Sexual health information about hepatitis (inflammation of the liver), looking at the forms of virus that cause it and how it affects people living with HIV.
Hepatitis (sometimes shortened to hep) is an inflammation of the liver. This large organ is on the right side of your body and has many functions, including turning your food into energy and filtering toxins such as alcohol out of your blood.
What causes hepatitis?
Hepatitis can occur because of:
– viral infection
– exposure to alcohol
The three most common viral forms are:
– Hepatitis A
– Hepatitis B
– Hepatitis C
The other forms of hepatitis – D, E, F and G – are very rare.
Scientists believe there is more to learn about the causes of hepatitis and more viruses to discover.
Vaccines can help protect you from hepatitis A and B. There is no vaccine against hepatitis C.
What happens if you have hepatitis?
Hepatitis can be acute or chronic.
Acute hepatitis is short term and begins after the first infection. It can lead to chronic hepatitis, which is long term.
Some types of hepatitis – such as hepatitis A – only cause acute infection.
Chronic hepatitis is long term and can cause lasting damage to the liver. Very serious cases can lead to liver failure or cancer.
Hepatitis and HIV
Co-infection with hepatitis B or hepatitis C is becoming a major cause of illness in people living with HIV.
Both viruses affect your liver and can make you very ill, and can be fatal. But there are treatments that can work well in people living with HIV.
Hepatitis A
Sexual health information about hepatitis A symptoms, how the virus is transmitted, vaccination against hepatitis A and how it can be treated.
Hepatitis A is a form of hepatitis caused by a virus that infects the liver. It’s easy to pass on during sex or get from contaminated food and water. Nearly everyone makes a full recovery.
Hepatitis A symptoms
Hepatitis A symptoms can be so mild you may not realise you have it, but up to six weeks after infection it can cause:
– mild flu-like symptoms
– diarrhea
– nausea
– extreme tiredness
– itchy skin
– stomach pain
– jaundice, where your skin and the whites of your eyes turn yellow, your urine turns dark and your faeces (poo) turn pale.
Symptoms can last several weeks and it can take months to get back to normal.
How it’s passed on
Someone with hepatitis A is most infectious two weeks before jaundice appears.
The virus lives in faeces (poo) and tiny traces of it carry the infection on the hands or on food prepared by an infected person. Water can also be contaminated, especially abroad.
The virus needs to get into the mouth to infect someone. This can happen during sex when tiny amounts of faeces (poo) get on fingers and into mouths through:
– rimming
– fingering
– anal sex without condoms
– handling used condoms and sex toys that have been in someone else’s anus.
How can I protect myself and others?
You can protect yourself by getting vaccinated. It’s especially important to do if you:
– have close contact with someone who has the infection
– are a gay man
– inject drugs
– travel to parts of the world where the infection is common.
You might be able to get vaccinated for free by your GP or a sexual health clinic. The vaccine protects you for 10 years or longer.
Although not as good as being vaccinated, you can also cut the risk by:
– avoiding sex that involves contact with faeces
– using condoms for anal sex
– washing hands after touching someone’s anus or handling used condoms and sex toys
– using a latex barrier (like a condom cut into a square) for rimming and latex gloves for fisting.
What should I do if I have hepatitis A?
Tell people you live with or have recently had sex with to ask their doctor about having an urgent vaccination.
Avoid sex and preparing food for others until you’re told you’re no longer infectious.
If you’re not vaccinated and are exposed to hepatitis A, you could still be protected from infection by a drug called human normal immunoglobulins (HNIGs). This can be given within two weeks after exposure and it can protect you for up to three to six months.
Treatment for hepatitis A
Most cases are diagnosed by GPs rather than sexual health clinics and no special treatment is needed.
A blood test will confirm whether you have picked up the virus.
The usual treatment for hepatitis A is simply to rest. You may need some time off work while you recover from the flu-like symptoms.
You should also:
– avoid paracetamol
– avoid recreational drugs to allow your liver to get better
– avoid alcohol until your liver recovers.
Once you have had hepatitis A you’re immune and cannot get it again, but you can still get other types of hepatitis.
HIV and hepatitis A
If you’re living with HIV and also have hepatitis A, please see our information on hepatitis A co-infection.
Hepatitis B
Sexual health information about hepatitis B symptoms, how hepatitis B is transmitted and how you can protect yourself by vaccination.
Hepatitis B (or hep B) is a form of hepatitis caused by a virus that infects the liver. It’s easy to pass on during sex or by sharing injecting equipment. Most people who get it make a full recovery, but for a minority it can be more serious.
