HIV transmission: guidelines for assessing risk - Canadian AIDS ...

HIV TRANSMISSION: Guidelines for Assessing Risk6. Assessing Risk of Hepatitis CTransmissionPart 1. Sexual ActivitiesThe risk of contracting hepatitis C through sexual contact isnot well-established. Recent studies show that there is littleto no hepatitis C virus present in vaginal fluids or semen.However, transmission can occur if blood is present, eithervisibly or through microscopic cuts or tears in the skinand/or mucosa.It must be stressed that this area is still being researched andno final conclusions have been made on the assessment ofrisk for transmission through sexual activities that do notinvolve the presence of blood.Kissing“Sucking face, necking, smooching”Potential for TransmissionThere is no potential for HCV transmission in pressing drylips together.In the absence of blood in the mouth, wet kissing can beclassified as no risk. Saliva that does not contain bloodpresents no potential for transmission.There is a small potential for transmission in wet kissingwhere blood may be exchanged. The presence of blood inthe mouth could be caused by recent brushing or flossing ofthe teeth, a sore in the mouth, gum disease, a recent toothextraction or biting or scratching one another (e.g. withthe teeth or orthodontic alliances, such as braces) duringkissing. Although it is likely that only a small amount ofblood would ever be present, the presence of a quantitysufficient for transmission of HCV to occur cannot bediscounted. The risk of transmission is increased whereblood is exchanged between mouths and where the mouthof the person receiving the blood contains ulcers or sores, orwhere there is evidence of dental recession.Note: It is recommended that a period of 30 minutes totwo hours be allowed to elapse after brushing or flossingteeth before sexual activity, due to the possibility of blood insaliva.Evidence of TransmissionThere is no evidence of transmission of HCV throughkissing alone.Assessment of Risk of HCV TransmissionWet or dry kissingNo exchange of blood . . . . . . . . . . . . . . . . . . . . . .No RiskWet kissingWith exchange of blood . . . . . . . . . . . . . . . . . . . . . . N/A** According to our model, the lack of documented cases in relationto the high potential of risk would lead this activity to becategorized as Negligible Risk. In this case though, the potentialfor risk associated with the activity and the lack of mentionin research literature precludes making a risk assignment.Oral Sex: Fellatio“Giving or getting head, headjob, blowjob, sucking off,blowing, face-fucking, going down, cock-sucking”Potential for TransmissionThere is a potential risk of transmission of HCV to thepartner giving fellatio if there is a disruption in the oralmucosa such as bleeding gums, cuts, sores, lesions, ulcers orburns in the mouth or by a recent tooth extraction and thepresence of blood from an abrasion or cut on the penis.It is recommended that the partner giving fellatio wait 30minutes to two hours after brushing or flossing teeth beforeengaging in fellatio, since brushing and flossing teeth maycause temporary bleeding of the gums.There is a similarly small risk of contracting HCV in gettingfellatio if blood from bleeding gums or sores in the mouthcould come into contact with an abrasion on the penis.Although it is likely that only a small amount of bloodHepatitis C Transmission41