Sex after HCV

[willy]

We should probably either have a thread or forum for sex...... but as I find interesting information I've just been adding it to this thread.  Here's a new one that helps us understand and quantify risk. PS......... This is only one (nearly the last, I think) of many articles on the link; read em all - Willy

http://www.hcvadvocate.org/news/newsLetter/advocate0403.html

Sexual Activity as a Risk Factor for HCV
Alan Franciscus
Editor-in-Chief, HCV Advocate

Percutaneous exposures, such as injection drug use or a blood transfusion prior to effective screening are well-documented risk factors for HCV, hepatitis B and HIV transmission. There are, however, clear differences between these viruses when it comes to their ability to be transmitted through sexual activity. There is an adequate amount of evidence indicating that HCV can be sexually transmitted but with much less efficiency than both hepatitis B and HIV.

To date the epidemiological studies evaluating the degree of risk of HCV transmission by sexual contact have had quite a few methodological limitations that are inclined to overestimate the amount of HCV infections associated with sexual contact. Early studies used first-generation anti-HCV assays, which have a higher false positive rate than second and third-generation assays. Studies vary in the completeness of risk ascertainment and many fail to carefully exclude HCV acquirement from non-sexual sources. Non-disclosure of injection drug use (IDU) as a risk factor is particularly important since assessing the contribution of sexual activity to HCV transmission is difficult in the presence of injection drug use. Finally, only a limited number of studies perform virological analyses to confirm that sexual partners are infected with the same virus thereby excluding acquirement from outside sources.

Sexual transmission of virus occurs when infected body secretions or infected blood are exchanged across mucosal surfaces. The presence of virus in body secretions is necessary but may not be sufficient for transmission to occur. Other factors that may influence transmission include the titer or amount of virus in body secretions (body secretion viral load), the integrity of the mucosal surfaces (some sexual practices may traumatize the mucosa, e.g., anal receptive sex and fisting), and the presence of other genital infections, both viral or bacterial including herpes simplex virus, trichomonas and gonorrhea.

Studies to detect HCV RNA in semen (seminal fluid and cells), vaginal secretions, cervical smears, and saliva have produced mixed results. Inability to detect HCV RNA in body secretions may be caused by technical aspects, including specimen collection and storage, and the ability to exclude cellular components and surmount the presence of polymerase chain reaction inhibitors. Even in studies using the most favorable methods for isolating HCV RNA, the majority of samples were negative for HCV RNA and those that were positive were of low titer (equal to 1000 copies/mL). A low titer of virus in genital secretions could explain why HCV is transmitted less efficiently than hepatitis B virus or HIV. Furthermore, there may be a lack of suitable target cells in the genital tract to allow infection to occur or infection may require the presence of abnormal mucosa (ruptured or damaged mucosa which would result from sexual injury or a bacterial or viral infection). Finally, while the presence of HCV RNA in semen, vaginal or cervical secretions supports the argument that HCV is sexually transmissible, a cell culture system or animal model is still needed to prove that HCV RNA detected in genital secretions represents infectious virus.

Sexual transmission has been assessed in varying populations of HCV infected individuals, and two main risk groups have been identified. The first risk group comprises those who have more sexual encounters and who are more likely to have multiple sexual partners, including men who have sex with men, female sex workers, attendees of sexually transmitted disease clinics, and those in HIV surveillance studies. The second risk group comprises persons who are in a long-term monogamous sexual relationship with someone who is chronically infected with HCV. There are differences in the rates of anti-HCV positivity by risk group with higher rates reported for the first risk group. These differences in rates of HCV infection may correlate with differences in sexual risk behaviors including and not limited to frequency or type of sexual activities. On the other hand, differences between risk groups may indicate inconsistent rates of exposure to non-sexual sources of HCV including injection drug use, intranasal cocaine use, tattooing, body piercing, dental exposure, toothbrushes, razors, etc. For this reason, sexual transmission findings from one risk group cannot be considered as widespread fact.

With that said, it has been found consistently in both prospective and retrospective studies that the risk of HCV transmission via sexual contact differs by the type of sexual relationship. Among individuals with multiple partners or those at risk for sexually transmitted diseases (STDs), the median seroprevalence of antibody to HCV is 4% (range, 1.6% to 25.5%) with the median rates being 6% (range, 1% to 19%) among female sex workers, 4% among men who have sex with men (range, 2.9% to13%), and 4% among attendees of STD clinics as well as individuals participating in HIV surveillance studies (range, 1.6% to 26%, which dropped to a range of 1.6% to 7% when limited to individuals without a history of IDU). HIV coinfection increases the rate of HCV transmission by sexual contact even though the precise mechanism is unknown.

