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Hepatitis C in Singapore: Symptoms, Testing & Cure

Hepatitis C is a blood-borne viral infection (sometimes grouped under STDs because of sexual transmission risk in HIV-positive MSM). Once untreatable, it is now curable in over 95% of patients with a short oral course of direct-acting antiviral therapy. Most chronic HCV is silent until late liver disease. There is no vaccine.

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Medically reviewed by · MD, SMC-registered · Pathogen: Hepatitis C virus (HCV) · ICD-10 B17.1, B18.2

Single green seedling pushing through cracked earth - hepatitis C is curable.

What is hepatitis c?

Hepatitis C is a viral infection of the liver. Around 75-85% of people who acquire HCV develop chronic infection, which over decades can lead to cirrhosis, liver failure and liver cancer.

Modern direct-acting antivirals (DAAs) cure over 95% of HCV in 8-12 weeks - one of the most dramatic therapeutic advances in modern medicine. The barrier is now detection: chronic HCV is silent and many carriers are unaware.

Pathogen: Hepatitis C virus (HCV) (Enveloped RNA virus, Flaviviridae).

How it spreads

  • Sharing needles or injection equipment - the dominant route
  • Unscreened blood transfusion or organ transplant (pre-1990s)
  • Mother-to-baby (~5% vertical transmission)
  • Tattoo, piercing, acupuncture or medical procedures with unsterilised equipment
  • Sexual transmission - low risk overall, higher in HIV-positive MSM with rough/unprotected receptive anal sex
  • Sharing razors, toothbrushes - rare but possible

Who is at risk? Should I get tested?

  • People who have ever injected drugs (even once, decades ago)
  • Anyone who received a blood transfusion in Singapore before 1992
  • Tattoos, piercings or medical/dental procedures with unsterilised equipment
  • HIV-positive men who have sex with men (sexual HCV transmission documented)
  • Healthcare workers with needlestick exposure
  • Children of HCV-positive mothers
  • People living with HIV

Should I get tested? Quick self-check

Answer the questions below - your concierge can advise on the next step.

  • Have you ever injected drugs, even once?
  • Did you receive a blood transfusion in Singapore before 1992?
  • Have you had a tattoo, piercing or medical procedure with shared equipment?
  • Are you HIV-positive, particularly with anal sex exposure?
  • Have you had a needlestick injury at work?
  • Do you have unexplained elevated liver enzymes or fatigue?

Symptoms

  • Most acute HCV infections cause no symptoms
  • Mild fatigue, nausea, abdominal discomfort
  • Jaundice (uncommon)
  • Chronic HCV is usually silent for 20-30 years
  • Late-stage cirrhosis: fluid retention, easy bruising, jaundice, confusion
  • Liver cancer in advanced cirrhosis

Asymptomatic in men

Around 80% of acute HCV infections have no symptoms; chronic HCV is silent for 20-30 years

Asymptomatic in women

Same as men - silent until late-stage liver disease in most cases

Source: see reference [1] below.

Singapore statistics

Estimated HCV prevalence in the Singapore general populationAbout 0.1%[2]
Estimated HCV prevalence among people living with HIV in SingaporeAbout 2%, mostly among people who inject drugs[2]
Acute hepatitis C cases reported in Singapore14 in 2024 and 8 in 2023[3]
Cure rate with modern direct-acting antiviral therapy>95%[1]
Global elimination target (WHO)By 2030[1]

Testing & window period

Method

Step 1: anti-HCV antibody (screening). Step 2 if positive: HCV RNA PCR to confirm current infection. Genotype is determined for treatment.

Specimen

Venous blood

Window period

Anti-HCV antibodies detectable 8-11 weeks post-exposure; HCV RNA from 1-2 weeks. Repeat at 3 and 6 months if initial negative and recent exposure.

Retest

After cure: HCV RNA at 12 weeks post-treatment confirms sustained virological response (SVR = cure). Anti-HCV antibodies remain positive for life despite cure - this is normal.

Treatment

First-line: A short oral course of direct-acting antiviral therapy, prescribed by our medical team in co-management with a hepatologist. Cure rates exceed 95%.

Alternative: Tailored regimens are available for cirrhosis, decompensated liver disease, or prior treatment failure - all under hepatologist co-management.

Partner management: Test partners only if shared injection equipment, or for HIV-positive MSM. Routine sexual partner notification is not generally needed except in those contexts.

Treatment is well-tolerated. Liver imaging is performed before treatment to stage fibrosis. Chronic HCV with advanced cirrhosis still requires ongoing cancer surveillance even after cure.

Follow-up

  • HCV RNA at 12 weeks post-treatment confirms cure (SVR12)
  • Annual liver imaging for cirrhosis cases even after cure
  • Reinfection screening if ongoing exposure
  • Vaccinate against hepatitis A and B (any remaining gaps) and ensure HIV testing

Prevention

  • Never share needles or injection equipment
  • Use sterile equipment for tattoos, piercings, acupuncture
  • Condoms for HIV-positive MSM (HCV transmission risk is higher)
  • Screen blood donors (universal in Singapore)
  • Universal precautions in healthcare settings

Vaccination

No hepatitis C vaccine exists. Prevention relies on harm reduction and avoiding blood-to-blood exposure.

See also: STI & hepatitis testing, HIV testing

FAQ

Hepatitis C - frequently asked questions

Clear answers, written by our clinical team. Tap any question for its direct permalink, or reach out to your Personal Concierge for anything else.

  1. Can hepatitis C be cured?

    Yes. Modern direct-acting antiviral therapy cures over 95% of HCV with a short course of well-tolerated oral medication. Cure is confirmed by undetectable HCV RNA 12 weeks after treatment ends.

  2. If I am cured, will my antibody test be negative?

    No - the anti-HCV antibody remains positive for life even after cure. Active infection is monitored using HCV RNA PCR, which becomes and stays negative after successful treatment.

  3. Should I be tested if I had a transfusion in the 1980s?

    Yes. Blood was not routinely screened for HCV in Singapore until 1992. A one-off anti-HCV antibody test is recommended for anyone who received blood products before that date.

  4. Can I catch HCV from sex?

    Sexual HCV transmission is uncommon overall - the risk is higher in HIV-positive MSM, particularly with unprotected receptive anal sex. Routine condom use is recommended in that context.

  5. Is there a hepatitis C vaccine?

    No - there is no HCV vaccine. Hepatitis A and B vaccines are unrelated and do not protect against HCV. Prevention relies on avoiding blood-to-blood exposure.

  6. How is HCV care arranged at Hisential?

    Your personal health concierge coordinates antibody screening, RNA confirmation, hepatologist referral, DAA treatment and cure confirmation in one confidential pathway.

Still have a question?

Your Personal Concierge replies within one business day - confidentially.

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References

  1. [1] World Health Organization. Hepatitis C - key facts (2024).
  2. [2] Communicable Diseases Agency, Singapore. Hepatitis C disease page.
  3. [3] Communicable Diseases Agency, Singapore. Communicable Diseases Surveillance in Singapore 2023 and 2024, Chapter 5: Blood-Borne and Sexually Transmitted Diseases.
  4. [4] Centers for Disease Control and Prevention. Hepatitis C information.

Other STI conditions

Browse our other in-depth STI guides - each covers symptoms, asymptomatic statistics by sex, Singapore data, testing windows, treatment and prevention.

See all STI conditions →

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