My girlfriend was diagnosed with Hep C and has all the tests including a liver scan. All tests have come back negative, and her liver is working at 100%. She was very ill when she first contracted the disease and has been told that she now has antibodies and fought off the virus. The question we have for the board is, we have been told by the doctors that she now cannot pass hep "c" on to anyone even with blood to blood contact. Although we can see in her blood she has been exposed to Hep C she cannot pass it on. Has anyone else had or heard of this situation? Please email any answers. Thanks in advance.

Well, here is the scoop.

Your girlfriend had the best possible result after an exposure. She was exposed and is undetectable for hepatitis C virus. The is great news.

It is unlikely that she is contagious, but the blood banks will not accept her as a donor. She should simply take precautions with her blood by covering cuts and generally being vigilent.

Otherwise, my advice is to skip alcohol and smoking, tattoos, or any other risky behavior (to self and to others), altogether.... forever.

Alcohol can, potentially, feed any virus lingering in tissue or sitting around somewhere laying dormant outside the bloodstream. She has no immunity from hepatitis C and could be exposed again, this time with different results. Sexual transmission is a greater risk TO her, rather than FROM her (this is no risk, actually)

An undetected test simply means that our technology may, or may not, register the virus to zero. I am allowing for the human error in labs and for the variations in testing when I say this.

I am recommending these precautions because your girlfriend may wish to become a mother one day. She should decide right now to be in the best possible health for herself and any future children and she is in a great position to do just that.

As for the rest, she is no more likely to transmit the virus than the next person, less if she is careful. There is an unimaginably large pool of undiagnosed people walking around. They are far more at risk than she will ever be and a far greater risk to others because they have no informaiton on how to prevent transmission.

I hope you take the information you have gained through this experience and urge everyone you know to be tested, risk factors or not. There is no true way to know where, or how, she was exposed to the virus (save a documented blood donor or something akin to it), so a test is a wise option for anyone.


I hope this helps,

thanbey



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thanbey, why is it that women are more likely to catch a bloodborne disease from a man when it is the woman who menstrates and even passes some blood during the other days?

Good question, Wes.........

The menstruating woman has an "open wound" when she is menstruating. She is vulnerable due to the female physiology that enhances the chances of conception, that being that the semen enters her body. The lining of the uterus is far more vulnerable at this time for any type of infection. It is shedding a layer and is vulnerable to invasion. The sperm travels through the uterus into the fallopian tubes under extreme pressure (to overcome any barriers) and is absorbed. Studies show that sexual transmission is related to viral load in the male.

Similarly, at any other time, she is also taking the sperm into her body during sexual intercourse. The male is injecting under pressure, making it even more likely to be in contact with the vulnerable tissues.

Men, on the other hand, do not have an opening, unless there is an open sore or herpes-type lesion on the penis. A man does not, as part of his physiology, absorb the vaginal fluid or take any fluid into his body. Menstrual flow would have to travel against the seminal flow in order to enter the male body. Even at that, the bloodstream is not vulnerable unless there is a break in the skin. Or, it would have to be absorbed into the healthy intact skin. If that happened, this disease would be really easy to contract by anyone! It isn't. It has to enter the body through an access point where the bloodstream is vulnerable. That isn't how men are built and it isn't the way nature set up the survival of our species.

Additionally, there are silent, undiagnosed diseases like chlymidia that actually have been shown to inhance the woman's vulnerability to infections such as HCV, HIV, syphilis, gonorhhea, and chlymidia. Then there are STD histories, or conditions like endometriosis that can have an impact on a woman's vulnerable physiology past the time of active infection or problems due to residuals of the disease.

Bottom line is, the menstrual flow WOULD be a risk IF it was taken and absorbed by the male body or through the skin. It isn't. Unless a man has an open wound on his penis, it is not even possible. How many men do you know who have an open sore on the penis want to have sex? Ouch!

I hope this helps,

thanbey

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[This message has been edited by thanbey (edited 10-19-2002).]

.

I have heard that there is small amounts of virus in both semen and saliva and that they are not considered major exposure pathways. Meanwhile, if a woman begins menstrating during sex, the chances of her blood contacting compromised skin somewhere on her partners body is considered a major exposure pathway. This is still confusing me a little.

I think that message confuses a lot of people. Sure seems to confuse the Gastro-Hep community of docs (primarily a male specialty), but not the GYN or STD folks. They have been studying this for a long time.

