Hepatitis C virus (HCV) is a blood-borne virus most easily transmitted through direct blood-to-blood contact. Transmission routes include:

  • Sharing needles and other drug injection equipment. People who inject drugs and share needles, syringes and other paraphernalia at the highest risk for HCV. Even people who experimented with drugs one time many years ago may unknowingly carry the virus. Non-injection drug equipment, such as shared straws or pipes, can also spread HCV. 
  • Sexual contact. The risk of acquiring hepatitis C through sex is generally low, but it is higher among men who have sex with men, people with HIV and people with multiple sex partners. HCV is not transmitted by casual contact such as hugging or kissing.
  • Mother-to-child. Women with HCV can pass the virus along to their babies during pregnancy or delivery. The risk is increased if a pregnant woman has a higher HCV viral load or also has HIV or hepatitis B. It is unlikely that HCV can be transmitted through breastfeeding or breast milk.
  • Shared personal items. HCV can be transmitted via personal items that come into contact with blood, such as razors or toothbrushes. The virus is not transmitted via shared household items such as eating utensils.
  • Tattoos and piercings. HCV transmission can occur in nonprofessional setting with nonsterile equipment and procedures. The risk of transmission in professional settings is very low.
  • Occupational exposure. Health care providers, emergency service workers and others may come into contact with blood on the job, but the risk of HCV acquistion in occupational settings is very low if proper precautions are used.
  • Blood transfusions and organ transplants before 1992. Thanks to screening of the blood supply, which began in the United States in 1992, the risk of HCV transmission is now very low.

Many people with HCV do not know they got it and do not consider themselves to be at risk, which means they do not seek testing and treatment and can pass the virus on to others.

Guidelines now recommend that all adults should be tested for HCV at least once. Women should be tested during each pregnancy, and people with ongoing risk should be tested regularly. This includes people who inject drugs, people living with HIV and gay and bisexual men who take HIV pre-exposure prophylaxis (PrEP).