Hepatitis B symptoms
Many people who get hepatitis B notice no symptoms, or have ones so mild that they’re easily missed. But after some weeks or months the infection can cause:
– loss of appetite
– nausea or vomiting
– extreme tiredness
– fever
– stomach pain
– jaundice, where your skin and the whites of your eyes turn yellow, your urine turns dark and your feces (poo) turn pale.
Symptoms can last for several weeks and it can take months to get back to normal.
Most people make a full recovery but up to 1 in 20 become ‘carriers’ with chronic (long-term) infection. They usually feel fine but stay infectious to others, with a small risk of going on to develop liver disease.
Around 1 in 100 people get a more serious illness which can be fatal if it’s not treated.
How it’s passed on
The virus can be passed on in these body fluids:
– blood
– semen
– pre-cum
– vaginal secretions.
It’s passed on through:
– oral, vaginal or anal sex without a condom
– rimming
– sharing sex toys
– sharing injecting drug equipment, such as needles and syringes, which can carry infected blood
– childbirth, from a mother to her baby.
It can be found in saliva but there are no proven cases of it being passed on through kissing. Infections from bites are rare.
Avoid sharing razors, toothbrushes, nail scissors, hair clippers and tweezers because traces of blood on them can pass on hepatitis B. This includes dried blood as the virus can survive for at least a week outside of the body.
How can I protect myself and others?
You can protect yourself by getting vaccinated. This is especially important if you belong to one of the high-risk groups. You’re high risk if you:
– have close contact with someone with the infection
– are a gay man
– inject drugs
– travel to parts of the world where the infection is common.
There is a vaccine which can protect you against both hepatitis A and B.
If you’re in a high-risk group for hepatitis B you can usually get vaccinated for free by your GP or at your sexual health clinic.
You may need a booster injection of the vaccination after five years.
If you have hepatitis B, tell people you live with or recently had sex with to urgently ask their doctor about vaccination. Avoid sex until told you’re no longer infectious.
Although not as effective as being vaccinated, you can also cut the risk by:
– using condoms for penetrative sex
– a latex barrier (such as a condom cut into a square) for rimming.
If you’re a carrier, you may want to tell a partner and explain that you’re infectious. That allows them to decide if they want to take precautions (such as getting vaccinated) or are happy to take any risk.
That way they cannot accuse you of infecting them without them knowing the risk was there.
If you’re not vaccinated against hepatitis B and are exposed to the virus, there’s a treatment which may stop you from being infected. Hepatitis B immunoglobulin (HBIG) is an injection of antibodies. It’s best to get it within 48 hours of exposure – you’ll be vaccinated at the same time.
What can I do if I think I have hepatitis B?
Cases are generally diagnosed by GPs, not sexual health clinics. If you had sex with someone recently or you share your house with others, they can be vaccinated to stop them getting the infection – they should see a doctor straight away.
Avoid sex until you are told you’re no longer infectious or until your partners have been vaccinated.
A blood test will confirm whether you have the virus.
Hepatitis B treatment
In most cases no treatment is needed for acute hepatitis B. It may take a while for you to recover and you may want to take some time off work.
You should also:
– avoid recreational drugs to allow your liver to get better
– avoid alcohol until your liver recovers
– avoid smoking because of the health problems it causes
– eat a healthy balanced diet.
If you have chronic hepatitis B, you may need treatment to slow down the replication of the virus. However, treatment cannot usually cure chronic hepatitis B. A small number of carriers go on to get liver disease (and a small number of those get liver cancer), and may need a liver transplant.
If your body clears hepatitis B, you’re immune and cannot get it again – but you can still get other types of hepatitis.
Hepatitis C
Sexual health information about hepatitis C symptoms, how it’s transmitted, the stages of infection and how it’s treated.
Hepatitis C is the most common type of viral hepatitis. It’s caused by a blood-borne virus that attacks the liver and is easily spread by sharing drug injecting equipment. It can also be spread through sex.
Without treatment, the virus can cause liver disease that can be fatal.
Most people will be offered 12 weeks of tablets with few side effects and these give a high cure rate of 90-95%.
There is no vaccine against hepatitis C.
Stages of hepatitis C infection
– The first six months of infection with hepatitis C is called the acute phase. Around 20-25% of people will clear the virus naturally during this time. (This percentage is lower for people who also have HIV.)
– People who don’t clear the infection will enter the chronic (or long-term) phase and can pass hepatitis C on to others.
Hepatitis C symptoms
Most people who get hepatitis C don’t notice any symptoms when they are first infected. It can take years before you feel ill, with symptoms often not easily identified as being due to hepatitis C.
