Hepatitis C

Hepatitis C affects people differently. Many people infected with Hepatitis C do not develop symptoms until it has caused significant damage to the liver. As a result, they may not realise they are infected with Hepatitis C until they get tested.

If you have Hepatitis C for less than six months, this is known as an acute infection. Infection persisting for more than six months is defined as chronic Hepatitis C.

Symptoms that can develop in those with Acute Hepatitis C include:

• Body aches and high temperature
• Feeling tired all the time
• Loss of appetite and stomach ache
• Feeling nauseous or vomiting
• Jaundice

Symptoms that can develop in those with Chronic Hepatitis C include:

• Muscle aches and pains
• Feeling tired all the time
• Feeling nauseous
• Brain fog
• Mood changes
• Depression or anxiety
• Itchy skin
• Indigestion or bloating
• Abdominal pain
• Swelling around the abdominal area
• Easy bruising or bleeding
• Leg swelling
• Unexplained weight loss
• Jaundice

Yes. Hepatitis C often causes no noticeable symptoms, especially in the early stages, so many people do not know they have it.

Some people may experience mild flu-like symptoms soon after infection, such as fatigue, fever, or feeling generally unwell, but many have no symptoms at all. Without testing, the infection can remain undetected for years while gradually causing liver damage.

If you think you may have been exposed to Hepatitis C, getting tested is the only way to confirm whether you have the virus. Early diagnosis allows treatment before significant liver damage develops.

If left untreated, Hepatitis C can cause progressive liver damage that may lead to serious health problems over time.

Potential complications include:

• Cirrhosis (scarring of the liver)
• Liver failure
• Liver cancer
• Less commonly, kidney disease and extrahepatic conditions, such as mixed cryoglobulinaemia and some kidney disorders

Effective antiviral treatments can cure most Hepatitis C infections, making early diagnosis and treatment the best way to prevent these complications.

Symptoms, when they occur, usually develop 2–12 weeks after exposure. However, most people with acute hepatitis C have no symptoms.

Hepatitis C is caused by the Hepatitis C virus (HCV). It is transmitted through direct contact with infected blood. You can become infected with Hepatitis C by:

• Sharing needles and syringes used to prepare and inject drugs.
• Having sexual intercourse (especially chem-sex).
• Sharing personal items such as toothbrushes, razors, nail clippers, or any other personal items that could be in contact with infected blood.
• Getting tattooed with unsterile needles.
• Mother-to-child transmission during pregnancy or childbirth can occur, although the overall risk is low.
• Occupational exposure to infected blood, such as needlestick injuries in healthcare settings.

Sexual transmission is uncommon in heterosexual couples but occurs more frequently in some higher-risk groups, particularly MSM with HIV or where blood exposure occurs.

Hepatitis C is not spread by kissing, hugging, water, food, breast milk, holding hands, towels, toilet seats, or sharing cutlery.

Your risk of getting Hepatitis C may be increased if you are:

• A HIV-positive man who has sex with other men
• Born to a Hepatitis C infected mother
• Received a blood transfusion or organ transplant before 1992
• Received a blood clotting factor for hemophilia before 1987
• On haemodialysis and there is poor infection control.
• Having ever injected drugs (even once)
• Being in prison
• Having ongoing exposure to infected blood

Hepatitis C is spread through blood-to-blood contact. The best way to prevent infection is to avoid contact with blood that may carry the virus.

You can reduce your risk by:

• Never sharing needles or other drug-injecting equipment
• Avoiding sharing razors, toothbrushes, nail clippers, or other items that may have traces of blood
• Choosing licensed tattoo and piercing providers that use sterile equipment
• Using condoms, particularly if there is a risk of blood exposure during sex
• Do not share equipment used for snorting drugs (such as straws or banknotes)

If you think you may have been exposed to Hepatitis C, a blood test is the only way to know if you have the virus.

Yes, although the risk is low. Hepatitis C is mainly spread through blood-to-blood contact, and sexual transmission is uncommon.

Using a condom reduces the risk of transmission during sex. The risk may be higher if blood is present, such as during menstruation or if either partner has cuts or sores in the genital area.

If you are concerned about a possible exposure, a blood test can confirm whether you have Hepatitis C.

No. Hepatitis C is not spread through kissing.

The virus is transmitted through blood-to-blood contact, not saliva. You also cannot catch Hepatitis C through hugging, sharing food or drinks, or using the same cutlery.

Yes, if the item has traces of infected blood on it.

Avoid sharing personal items such as:

• Razors
• Toothbrushes
• Nail clippers or scissors
• Hair clippers

These items can sometimes carry small amounts of blood. Hepatitis C is not spread through casual contact, including hugging, sharing food, drinks, or cutlery.

Yes, but the risk is extremely low in the UK today.

Routine screening of donated blood has made transfusion-related hepatitis C extremely rare in the UK. If you received a blood transfusion in the UK before September 1991, it is worth considering a Hepatitis C test, as the virus often causes no symptoms for many years.

Hepatitis C is diagnosed with blood tests.

Diagnosis usually involves two steps:

• An antibody test checks whether you have ever been exposed to the virus.
• If positive, a PCR (RNA) test confirms whether the virus is currently active in your body.

