What is Hepatitis?
Hepatitis is the name for inflammation of the liver caused by several different viruses. The viruses are classified by letters of the alphabet - with types A, B, and C being the most common. Each of these viruses can be transmitted in a number of ways, some sexually. Hepatitis B and C viruses can cause inflammation of the liver, liver failure, liver cancer, and death. Hepatitis B is the most common cause of liver cancer in the world. Chronic Hepatitis C (HCV) is the leading cause for liver transplants.

How many people have it?
It is estimated that there are between 125,000 and 200,000 Hepatitis A infections (HAV) per year in the United States. Approximately 1.25 million people in the United States have chronic Hepatitis B virus (HBV), with an estimated 78,000 new HBV infections each year. HCV is the most common chronic blood borne infection in the United States. It is estimated that about 4 million Americans have been infected with HCV, of whom 2.7 million have chronic infections. There are approximately 25,000 new infections in the U.S. each year.

Why worry about Hepatitis?
HAV usually runs its course without treatment. Once infected, you cannot be re-infected. Both HBV and HCV can attack in acute or chronic forms. The acute forms resemble a bad illness that can last for a few weeks, up to a few months. If the illness turns chronic (long-lasting), both Hepatitis B and C can ultimately lead to liver failure and death.

Important Note: Hepatitis B infection in someone who is HIV+ is more likely to turn into chronic HBV. It is estimated that 5,000 people die each year in the United States due to complications of cirrhosis and liver cancer as a result of HBV.

How is Hepatitis spread?
HAV is highly contagious and is spread from person to person via contaminated food, water or stool. A person is most infectious in the two weeks after exposure, but before symptoms show up - which means people can spread the virus without even knowing they have it.

Poor hand washing and contaminated water supplies can easily transmit HAV, as well as many types of anal sex such as rimming, fisting, fingering, and anal intercourse. Contact with something that's been in contact with the anus of an infected person can also transmit the virus. This means that sharing sex toys, kissing someone who's been rimming, and sucking someone who's just topped someone else can all be risky activities for transmitting HAV.

HBV is the most common sexually-transmitted type of viral hepatitis. People can be infected through anal and vaginal sex by sharing body fluids (blood, semen and vaginal fluids). It is possible, although rare, for Hepatitis B to be transmitted solely via oral sex. People who share or use needles with contaminated blood can be infected. Currently, blood transfusions are rarely the cause of HBV infections in the United States due to the improved screening of blood supplies. Although tattoo, body piercing, and acupuncture needles may transmit HBV, they account for only a small proportion of the total reported cases in the United States.

People who share or use needles or injection drug equipment (works, cotton, cookers, spoons) contaminated with blood can be infected with HCV. Most cases of HCV in the general population today have been the result of blood transfusions in the past. Currently, proper screening for Hepatitis B and C is being done on all blood supplies in the United States.

The risk of transmission via oral and anal sex is unknown, but likely to be very low.

What are the symptoms?
Within all three types of hepatitis - A, B, C - the severity and type of symptoms vary greatly. Many people do not have symptoms at all. If you do have symptoms, they could include fatigue, stomach pain, yellowing of the skin or eyes (jaundice), dark urine, light colored stool and/or fever.

In Hepatitis A, symptoms usually appear 2-6 weeks after infection. In Hepatitis B, symptoms usually appear 6 weeks to 6 months after exposure, if at all. Hepatitis C symptoms, if any, will show up 2 weeks to 6 months after exposure. Symptoms may be brief or last several weeks.

What is a Hepatitis test like?
Hepatitis is diagnosed via a blood test for hepatitis antibodies. HAV antibodies may be detected as early as the onset of symptoms. HBV usually takes between 3 weeks to 2 months to show up in the blood. The average time it takes for a person infected with Hepatitis C to develop antibodies is 8-9 weeks after exposure.

How is Hepatitis treated?
General treatment for all types of early hepatitis is bed rest and fluid intake. Fluid intake is important to prevent dehydration. Avoidance of alcohol is strongly encouraged to reduce further liver damage. Hepatitis A and acute forms of B and C will eventually run their course, although recovery may take several months.

Chronic HBV can be a fatal disease. There is no cure, although treatments are available to help stop virus replication. Interferon, an antiviral agent, has been 40 percent effective in eliminating chronic HBV infection. It is most effective for people who were infected as adults.

New prescription drugs are now also available including Lamivudine (Epivir) and Adefovir dipivoxil (Hepsera). Talk to your health care provider for more information and to see whether they may be right for you.

HCV is treatable. New studies have shown that up to nearly 50% of people who undergo one year of therapy can be cured. Treatment will differ depending on the stage of illness at the time you seek treatment. Your health care provider can help you make the best decisions about your treatment based on your personal needs and health status.

What can I do if I have Hepatitis?
The most important thing is to avoid alcohol and other drugs like acetaminophen (the active ingredient in Tylenol and Vicodin) because it can further damage your liver. In general, you want to eat healthfully, get plenty of rest, and exercise moderately. You need to see your medical provider on a regular basis to work together on your treatment plan. Don't take any new medications, including herbal or over-the-counter drugs, without talking to your provider first.

If you know you have HBV, you can protect others by using condoms during sexual activity.

If you know you have HCV, you can protect others by not donating blood, body organs, tissue or semen; covering any cuts or sores you have to prevent spreading infectious blood or secretions; not sharing personal hygiene items such as razors or toothbrushes and not sharing needles or any other works. Currently there are no recommendations for condom use with HCV infected partners, however there are many other reasons to use condoms regularly for sexual activity.

How do I avoid getting Hepatitis?
Effective vaccinations are available to protect you against Hepatitis A and B. Both are recommended for those at high-risk of infection including men who have sex with men and health workers. Currently there are no shots to protect you against Hepatitis C. City Clinic offers Hepatitis A and B shots for those who are eligible. Please call 415-487-5500 for further information.

A new combination vaccine called Twinrix has been approved for protection from both HAV and HBV in people who are 18 and older. It reduces the total number of injections for vaccination from both viruses from five to three.

If you have not yet been vaccinated and you engage in anal sex activities, using condoms for intercourse and cut-up non-lubricated condoms, household plastic wrap or dams (square pieces of latex) for oral-anal sex can significantly reduce your risk of contracting hepatitis. In addition, wash your hands and sex toys as soon as possible after anal contact.