HCV levels in semen

It is generally considered today that rates of sexual HCV transmission are low, about 5%. However, there is much controversy about how and when HCV is transmitted sexually. Although HCV has been found in semen, there does not appear to be evidence yet that the exchange of semen transmits HCV. But I think further research is needed to examine if there are circumstances or conditions in which HCV can be transmitted by semen and how HCV can be transmitted sexually.

The CDC says risk for sexual transmission increases if a person has multiple sex partners and is active sexually. Remember HCV is transmitted by blood-to-blood contact. Studies show that risk for sexual transmission may be increased when the following circumstances are present during sexual contact: STDs, open sores, anal sex, and sex during menstruation; several studies show increased risk for sexual transmission among men who have sex when risky sexual behaviors which may draw blood are used such as fisting. Recent studies suggest that a high HCV viral load may promote sexual transmission.

Since higher HCV viral load in HIV-infected individuals has been observed at times it raises the question whether HCV sexual transmission is a greater risk for HIV-infected individuals. I don’t think this has been adequately studied. Studies do show that among pregnant women HIV increases the risk for HCV transmission several times.

HCV is usually transmitted via the blood, but HCV RNA has been detected recently in seminal fluid. This study was done to study HCV seminal shedding and factors that could influence the presence of HCV in the seminal fluid of men coinfected with HCV and HIV-1. HCV and HIV-1 genomes were assayed in multiple paired blood and semen samples obtained from 35 men enrolled in an assisted medical procreation protocol.

HCV RNA was found intermittently in semen samples from nine patients (25.7%). Samples from nine men with HCV RNA in their semen and 26 men without were compared to further analyse these parameters. No correlation was found between HCV RNA in the seminal fluid and age, HCV virus load, the duration of HIV-1 infection, HIV treatment, the CD4+ cell count, HIV-1 virus load or HIV-1 detection in the semen.

The intermittent detection of HCV RNA in semen samples support the systematic search for HCV RNA in semen and the use of processed spermatozoa in assisted medical procreation of infertile HCV serodiscordant couples.

Comment

In practice condom will protect against HCV and HIV, in contrast to HBV. Sound advice is to use them to protect against the risk of sexual HCV transmission and get vaccinated against hepatitis B and hepatitis A.