 Whether hepatitis C can be transmitted through sexual activity is controversial. While there is an association between high-risk sexual activity and hepatitis C, and multiple sexual partners are a risk factor for hepatitis C, there is no conclusive evidence that hepatitis C can be transmitted by sexual activity, since people who report transmission with sex as their only risk factor may actually have used drugs but denied it. The majority of evidence supports there being no risk for heterosexual couples with only one sexual partner. Sexual practices that involve higher levels of trauma to the anogenital mucosa, such as anal penetrative sex, or that occur when there is a concurrent sexually transmitted infection, including HIV or genital ulceration, do present a risk. The United States Department of Veterans Affairs recommends condom use to prevent hepatitis C transmission in those with multiple partners, but not those in relationships that involve only a single partner.