Persons in long-term monogamous partnerships, on the other hand, are at lower risk of acquiring HCV (0% to 0.6% per year) than persons with multiple partners or those at risk for sexually transmitted diseases (0.4% to 1.8% per year). This difference may reflect differences in sexual risk behaviors or differences in rates of exposure to nonsexual sources of HCV. Early studies found that the rate of HCV positivity in partners increased with the longer duration of marriage, suggesting that the risk of sexual transmission correlated with frequency of contact. However subsequent studies adjusting for age did not find a consistent relationship between the duration of the sexual relationship and the HCV positivity of the partners. Overestimation of the rate of sexual transmission of HCV occurs when antibody testing alone is used to make the assessment. So, based on only those seroprevalence studies that used genotyping or sequence analysis of the hypervariable region of E2 (the envelope region of the HCV genome), in monogamous, heterosexual partners of hepatitis C-infected, HIV-negative persons, the frequency of antibody-positive and genotype-concordant couples is 2.8% to 11% in Southeast Asia, 0% to 6.3% in Northern Europe, and 2.7% in the United States.

The mounting evidence indicates that HCV virus can be transmitted by sexual contact but much less efficiently than other sexually transmitted viruses, including both the hepatitis B and the HIV viruses. However, because sex is such a common behavior and the numbers of HCV-infected individuals in the United States is substantial, sexual transmission of HCV likely contributes to the total burden of infection in the United States. Current recommendations about sexual practices are different for persons with chronic HCV infection who are in steady monogamous partnerships versus those with multiple partners or who are in short-term sexual relationships. HCV positive individuals in longer-term monogamous relationships need not change their sexual practices although they should discuss safer sex options if either partner is concerned about sexual transmission. If couples wish to reduce the already low risk of HCV transmission by sexual contact, barrier precautions may be used. Partners of HCV-positive persons should be considered for anti-HCV testing. For HCV-infected individuals with multiple or short-term sexual partners, barrier methods or abstinence are recommended.

Copyright April 2003 – Hepatitis C Support Project – All Rights Reserved. Permission to reprint is granted and encouraged with credit to the Hepatitis C Support Project

[fmors]

Since being diagnosed with HCV in January my wife is not comfortable having sex without me using a condom.  I now find myself avoiding having sex with her, as I can't stand to wear a condom.  I feel we are growing apart because of this and other issues associated with the disease.  I contracted this disease almost 30 years ago and we have been married for 18 years.  She thinks I am more contagious now as my viral load is over 3 million.  She spoke with my Gastro. Dr. regarding protection and he reassured her that nothing needs to change, but she is still uncomfortable having unprotected sex.  We used to have a very good and active sex life.

[willy]

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15128350

Lack of evidence of sexual transmission of hepatitis C among monogamous couples: results of a 10-year prospective follow-up study.

Vandelli C, Renzo F, Romano L, Tisminetzky S, De Palma M, Stroffolini T, Ventura E, Zanetti A.

Dipartimento di Medicina Interna, Universita di Modena e Reggio Emilia, Modena, Italy.

The risk of sexual transmission of hepatitis C virus (HCV) infection was evaluated among 895 monogamous heterosexual partners of HCV chronically infected individuals in a long-term prospective study, which provided a follow-up period of 8,060 person-years. Seven hundred and seventy-six (86.7%) spouses were followed for 10 yr, corresponding to 7,760 person-years of observation. One hundred and nineteen (13.3%) spouses (69 whose infected partners cleared the virus following treatment and 50 who ended their relationship or were lost at follow-up) contributed an additional 300 person-years. All couples denied practicing anal intercourse or sex during menstruation, as well as condom use. The average weekly rate of sexual intercourse was 1.8. Three HCV infections were observed during follow-up corresponding to an incidence rate of 0.37 per 1,000 person-years. However, the infecting HCV genotype in one spouse (2a) was different from that of the partner (1b), clearly excluding sexual transmission. The remaining two couples had concordant genotypes, but sequence analysis of the NS5b region of the HCV genome, coupled with phylogenetic analysis showed that the corresponding partners carried different viral isolates, again excluding the possibility of intraspousal transmission of HCV. 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.

