Hepatitis A, Hepatitis B, Hepatitis C
AVERT.org has more information about other STDs including statistics and our STD booklet.
The majority of the information on this page can be applied universally, and is not country specific. However, certain sections, such as 'Where to go for help', 'Treatment' and 'Testing' may be specific to the UK.
Heptatitis A
Hepatitis is inflammation of the liver. This can be caused by alcohol and some drugs, but usually it is the result of a viral infection. There are many types of virus which can cause hepatitis. Each of these viruses acts differently.
How it's spread
The hepatitis A virus (HAV) is a common infection in many parts of the world. It is possible to become infected through eating or drinking contaminated food or water.
The hepatitis virus is found in faeces. It can be passed on if even a tiny amount of faeces from a person with hepatitis A comes into contact with another person's mouth.
This means the virus can also be passed on sexually through practices such as rimming. Personal hygiene, with careful hand washing, can minimise the risk of the virus being passed on.
Signs and symptoms
People may have no symptoms at all, but they can still pass on the hepatitis virus to others. Symptoms may include:
- a short, mild, flu-like illness
- nausea and vomiting
- diarrhoea
- loss of appetite
- weight loss
- jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces)
- itchy skin.
Some people may need to be admitted to hospital.
Where to go for help
- Your local NHS sexual health (GUM) clinic.
You can find details of your nearest NHS sexual health clinic in the phone book under genito-urinary medicine (GUM), sexually transmitted diseases (STD) or venereal diseases (VD). Or phone your local hospital and ask for the 'special' or GUM clinic. Our help and advice page links to websites which can tell you where to find your nearest clinic.
You will get free, confidential advice and treatment. You can go to any NHS clinic anywhere in the country - you don't have to go to a local one - and you don't have to be referred by your GP. (Non-NHS sexual health clinics may not always offer the full range of services which are available at NHS sexual health clinics.)
- If you are in the UK, go to www.playingsafely.co.uk to find details of STD clinics.
- If you are in the USA, go to http://herpes-coldsores.com/support/std_clinic_us.htm. From this site you can also find details of STD clinics in Australia, New Zealand, Puerto Rico and India.
- A hospital Accident and Emergency department.
- Your own GP.
The tests for hepatitis A
Your GP or doctor at an NHS sexual health (GUM) clinic can diagnose hepatitis A by carrying out blood tests. You will be asked questions to try to discover the source of the infection.
What does a positive test result mean?
It could show:
-
Past infection. This means that you have been in contact with the hepatitis A virus and your body has cleared it. You now have a natural protection against future infection with the hepatitis A virus.
-
Current infection. By the time most people have developed symptoms of hepatitis A they will be less infectious to others, but in the weeks before this there will have been a risk of passing on the infection. Your doctor will ask you questions to find out if others have been at risk of hepatitis A. Those who have been in contact with the virus and have become infected may be given an injection to reduce the severity of the symptoms.
Most of the symptoms of hepatitis A settle after a few weeks, although some people can feel tired for a number of months after infection. There is little likelihood of chronic liver damage and no chronic carrier state (where a person remains chronically infected).
What does a negative test result mean?
This result means that you have never been in contact with hepatitis A and have no natural protection against it.
If you are thought to be at risk of hepatitis A infection, the doctor may advise you to be immunised.
Diagnosis and treatment
Infection with hepatitis A is usually mild, but occasionally causes severe inflammation of the liver, requiring admission to hospital.
Immunisation
For hepatitis A you are given a single injection in the arm which gives you protection for a year. A second booster injection at 6 to 12 months gives you protection for up to 10 years. Most hepatitis A immunisations are given to people who are travelling to parts of the world with a high incidence of hepatitis A.
These injections are available from your GP.
You can also get immunised to prevent hepatitis A developing, if you have recently come into contact with it.
Immunisation is also recommended for those whose sexual practices are likely to put them at risk.
Follow-up
If you are infected with hepatitis A, you should limit the amount of alcohol you drink. The doctor may also offer you dietary advice.
Your doctor will advise you about any precautions necessary to ensure that you avoid infecting others with the virus.
Heptatitis B
Hepatitis is inflammation of the liver. This can be caused by alcohol and some drugs, but usually it is the result of a viral infection. There are many types of virus which can cause hepatitis. Each of these viruses acts differently.
How it's spread
The hepatitis B virus (HBV) is very common worldwide. It is very infectious.
