How Are Hepatitis C Infections Transmitted?

How to protect yourself and others from hep C.

Medically reviewed in July 2021

How do you protect yourself from an infection that usually remains silent until it’s done you serious harm? By educating yourself about the risk factors, and avoiding them. Hepatitis C is one such illness, but fortunately, there’s just one big thing you need to know to avoid it: Don’t come into contact with blood of people who might have the disease.

Unlike other types of hepatitis, which can spread through sex or contaminated food, the hepatitis (hep) C virus is nearly always transmitted through infected blood. What’s more, that blood must pass through your skin into your bloodstream to infect you—say, via an injection or an open sore. 

Here are the key facts about the causes of hep C infection:

Drug use is the #1 cause. According to the Centers for Disease Control and Prevention (CDC), about one in three young users of injected “street” drugs have hep C, and that number climbs as high as 90 percent among older or long-time users. Needle sharing is the main reason, especially for people who used drugs in the 1970s or 80s, before the risks were understood. And some cases of infection have involved non-intravenous drug use, like sharing straws or pipes to snort or smoke cocaine, methamphetamines and other hard drugs.

If you use drugs, never share needles or other equipment with anyone else. And try to get in a treatment program to help you stop.

Sexual transmission is uncommon. In general, experts believe that transmission during sex requires contact with blood, such as in rough sex. In long-term, monogamous couples in which one partner has the virus, the risk of the other partner getting it is actually very low. You can’t get hep C through kissing or touching, and there’s also no evidence that it spreads through oral sex. However, for reasons that aren’t completely understood, the risk of sexual transmission is higher in those who have multiple partners, or have HIV or another sexually transmitted disease.

Still, it’s smart to practice safe sex. To reduce your chance of infection, the American Liver Foundation suggests that you limit your number of sexual partners or have sex with only one person. And use a condom every time, especially if you have rough sex, sex during one partner’s menstrual period or if one partner has an open sore.

Blood transfusions are safe. This was a common way to get the virus before blood screening became available in 1992. Now that all blood products are tested, the CDC says the risk of infection is less than 1 in 2 million.

Getting a tattoo or piercing? Check out the facility. You can become infected with hep C if contaminated tattoo or piercing equipment is used on you. However, no outbreaks have been linked to licensed, regulated parlors. If you get body art, find a trained, professional artist who wears disposable gloves and uses single-use, disposable needle kits. Don’t be afraid to ask what infection control practices the artist uses, particularly how surfaces are cleaned and whether any items are re-used. Look around the work area. If it seems unclean or you see blood anywhere, walk away.

It is possible—though very unlikely—for the virus to spread within a household. When it does, it’s usually a result of direct, through-the-skin exposure to the blood of an infected household member. Hep C isn’t spread by coughing, sneezing or sharing eating utensils. However, don’t share personal items such as toothbrushes and razors, which could carry small amounts of blood.

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