Transmission

The hepatitis A virus (HAV) is excreted in the feces (stool) of an infected person and ingested through the mouth, mostly from contaminated water (including ice), shellfish, vegetables, fruit, and other insufficiently cooked foods. Infection is also possible during sex, e.g. through contact between the mouth and the anus or when touching the mouth with the fingers after contact with the anus, a used dildo or condom, or a shared lubricant container. In recent years, clusters of hepatitis A cases among men who have sex with men have been observed especially in big cities. Transmission is also possible through close contact, such as in kindergartens, schools or at home, or when using drugs together.

The hepatitis B virus (HBV) is highly contagious and is mainly transmitted through blood. Smaller amounts of HBV, which can still be sufficient for an infection, are also contained in the saliva, breast milk, semen, lacrimal fluid as well as in the urine or vaginal secretion of infected persons. HBV is mainly transmitted during sex; the risk increases if blood enters the body (an amount invisible to the naked eye is already sufficient). Contact with infected blood is also possible when sharing equipment for drug use, tattooing and piercing, and when sharing or mixing up toothbrushes, shaving gear, nail scissors, or the like.

The hepatitis C virus is mainly transmitted through blood, much more easily than HIV. In Europe, most infections are attributed to sharing equipment for drug use. Transmission is also possible when tattooing and piercing and when sharing or mixing up razors (and probably also nail scissors and toothbrushes). In countries with high HCV prevalence, there is also a risk during medical procedures under poor hygiene conditions.

The risk of transmission to the baby during pregnancy or birth is less than 5% in Germany. For people who could become pregnant, protection from hepatitis C as well as diagnosis and treatment of a potential infection are particularly important, because highly effective hepatitis C medications must not be taken during pregnancy and are also not approved for use in young children.

Transmission during sex is possible but occurs very rarely even when having vaginal or anal intercourse without a condom or internal condom; the majority of documented cases in recent years affected men who have sex with men (MSM), especially MSM with HIV. There is a generally increased risk if blood plays a role, such as in sexual practices involving a high risk of injuries or when there is rectal bleeding. Intestinal secretion containing HCV can also be passed on from one receiving person to the next receiving person, e.g. with the penis or a dildo (even when using a condom) or with the hands (even when using gloves). Transmission is also possible through traces of blood containing HCV in shared lubricant containers.