You have your test result. Positive. Hepatitis C. Maybe your stomach dropped for a moment, maybe you already had a hunch. However you're feeling right now: take a deep breath. Because here's the short version of everything that follows: hepatitis C today is fully curable in the vast majority of cases. A few weeks of tablets, very well tolerated and the virus is gone. By getting tested, you did the right thing. Now it's just about taking the next step.

First things first: a reactive result is not yet a diagnosis

The first test for hepatitis C is usually an antibody test (anti-HCV). It's deliberately built to be highly sensitive, because it shouldn't miss anyone, not even when contact with the virus was a long time ago. That's exactly what makes it a good screening test: it picks things up early and reliably.

What it tells you: your immune system came into contact with the virus and produced antibodies against it. What it doesn't tell you yet: whether the virus is active in you now. Antibodies stay detectable even when the infection is long over. In roughly a quarter to a third of people the virus clears on its own, and the antibodies stay behind anyway.

That's why labs often call this kind of result "reactive" rather than "positive". It's a finding that should be followed up, and the follow-up is a single additional test: the HCV RNA test (PCR). It looks directly for the virus in your blood and answers the question that actually matters. It's worth taking this step soon, because only this result determines whether and how you'll be treated.

What is hepatitis C, exactly?

Hepatitis C is an inflammation of the liver caused by the hepatitis C virus (HCV). It's transmitted mainly through blood, classically through shared drug-taking equipment and, in the past, through blood products. Transmission during sex is rarer than with most other STIs, but still possible. 

The risk is higher, for example, with practices that cause small injuries, during chemsex or alongside an HIV infection. Shared razors, toothbrushes or sex toys can also be a route of transmission.

Would you even notice anything?

Usually not, at least not for a long time. A recent hepatitis C infection often runs its course with no symptoms at all. If symptoms do appear, they're easy to mistake for something else:

• Tiredness and feeling run down
• A flu-like feeling, aching limbs
• Pressure or pain in the upper right abdomen
• Yellowing of the skin or eyes (jaundice)
• Dark urine, pale stools
• Loss of appetite or nausea

The tricky part: chronic hepatitis C can tick along quietly for years without you noticing a thing. That's why a test is often the only way to find out at all.

Why should I take this seriously?

Because untreated chronic hepatitis C can wear the liver down over a long period. Over years to decades it can lead to scarring of the liver tissue (cirrhosis) and, more rarely, to liver cancer. This happens slowly and often unnoticed.

The good news: that's exactly what can be prevented. Once the infection is treated and cleared, the liver recovers in most cases. And you're already on your way there.

What happens now? The next steps

Get it followed up. First, an HCV RNA test (PCR) establishes whether there's an active infection. Only this result says whether and how you'll be treated.

See a specialist. Hepatitis C is handled by gastroenterologists, hepatologists or infectious disease specialists. They'll check your liver values, assess the condition of your liver and identify the exact type of virus (genotype). It sounds like a lot, but it's routine.

Start treatment. Hepatitis C is treated today with direct-acting antivirals (DAAs). As a rule you'll take tablets over 8 to 12 weeks. The cure rate is over 95%, the medication is well tolerated and in Germany the cost is covered by statutory health insurance.

Protect others. As long as the infection is active, the main thing is avoiding contact with blood: don't share razors, toothbrushes or drug-taking equipment, and use condoms for sex where blood contact is possible.

Tell your contacts. People you've had blood or sexual contact with where there was a possible risk should get tested too. It's the part nobody looks forward to, but it gives others the chance to know early.

How do I protect myself going forward?

Unlike hepatitis A and B, there's no vaccine against hepatitis C (yet). You can still protect yourself well:

• Don't share anything that might have blood on it (razors, toothbrushes, needles, snorting tubes)
• For sex where blood contact is possible, use condoms and gloves, and don't share sex toys unprotected
• Test regularly, especially with changing partners or a higher risk

And one important point: having cleared hepatitis C doesn't make you immune. You can catch it again. So testing still makes sense after you've been cured. If you want, you can also get vaccinated against hepatitis A and B, which takes further strain off your liver.

No reason to panic

Testing positive for hepatitis C isn't a catastrophe, even if it feels that way at first. A reactive antibody test is an indication, not yet a diagnosis, and what it really means is settled by a single additional test. And if there is an active infection, hepatitis C is one of the few chronic viral infections today that can be cured completely. You've already taken the most important step. Now it's just about seeing it through.