What does Hepatitis do to you?

Hepatitis
A – B – C – D – E

The following is a © extract from

"Sexplained One - Sex & Your Health" by Helen J Knox

“Sexplained One – Sex & Your Health” by Helen J Knox

What is hepatitis A B C?

Hepatitis means inflammation of the liver:

* the hepatic gland (liver) is the largest gland in the body; 

* ‘itis’ means ‘inflammation of’.

There are many causes of hepatitis but this book concentrates on the viral causes; predominantly Hepatitis A, B and C.

 

Other name(s)

Viral hepatitis is described alphabetically:

 e.g. 

* Hepatitis A, Hep A, HAV (hepatitis A virus); 

* Hepatitis B, Hep B, HBV; 

* Hepatitis C, Hep C, HCV.

 

Terminology

Acute hepatitis – short-term inflammation of the liver, during which the immune system clears the virus within six months.

Chronic hepatitis – long-term inflammation of the liver, in which the infection persists beyond six months because the immune system cannot clear the virus from the body.

Stages of hepatitis infection include:

(1) inflammation – immune activity within the liver; 

(2) fibrosis – thickening and an accumulation of scar tissue in the liver; 

(3) cirrhosis – extensive destruction 

of liver cells with associated scarring throughout the liver; 

(4) hepatocellular carcinoma – primary liver cancer.

 

What does the liver do?

The liver is the second largest organ in the body, weighing about 1-2 kg (3-6 lbs), situated in the right upper abdomen. It is the main ‘factory’ in the body and performs so many tasks that it is vital for life.  

 

The liver:

* converts food into chemicals necessary for life and growth; 

* produces quick energy when needed; 

* manufactures new body proteins; 

* stores sugars, vitamins and minerals; 

* aids digestion by processing bile; 

* digests fat; 

* neutralises and destroys poisons; 

* controls the production of cholesterol; 

* maintains hormone balance; 

* stores iron; 

* helps the body resist infection by producing immune factors (substances); 

* regenerates its own tissue.

(Ref: This information was taken from The British Liver Trust leaflet on Hep B, with permission.)

 

What is viral hepatitis?

Viral hepatitis can be serious for some people while others are not affected by it, long term.

When affected:

* some people become chronic carriers – they have it long term or for more than six months and pass the virus on for several years while others don’t pass the virus to others; 

* severe scarring (fibrosis) may occur which may lead to cirrhosis (see below); 

* the blood supply inside the liver may become blocked, causing one type of high blood pressure, local to the area; 

* the immune system may be weakened; 

* alcohol may not be tolerated; 

* liver cancer and/or liver failure may occur, both of which are life threatening. 

 

Where does hepatitis come from?

The main non-viral, non-infectious causes of hepatitis are: 

* alcohol excess; 

* fatty liver disease;

* side effects of some drugs and chemicals;  

* autoimmune chronic active hepatitis.

 

The viral and infectious causes are:

1 Hepatitis A virus (HAV); 

2 Hepatitis B virus (HBV); 

3 Hepatitis C virus (HCV or Non-A-non-B hepatitis);

4 Hepatitis D virus; 

5 Hepatitis E virus; 

6 Non-A-E hepatitis (causing a minority of liver disease).

 

Where are the different hepatitis viruses found?

In overview, viral hepatitis may be found in an infected person’s:

* blood and blood-stained body fluids; 

* vaginal secretions and ejaculate;  

* blood-stained saliva, breast milk, sweat, tears, urine and faeces;  

* shared sex toys;

* contaminated drug injecting equipment – i.e. used/shared needles and syringes; shared water ampoules, filters or spoons used during the injecting process; 

* shared razors, apples (blood stained after being bitten), nail-files, toothbrushes, scissors, knives, spoons, drinking glasses, cans/bottles and chewed or sucked pens/pencils, can harbour the virus; 

* fights, bites, tattooing, body piercing and the teenage bonding game of ‘blood brothers’; 

* dental or medical treatment in countries where blood is not screened or where medical equipment is not adequately sterilised; 

* and contaminated water (and shellfish found in that water) may harbour Hep A and/or E.  

 

Where are the different hepatitis viruses found?

By virus:

Hepatitis A – is generally found in:

* contaminated food or water supplies (oral route of transmission); 

* shellfish caught in contaminated waters; 

* areas of overcrowding and poor hygiene; 

* if infectious people are handling food in an unhygienic manner; 

* and commonly passed through unprotected oral sex as found in human faeces (bowel waste) of infectious people (faecal route of transmission). 

It usually causes a short-term illness.

Vaccination is available against Hepatitis A. 

 

Hepatitis B – also known as HBV (Hepatitis B virus) – is found: 

* in infected blood and body fluids contaminated with the virus e.g. saliva, semen/ejaculate, vaginal secretions (sex), urine; 

* in contaminated drug injecting equipment, including needles & syringes, water ampoules (sealed glass capsules) or mixing glasses, filters and spoons etc.; 

* in some blood transfusions, where screening may be poor or absent; 

* and it can be passed via unprotected sex and can lead to long term, serious illness which may become life threatening.

Vaccination is available against Hepatitis B, which also protects against Hepatitis D.

