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Hepatitis

What is it?

Hepatitis is an inflammatory condition that affects the liver, and it is most commonly caused by a viral infection (covered in this article), but can be caused by other factors such as toxins or psychoactive drugs. There are several kinds of hepatitis that can be sexually transmitted, and it is on these three types (Hepatitis A, B, and C) that this article will focus. Of these three, Hepatitis B (HBV) is the most common. Hepatitis B and C can more commonly lead to chronic disease and are the most common causes of liver cirrhosis and liver cancer. Hepatitis A infections are usually mild, with most fully recovering and developing immunity from further infections, but they can also be serious, especially in areas of the world with poor sanitation, and can also lead to liver complications. Hepatitis B infections are also usually mild and symptom-less, and are most commonly spread through sexual activity. However, long-term infection is possible, with about 2-6% of adults with HBV developing it chronically, which can lead to serious liver complications. Hepatitis C begins with an “acute” phase, which is often asymptomatic, and as many as 14-50% of patients will not progress to the “chronic” phase, which can be quite serious, and usually causes permanent liver damage.

How did I get it?


Hepatitis A (HAV)

Hepatitis A is most commonly spread through fecal contamination, which means it can be spread through anal sex as well as preparing food after going to the bathroom and not washing your hands. It is also possible to get HAV from genital or oral contact with someone who carries the virus. Note that typical measures to prevent STIs (like condoms or dental dams) do NOT protect against HAV and that the most effective method of prevention is the HAV vaccine. This vaccine is recommended for those who engage in anal sex, those who live with or have sex with someone who has HAV, those who inject drugs, or those with chronic liver conditions.

Hepatitis B (HBV)

Hepatitis B is most commonly spread through contact with blood or other bodily fluids during genital, anal, or oral sex with someone who has HBV. It is very common; 10-40% of people seeking treatment at STI clinics have evidence of past or current HBV infection, meaning it never hurts to get tested for HBV. There is an HBV vaccine, which is recommended and offered to all those who visit STI clinics, or the adult sexually active population. If you are sexually active, get on down to a clinic and get the vaccine, just to be safe! It is recommended for all sexually active people who are not in long-term or monogamous relationships, those seeking evaluation/treatment for another STI, or those with sex partners who have HBV.

Hepatitis C (HCV)

Hepatitis C is most commonly spread through contact with an infected person’s blood. Sharing needles can lead to HCV as well as (albeit more rarely) sexual contact with a carrier of HCV. Condoms and dental dams can reduce the risk of contraction, and there is no vaccine for HCV currently, so while it is uncommon, testing for HCV is important. It can be detected with a blood test. Men who identify as gay and are HIV-positive are at a higher risk of contracting HCV.

What are the symptoms?

Hepatitis A (HAV)

The incubation period for HAV is 14-28 days from exposure to infection. Common symptoms of an infection are fatigue, loss of appetite, nausea, vomiting, headache, fever, dark urine, jaundice, and liver enlargement and/or tenderness. Most adults who have HAV will have these symptoms, which usually resolve within two months of the infection, after which the body will create antibodies to prevent a second infection.

Hepatitis B (HBV)

The incubation period for HBV is 4-12 weeks from exposure to infection, but you can still be contagious during this period. Most HBV infections are asymptomatic, but when symptoms present they are usually joint pain, skin eruptions, a hive-like rash, fatigue, loss of appetite, nausea, vomiting, headache, fever, dark urine, jaundice, and liver enlargement and tenderness.

Hepatitis C (HCV)

The incubation period for HCV is 2-25 weeks from exposure to infection; after 180 days, an infection is considered chronic. Most HCV infections are also asymptomatic, but when symptoms present (more usually in acute cases) they are usually fatigue, loss of appetite, nausea, vomiting, headache, fever, dark urine, jaundice or liver enlargement and tenderness.


What do I do when the test comes back positive?

Hepatitis A (HAV)

HAV cannot be cured, as it is a viral infection, but prophylaxis post-exposure (as well as the vaccine) can prevent infection. The body fights off most infections naturally, resulting in future immunity to HAV infections. Medications to manage symptoms exist; however, the WHO cautions against the use of “unnecessary medications” to manage symptoms, which may take weeks or months to recover from; prescribing anti-nausea medication as well as Acetaminophen or Paracetamol can be harmful.  If your symptoms are severe, talk to your doctor about individualized symptom management plans, which could include therapy aimed at maintaining comfort and nutritional balance.

Hepatitis B (HBV)

HBV also cannot be cured, although there are medications available to manage symptoms in acute and chronic infections (http://www.hepb.org/treatment-and-management/treatment/). Acute infections almost always go away on their own within 4-8 weeks. 1 in 20 cases of HBV become chronic, meaning the person with HBV is now a carrier and can pass on the virus, usually for the rest of their lives. This can also lead to liver complications (like cirrhosis and cancer), but only 20% of patients with chronic HBV die directly from liver complications. Talk to your doctor, a healthcare provider, or go to Planned Parenthood to discuss medication options for symptom management for acute or chronic cases.


Hepatitis C (HCV)

About 15-25% of those who become infected with HCV will get an acute infection, which clears spontaneously from the body within 6 months and is almost always asymptomatic. Those who don’t recovery within 6 months go on to become carriers, and chronic HCV can lead to chronic liver disease, cirrhosis, or liver cancer. However, not everyone with chronic HCV develops liver problems, and hepatitis C can be cured, which is the goal of treatment. Medications such as sofosbuvir, daclatasvir and a sofosbuvir/ledipasvir combination achieve cure rates over 95%, but access to these medications can be costly. Talk to your doctor about medications to manage symptoms of acute infections and curative treatments for chronic infections.

Hepatitis A, B and C are all reportable diseases (meaning the US Department of Health collects data on how many cases occur), so your healthcare provider will likely inform you of reporting practices and guide you on steps to contacting to past partners (see “Talking to Partners” section). The healthcare provider, not the patient, is responsible for reporting individual cases to the correct organization, which might include both the DOH and the CDC.