Hepatitis C: Symptoms, Treatment, and Cure in Singapore
Hepatitis C is a viral liver infection caused by the hepatitis C virus (HCV). It is primarily bloodborne and becomes chronic in 75–85% of cases, but unlike hepatitis A and hepatitis B, hepatitis C is now actually curable: direct-acting antiviral (DAA) therapy clears the virus in over 95% of patients with an 8 to 12 week oral course.
Medically reviewed by Dr. Qiao Yufei, MD
This guide covers what hepatitis C is, how it spreads, the acute-vs-chronic distinction, two-step diagnostic testing (anti-HCV antibody + HCV RNA), pan-genotypic DAA regimens, and why there is still no hepatitis C vaccine. Hepatitis C is one of several conditions covered in our broader STDs in Singapore overview.
What is hepatitis C?
Hepatitis C is a viral infection of the liver caused by the hepatitis C virus (HCV), an RNA virus. The infection often goes unnoticed for years because most people have no early symptoms. The clinical course is striking:
- Acute hepatitis C: usually mild or asymptomatic; about 15 to 25% of acute infections clear naturally without treatment
- Chronic hepatitis C: develops in 75 to 85% of acute infections. Often silent for decades, then progresses to cirrhosis, liver failure, or hepatocellular carcinoma in a significant minority
Per the US Centers for Disease Control and Prevention (CDC), hepatitis C is one of the most common bloodborne infections worldwide, and was a major cause of liver transplantation in many countries before DAAs became widely available.
Yes. Hepatitis C is now curable in over 95% of cases with direct-acting antiviral (DAA) therapy: an 8 to 12 week oral course. This is the major clinical distinction from chronic hepatitis B, which can be suppressed but not cured. After treatment, a sustained virologic response (SVR) at 12 weeks confirms cure.
How hepatitis C differs from A and B
Hepatitis A, B, and C share a name but differ significantly in transmission, course, prevention, and treatment.
Hepatitis A
- Transmission: fecal-oral
- Course: always acute, never chronic
- Vaccine: yes, highly effective
- Treatment: supportive only; recovery is the rule
Hepatitis B
- Transmission: bloodborne, sexual, mother-to-child
- Course: acute or chronic (5–10% of adults)
- Vaccine: yes, highly effective
- Treatment: antivirals suppress chronic infection; no cure
Hepatitis C (this page)
- Transmission: bloodborne (mainly), uncommon sexually
- Course: mostly chronic (75–85% of acute infections)
- Vaccine: no vaccine available
- Treatment: DAAs cure over 95% in 8–12 weeks
Why hep C is different
- The only one that is actually curable with current therapy
- No vaccine despite decades of research (HCV mutates rapidly)
- Often silent for decades before symptoms appear
- WHO target: eliminate as a public health threat by 2030
How hepatitis C spreads
Hepatitis C is primarily bloodborne: it requires blood-to-blood contact. This is a key distinction from hepatitis B, which transmits more readily through sexual fluids.
- Sharing needles or drug paraphernalia (the most common route worldwide, including in Singapore)
- Unsterilised medical, dental, or tattoo equipment (rare in Singapore but a global concern)
- Needlestick injuries in healthcare settings
- Blood transfusion before universal HCV screening (rare today; Singapore introduced screening in 1992)
- Mother-to-baby transmission during childbirth (about 5% risk; higher with HIV co-infection)
- Sexual transmission: uncommon for heterosexual couples but more significant for men who have sex with men (MSM), particularly with HIV co-infection or rough sex involving blood
Hepatitis C is NOT spread by
- Casual contact (hugs, handshakes, sharing food, kissing)
- Coughing or sneezing
- Mosquitoes or other insects
- Breastfeeding (unless nipples are cracked or bleeding)
Who is at higher risk?
- People who inject drugs or share needles, even once long ago
- People who received blood transfusions or organ transplants before 1992
- People born to HCV-positive mothers
- People with HIV (HCV co-infection is common)
- Healthcare workers exposed to needlestick injuries
- People with chronic kidney disease on long-term dialysis
- Men who have sex with men, particularly with HIV co-infection
Signs and symptoms of hepatitis C
Hepatitis C is often called a silent infection: most people with acute hepatitis C have no symptoms or only mild flu-like symptoms, and chronic hepatitis C can persist for decades without overt signs. This is why blood-test screening of at-risk populations is so important.
Acute hepatitis C (2–12 weeks after exposure)
- Often no symptoms at all
- Fatigue, mild fever
- Nausea, loss of appetite
- Right upper abdominal pain
- Joint or muscle aches
- Jaundice (less common than in hep A or B)
Chronic hepatitis C (often silent)
- Often no symptoms for years to decades
- Persistent fatigue (when symptomatic)
- Mild abdominal discomfort
- Late: jaundice, abdominal swelling, easy bruising (signs of cirrhosis)
- Late: weight loss, leg swelling, confusion (advanced liver disease)
How hepatitis C is diagnosed
Hepatitis C diagnosis is a two-step blood test:
- Step 1: anti-HCV antibody screen. Detects past or current exposure to HCV. Positive means you have been infected at some point; it does not distinguish between past (cleared) and current infection.