From my experience with the GI/HEp physician community, particulalry the male dominated gastro/hep is that, they are specialists in liver disease, but not women's health, pain management, or neurology (to name a few). TMany statements are made, and become lore, outside their area of expertise. This falls into the category of virology rather than hepatology anyway. Doctors are not immune to the cultural messages that have permeated healthcare regarding women and their health for deacades, perhaps centuries. One of those cultural messages is that a woman is unclean during the mensus. Without any science to back it up, and in complete opposition to the physiology of the situation, this assumption has lead to messages that promote this notion of uncleanliness.

There is actually only a small amount of blood in the mensus and when a viral load is found, it is minimal.

Semen, on the other hand, can have significant amounts of virus on PCR. However, it is in the mechanism of contraception that risk takes place, not in the semen itself. Digestive juices neutralize this risk, as does getting semen on the skin.

Transmission from either fluid on the skin may be an equal risk, albeit a very low risk.

The CDC lists "high risk" sex as having a partner with herpes, for example. Anal sex is high risk, regardless of gender. So is anything that draws blood.

I get calls asking how to sterilize leather and certain battery operated "toys" (you can't)

In theory, any exposure to any blood of an infected person is a potential risk. There is no documented case of sexual transmission from female to male.

There are ongoing studies regarding why it does not occur more frequently in long term monogamous partners. The thinking is that there is immunity build up by minute repeated exposure over time.

On the other hand, there is research that concludes that transmission does take place more frequently over time. It may be due to increases in male viral load with age and progresssion. Those studies are just beginning.


thanbey

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[This message has been edited by thanbey (edited 10-19-2002).]

Not just cuts and abrasions but also impaired epidermal permeability barrier function.

I would be interested in seeing a report that states a lowered viral load in blood from menses.

I am not aware of a published report on it (I am actually looking for funding for such a project as we "speak") But if you find one, please share it.

I think most of the research being worked on right now is on maternal child transmission. Gender studies haven't been done to any large degree that I am aware of. Most of what we see in the published literature pertains to men. What I have gleaned has been from presentaitons at conferences and in private conversations with researchers.

To my knowledge, I am the person who has organized the only presentation on HCV and Women's Health to date.

But, I am not aware of everything, so maybe someone else is working on this somewhere.

I hope this helps,

thanbey

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[This message has been edited by thanbey (edited 10-19-2002).]

this all i can find searching for "viral load menses"

"...CONCLUSION: We provide evidence of elevated vaginal cytokine levels during menses, which appear to regulate vaginal and not plasma HIV shedding, suggesting that a menstrual cycle pattern exists for cytokine production in HIV-positive women impacting vaginal shedding of HIV."

"...CONCLUSION: HIV-1-RNA levels vary with the menstrual cycle in the female genital tract but not the blood compartment. HIV-1-RNA levels are higher in endocervical canal fluid than in blood plasma. These findings may have important implications for sex-specific pathogenesis, heterosexual transmission, and contraceptive hormone interventions in HIV-1-infected women."


Thanks, Wes

First, please cite the source. This is very interesting and I'd like to read the whole paper.

Second, this specifies ELEVATED, so wouldn't this mean risk for all the time, not just during mensus?

And last, there is no evidence that this applies to HCV, unless you know of some research to this effect. A lot of assumptions have been made regarding the possible transfer of info from HIV to HCV, but I think caution is the watchword here. Nevertheless, this is really something to consider.

If you look at transmission from mother to child, it is rare for HCV and not very rare at all in HIV. So, that leads me to think we are not looking at the same dynamic.

Thanks a lot for this, Wes!

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

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[This message has been edited by thanbey (edited 10-19-2002).]

AIDS 2001 Aug 17;15(12):1535-43

A menstrual cycle pattern for cytokine levels exists in HIV-positive women: implication for HIV vaginal and plasma shedding.

Al-Harthi L, Kovacs A, Coombs RW, Reichelderfer PS, Wright DJ, Cohen MH, Cohn J, Cu-Uvin S, Watts H, Lewis S, Beckner S, Landay A; The WHS 001 Study Team.

Department of Immunology/Microbiology at Rush-Presbyterian St Luke's Medical Center, Chicago, IL 60612, USA.

Am J Gastroenterol 1994 Aug;89(8):1201-2

HCV RNA is present in the menstrual blood of women with chronic hepatitis C infection.

RESULTS: HCV RNA was present in the menstrual blood of all chronically infected patients tested. All controls were negative for menstrual blood HCV RNA.

