That got your attention, yes?

The problem we on this board (and in the general population) have in our conversations about hep c and sex is reconciling the fact that there are no firm guarantees of safety, but no loud alarm bells either. There is no need for panic, but it is irresponsible to claim there is no risk--how to balance these? This is still another "grey area" with hep c, needing honest self-examination, careful thought, and judgement.

I mentioned in an earlier post that as far as my amateur readings have gone, every bodily fluid (from a hep c patient) that has been tested for the presence of hep c viral particles has been shown to contain them. This is true of blood as we well know, saliva, tears, semen, and so on.

Further on the worrisome side, although the numbers always seem low, every study I've seen of long term monogamous couples with one infected partner have found a few examples--usually between five and fifteen percent--of both partners being infected, with the high possibility that one (male, no doubt) has infected the other. As Thanbey has pointed out, a few very sophisticated studies have shown similar genetic patterns between the viruses infecting some pairs (i said SOME), increasing the likelihood that one got it from the other. Yes, some pairs no doubt got it together from shared tatooing or drug use behaviors, but the evidence leans to the obvious here--at least a few folks seem to have infected other folks, sexually.

So, it can happen.

On the other hand, this does not make hcv very like the STD's we are used to thinking of--a percentage much higher than five or ten percent will transmit gonorrhea or hiv or herpes if unprotected sex continues long term. (I'm sure the percentage is much higher than five percent for these diseases after even one single encounter never mind for years,
as in the hcv couples that were studied.) Detailed, extended studies of long term couples are not needed to convince us that herpes, for example, is a real risk in unprotected sex.

So hep c is transmissable, but it seems pretty different, too. It is contagious, but much less so than the diseases we usually think of as sexually transmitted.

To me this is like the issue of contagion and hep c in general--outside of sex. That is, we cannot say that there is NO chance of transmitting to others--let's say family members or roommates--but it sure is not contagious in the sense of the flu or chicken pox or something like the more common std's. Common sense and normal cleanliness, with special care about blood, seem to be all that is required to protect the family. But we sure wouldn't want the family going around unaware of the need for these common sense measures--using each others' razors or something. We'd tell 'em about the issue and lay out some guidelines. In other words, to ignore the virus would be foolhardy, but to give up normal family living out of fear of the virus would be crazy.

This means to me that in the case of sex, yes, to ignore possible transmission, to take no precautions, to fail to let a partner know, these would be irresponsible behaviors. But are we on fire with a raging venereal disease? no.

And, very important, today's attitudes toward unprotected sex are so radically different from what they were only 10 or 20 years ago, that the social context is totally transformed. We are now so used to talking about and using condoms and other safe sex practices, and to being careful with people we do not know well, and to discussing honestly (with people we know a bit better) our fears and knowledge, and to saying "No" if no protection is available, and so on, that this is a different world from the one we grew up in.


I regularly read a couple of different hep message boards, and I can't remember reading a single example of a couple or a single person who stopped having sex because of the hep. It's a challenge, but it is surely a surmountable one.

Boy, I had no idea I was gonna go on at this length when I began. I guess the topic gets my attention real well, too! Well, it's worth the time to think about and discuss. We may have a virus, but we're human--sex matters to us, intimacy matters, affection matters, honesty matters---just like BEFORE we got diagnosed. Only now, we have extra reason to face it all a bit more candidly.

My thoughts and opinions, only, as always.

Peace----

sean

Sean,

You have done a fabulous job of laying out the issues.

Forgive me for adding one more.

While the world has changed with respect to our openess, one thing has changed very little.

That is the power struggle between the sexes over condom use. Women, especially young women, DO have difficulty saying no to sex without a condom. (Yes, I have an article about this, too!)

Men, please, if you have hepatitis C I urge you to be more sensitive to this issue. I get many many calls from men (and I am dead serious here) asking me to talk wives and girlfriends into having sex without a condom. Neither hepatitis C, not condoms are the issue. The issue is trying to get someone to do what you want them to do without recognizing their feelings and concerns. That's the relationship killer, not hepatitis C.

This is a decision between two intimate people. If your partner is anxious or fearful, YOUR sex life will suffer. Talk to each other, respect your partner's fears and act with love and concern for her feelings.

I hear that relationships end because of hepatitis C, yet from the contacts I have, I have to wonder if the underlying problems are the same as for everyone else, fear, lack of communication and power issues.

Just my additional 2 cents.

Thanks Sean, for your wonderful post.

thanbey
www.hcop.org (http://www.hcop.org)

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wow. I am disappointed to hear this about my fellow males. I guess if i were the cynical type i would not be surprised, but i am. And, sorry to say, upon reflection, it sort of figures.


Thanks for your kind comments--and useful additions.


sean

Howdy all-
I was just reading though some past posts, thought I might add here that although HCV has been detected in saliva, tears, semen, it is important to state that these samples have to have blood particles in them to contain the HCV virus and the recepicant would have to have an access into the blood stream,
[my own words based on facts from Roches HCV manual ]

Be well+


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--Get Outdoors-Enjoy Life----Neil

[This message has been edited by LOST1 (edited 12-18-2002).]