The virus can be spread in the following ways:
- by unprotected (without a condom) penetrative sex (when the penis enters the anus, vagina or mouth) with someone who is infected. Also by sex which draws blood with someone who is infected
- by sharing contaminated needles or other drug-injecting equipment
- by using non-sterilised equipment for tattooing, acupuncture or body piercing
- from an infected mother to her baby, mainly during delivery. Immunisation of the baby at birth prevents the transmission of hepatitis B
- through a blood transfusion in a country where blood is not tested for the hepatitis B virus. All blood for transfusion in the UK is tested.
Signs and symptoms
People may have no symptoms at all, but they can still pass on the virus to others. Symptoms may include:
- a short, mild, flu-like illness
- nausea and vomiting
- diarrhoea
- loss of appetite
- weight loss
- jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces)
- itchy skin.
Some people may need to be admitted to hospital.
Most adults infected with the hepatitis B virus fully recover and develop life-long immunity. Between 2% and 10% of individuals infected as adults will become chronic carriers, which means they will be infectious to others and can develop chronic liver damage. Infected children, especially new-born babies, are much more likely to become chronic carriers.
If a person continues to be infected over a number of years with the hepatitis B virus, they could develop the following complications:
- chronic hepatitis
- liver cirrhosis
- liver cancer.
Where to go for help
- Your local NHS sexual health (GUM) clinic.
You can find details of your nearest NHS sexual health clinic in the phone book under genito-urinary medicine (GUM), sexually transmitted diseases (STD) or venereal diseases (VD). Or phone your local hospital and ask for the 'special' or GUM clinic. Our help and advice page links to websites which can tell you where to find your nearest clinic.
You will get free, confidential advice and treatment. You can go to any NHS clinic anywhere in the country - you don't have to go to a local one - and you don't have to be referred by your GP. (Non-NHS sexual health clinics may not always offer the full range of services which are available at NHS sexual health clinics.)
If appropriate, these services may refer you to a hepatologist or specialist gastroenterologist.
- A hospital Accident and Emergency department
- Your own GP
- If you are in the UK, go to www.playingsafely.co.uk to find details of STD clinics.
- If you are in the USA, go to
http://herpes-coldsores.com/support/std_clinic_us.htm, from this site you
can also find details of STD clinics in Australia, New Zealand, Puerto
Rico and India.
Your GP or doctor at an NHS sexual health (GUM) clinic can diagnose hepatitis B by carrying out blood tests. You will be asked questions to try to discover the source of the infection.
The tests for hepatitis B
What does a positive test result mean?
It could show:
-
Past infection. This means that you have been in contact with HBV and your body has rejected it. You now have a natural protection against the virus.
-
Carrier. This means that you carry HBV and can pass it on to others. You are at risk of chronic liver disease and may be referred to a specialist centre for further assessment.
A positive result can be confirmed by further tests and referral to a specialist. To find out how much hepatitis B may be affecting the liver, and what may be the best treatment for this, a small sample of liver tissue may need to be taken (a liver biopsy).
What does a negative test result mean?
This result means you have never been in contact with HBV and have no natural protection against it.
If there is a chance you have been recently exposed to the virus, your doctor may advise you to have a repeat test and be immunised against hepatitis B.
Diagnosis and treatment
Many people do not require treatment, as the inflammation of the liver may not be severe. If you need treatment for liver inflammation, you will be referred to a specialist centre for a full assessment.
Immunisation
Three injections are given over a period of 3-6 months. A blood test is taken once the course of injections is completed to check that they have worked. Immunity should last for at least 5 years.
The injections are available at your local NHS sexual health (GUM) clinic, or from your GP.
Follow-up
If you are diagnosed as having an active infection with hepatitis B, you will be advised to have regular blood tests and physical check-ups. All carriers should expect to be referred to specialist services.
If you are infected with hepatitis B, you should limit the amount of alcohol you drink. The doctor may also advise you to avoid fatty foods and follow a low-salt diet.
If you have hepatitis B, you should use a condom for penetrative sex to prevent passing on the virus.
Your partner should also be immunised against hepatitis B (if not already infected).
Your doctor will advise you about any precautions necessary to ensure that you avoid infecting others with the virus, such as not sharing toothbrushes or shaving equipment.
Remember, using condoms can reduce your risk of getting or passing on sexually transmitted infections.
Heptatitis C
Hepatitis is inflammation of the liver. This can be caused by alcohol and some drugs, but usually it is the result of a viral infection. There are many types of virus which can cause hepatitis. Each of these viruses acts differently.
