Risks and causes

This section contains more detail about how you may have been exposed to hepatitis C.

How hepatitis C can be passed on

Hepatitis C is spread via blood-to-blood contact. This means that blood infected with hepatitis C must get into the bloodstream of an uninfected person to be passed on.

You may have been exposed to hepatitis C if you have ever:

• shared equipment (needles, syringes, spoons, straws) used to take recreational or performance-enhancing drugs, such as anabolic steroids, even once
• had a blood transfusion or organ transplant in the UK before the mid-1990s
• had medical or dental treatment in a country where infection control procedures may be poor
• had tattoos, piercings, acupuncture or electrolysis where infection control procedures may be poor e.g. unlicensed venues, the armed forces or in prison
• shared personal hygiene products, such as razors and toothbrushes, which may have small droplets of blood on them
• had unprotected sexual contact where blood was present
• worked in an environment where you may have come into contact with infected blood, such as through a needlestick injury
• been exposed to the hepatitis C virus while your mother was pregnant (around 5% of mothers who have hepatitis C will pass the infection on to their baby).

Recreational drug equipment

Around 90% of hepatitis C cases in the UK occur in people who inject drugs or have injected them in the past.

Needles and syringes

Sharing equipment used to take recreational drugs is a huge risk for hepatitis C infection through blood-to-blood contact.

This applies to sharing the needle and syringe, as well as to water, filters and spoons – even if you are using a new needle.

Any needle that has been used before could still have invisible drops of blood attached to it. When the needle is placed on a spoon, the blood can dissolve in the water and be deposited on the spoon or the filter.

The best way to avoid transmitting the virus when you use drugs is to avoid sharing equipment with others. Make sure you always use new syringes, new needles, a clean spoon, sterilised water and a new filter.

It is important to dispose of used needles carefully. The best place is a proper sharps bin, which you can get from your local needle exchange and some pharmacies. The next best thing is to recap the needle and put it in a sealed plastic container.

Straws and rolled up notes

If you share a rolled-up note or straw for snorting drugs you also risk exposing yourself and others to hepatitis C. 

Cocaine is corrosive and can thin the membranes in the nose, making it more likely that you will bleed. If even tiny drops of blood – often too small to see – get onto the straw or note, it is possible that blood-to-blood contact may take place if the straw or note is shared.

To reduce your risk of exposure to hepatitis C, do not share straws or notes when snorting drugs.

If you’re using alcohol or other drugs, you can still get treatment for hepatitis C.  

However, it is a good idea to consider stopping your drug use whilst on treatment to help protect your liver from further damage and to help ensure you take your treatment correctly.

Find organisations who can provide advice and support to help you safely reduce your drug use on our Other helpful organisations page.

Blood and blood products

Medical treatment abroad

If you have had medical or dental treatment in a country outside of the UK, you could be at risk of contracting hepatitis C when medical equipment has not been sterilised properly.

In countries such as Egypt, Cameroon, Moldova, Romania and Pakistan, the infection rate for hepatitis C is higher than in other places. This is partly because the infection has been transmitted through unsafe medical practices, especially the reuse of injection equipment in the healthcare setting.

In addition, the World Health Organization reports that whilst 99.8% of blood donations in high-income countries are screened for hepatitis C, only 76 to 83% of blood donations are screened in lower-middle-income and low-income countries. This means that if you have had a blood transfusion abroad, you could be at risk of hepatitis C.

You should have a hepatitis C test if you know you have had a blood transfusion or medical treatment in a country with a high infection rate of hepatitis C or you were concerned about infection control during your treatment.

Mother to baby

Transmission of the hepatitis C virus from a mother to her unborn child is uncommon. 

About 5 in 100 babies born to mothers who have hepatitis C will get the infection. If a mother is also HIV positive than the risk of passing on hepatitis C to the baby is higher.

Hepatitis C has not been found to cause complications during pregnancy.

The usual amount of time before testing a baby for hepatitis C is 18 months. This is because babies will carry their mother’s antibodies and it takes a while before your baby’s body is able to clear the antibodies.