Sean had it completely correct in his post.

The virus has been found in blood and body fluids. We do not know all the mechanics of transmission at this point. However, we do know that the virus gets into the body via the bloodstream of the person who gets infected. We have no idea how much virus must be present or what all the elements are that must be in play for an infection to take hold. It is possible that more people have been exposed and simply fought off the virus, thus never becoming infected. There are many theories and possibilities.

Most virologists (and certainly our medical director)would argue that the statement that blood MUST be present for a transmission to take place is false. We haven't got the evidence yet that the presence of blood is absolutely required and I would not like to see anyone rely on information that says it is necessary in order for transmission to take place.

Blood can also be present in microscopic amounts and not be visible to the naked eye.

Take precautions for the worst and hope for the best, as they say. But, neither dismiss the chances of transmission, nor make yourself crazy over it.

Have a loving and happy holiday season!

thanbey
www.hcop.org (http://www.hcop.org)

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[This message has been edited by thanbey (edited 12-17-2002).]

so does everyone want a box of condoms for Christmas ?
Good information, you all have made good points.
I have been married 18 years & my wife won't get tested so we don't know if she has hep c or not.
She wants to use condoms to make her feel more comfortable so we do.
Am I crazy about it ( NO )
I read so many articles that say they have been married x number of years & never had protected sex, bla bla bla, & don't have it so don't worry ect.
I got it some where & I am not in any risk group.
A person deserves the common courtesy of being able to make an educated decision period.
I certainly would if the shoe was on the other foot so to speak.

T-
Let me re-instate my comment, I agree that Sean was completely correct in his post, and also not to disagree also with your medical director, as Sean stated about amateur Reseaching, my comment is also just based on what was found from my own amateur reading,and would also would not want anyone to rely on information that may make them relax on taken precautions.
Having said that, I relaid my comment based on information available from material from the HCV mannual from Roche, Now Roche being very close to the leading reseachers on HCV, that have spent countless time and millions on reseach, I will, with all due respect to your medical director, take Roches word about their research.
The blood particle's I spoke of were of course, more than likly microscopic, and would not be visible by the naked eye, my point was that they stated that, as I read it, no matter how microscopic the blood particle is- it had to have a blood particle in a body fluid sample to carry the virus.

As always use precautions, live , be well+


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--Get Outdoors-Enjoy Life----Neil

The only reason for my comment was so that no one would relax their guard on taking precautions.

There is otherwise no particular benefit to "dueling experts", so I will leave it at that.

By the way, I serve on Roche's Diagnostic Advisory Board with folks who have won Nobel prizes for their work in this area. The whole issue is far more complex than either of us could explain or they could fully go into in that book but, again, the public health message is that no one should let down their guard or play down the seriousness of potential for transmission.

Have a good holiday,

thanbey
www.hcop.oreg (http://www.hcop.oreg)

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T-
I was in no way trying to be either "dueling" nor by any means an "Expert"- just passing on info I feel may be helpful,I am sorry if the post seemed otherwise.

I agree completely with all of your last post,

Happy Holidays,be well +


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--Get Outdoors-Enjoy Life----Neil

Here's what we know:

1. Hepatitis C can be sexually transmitted. This is not a theory. It is an established fact.

3. The risk is greater to women than to men.

4. The risk appears to be greater in those with multiple sexual partners and those who have "high risk" sex, including anal sex and sex without a condom, an STD ( ie chylamidia, herpes) or history thereof.

5. Each couple has a relative risk depending on what their sexual practices are, their age, and the number of partners they have had, and their combined medical history.

6. The risk to long term monogamous couples appears to be about 5-15%, but it does tend to increase over the length of the relationship and with age in some studies. The risk is higher for those with multiple sexual partners.

7. Sexual transmission and IV drug use are only two of many potential vectors for the transmission of hepatitis C. In one person, we cannot tell exactly how they were infected, even if they are an IV drug user, but if they are an IV drug user, the attribution of infection vector will go to the IV drug use regardless of any other factors including blood translfusions etc.

8. Unlike most exposures, sexual exposure is usually a repeated exposure. In those with mulitple sexual partners or those who have sexual partners who have lots of sexual partners, it is prudent to protect oneself and others.

9. Uninfected people marry infected people all the time (often without knowing it, I suspect) and do not contract hepatitis c.

Here's what we do not know:

1. What the actual risk is for any tranmission in any individual unless it can be traced genetically.

2. What the cause (vector) of an infection is for an individual. About 100% of those with HCV have multiple risk factors which may include sex with someone whose medical history is unknown to them, a medical procedure, or a blood product before 1992.

3 What the protective factor might be for long term couples in a monogamous relationship.


To clarify my position on this:

I have never said that the risk of sexual transmission is "high." I do not know that to be a fact. But the reverse is also true. I do not know whethre it is low, either. 5%-15% of a large number is a large number of people, particulalry with such a large pool of undiagnosed people in this country.

I do not think this information is a cause for panic in you or anyone else.
I regret that you feel the way you do, but it is what it is, even if we are not quite sure what it is at this juncture.

I do think that most of the information available on this topic underestimates the potential for risk, particularly for those who have multiple sexual partners.