PMID: 15128350 [PubMed - indexed for MEDLINE]
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I hope this helps you.  A few possibilities exist; maybe this will solve everything.  It is also possible that it isn't a HCV thing, but rather a relationship problem.  If so you might also consider counseling.  If it's a problem that therapy solves you find that in addition to having better sex other areas of your life together may improve. 

 It may not be any one thing.  I have sometimes wondered if I were to do TX and become clear of the virus...... would I have some vestiges of fear about re-catching it myself? 

Good luck and keep trying.   

Willy

[DjTurtle]

  fmors, I am sorry to hear that she feels that way. I always figured if my hus had not got it after 20 years and none of my 4 kids that I gave birth to before I knew I had it, then it is little to no possibility of passing it during sex. If you think about it, it makes sense. Your infected blood has to get into her bloodstream. Now if you shared a needle, maybe. And I guess if you had sex during menstruation, but even then, you would have to have some free flowing blood enter into an open blood stream of hers. I know it is not a pleasant topic, but I really think people need to think clearly about it. The only couples I know about that both have it, are because they both were sharing needles. Please try to get her to talk to more of us heppers and doctors. I have a site with a chatroom on thursday and Saturday nights from 8pm to 11pm that I have been told I could share in here. I feel this would be a good time to share.
  http://groups.msn.com/hcvsupport

Dealing with having hep c is hard enuf without having other stressful issues also.

Hope she comes round,
DjTurtle aka Dawn

[fmors]

Thanks DjTurtle and Willy50.  Hopefully she will come around.

[Helen]

fmors,
 I hope so, you know when I was first diagnosed, I was the one afraid, told my hubby maybe he should wear a condom, he looked at me like I was crazy, he said after all these years ( 30 in May) he really wasnt worried about it and that I was being rediculous. I was really afraid he would be standoffish but that hasnt been the case at all. As has been suggested maybe you can get her to read here and also give her a little time, Just keep the communication as open as you can. AND maybe you should use a condom for now at least, let it sink in do whatever you have to do to not let this cause you to drift apart.
 Good luck to you, Helen

 PS: also carried both of my sons while infected and both tested negative.

[willy]

Here is an interesting thread from a dating forum where the beginning poster asks what the appropriate time to disclose his HCV positive status to a person is.

There are quite a few pages of replies.  Some are kind and some are not.  Some are informed and others are less so.  There are some good responses and the ones that may be a little mean spirited or uninformed are still important to read since that is what we may encounter when we inform people of our status.

http://forums.plentyoffish.com/datingPosts5360237.aspx

There are also likely other similar type threads where one might also investigate dating and where it may also apply to STDs, disclosing other illnesses, or any other information as it may aplly to dating.

Willy

[desertheart]

Ok willy now we know where you are when you arent on here

[DjTurtle]

Wow! Willy!
I went to that site and read the thread. I was so disgusted by the time I finished!  Many of them think of hep c as an STD. The guy was asking about when to tell gf he had hep c. I think if the relationship is progressing, that a person should tell. They were soundking like the reason to tell is that it is a form of std. The reason I would want to tell a gf or bf, is not really how it is contracted. If it becomes serious, this person should know, as it would be like marrying someone that has cancer without them knowing. We all know that that can be a hard road to haul for the spouse.
I am still steaming somewhat, but am calming down. That read only makes it more important to educate the population.

DjTurtle

[negative1]

I was infected about 30 years ago and was married and my wife did not get it.  ( Oh wait, we had a low % cuz we naver HAD sex) But now I have been with my girlfriend for 4 years and we don't use anything and she is neagtive. We did, however cut out the use of whips and chains, but once again, it is a choice you have to make!
Earl

( not being disrespectful here, just trying to add some humor)

[attachment deleted by admin]

[negative1]

Darn...that was the nicest attachment that I had on here and it was here for the longest time!
There was no nudity in it, just some humor and fun!

Earl

[Helen]

Earl, it was probably deleted to make room for other stuff  We've been having to do that every once in a while because we just dont have enough room for all the pics. Sorry. 
 So if you notice stuff missing here and there and didnt get a pm telling you there was some kind of problem
with it thats why, we just needed the space. 
 Hopefully we'll get upgraded soon and be able to hold alot more. 

[negative1]

So Helen, the pic with the guys and girls in leather and bondage didn't have anything to do with it then huh?

LOL

[Helen]

I dont know, I dont remember seeing it BUT we always send a pm if it was removed for that reason
to let the poster know why so I think it was just a random deletion.