Hepatitis C and sex between men: fisting, slamming, blood, and a cure

What is hepatitis C?

Hepatitis C is a liver infection caused by the HCV virus. WHO estimates about 47 million people were living with chronic hepatitis C worldwide in 2024. Untreated, it can silently progress to cirrhosis and liver cancer.

It is first and foremost a bloodborne virus. But WHO also recognises sexual transmission among men who have sex with men, linked to blood exposure.

How is it caught between men?

Hépatites Info Service explains that sexual risk is generally very low, but rises sharply with traumatic practices involving bleeding, particularly among HIV-positive men or men on PrEP with several partners:

• fisting without single-use gloves, or with a shared tub of lube;
• toys passed between partners;
• SM with blood (blood play);
• long or repeated penetration that irritates the lining (group sex, chems);
• sharing syringes (slamming), but also snorting straws and crack/crystal pipes.

HCV survives several days on equipment: any sharing counts.

What are the symptoms?

Usually none. Sometimes, according to WHO: tiredness, fever, loss of appetite, nausea, stomach pain, dark urine, jaundice. That’s why only testing tells you.

How do you get tested?

With a blood test (antibodies, then a virus test if positive). Sexosafe notes that PrEP follow-up includes hepatitis C testing every 3 months. If you’ve had hepatitis C before and were cured, antibodies stay positive: the doctor will test directly for the virus (RNA).

A treatment that cures

This is the big breakthrough: direct-acting antivirals cure more than 95% of hepatitis C cases, according to WHO, with a few weeks of pills and few side effects. In France they are covered.

Careful: you are not immune after being cured. There is no vaccine against hepatitis C. Reinfections are common among men who keep the same practices without protection: hence regular testing.

How to protect yourself?

Sexosafe and Hépatites Info Service recommend:

• one glove per partner for fisting (nitrile is tougher and less allergenic than latex), short, filed nails;
• your own tub of lube, or single doses; only one person dips into it;
• a new condom on every shared toy, toys washed after use;
• your own drug equipment: your straw, your syringe, your pipe (free from harm-reduction services and AIDES in France);
• stopping at the first sign of bleeding.

Condoms remain the main protection during penetration.