Having sex when you have Hepatitis C


Important messages:
- Your doctor will know if you are “officially” cured, at 12 weeks after you have completed treatment. Until then, you can still pass on the virus to your sex partners.
- Do the best you can to reduce the risk of transmission.
- Choose for one-on-one dates and make sure to be top only or bottom only during that date.
- Don’t use chems or alcohol: they will cause too much stress to your liver.


Be careful until 12 weeks after treatment

A hepatitis C infection has three stages. Until the last stage it is important to be careful.
Stage 1 – infected, but not yet treated
There is a high risk of passing on the virus to your sex partner.

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Your viral load can be extremely high when you recently acquired hepatitis C. You could easily have millions of virus particles per ml of blood. If you are not yet on treatment, there is a very high risk to infect your sex partners.

Stage 2 – you are receiving treatment
Most of the times there is high risk of transmission during the first four weeks. After that the risk should be smaller (but there still is risk).

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  • Treatment takes 8-12 weeks. The treatment will reduce the number of virus particles (“viral load”) in your blood. In 90% of the cases, the body will be free of the viral load around four weeks after treatment began.
  • Once your viral load falls to zero, or to a very low point, there will only be a small infection risk to others. However, it is hard to say how small. So there is still a risk of transmitting the virus.
  • There is also a small chance that your viral load may still be measurable (or measurable once again) at the end of your treatment. In other words: you have to realise that until the end of your treatment you may pass on the virus to someone else.

Note: If the viral load is gone from your body after 4 weeks, this doesn’t mean that you can stop your treatment. It is important that you continue to take your medication every day until the end of your treatment.


Stage 3 – you have completed treatment, but not officially cured
Generally, the risk of passing on the virus to someone else once treatment stops is small, but you should remain being careful until you are officially cured.

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Even after you’ve completed treatment and your doctors can no longer find virus particles in your blood, you are still not officially cured.

  • You will always have to wait 12 weeks after the end of treatment to know if you are officially cured. This is because the virus sometimes comes back when treatment stops.
  • When doctors can find no virus particles in your blood after this period, then you are officially cured. This happens in 95% of cases. The virus returns after treatment in only about 5% of cases. But if you are getting treatment for acute hepatitis C and you take your pills every day, you are very likely to be among the 95%.

So, although the risk is small that you will pass on the virus to your sex partners after being treated, you should remain being careful until you are officially cured. The reason: if the virus is still in your blood when treatment stops, you may have a resistant virus. That means that the virus that cannot be treated with the medication you were given. We should all do everything we can to stop these resistant viruses from being passed around.

Have a look at the sex techniques below to see which acts are safe for hepatitis C.

Oral sex

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In principle safe:

kissing - unless your gums are bleeding.
giving your partner a blowjob
rimming your partner – unless your gums are bleeding.

Not recommended:
- getting a blowjob - you could come in his mouth unexpectedly while your sperm may contain the virus.
- being rimmed - your rectal fluids may cointain the virus. Therefore it is better to avoid being rimmed.

Anal sex

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Choose one role during sex: be top only or bottom only.

If you choose to be top

In principle safe:

  • you fuck him with condoms
  • you use dildos/toys on him - only use his toys, never share toys.
  • you fist him with gloves – make sure to not have any wounds on your forearms. Put on gloves before touching your partner’s ass.

Not recommended:
- your partner touches your ass during sex. Tip: to be sure this doesn’t happen, keep on your trousers or underwear (but no jockstrap).

If you choose to be bottom

In principle safe:

  • he fucks you with a condom
  • he uses dildos/toys on your ass - only use your toys, never share toys.
  • he fists you with gloves - unless he has any wounds on his forearms.

Not recommended:
- you touching your partner’s ass during sex. This is not only because you may have a (very small) wound on your fingers or under your nails. But also because you may have your “own” lube on your fingers, for example because you have touched your ass or his dick while he fucked you. The lube on your fingers could carry the hepatitis C virus.
- your sex partner sitting of laying in your lube residue or on your towel. Hepatitis C may be in your lube or on your towel when it has lube residue on it.

Other sex techniques

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In principle safe:

  • jacking off your partner
  • having him jack you off – make sure none of your sperm touches his mouth (inside or out), cock or ass. Your sperm may contain the virus.
  • BDSM - as long as you avoid blood-to-blood contact and don’t share equipment.
  • having your nipples played - as long as he does it gently enough to keep the skin from breaking. In other words: avoid damaging the skin.
  • piss play - as long as there’s no blood in your urine.

Not recommended:
-  scat sex – your stool may contain hepatitis C virus.

Chems and alcohol

It is advised that you do not use chems or alcohol if you have hepatitis C.

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Because your liver will be inflamed from the infection, alcohol or chems could cause too much stress to your liver. Even if you are being treated for hepatitis C. Both your medication and the chems/alcohol are be broken down by your liver, causing liver stress. If you put your liver under any more stress:

  • it might not be able to entirely break down your hepatitis C medication the right way, and this can create side effects.
  • it might not be able to entirely break down the chems you have taken. You could overdose on the chems.

Best is not to take chems or alcohol when you have sex until you are officially cured (in principle 12 weeks after your treatment). This will also keep you sharp on reducing the risk of transmitting hepatitis C.

If it hasn't been safe

If you think anything unsafe for hepatitis C occurred during sex, contact your HIV nurse or the GGD STI nurse as soon as possible. They can provide you with a warning code for your sex partner(s) to get tested.

Telling you have hepatitis C?

A lot of men find it hard to decide if they should tell sex partners that they have hepatitis C before having sex.

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If you tell a partner that you have hepatitis C, it means you can both keep the sex safe. It also means that your partner will understand why you (suddenly) want to use condoms. But telling people you have the virus also presents a dilemma. You want to be honest, but possibly some men don’t want to have sex with you if they know that you have hepatitis C. Most of your sex partners would rather be safe than sorry, and will only want to have sex with you again once you’ve been cured. It’s a difficult situation, and we don’t have any advice to offer that would make it any easier. You really have to decide for yourself how to deal with this dilemma.