How it's spread
The hepatitis C virus (HCV) can be spread in the following ways:
- by sharing contaminated needles or other drug-injecting equipment. If you have ever shared drug-injecting equipment, you may want to be tested for hepatitis C
- by using non-sterilised equipment for tattooing, acupuncture or body piercing
- by unprotected sex which draws blood with someone who is infected. Also, if you have sex with an infected woman who is on her period, or if you have sex with someone who is infected and who has sores on their genitals that may bleed. Sexual transmission is not a common way of becoming infected with hepatitis C
- on rare occasions, from an infected mother to her baby, mainly during delivery. The risk may be greater if the mother is also infected with HIV
- through a blood transfusion in a country where blood is not tested for the hepatitis C virus. All blood for transfusion in the UK is tested.
- by sharing notes used to snort cocaine.
Signs and symptoms
People may have no symptoms at all, but they can still pass on the virus to others. Symptoms, though not common, may include:
- a short, mild, flu-like illness
- nausea and vomiting
- diarrhoea
- loss of appetite
- weight loss
- jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces)
- itchy skin.
Some people may need to be admitted to hospital.
Current evidence suggests that only about 20% of individuals who have been infected with the hepatitis C virus appear to clear the virus from the blood, whilst about 80% will remain infected and can pass on the virus to others. If a person continues to be infected over a number of years with the hepatitis C virus, they could develop the following complications:
- chronic hepatitis
- liver cirrhosis
- liver cancer.
Where to go for help
- Your local NHS sexual health (GUM) clinic
You can find details of your nearest NHS sexual health clinic in the phone book under genito-urinary medicine (GUM), sexually transmitted diseases (STD) or venereal diseases (VD). Or phone your local hospital and ask for the 'special' or GUM clinic. Our help and advice page links to websites which can tell you where to find your nearest clinic.
You will get free, confidential advice and treatment. You can go to any NHS clinic anywhere in the country - you don't have to go to a local one - and you don't have to be referred by your GP. (Non-NHS sexual health clinics do not always offer the full range of services which are available at NHS sexual health clinics.)
- A hospital Accident and Emergency department.
- Your own GP
- If you are in the UK, go to www.playingsafely.co.uk to find details of STD clinics.
- If you are in the USA, go to http://herpes-coldsores.com/support/std_clinic_us.htm, from this site you can also find details of STD clinics in Australia, New Zealand, Puerto Rico and India.
The tests for hepatitis C
Tests for the hepatitis C virus (HCV) have only been available since 1989.
Your GP or doctor at your local NHS sexual health (GUM) clinic can diagnose hepatitis C by carrying out blood tests. You will be asked questions to try to discover the source of the infection.
What does a positive test result mean?
It means that you may be a carrier of the hepatitis C virus and can pass it on to others.
The first test given will be a test for antibodies to the hepatitis C virus (anti-HCV). If this test is positive, it means that you have been exposed to the hepatitis C virus and that your body has responded by producing antibodies. This test does not indicate whether or not you are STD ll infected. You will normally be referred on to a specialist for a further test to try to find out if this is the case.
The specialist will carry out another blood test to look for the hepatitis C virus (HCV-RNA). Although some people do clear hepatitis C, most people remain chronically infected and are therefore infectious to others. To find out how much hepatitis C may be affecting the liver, the specialist will also perform liver function tests (LFT) and may also take a small sample of liver tissue (a liver biopsy). The results of the LFT and/or liver biopsy help the specialist decide whether you would benefit from treatment or not.
Clearing the virus does not mean you are immune to reinfection.
What does a negative test result mean?
This result probably means that you have never been in contact with the hepatitis C virus.
However, as the tests rely on the detection of antibodies to HCV, and the antibodies can take some months to develop, your doctor may advise you to have a repeat test if there is a chance you have been recently exposed to the virus.
At present there is no vaccine available to protect against hepatitis C.
Follow-up
If you are diagnosed as having an active infection with hepatitis C, you will be advised to have regular blood tests and physical check-ups. All carriers should expect to be referred to specialist services.
If you are infected with hepatitis C, you should limit the amount of alcohol you drink. The doctor may also advise you to avoid fatty foods and follow a low-salt diet.
Transmission of the hepatitis C virus by penetrative sex does occur, although it is not common. If you are infected it is advisable to use a condom for penetrative sex to ensure that you do not pass on the virus to your partner(s).
Your doctor will advise you about any precautions necessary to ensure that you avoid infecting others with the virus, such as not sharing toothbrushes or shaving equipment.
Remember, using a condom can reduce your risk of getting or passing on sexually transmitted infections.
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The information on this page was originally produced in the form of factsheets by Health Promotion England.
Copies of the leaflets can be ordered in the United Kingdom through the NHS Responseline, on Tel: 08701 555 455.
Crown copyright material is reproduced with the permission of the Controller of HMSO and the Queen's Printer for Scotland.