Hepatitis C virus (HCV) is transmitted primarily through blood-to-blood contact. You cannot contract the virus through casual contact, including coughing, kissing, hugging, sneezing or sharing food, cups or utensils.

The main ways HCV is transmitted include:

  • Sharing injection drug equipment, including syringes and cookers. Always use sterile injection supplies or clean them with bleach.
  • Blood transfusions and organ transplants that took place before widespread screening of the blood supply began in 1992. These procedures are now safe.
  • Tattooing and piercing using unsterilized equipment, including those done inside correctional facilities.
  • From mother to child during pregnancy or delivery. Mothers with hep C have about a 5% chance of transmitting the virus to their infants. That figure rises for those who also have HIV, hepatitis B or a high hep C viral load. Breast feeding poses little or no transmission risk.
  • Sexual transmission of HCV among heterosexuals is uncommon. However, there is an emerging epidemic of sexually transmitted hep C among men who have sex with men and don’t use condoms consistently, with higher rates seen among HIV-positive men.

About 70% of people living with hep C in the United States are baby boomers—those born between 1945 and 1965. An estimated 2% of this birth cohort has the virus. Research suggests that many baby boomers with hep C likely contracted the virus through medical procedures when they were decades younger. Others might have contracted the virus through injection drug use long ago.

In recent years, the opioid crisis has driven up hep C transmission among younger people who inject drugs. This has in turn led to rising rates of mother-to-child transmission of the virus. Young people who test positive for the virus today, a recent study found, are often unaware of the risks of contracting hep C.

People who are at higher risk of hep C include those who:

  • Have injected drugs at any point in their lives
  • Received a blood product for clotting problems prior to 1987
  • Received a transfusion or organ transplant before 1992 or from a donor who was later diagnosed with hep C
  • Are living with HIV
  • Have ever received long-term kidney dialysis
  • Have persistently abnormal liver enzyme levels, such as ALT or AST
  • Were born to a mother with hep C
  • Have had potential exposure to HCV through their job, such as a needle stick in a health care setting
  • Have received a tattoo or piercing outside of a professional setting.

Hep C Testing

All adults should be tested for hep C.

The U.S. Preventive Services Task Force recommends that all people age 18 and older receive a hep C test at least once in their life, regardless of risk factors. All pregnant women should be screened. People with an ongoing risk of contracting hep C, including those who inject drugs and men who have condomless sex with other men, should receive routine screening for the virus.

First, you will receive a test that looks for antibodies to hep C.

  • If the test is negative, you do not have the virus, nor did you ever.
  • If the test is positive, you will need a second test, a genetic screen called a PCR test, which looks for the presence of HCV itself.

If both your antibody and PCR test are positive:

  • You currently have hep C.
  • If more than six months have passed since you acquired hep C, you have chronic infection.
  • If you likely contracted the virus during the six months leading up to your test, you have acute infection. In about 25% of cases, people with acute infection will spontaneously clear HCV within six months without treatment. Nevertheless, treatment is recommended for people with acute infection.

If the antibody test is positive but the PCR test is negative:

  • You previously had hep C and your immune system spontaneously cleared it.
  • You previously received a false positive result, meaning that you never had HCV, but the test incorrectly found that you did.