10 Most Common Hepatitis C Questions—Answered

by Amy Marturana Winderl Health Writer

For the recently diagnosed, hepatitis C raises a lot of “can I”s: Can I spread it through kissing? Can I have a beer? Can I safely have a baby? But many Googled answers contain more misinformation than a certain president’s tweets. To save you the trouble of fact-checking, we’ve compiled expert-backed answers to some of the most common questions about living with the chronic liver condition known as hep C.

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First, What Exactly Is Hepatitis C?

Let’s start with the basics. Hepatitis C is a liver infection caused by the hepatitis C virus (also known as HCV) and transmitted through the blood. The virus attacks the liver and leads to inflammation, which can eventually bring about serious liver damage, scarring (called cirrhosis), and possibly even liver failure. Scary…but: Modern hep C treatments, called direct-acting antivirals, are extremely effective—the cure rates are over 90 percent. Plus, treatments have minimal side effects, so most people don’t notice an interruption in their daily lives.

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Can Hepatitis C Spread Through Saliva?

Two letters: N.O. Hepatitis C is spread when the blood of an infected person gets into the body of another person. It does not spread through coughs and sneezes or from sharing food or drinks. There’s also no evidence that kissing transmits the virus, says Raymond Chung, M.D., director of the Hepatology and Liver Center at Massachusetts General Hospital and an associate professor of medicine at Harvard Medical School. “Theoretically, it’s possible if both people have an open wound on or in their mouths,” he says, “so maybe hold off on any kissing when your mouth is bleeding.”

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What If I Accidentally Use My Partner’s Toothbrush or Nail Clippers?

Sharing personal care items that have come into contact with a person’s blood—like toothbrushes, nail clippers, and razors—can increase the chances of spreading hep C, but it’s not a common mode of transmission. “The risk of any one single episode of that nature is going to be exceedingly low,” Dr. Chung says. “It’s more about avoiding the behavior or habit to reduce the number of potential exposures.” So while you should not purposely share these items with someone who has hep C, there’s no need to freak if you accidentally slip up once or twice.

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Can I Have Sex Safely With Hep C?

Hep C can be transmitted through unprotected sex, but the risk is low. Having multiple sexual partners, rough sex, or anal sex—basically, any time blood may be involved—increase the risk. Dr. Chung recommends following the same rules of safe sex that apply to anyone who is sexually active and not in a monogamous relationship: Tell all new sexual partners that you have hep C and always use a condom. If you’re in a long-term, monogamous relationship, you don’t need to take any extra precautions, Dr. Chung says.

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Can I Get a Tattoo or Piercing After Treatment?

Cleanliness is the most important factor here. “As long as you see a reputable, professional tattoo artist or piercer who uses appropriate hygienic practices between clients, there’s no reason you can’t get a new tattoo or piercing after hep C treatment,” Dr. Chung says. Remember: You can be re-infected with HCV at any time, so it’s important to vet the facility in advance. Confirm the tattoo or piercing shop uses sterile practices, including wearing gloves, disinfecting all surfaces, and using single-use needles or completely sterilizing tools between uses.

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Can I Get a Manicure or Pedicure If I Have Hep C?

The risk of transmitting hep C at a nail salon is extremely low, Dr. Chung says. Again, the key is that the salon uses single-use tools or follows strict sterilization procedures between each person. That means heat-sterilizing metal tools in a machine called an autoclave, and never reusing items like pumice stones, nail buffers, and foam toe separators. To further reduce your risk, hold off on a mani or pedi if you have an open wound on your hands or feet, skip cuticle pushing and especially clipping, and don’t shave your legs right before a pedicure to avoid microscopic skin cuts.

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Can I Drink Alcohol Again After I'm Cured?

There’s not one universal answer here. Some people may need to stay sober after they complete treatment for HCV—specifically anyone with advanced liver disease or those who need a liver transplant. But if that’s not you, your doctor will likely say it’s okay to drink in moderation once you’re cured, says Nikolaos Pyrsopoulos, M.D., a professor of medicine and chief of gastroenterology and hepatology at New Jersey Medical School. But until your doctor gives the thumbs up, it’s crucial to avoid all alcohol, as it can accelerate liver damage, Dr. Pyrsopoulos says.

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When Is It Safe for Me to Get Pregnant?

It’s best to wait until after you complete treatment to get pregnant, Dr. Chung says. “There’s no risk of transmission once you’re cured.” (You’re considered cured if a blood test comes back negative for HCV three months post-treatment.) If you find yourself pregnant with hep C, the chances your baby will get it are pretty low—about 6 percent. One exception: “Mothers with both hep C and HIV tend to have considerably higher viral loads, meaning there’s more of the virus in their blood, so the risk goes up to 20 percent,” Dr. Chung says. It’s not clear if hep C medications are safe during pregnancy, so most doctors will delay treatment until after you give birth.

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What Happens If I Pass Hep C to My Baby?

If you have hep C while pregnant, your baby will be tested for it around 18 months old. Waiting gives them time to potentially clear the virus without medication—this happens in about 30 percent of people with hep C. If they test positive, they’ll be monitored and eventually treated at an appropriate age, Dr. Chung says. Depending on the strain, hep C treatments can be given as early as age 3. And don’t worry: There’s virtually no risk that your child will develop liver disease while waiting for treatment.

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Is It Dangerous to Breastfeed With Hep C?

You can typically safely breastfeed your baby, even if you have hepatitis C and they don’t. According to the Centers for Disease Control and Prevention, there is no evidence that breastfeeding spreads hep C. However, there isn’t enough information on transmission rates when the nipples are cracked or bleeding, so if this happens to you, it’s best to take a break from nursing until your nipples are healed. In the meantime, pump and discard the milk, as there’s a small chance blood could make its way in.

Amy Marturana Winderl
Meet Our Writer
Amy Marturana Winderl

Amy is a freelance journalist and certified personal trainer. She covers a wide range of health topics, including fitness, health conditions, mental health, sexual and reproductive health, nutrition, and more. Her work has appeared on SELF, Bicycling, Health, and other publications. When she's not busy writing or editing, you can find her hiking, cooking, running, or lounging on the couch watching the latest true crime show on Netflix.