CONCLUSIONS: 1) HCV RNA is routinely present in the menstrual blood of women chronically infected with this virus. 2) Knowledge of the presence of HCV RNA in menstrual blood should help facilitate appropriate guidelines for the sexual counseling of patients with chronic HCV infection.


[This message has been edited by Wes1212 (edited 10-19-2002).]

Biol Res Nurs 2002 Jul;4(1):22-30

Presence and predictors of hepatitis C virus RNA in the semen of homeless men.

"...Semen and bloodfrom 80 HCV-infected homeless men were evaluatedfor the presence of HCVRNA by means of branch DNA and transcription-mediated amplification analyses. Associations of selected demographic and behavioral characteristics of the participants with presence or absence of HCV in their semen were also assessed. HCV RNA was detected in the semen of 36% of the sample. Associations were found with HCV RNA in semen and older age, higher viral loads of HCV in blood, current alcohol and lifetime methamphetamine use,and having been vaccinated for the hepatitis B virus. Findings suggest that sexual transmission of HCV is plausible and shed light on the need to conduct more in-depth investigations."

[This message has been edited by Wes1212 (edited 10-19-2002).]

All I know is I was diagnosed in January, this year, with likely infection 19 years ago from a single blood transfusion. The next year, I began to have "elevated enzymes". Docs were not concerned. This year, though, besides the enzymes, both GGT and Direct Bilirubin were slightly out of range. Ran the tests, PCR was >1,000,000 copies on a 600 - 1,000,000 calibrated assay. The point is, my wife (41 years of marriage) tested negative and we never used any "protection" during this time. I know, just my experience ...

Oral sex is not a risk for hepatitis C. It is, however, a risk for hepatitis A and this poses a real health risk to those already infected with hepC. Get vaccinated against hepA and B if you have not already done so.

Be meticulous about cleanliness, if you catch my drift.

Use condoms each and every time if you are still dating until a monogamous relationship has taken hold and you are both all clear for everything else. This helps protect both parties from a number of potential health problems.

There has been discussion about really bad dental hygiene in both parties resulting in a transmission, but there is only one recorded case of this. Otherwise oral sex is not considered a risk for hepatitis C.

Nature provides a high speed high pressure delivery system for semen into the female. I can't remember the exact spreed an ejaculate hits the reproductive organs of the female, but I found it astonishing. That is what I meant by the phrase.

I'm sorry your girlfriend left over this. I hope you find someone who will appreciate you and with whom you will have kids. I know from experience that the right person is worth waiting for.

Let's hear more from you!

thanbey

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[This message has been edited by thanbey (edited 10-19-2002).]

I understand the feelings regarding your situation. All I can say to you is that perception may not be reality.

Not everyone will run in the other direction because you have hepC. There WILL come a time when you have someone who will accept you just the way you are just because you are you.

Who knows what options will be there when you are ready for them?



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Dear Is- This- Real-?,
I had to reply to your situation because you are wrong about losing hope in the love department. My husband told me about his hep C on our 3rd date and it alarmed me but didn't scare me totally away. Once I started to research the disease I found out the transmission through sexual contact is very low. Our specialist doesn't reccomend any precautions at all... only that I get tested, which I haven't yet, but intend to. There is hope... and someone out there for you http://www.healthboards.com/ubb/smile.gif

Hi Is this for Real?????

I think this thread has more really useful information and good advice than I have seen in whole pages of other posts, or on other boards.

Thanbey's words are, as usual, so helpful.

If it helps further, I met a woman a few years ago, and we were dating when the diagnosis came in. She stayed with me, and we married this last summer, and are having a ball. She and I are not especially paranoid about transmission, just sensible.

Love can happen anywhere, anytime, to anyone. Even me.(!) So, keep in good heart.

By the way, fear can strike anyone, too, so don't be surprised if it takes a little care when revealing this news to a partner, or potential partner. This is our lot--but it is NOT the end of our love life!

Peace--

sean

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Listen Isthis,

Nothing has changed? Only that you were worried way beyond what the facts required back then, and still are.

Everyone I know with this virus has been able to achieve a normal love life. Or, at least, the heartbreaking difficulties they've had are about the same as those my un-infected friends have. Every one. Some are married, fathering or bearing children or not (what??!!?? children??you mean they skipped the condoms to achieve conception??yes, that's what I mean--although in most cases they had kids before diagnosis. Still, many spouses are more understanding than you imagine.)

Get out there and mix it up. Look for your love, se's out there. You've got to get out, too.

Stop worrying so much, please. You're gonna wear yourself out. Bad for the liver.


sean