If you think you have been recently exposed, it is important to test at the right time, as the virus may not be detectable immediately.

The two main tests used to diagnose Hepatitis C are an antibody test and a PCR (RNA) test.

The antibody test shows whether you have ever been exposed to the virus. If it is positive, a PCR test is used to confirm whether you have an active infection. A PCR testing detects HCV RNA, confirming current infection. If Hepatitis C is confirmed, additional tests may be recommended to assess your liver health.

An accurate diagnosis depends on using the right tests at the right time after possible exposure.

Your healthcare provider will consider:

• Your risk of exposure and medical history
• The timing of your test, as recent infections may not be detectable immediately
• The results of both the antibody and PCR (RNA) blood tests

Because Hepatitis C often causes no symptoms, testing is the only reliable way to diagnose it.

Yes. Several conditions can cause symptoms similar to Hepatitis C, including other viral infections and liver diseases.

Because symptoms such as fatigue or jaundice are not specific to Hepatitis C, it cannot be diagnosed based on symptoms alone. Blood tests are needed to confirm the infection.

Hepatitis C is diagnosed using blood tests. Additional investigations such as FibroScan assess liver damage but do not diagnose the infection.

If an active infection is confirmed, additional tests such as liver function tests or a FibroScan may be used to assess liver damage and help guide treatment. These tests do not diagnose Hepatitis C but provide information about the health of your liver.

No. A physical examination alone cannot diagnose Hepatitis C.

Although signs such as jaundice may suggest liver disease, many people with Hepatitis C have no visible symptoms. Blood tests are required to confirm the diagnosis.

No. Hepatitis C cannot be diagnosed based on symptoms alone.

Home sampling kits are available and can test for Hepatitis C antibodies using a blood sample collected at home. If the result is positive, a PCR (RNA) test is needed to confirm whether you have an active infection. Any positive home test should be followed up with a healthcare provider.

More than 95% of people with hepatitis C can be cured with modern direct-acting antiviral (DAA) treatment.

Acute hepatitis C is often asymptomatic. Without treatment, some people clear the virus naturally, while others develop chronic infection. Around 30% of infected patients clear the virus within 6 months of infection.

Approximately 55–85% of people develop chronic hepatitis C. Without treatment, chronic hepatitis C can lead to progressive liver fibrosis, cirrhosis, liver failure, and liver cancer over many years.

Successful treatment does not give you any protection against getting Hepatitis C again.

You can reduce your risk of reinfection by avoiding blood-to-blood exposure, not sharing injecting or drug-use equipment, practising safer sex where there is a risk of blood exposure, and using sterile equipment for tattoos or piercings.

Yes. It is essential to tell your partner that you have been infected with Hepatitis C so that they can get tested to prevent the infection from passing on to others.

Unfortunately not. Having Hepatitis C in the past does not protect you from getting it again.

Yes, in some cases. If you had significant liver scarring (cirrhosis) before being cured of Hepatitis C, you will still need regular long-term liver monitoring. Although successful treatment eliminates the virus, it does not completely remove the risk of developing liver cancer (hepatocellular carcinoma) in people with established cirrhosis. Your specialist will usually recommend ongoing surveillance, which often includes liver ultrasound scans (with or without blood tests such as alpha-fetoprotein) every six months. If you did not have cirrhosis before treatment, routine liver cancer surveillance is generally not required unless there are other risk factors or underlying liver disease.

Yes. Hepatitis C can be passed from a mother to her baby primarily during pregnancy or at the time of birth, but the risk is low.

The risk is around 5% if the mother has an active Hepatitis C infection and may be higher if she also has HIV. Babies born to mothers with Hepatitis C should be tested after birth according to current medical guidance.

Most pregnancies are uncomplicated, but Hepatitis C can increase the risk of certain pregnancy-related complications.

These may include:

• Passing the virus to the baby (around 5% risk)
• Gestational diabetes
• Intrahepatic cholestasis of pregnancy
• May be associated with preterm birth or low birth weight

Regular antenatal care and monitoring can help manage these risks.

Hepatitis C is relatively uncommon during pregnancy in the UK.

The risk of passing the virus to the baby is low, occurring in around 5% of pregnancies where the mother has an active infection. If you think you may be at risk, speak to your healthcare provider about testing.

Hepatitis C is not usually treated during pregnancy.

Direct-acting antiviral (DAA) treatment is not routinely recommended during pregnancy because there are insufficient safety data. Treatment is usually offered before pregnancy or after delivery.

Yes. If you have Hepatitis C or think you may be at risk, early testing and regular antenatal care are important.

Healthcare providers may take steps to reduce the baby's exposure to blood during delivery when possible. Breastfeeding is considered safe unless your nipples are cracked or bleeding.

Hepatitis C does not usually affect recovery after childbirth.

Breastfeeding is considered safe because Hepatitis C is not spread through breast milk. However, if your nipples are cracked or bleeding, it is recommended to stop breastfeeding from the affected breast until it has healed.

Treatment is usually offered after pregnancy. The timing of treatment during breastfeeding should be discussed with a specialist, as safety data for direct-acting antivirals during breastfeeding remain limited.