The symptoms can include:
– mild flu-like symptoms
– nausea
– extreme tiredness
– itchy skin
– stomach pain
– jaundice, meaning your skin and the whites of your eyes turn yellow, your urine is dark and your faeces (poo) are pale
– mental confusion (often called ‘brain fog’) and depression – these are specific to the C strain of hepatitis.
How it’s passed on
The hepatitis C virus is found in blood and is passed on when infected blood gets into another person’s bloodstream. It’s seen as unlikely (but not impossible) that it can be passed on in semen.
Most people get the virus from sharing drug-injecting equipment such as needles, syringes, water cups, tourniquets, spoons, filters and swabs. Sharing things like straws and banknotes that are used for snorting drugs might pass the virus on, as can sharing pipes.
In the UK piercing and tattooing should be safe – but unsterilised equipment abroad can spread the virus.
An infected person risks infecting others if they share anything that might have blood on it like a toothbrush or razor. A pregnant woman with the virus can give it to her baby during pregnancy or childbirth.
Blood transfusions in Greece are safe as blood is screened.
You can also potentially get it from medical or dental treatment abroad in countries where hepatitis C is common and infection control is inadequate.
Hepatitis C and sex
Hepatitis C is rarely passed on during sex between a man and a woman. There’s also no significant spread of hepatitis C among HIV negative gay men. But the infection has spread sexually among gay men with HIV and is much more common among them.
Gay men, chemsex and hep C
Group sex and chemsex parties provide the perfect storm for hepatitis C transmission.
If you’re taking drugs and having sex for longer your inhibitions are likely to be lowered and the delicate skin lining the anus can be damaged, causing bleeding. Hep C is very infectious and is easily passed on through group sex – it can even be passed from one person to another on fingers.
The virus spreads through anal sex and fisting when condoms and gloves are not used. It’s also passed on during group sex, on objects such as sex toys, fingers, enema equipment, condoms, latex gloves or in contaminated lubricant.
How can I protect myself and others?
– Never share injecting drug equipment (eg, needles, syringes, swabs, spoons, filters) or things that may have blood on them such as toothbrushes and razors. Also avoid sharing straws or rolled up banknotes if snorting drugs with others.
– Use condoms for anal and vaginal sex and latex gloves for fisting.
– During group sex, cover anything which goes from one partner to another with a fresh condom or fresh latex glove for each new person it enters. Clean objects with warm water and anti-bacterial soap before using them on a new partner.
– Don’t share enema equipment or pots of lubricant.
If you have hepatitis C you may want to tell a partner and explain that you’re infectious. They can then decide if they’re happy to take any risks and whether they want to take precautions. That way they cannot accuse you of infecting them without them knowing that the risk was there.
What can I do if I think I have hepatitis C?
A doctor or sexual health clinician can test you to see if you have hepatitis C. If you do, effective treatment with fewer side effects than the older medicine is available and you can discuss how to avoid infecting your sexual partners or people you live with.
It can take three to six months before the blood test for hepatitis C will be able to detect signs of infection in your blood. For people with HIV who may be immunocompromised, the antibody may not be detectable and it may be necessary to request an RNA test which detects the virus.
Is there a vaccination against hepatitis C?
No, there is no vaccination against hep C, but you can be vaccinated against hepatitis A and B.
If you already have hep C, it’s recommended to have the vaccination against hep A and B to protect your liver from further damage.
Hepatitis C treatment
Drug treatment is available and has recently improved, with a better success rate and fewer side effects. In fact, 90-95% of people can be cured by the new medications, known as direct acting antivirals (DAAs). These are taken in tablet form once or twice a day, typically for 12 weeks.
You can find out more detailed information about treatment for hepatitis C on the Helpa-Prometheus website.
If you have hepatitis C you should also:
– avoid alcohol
– avoid smoking as it can make the liver damage worse
– avoid recreational drugs to allow your liver to get better
– eat a healthy, balanced diet.
If you’re cured of hepatitis C, you’re not immune – you can get hep C again. You can also still get other types of hepatitis, and having hepatitis C and another type is more serious.
Why should I get treated?
Hepatitis C can be fatal when left untreated.
Untreated hepatitis C can lead to scarring of the liver known as cirrhosis.
A small number of people with cirrhosis will go on to get liver failure, the only treatment for which is a liver transplant. A small proportion of people with cirrhosis develop liver cancer.
Giving blood and organ donation
If you have hepatitis C, you cannot give blood.
In a recent research study in America (the THINKER trial at the University of Pennsylvania) kidneys from people with hepatitis C who had died were transplanted into patients who did not have the virus.
All of the recipients subsequently contracted hepatitis C but were treated for it and all were cured. The benefit of receiving a kidney outweighed the risk of not clearing hepatitis C.