The accumulated evidence indicates that hepatitis C virus (HCV) can be transmitted by sexual contact but much less efficiently than other sexually transmitted viruses, including hepatitis B virus and human immunodeficiency virus (HW). However, because sex is such a common behavior and the reservoir of HCV-infected individuals is sizable, sexual transmission of HCV likely contributes to the total burden of infection in the United States. Risk of HCV transmission by sexual contact differs by the type of sexual relationship. Persons in long-term monogamous partnerships are at lower risk of HCV acquisition (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, such as injection drug use or shared razors and toothbrushes. In seroprevalence studies in monogamous, heterosexual partners of HCV-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. Among individuals at risk for sexually transmitted diseases (STDs), the median seroprevalence of antibody to HCV (anti-HCV) is 4% (range, 1.6% to 25.5%). HWcoinfection appears to increase the rate of HCVtransmission by sexual contact. 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 s d t'elatiOnShipS.(HEPATOLOGY 2002;36:S99-S105.) ercutaneous exposures, such as blood transfusion and injection drug use, are well-established risk P factors for hepatitis C virus (HCV) infection. The risk of HCV transmission by sexual contact, however, is less well defined. The accumulated epidemiologic evidence indicates that HCV can be transmitted by sexual contact but much less efficiently than other sexuallytransmitted viruses, including hepatitis B virus and human immunodeficiency virus (HIV).
There are several case reports of acute hepatitis C occurring in persons whose only risk factor appeared to be a HCV-infected sexual partner.'J The strength of these reports lay in their ability to document seroconversion in an Abbreviations: HCK hepatitis C virus; anti-HCK antibody to H C E HIK human immunodeficiency virus; STD, sexual4 transmitted disease.