Since the discovery of hepatitis C virus (HCV) in 1989, there has been much debate regarding its potential modes of transmission particularly as only about half of the reported cases of acute HCV have a defined parenteral exposure. It has been clearly established that blood-blood contact is important in its transmission, but the question of sexual transmission has caused more controversy with studies producing conflicting evidence. The objective of this review was to examine the current evidence on all reported routes of transmission of hepatitis C with particular attention to sexual transmission in men having sex with men (MSM) and HIV-positive individuals. We conducted PubMed searches using keywords hepatitis C, transmission, sexual, HIV, MSM, mother to child, haemophilia, intravenous drug use, tattooing and skin piercing. The bibliographies in articles identified were also searched.