HCV can be transmitted sexually, such as through anal mucosal lesions caused by sexual practices such as fisting or through ulcerative STIs such as syphilis; through sharing paraphernalia for nasal and intravenous use of recreational drugs, such as heroin, cocaine, methamphetamines, and ketamine; or by proctosurgical interventions, e.g., in the treatment of condylomata [50 –55 ].
Source: wiktionary