Breastfeeding is considered safe since there is no proof that hepatitis C can be transmitted via breastmilk. If your nipples are cracked and bleeding, do not breastfeed until the nipples are healed.

Hepatitis C should have a minimal effect on you caring for your baby. You should feel comfortable doing everything a parent wants to do for their child.

Children can be treated for hepatitis C using a course of tablets. The success rate for treatment for children is 99%.

Sexual contact

Hepatitis C may be transmitted during unprotected sex, although this risk is considered very low.

The risk of sexually transmitting hepatitis C depends on the type of sex you are having. 

Any activity which results in one or both partners bleeding is considered higher risk for transmission.

Bleeding can happen:

• during anal sex
• during rough vaginal sex
• if you or your partner has a sexually transmitted infection, ulcer or yeast infection
• when you or your partner is on their period.

There is no evidence that hepatitis C can be transmitted through oral sex. However, it may be possible if blood is present.

The risk of the sexual transmission of hepatitis C is considered to be extremely low in monogamous heterosexual relationships. 

One study looked at 895 monogamous heterosexual people whose partner had chronic hepatitis C. Over a 10 year period, none of them were infected by their partner. However, these couples did not have unprotected sex while the woman was on her period.

The risk to gay, bisexual and men who have sex with men (GBMSM) and other people who might have unprotected anal sex is higher than to the general population.

This is because anal sex can cause small tears around the opening of the anus. These tears can bleed, putting you at higher risk of contracting or passing on hepatitis C.

To reduce your risk of contracting hepatitis C during sexual activities, you should always use barrier contraception such as a condom. If you test positively for hepatitis C, you should continue to use barrier contraception while you undergo treatment and until tests confirm that you have tested negatively for the virus.

If you think you have been exposed to hepatitis C during sex, you can ask for a hepatitis C test from your GP, sexual health clinic or GUM clinic.

Find out more about how to protect yourself and your sexual partner on our Preventing transmission page.

HIV co-infection

Hepatitis C prevalence is much higher among people who are HIV-positive than those who are not.

If you have HIV, you should also be tested for hepatitis C.

Needlestick injuries

Needlestick injuries are an occupational hazard of many healthcare workers, including nurses, anaesthetists, dentists and laboratory technicians.

They happen when you pierce or puncture your skin with a used needle.

Despite the risk, it is very rare for hepatitis C to be transferred via a needlestick injury. The estimated risk for infection after a needlestick injury or cut exposure to infected blood is approximately 1.8%.

Personal hygiene products

Sharing personal hygiene products such as toothbrushes, razors or hair and nail clippers with someone carrying the virus may pose a potential risk of contracting hepatitis C.

The hepatitis C virus can be present in very small traces of blood, often invisible to the naked eye. Scissors, clippers and razors may have been exposed to infected blood if they are not sterilised every time they are used.

Similarly, traces of blood which could contain the virus may be present on toothbrushes. If they are shared by a person with bleeding gums or a mouth injury, transmission is possible. The risk is hard to assess but is considered very low.

To reduce your risk, avoid sharing personal hygiene products which can cut or graze the skin.

The risk of contracting hepatitis C at the hairdresser or barber is minimal. Most hair salons take health and safety very seriously and will sterilise equipment between each customer.

If you are worried, ask your hairdresser or barber about their sterilisation process.

Tattoos and piercings

The risks of contracting hepatitis C through tattooing are mainly associated with reused and unsterilised needles, although the virus has also been found in tattooing ink.

In the UK, the licensing procedures carried out in tattoo and piercing studios are subject to regulation. Local councils conduct inspections of premises to ensure that they are compliant with health and safety laws. Tattoo artists must be licensed by their local council.

Some health and safety requirements differ between councils. For example, some require artists to have their own sink, whereas others will allow artists to share.

The Department of Health and Social Care has produced a model set of byelaws that set out the standards that you ought to expect from a tattooing parlour. 

You are unlikely to find these standards in other countries. Tattooing with reused equipment in high-risk countries is a significant risk, as is tattooing in prison or at unlicensed venues in the UK.

If you want to get a tattoo, make sure you visit a licensed venue.

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