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Sexual transmission of hepatitis C occurs, but this is quite infrequent. The frequency of sexual transmission increases if there is anal intercourse, or if intercourse takes place during menstruation. Transmission through kissing, especially if there are sores in the mouth, is theoretically possible, but has not been scientifically proven. Saliva is not infectious unless it contains blood. Sharing personal hygiene items such as toothbrushes and razors also can potentially transmit the infection.
Hepatitis C is present primarily in the blood, and to a lesser degree in specific other body fluids, of an infected person. Today, it is passed most commonly through sharing of used needles by injection drug users. Prior to 1990, it was commonly passed through blood transfusions. However, since 1990, all donated blood is tested for hepatitis C virus, so it is extremely rare for hepatitis C to be acquired through a blood transfusion.
Transmission of hepatitis C occasionally occurs in healthcare settings, such as hospitals and clinics, when established infection control protocols are not followed. Healthcare workers who do not follow these protocols can become infected if they sustain a needle stick from a patient who carries hepatitis C virus.
An uncommon, but real mode of transmission is through organ transplantation when the donated organ comes from a person who carries the hepatitis C virus. The use of HCV-positive organs is currently reserved for the most serious cases requiring transplantation.
Transmission of hepatitis C from an infected mother to a newborn does occur, but it is most common if the mother has measurable HCV in her blood. (See hepatitis C diagnosis section). Transmission is infrequent if the mother has no detectable hepatitis C virus in her blood. Breastfeeding has not been documented as a way to transmit hepatitis C.
Hepatitis C is associated with hemodialysis, a technique used to "clean" the blood in patients with end-stage kidney disease. Careful attention to sterilization of equipment and carefully following infection control procedures should reduce or eliminate dialysis-associated transmission of hepatitis C. Likewise, hepatitis C has rarely been transmitted by the use of other incorrectly sanitized medical equipment, which is preventable using correct infection control techniques.
Tattooing and body piercing have been documented to transmit the hepatitis C virus when recommended sterilization and infection control procedures are not followed.
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Rosen HR. Clinical practice. Chronic hepatitis C infection. N Engl J Med. 2011 Jun 23;364(25):2429-38