Direct percutaneous inoculation is the most efficient mode of transmitting HCV, although sexual, household occupational and vertical transmission of HCV may also occur (63-67). HCV intra-spousal transmission appears to be rare in the absence of a parenteral risk in the partner. In case-control studies sexual co-habitation with an anti-HCV-positive person was not identified as a risk for infection. Therefore HCV is not considered to be a sexually transmitted disease. Some factors, however, such as sexual promiscuity, HIV and HSV2 co-infections are associated with sexual transmission of hepatitis C (66,67). It is not clear whether the probability of transmission between partners increases with decades of marriage and/or age (68,69). This does not necessarily represent sexual transmission.

 
The infected person should inform sexual partners. Testing should be offered to the sexual partner. Patients should be advised to avoid sharing items of personal hygiene. In short-term sexual relationships condom use is advised. Unprotected sex during menstruation should be avoided. Couples should be given information about the risks of transmission, and about precautions which may reduce the risk of transmission. The committee neither recommends nor recommends against the use of condoms in stable monogamous relationships.  It is up to the couple to make a decision, based upon the best information that can be provided to them.