your partner has hepatitis C and you do not, you did not give it to him but are at some risk for future infection.  Secondly, while receptive rectal intercourse is probably riskier than insertive, there is still an elevated risk of HIV for the insertive partner again--far higher than for heterosexual genital sex .

Hope this helps.. EWH