For committed, long term couples the decision regarding condoms is one they should come to together based on the comfort level of the uninfected partner.

As a media message (which this board is) caution and precaution are prudent messages.

I hope his helps and you have a happy, healthy holiday.

thanbey
www.hcop.org (http://www.hcop.org)




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I invite you to consider that the changes you must make in your life will be minor ones in the greater scheme of things.

You will find love (or allow it to find you), and you may also have a passle of kids, God willing.

The last chapter has not yet been written. The cure (or at least, better treatment)will likley come sooner rather than later.

peace,

thanbey
www.hcop.org (http://www.hcop.org)

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Boy, this really DID get our attention.

Well, like i said, it is worth the time and effort, as the issue is so important.

And, as I read our posts, I am so proud of us--the quality of discussion on this mssage board is so high, and the respect and helpfulness so constant,...well, it's just great.

This is one of the most informative and honest series of posts I've seen anywhere (Not talking about mine that strated it--talking about the very open discussion that followed that.)

Merry all week to all here--and everywhere. I'm off to Quebec to learn to fall down mountains on slippery boards--or more likely on my behind. Snowboarding is, I bet, much more dangerous than hep c ever was.

About to find out, anyway.


peace again. to one and all

sean

Same here. Spent time in BC being support crew to the annual ski bum festival.

Best wishes for a terrific New Year.

thanbey www.hcop.org (http://www.hcop.org)

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Hey Is,

Happy New Year.

Seems to me you read and summarized the article correctly. the sentence they chose to highlight:
"Although considerable inconsistencies exist among studies, data indicate overall that sexual transmission of HCV appears to occur, but that the virus is inefficiently spread through this manner."
is a good summary sentence.

So, something to treat with care, on the one hand, but no need to panic, on the other. Let's just keep being sensible, and respectful especially of our uninfected partners.

peace


sean

WOW....making love with your spouse just became dangerous to your health?

I know all the different studies and percentages every one talks about....but my husband and I have decided not to freak out about my hep c...(or my non-detectable) hep c....
We have been married 20 years...been together sexually for about 22 years.....I have two children after become infected and my oldest after infection is 25...and the blood bank still takes blood from her for new babies...she has a rare blood type....they are aware of my hep c...

I am not saying ignore hep c..I just say keep everything on the up and up...if your spouse doesn't care and you agree..go for it...

protect your family by putting YOUR nail files and toothbrushes ect...away...But I don't think anyone should worry about stitistics or numbers...they are always changing and you can only do the best you can do...

I understand how some of these post can freak you out...try and remember it's just someone elses opinion...Keep God in your heart...and press on..

43 more days to go and I am off meds....YEAA....
jj


[This message has been edited by joann jennings (edited 01-06-2003).]

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I am bringing this discussion up again because the topic is being discussed again.

I hope it helps,

thanbey

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...all information is intended for general information and is not an attempt to speak to the specifics of any one person's medical situation or decision...........

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Sean thanks for bringing this up.
Everytime I mention it on any site it always gets people fired up.
All I know first hand is that my wife now has it & we both are the same geno type so I think it's a safe bet that one of us gave it to the other.
19 years of dedicated marriage to each other & there are no risk factors for either one of us.
Why would anyone that knows they have hep c even consider taking the risk of giving this to anyone else ?
How selfish is that ?
If anyone with this mindset has any feelings for their spouse or the person they are in a relationship with & they get hep c as my wife has you will never forgive yourself.
I did not know I had hep c until it was obviously too late to protect my wife.

Are there any statistics for the types of sex that increase the probability for transmission?

If a person indulges only in oral sex is the risk of transmission lower (assuming care is taken to ensure there are no STDs, menstruation, UTI, mouth, nose or throat sores)?

Is it likely that sexual acts which involve frequent agitation (and rupture/tearing) of sensitive mucous membranes would have an increased potential for risk of transmission (anal, vaginal penetration)? Is this not the reason for the prevalent outbreak of HIV among gay men?

I recently read a newspaper article from the leading hcv research doctor that indicates there are no PROVEN cases where sexual transmission was the vector for transmission from one person to another person.

Could the statistics not be based on the prevalence of sex between partners who were coinfected whereas the actual cause was by other vectors of transmission (shared razors, toothbrushes, clippers, cutlery, food prep)?

Statistics always bother me, even when the numbers are low, and based on so many unproven premises, they seem to add up to so much more.

I think there is real benefit in protecting yourself and your sexual partner from other transmissible diseases. This not only protects you from contracting another problem you don't need, but this will also eliminate the extremely low probability of transmission of hcv.

Being responsible and honest is the answer.

Diana

Hasn't this topic been worked enough? Why does it always climb to the top of the posts? Maybe there should be a new forum dealing exclusively with the sexual aspects of HCV.

Based on what we know, and DON'T KNOW, it all seems pretty simple. If you care, protect yourself, and, or your partner. At this point, it doesn't take scientific studies to draw this conclusion. These studies are mostly incomplete and conjecture. I don't say this to be inflamatory, we just don't know enough, yet. Sometimes, ordinary common sense can confuse us all.