- Step 2: HCV RNA (PCR) test. Confirms whether the virus is currently active. HCV RNA positive = active infection requiring treatment. HCV RNA negative + antibody positive = past infection that has cleared (about 15 to 25% of acute infections clear naturally).
Additional tests once active infection is confirmed:
- Liver function tests (ALT, AST, bilirubin) and platelet count
- Liver fibrosis assessment: FibroScan (transient elastography) or APRI/FIB-4 scores from blood markers, to determine the degree of liver damage
- HCV genotype: historically important for treatment selection, but less critical with modern pan-genotypic DAAs
- Co-infection screening: HBV, HIV (often co-occur and affect treatment decisions)
At Mediway Medical Centre, the standard initial test is the anti-HCV antibody screen, with reflex HCV RNA testing if positive.
Hepatitis C treatment: direct-acting antivirals
Hepatitis C treatment has been transformed over the past decade by direct-acting antivirals (DAAs): oral medications that block specific steps in HCV replication. Cure rates exceed 95%, treatment courses are 8 to 12 weeks, and side effects are minimal compared with the older interferon-based therapies.
Pan-genotypic DAA regimens used in Singapore
Once-daily single tablet, 12 weeks. Effective across all HCV genotypes (1 to 6). Standard first-line option in many treatment guidelines.
Three tablets once daily, 8 weeks for treatment-naïve patients without cirrhosis. Pan-genotypic. Often used when shorter duration is preferred.
Other DAA combinations (elbasvir/grazoprevir, sofosbuvir/ledipasvir) are available for specific genotypes and patient profiles.
Sustained virologic response (SVR) confirms cure
An SVR at 12 weeks after completing treatment (HCV RNA undetectable) is considered cure. Long-term follow-up shows the cure is durable. Liver fibrosis can partially regress over time, particularly if cirrhosis was not yet established.
Treatment is for almost everyone
- All patients with chronic hepatitis C should be considered for treatment, regardless of liver disease stage
- Acute hepatitis C is typically treated promptly to prevent transition to chronic
- Pregnancy, severe kidney impairment, and a few drug interactions can require regimen adjustment
- Patients with cirrhosis remain at increased risk of liver cancer even after cure and need ongoing surveillance (6-monthly ultrasound + AFP)
How to prevent hepatitis C
There is no hepatitis C vaccine. Decades of research have not yet produced one, partly because HCV mutates rapidly and exists as several genotypes. Prevention relies on avoiding bloodborne exposures and, increasingly, treating identified cases promptly to reduce onward transmission ("treatment as prevention").
Avoid bloodborne exposures
- Do not share needles or any drug equipment
- Use sterile equipment for tattoos, piercings, and acupuncture
- Do not share razors, toothbrushes, or nail clippers
- Healthcare workers should follow standard precautions
Practise safer sex
- Use condoms consistently, particularly if you are MSM, HIV-positive, or have multiple partners
- Avoid sharing sex toys or use a fresh condom on them between partners
Treatment as prevention
Diagnosing and curing chronic hepatitis C in people at risk reduces the pool of infectious individuals, protecting partners and the wider community. The WHO has set a global target to eliminate hepatitis C as a public health threat by 2030, achievable through scaled-up testing and DAA treatment.
Get tested if at risk
Routine HCV testing is recommended for: people who have ever injected drugs, recipients of blood products before 1992, people on long-term dialysis, healthcare workers with needlestick exposure, people born to HCV-positive mothers, MSM with HIV co-infection, and anyone with persistently elevated liver enzymes of unclear cause.
What happens if hepatitis C is left untreated?
Untreated chronic hepatitis C can silently progress over decades to severe liver disease in a significant minority of patients:
- Liver cirrhosis: scarring of the liver, develops in about 15 to 30% of chronic hepatitis C patients over 20 to 30 years
- Hepatocellular carcinoma (liver cancer): hepatitis C is a major cause of liver cancer worldwide; annual incidence is 2 to 4% in patients with established cirrhosis
- Liver failure: end-stage liver disease, may require liver transplantation. Hepatitis C was the most common indication for liver transplant in many countries before DAAs
- Extrahepatic manifestations: cryoglobulinemia (small blood vessel inflammation), kidney disease, lymphoma, type 2 diabetes risk
- Onward transmission to needle-sharing contacts or sexual partners
The transformative news: most of these are preventable through DAA treatment, which cures hepatitis C in over 95% of patients. Even patients with established cirrhosis benefit substantially: cure halts further liver injury, reduces (but does not eliminate) liver cancer risk, and may reverse some fibrosis over years.
