[Question #2499] hep???

45 months ago
Hi,

I just went and got tested for hep, but I am a bit anxious about results.  I went for my annual physical a couple of months ago and I asked the doctor about some spots on my legs.  He referred me to derm who diagnosed it as lichen planus.  I went back to my doctor for follow up and asked if  I should be tested for hep c and he said no.  He said that my enzymes (alt, ast) were fine (my bilirinim was a little high 1.5 but still in range.  I said ok.

This past weekend, I noticed a dry spot in my check and it's kinda white. I also notice a little dark spot back on gum behind my molar.  I have an appointment with dentist Wednesday so I don't know if it has spread to mouth yet. I decided to get tested since lichen planus is common among hep c.  My question is that I don't use drugs and only have protected sex.  I did have an encounter toward later part of last year with an escort.  She had some bruises on her arm and I did suspect drug use.  I had protected sex for about 5 minutes and decided to change position.  I notice blood on condom so I stopped.    I removed the condom and she used her hand to masterbate me.  I later used my hand to finish.  

I have genital herpes (not really bad ones just a few bumps once or twice year. I don't think that I had any open sores but not sure especially since the masturbation  was a little rough since she didn't have any lotion.   How likely is it that I got hep c from touching the condom and then myself or from her hand.  I removed the condom and wiped my hands.  There was no visible blood anywhere.  I told doc that I had protected sex but not all the details.  He assured me right away that if I had an active virus infection my lab results would show.

thanks.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome to the forum. Thank you for your confidence in our services.

Contrary to popular beliefs, hepatitis C virus (HCV) is almost never sexually transmitted. Even after 10 or more years of marriage and regular unprotected sex, the spouses of people with HCV have litte or no higher frequency of being infected than anyone else, assuming the couple also does not share blood, e.g. by shared drug injection equipment. The ONLY proved sexual transmission scenario for HCV is among gay men who participate in potentially traumatic rectal practices, i.e. with likely blood exposure. And your encounter with the escort was condom protected for the parts that matter; hand-genital contact for sure is risk free.

Having genital herpes due to HSV2 (but not HSV1) increases the risk of HIV, if a partner is infected. But it isn't known to have any effect on susceptibility to any other infections. (By the way, that your herpes recurs infrequently and is otherwise mild is irrelevant. The increased HIV risk is exactly the same in people with frequent or severe outbreaks as in people with none at all, i.e. HSV2 without symptoms.)

I'm not sure what you mean to imply by describing your lichen planus. That's a minor kind of dermatitis that does not have any effect on risk of HCV or any other infection.

All things considered, I see no reason for concern you might have caught hepatitis C.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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45 months ago
Hi Dr.

Thank you for your response I do feel a bit less anxious about the results that I should receive tomorrow.  The reason why I mentioned Lichen is that I read that 60% percent of Lichen Planus diagnoses have HCV.   I felt comfortable with my doc until it started to move to my mouth and wanted to be sure.  Just one follow up question...it seems odd that it is so unlikely to catch hep from sex when blood is present if you can catch it from using a toothbrush.  I would think that menstruation blood would be more contagious than blood from brushing your teeth.  In my situation, there was significant blood on condom and I removed the condom.  I wiped hand off but masterbated with same hand  and I think (not so sure) that I may have had a sore that was healing.  It seems plausible.    

Lastly, if a person did have an active hcv infection with lichen planus in mouth and legs, would it be safe to assume that the liver results would be elevated.  thank you again for all of your help.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Interesting. I was unaware of any association of lichen planus with HCV. My initial reaction to this reply was skepticism, but it led me to the medical literature and you are correct. However, 60% probably is too high. According to a very recent review publication (https://www.ncbi.nlm.nih.gov/pubmed/28689593), various studies have reported that 4% to 24% of people with lichen planus have chronic hepatitis B. But apparently there is consensus among liver disease experts that LP indeed should prompt HCV testing. My lack of awareness is partly reflected in my reply above:  because HCV is not an STD or frequently sexually transmitted, most STD experts are definitely not hepatitis C experts! Thanks for helping educate me. 

The research studies and other analysies of sexual transmission of HCV are quite clear in their results. I'm unaware of data on sex during menstruation and HCV risk; it seems plausible, but the overall evidence against sexual transmission are strong. Early studies of long term spouses found a modestly increased prevalence of HCV in wives or husbands of infected persons, but later studies that controlled for blood exposure other than sex found no such associations (seeming to exclude sex during menstruation as a risk). Among people attending STD clinics, history of sex with an HCV infected person does not predict infection in the exposed person. And HCV is not consistently present in genital fluids (e.g. semen) of infected persons, and usually at low levels -- very different than similar studies of hepatitis B. As for toothbrushes, that's one of those theoretical risks that rarely pans out. Don't confuse lists of potential risks with actual risks in the real world. (This is similar to HIV risks always listing oral sex, even though oral sex almost never transmits HIV, with no proved cases of oral to penile transmission.)

You might get more meaningful feedback about your situation from a forum or other online sources that emphasize liver disease. But in the meantime, I remain confident you are not at risk of HCV from the exposures you have described.


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45 months ago
Thanks Doc.   Hopefully, I will hear something back soon.  They said 24-48 hrs.   A bit disappointed that my primary doc didn't do testing couple of months back and gave me this false hope.  Last time I do a dumb thing like this again regardless.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
OK, understood. But note that the lichen planus association appears to be only with chronic hepatitis C. If you should have a positive test, it probably would reflect a longstanding infection, not one acquired during your recent sexual exposures.

I'll leave this thread open pending your test result, when I will be happy to comment one more time.

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45 months ago
Well, that makes me feel a little more optimistic.  If it were chronic, it is highly likely that my annual physical would have show some levels of elevated liver enzymes.  thanks again.  I will post results once I receive.
45 months ago
negative doc... once again you are right.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Sorry for the long delayed final reply, but glad to hear of the negative result (although of course not surprised!) ---