Yes, hepatitis C can be sexually transmitted, but the risk is low. Hepatitis C spreads when blood carrying the virus enters another person's bloodstream, and sex usually doesn't involve enough blood contact for that. The risk climbs in specific situations: sex that causes mucosal tearing, the presence of other STIs, and especially among people with HIV.
most unaware
8–12 weeks of pills
| Item | Value |
|---|---|
| Acute reports | ~5,000/yr |
| Living with chronic HCV | ~2.4 million — most unaware |
| Cured by DAAs | >95% — 8–12 weeks of pills |
| Vaccine | none |
The essentials: how hepatitis C actually spreads
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), and it travels through blood. When blood from an infected person enters another person, infection can follow CDC. That blood-borne route is why sharing needles or syringes spreads it so efficiently. Sex works differently. The virus lives at high levels in blood but only sparingly in semen and vaginal fluid, so ordinary intercourse rarely transfers enough virus to take hold.
The exceptions matter. Sexual risk rises when blood gets into the mix: anal sex (which more easily causes small tears in the rectal lining), sex during menstruation, rough or group sex, genital sores from another STI, and chemsex involving shared injection equipment. HIV co-infection is the single biggest amplifier. Outbreaks of sexually acquired hepatitis C have been documented mainly among men who have sex with men living with HIV. If you're in a monogamous heterosexual relationship with no blood exposure, the per-act risk is very low, though not zero.
Hepatitis C is divided into two phases. Acute infection covers the first six months after exposure; chronic infection is what develops in most people who don't clear the virus on their own, and without treatment it lasts a lifetime. Unlike hepatitis B, hepatitis C is now curable, with modern therapy curing more than nine in ten people who take it. For a deeper look at passing it to a partner, see our guide on whether is it possible to give hepatitis c to someone else?.
Acute hepatitis C reports run around five thousand a year, but that figure vastly undercounts the roughly 2.4 million Americans living with chronic HCV, most of whom don't know they have it CDC surveillance, 2023. Silent, undiagnosed infection is the rule, so testing matters more than worrying about exact transmission odds.
Symptoms: why hepatitis C is so often silent
Most hepatitis C infections cause no symptoms at all, which is why the virus spreads so quietly. When acute symptoms do appear, jaundice — a yellowing of the skin and the whites of the eyes from a backup of bilirubin the inflamed liver can't process — shows up in only about 20 to 30 percent of people. Nonspecific complaints like fatigue, poor appetite, abdominal pain, and dark urine occur in roughly 10 to 20 percent CDC. Because these mimic a passing stomach bug or general tiredness, they're easy to dismiss.
Chronic hepatitis C is even quieter. It frequently causes no specific symptoms for twenty years or more while it slowly inflames and scars the liver. Over decades, that unchecked scarring can progress to cirrhosis (severe, permanent liver scarring that impairs liver function), liver failure, and liver cancer. People feel fine while the damage accumulates, so you cannot rule out hepatitis C based on how you feel.
Testing: who should get checked, and how it works
Diagnosis is a two-step process. It starts with an HCV antibody test, which detects whether your immune system has ever responded to the virus. If that's positive, the lab automatically runs a nucleic acid test (NAT) for HCV RNA to confirm a current, active infection, because antibodies stay positive for life even after the virus is gone CDC testing. A positive antibody with a negative RNA means past infection that's been cleared or cured.
Screening guidance is broad on purpose, given how silent the infection is. CDC recommends screening all adults aged 18 and older at least once, and screening pregnant people during each pregnancy. The USPSTF gives a Grade B recommendation for one-time screening of adults aged 18 to 79 USPSTF. If you have ongoing risk — injection drug use, an HIV diagnosis, or higher-risk sex — you'll need testing more often than once.
Practically, this is a simple blood draw, and many of the other infections people get screened for alongside it come from a urine cup, a self-collected swab, or a quick exam, with results usually back in a few days. You can get an HCV antibody test and a full STI panel free or low-cost at health departments, Planned Parenthood, and Title X clinics. If you're trying to time a check after a possible exposure, read when to test after exposure, then book a hepatitis c test or get tested for a broader panel.
Treatment: hepatitis C is now genuinely curable
Treatment has transformed. Hepatitis C is cured in more than 95 percent of people who complete an 8-to-12-week course of oral direct-acting antiviral (DAA) pills WHO. DAAs work by blocking specific proteins the virus needs to copy itself, shutting down replication until the virus is cleared from the blood. The cure holds in over 99 percent of people followed five years out.
The simplified regimens are concrete and well-established: glecaprevir/pibrentasvir taken for eight weeks, or sofosbuvir/velpatasvir taken for twelve weeks. Specialist guidance now recommends treating essentially everyone with active HCV, not just advanced or symptomatic cases AASLD/IDSA Guidance. Finish the entire course even after you feel fine, because stopping early invites the virus back and risks resistance.
Cure doesn't grant immunity. Hepatitis C antibodies stay positive for life, so reinfection is possible if you're exposed again, and only an RNA (viral) test can detect a new infection — the antibody test can't. Anyone with ongoing risk should retest annually. Full details on regimens and what a course is like are in our hepatitis c cure guide.
Prevention: there's no vaccine, so behavior is the protection
Unlike hepatitis A and B, there is no vaccine for hepatitis C, so prevention rests entirely on avoiding blood-to-blood contact CDC prevention. The highest-yield steps target the highest-risk routes:
- Never share needles, syringes, or any drug-injection equipment — this is the dominant transmission route.
- Use syringe services programs, which provide sterile equipment and dramatically cut transmission.
- Don't share personal items that can carry traces of blood, like razors, toothbrushes, or nail clippers.
- Use condoms during higher-risk sex — anal sex, sex with multiple partners, or sex when other STIs or sores are present — to reduce the small but real sexual risk.
- Get tested at least once as recommended, and retest if you have ongoing risk, since routine testing catches infections that produce no symptoms.
For couples, ask your clinician whether your partner should be tested so you're not unknowingly passing it back and forth. A diagnosis here is common and treatable, and clinics handle it daily.
When to see a clinician
Book a test if you've ever injected drugs, even once long ago; if you've had a possible blood exposure; if you have HIV or have higher-risk sex; if you're pregnant; or simply if you're 18 or older and have never been screened. See a clinician promptly if you develop jaundice, unexplained fatigue, abdominal pain, or dark urine. Don't wait for symptoms, because most people who have hepatitis C never get any until the liver is already damaged. A positive antibody result is not a verdict; it's the first step toward a confirmatory RNA test and, if needed, a cure.