Tatoos done under sterile conditions are safe, but unsterile tattooing can transmit the bloodborne hepatitis C virus (HCV), as well as hepatitis B and HIV. 

What do you need to know to avoid acquiring HCV while getting a tattoo? Here are some answers to common questions.

How can hepatitis C be transmitted through tattooing?

The hepatitis C virus is a bloodborne virus that can be spread via objects that come into contact with blood from more than one person, including tattoo needles, ink containers and other equipment. When you get a tattoo, your skin is pierced by a needle and injected with a small amount of ink. HCV can be transmitted if proper infection control procedures are not used.

How many people with hepatitis C got it through tattooing?

It is not clear exactly what proportion of people with HCV got it through tattooing. In the United States, sharing eqipment to inject drugs is the most common transmission method. Some studies have found that people with hepatitis C are more likely to report having a tattoo, even when other major risk factors are taken into account. But other studies have shown no evidence of an increased risk if tattoos are done in a professional parlor with proper infection control. Tattoos done at home, in prison or in other non-professional settings carry a greater risk of infection.

How can I protect myself against hepatitis C when getting a tattoo?

1. Use a licensed professional tattoo parlor with reputable artists. Licensing and certification laws vary by state. One way to do this is to read reviews or choose a parlor where people you know have gotten tattoos and had a good experience.

2.  Ask tattoo artists what procedures they use for cleaning, sterilizing and maintaining equipment and how often they do it. Autoclaves—machines that use heat and pressure for sterlization—should be used for reusable equipment such as tattooing machines.

3. New sterile needles, which fit into the tattoo machine, should be used for each client.

4. Artists should use a new pair of latex gloves for each client and wash their hands before putting on and after taking off gloves.

5. Ink should be portioned out into disposable pots for each client rather than filling needles from a common container. Leftover ink should not be put back into its original container.

6. Items that come into contact with blood and cannot be sterilized—such as gloves, cotton swabs and paper towels—should be disposed of immediately and labeled as a biohazard.

7. Work surfaces should be cleaned and disinfected regularly.

I already have a tattoo. Could I have hepatitis C and don’t know it?

If your tattoo was done in a professional parlor using proper infection control, the chances that you got hepatitis C from the procedure are low. Infection was likely more common before the 1980s, when awareness of bloodborne virus transmission increased and precautions were adopted due to AIDS.

But many people—including those with no obvious risk factors—have HCV without knowing it. Early hepatitis C often has no symptoms. The Centers for Disease Control and Prevention now recommends that all adults should be screened for HCV at least once, regardless of risk factors, and those with ongoing risk should be tested regularly. Testing is a two-step process that first screens for HCV antibodies (indicating prior exposure) and then, if positive, tests for HCV RNA (indicating active infection).

If I find out I have hepatitis C, what should I do?

About a quarter of people infected with HCV clear the virus on their own without treatment. The rest develop chronic infection that, over time, can lead to liver fibrosis, cirrhosis and liver cancer. Guidelines recommend that all people with active HCV infection should be treated, regardless of the current stage of liver disease. 

Modern direct-acting antiviral therapy involves well-tolerated once-daily pills taken for two or three months. (Interferon-based therapy, which involved weekly shots, is now seldom used in the United States.) Antiviral therapy cures more than 95% of treated people.

I have hepatitis C. Can I still get a tattoo?

Yes, people with HCV can safely receive tattoos. Disclosing your statis is up to you. Professional artists shoud assume all clients could be positive and take necessary precautions.

This article has been updated to include new information about hepatitis C testing and treatment.