Frequently asked questions
01 What is hepatitis C?
Hepatitis C is a viral infection of the liver caused by the hepatitis C virus (HCV). It is mainly bloodborne and can be acute (short-term) or chronic (long-term), with chronic infection potentially leading to cirrhosis, liver failure, or liver cancer over decades. Unlike hepatitis A and B, there is no vaccine for hepatitis C. However, hepatitis C can now be cured in more than 95% of treated cases with direct-acting antiviral medication.
02 What are the symptoms of hepatitis C?
Most acute hepatitis C infections cause no symptoms or only mild flu-like symptoms (fatigue, nausea, low-grade fever). When symptoms occur, typically 2 to 12 weeks after exposure, they may include fatigue, joint pain, nausea, abdominal discomfort, and occasionally jaundice. Chronic hepatitis C is silent for many years in most people, with symptoms appearing only once advanced liver damage has developed. This is why testing is recommended for anyone with risk factors, even without symptoms.
03 How is hepatitis C transmitted?
Hepatitis C is mainly bloodborne. The most common route worldwide is sharing needles or other injection equipment. Other routes include unsterilised medical or tattoo equipment, blood transfusions before universal screening (very rare in Singapore now), needlestick injuries, and rarely mother-to-baby transmission during childbirth. Sexual transmission is less common than bloodborne transmission, but risk may be higher with blood exposure, multiple partners, certain sexual practices, or HIV co-infection. It is not spread through casual contact.
04 How is hepatitis C diagnosed?
Hepatitis C is diagnosed using a two-step blood test. First, an anti-HCV antibody screen detects past or current exposure. If positive, a confirmatory HCV RNA test (PCR) detects active virus. A positive HCV RNA result indicates active infection requiring treatment, while a negative HCV RNA with a positive antibody result usually means past infection that has cleared. About 15 to 25% of acute infections clear naturally without treatment.
05 Can hepatitis C become chronic, and what are the risks?
Yes. Without treatment, around 75 to 85% of people with acute hepatitis C develop chronic infection. Chronic hepatitis C can silently damage the liver over many years, leading to cirrhosis, liver failure, or liver cancer (hepatocellular carcinoma). The risk of complications is higher with longer infection duration, heavy alcohol use, co-infection with HIV or hepatitis B, and other liver conditions. Modern treatment cures most chronic hepatitis C and substantially reduces these long-term risks.
06 Can hepatitis C be cured, and how is it treated?
Yes. Hepatitis C can now be cured in more than 95% of treated cases with direct-acting antiviral (DAA) therapy: direct-acting antiviral tablets, usually taken for 8 to 12 weeks. Side effects are usually mild, and treatment is suitable for most patients regardless of genotype, age, or stage of liver disease (with dose adjustments where needed). Cure is confirmed by a sustained virologic response (SVR), measured 12 weeks after treatment ends.
07 Is there a hepatitis C vaccine?
No. There is no vaccine for hepatitis C, despite ongoing research. This is a key difference from hepatitis A and B, which both have safe and effective vaccines. Prevention relies on avoiding bloodborne exposures: using sterile needles, ensuring blood products are screened, choosing reputable tattoo and medical providers, and practising safer sex. Prompt treatment of identified cases also helps reduce onward transmission.
08 Can hepatitis C come back after being cured?
Once cured (sustained virologic response at 12 weeks), the original hepatitis C infection does not return. However, reinfection is possible if you are exposed to the virus again, since DAA treatment does not provide long-term immunity. People with ongoing risk factors (such as injection drug use or unprotected sex with high-risk partners) should continue regular screening, even after a successful cure.
09 Can hepatitis C be passed from mother to baby during pregnancy?
Mother-to-baby transmission can occur, with studies estimating risk at around 6% to 7% among exposed infants. The risk is higher if the mother also has HIV or a high HCV viral load. There is no specific intervention to prevent vertical transmission at the time of delivery, but most affected children remain well, and modern treatment with direct-acting antivirals is now available for older children and adults if needed. Hepatitis C is not spread through breastfeeding unless nipples are cracked or bleeding.
10 Where can I get hepatitis C testing or treatment in Singapore?
Mediway Medical Centre offers hepatitis C blood testing (anti-HCV antibody and confirmatory HCV RNA), GP review, and referral for specialist liver care where appropriate at our Clarke Quay clinic. For comprehensive STI screening, see our STD test page. Book a consultation through our online booking, WhatsApp, or call 6909 0190.
Related conditions and next steps
References: CDC: Hepatitis C · WHO: Hepatitis C fact sheet · HealthHub Singapore
This page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Consult a qualified healthcare professional for diagnosis and treatment of suspected hepatitis C infection.