 

Hepatitis C – of which there are at least six types – each of which has many sub-types, is found:

* in contaminated blood in transfusions or shared drug injecting equipment, including needles, syringes, filters, spoons and water ampoules (sealed glass capsules) or mixing glasses, as with Hepatitis B; 

* and, if indulging in high risk activities, it can be passed during unprotected sex; 

NO VACCINE is available against Hepatitis C as there are so many types and sub-types of the virus that there is unlikely to be one in the near future. It can lead to long term, serious illness, which may become life threatening.

 

Hepatitis D which requires Hepatitis B to survive:

* is found and passed the same way as Hepatitis B;

* it can lead to long term, serious illness, which may become life threatening. 

Vaccination against Hepatitis B protects against Hepatitis D.

 

Hepatitis E is similar to Hepatitis A and it is found and passed:

* in contaminated drinking water; 

* via the oral/faecal route. 

It doesn’t generally cause life threatening illness, except in pregnant women, amongst whom there is a 20 per cent fatality rate.

There is NO commercially available vaccine against Hepatitis E, although some are in development.

 

How is viral hepatitis transmitted?

There are different routes of transmission:

* Hep A – oral-faecal route, via contaminated food, water or close contact; 

* Hep B – via blood/body fluids and mother-to-child during pregnancy; 

* Hep C – via blood/body fluids and mother-to-child during pregnancy; 

* Hep D – via blood/body fluids (only found with HBV); 

* Hep E – oral-faecal route, via contaminated food, water or close contact.  

 

How infectious is viral hepatitis?

Although viral hepatitis may remain active outside the body for various lengths of time, it requires an entry point in the skin or mucous membrane to be infectious. Because Hepatitis B virus is 100 times more infectious than HIV, sensible precautions are always recommended.

It is known that the Hepatitis B virus can remain active in dry blood for over six months.

It is not clear how long the Hepatitis C virus can remain active in dry blood. It is thought to live for one to three weeks, although it is suggested that it can live up to three months or longer. 

(PHLS Colindale, London, 2000) 

 

Needlestick Risk

Only one incident, such as needlestick injury (e.g. accidental scratch with an infected syringe in a healthcare setting) containing a tiny amount of virus particle is required to cause infection.

To show how Hepatitis B is considerably more infectious than HIV, from one needlestick injury with an infected syringe, the risk of infection is approximately:

* 0.3%  for HIV (1 in 300) 

* 3%     for Hepatitis C (1 in 33)  

* 30%   for Hepatitis B (1 in 3)

 

Is viral hepatitis always infectious?

No. Viral hepatitis is not always infectious.

Infectivity of a virus, like Hepatitis A, B or C, is dependent on:

* the inoculums or dose you are exposed to;

* the entry point for the virus, and your immune response to it;

* the specific viral characteristics that allow it to be infectious (e.g. the cold virus is specifically adapted to attack the respiratory tract). 

So, a large dose of virus in the blood into a wound is much more of a risk of infection than a scratch to the skin with a tiny amount of virus. 

 

How long does viral hepatitis take to present with symptoms (incubation period)?

Incubation times differ but on average incubation times are:

* Hep A – 15-45 days (approx two to six weeks / two months); 

* Hep B – 40-160 days (approx six to 22 weeks / 6 months); 

* Hep C – 28-270 days (approx four to 38 weeks / 9 months); 

* Hep D – up to 6 month; 

* Hep E – four to eight weeks. 

 

What blood tests are there, to check if I’ve got hepatitis? 

There are special blood tests to check if you’ve been exposed to viral hepatitis; and if so, to which strain.

 

Virology and antibodies

The terminology associated with viral hepatitis is complex, but understanding some of the main terms used and the meaning of key test results will help to keep you informed about your condition. 

Understanding the significance of antibodies and antigens is a good place to start. 

An antigen is a foreign or invading protein substance that enters the body. Your body’s immune system defends against antigens by producing its own special proteins that bind to the invader to destroy them. These are antibodies, also known as immunoglobulin. 

The production of antibodies against antigens is known as your ‘immune response’. Many of the following tests are used to measure your immune response. 

 

Is it acute or chronic? 

An acute illness means a short, sharp illness of sudden onset that may be severe. Most people recover within a few weeks without lasting effects. 

A chronic illness is one that lasts a long time (more than six months), possibly for the rest of a person’s life. 

 

Hepatitis A (HAV) 

This is a test to detect whether you have produced antibodies known as immunoglobulin M and immunoglobulin G against the hepatitis A virus (HAV). 

A total antibody test is able to indicate both current and previous infection with hepatitis A. 

It will also read positive after you have received the hepatitis A vaccination. 

It is presumed that one infection with hepatitis A produces lasting immunity (protection) against further infection. 

 

Hepatitis B (HBV) 

– antiBODY and antiGEN tests 

Most people who come into contact with hepatitis B (HBV) will rid themselves or ‘clear’ the virus during the first six months of their infection. 

The disease is known during this phase as acute hepatitis B. People who do not clear the virus after six months will be diagnosed as having chronic hepatitis B. 

Tests are carried out to look for antigens and antibodies in your blood. 

 

These are a sign or indication that: 

* you have a new infection;

* your infection is likely to go away by itself;

* you have been infected by the virus in the past;

* your infection has become chronic.

 

These antigens and antibodies are known as serological or viral ‘markers’. 

Medical staff will look for markers in your blood over the course of your infection to see how the virus is progressing and/or responding to treatment. 

In particular, finding the ‘surface’ and ‘e’ antigens known as HBsAg and HBeAg and their corresponding antibodies will be very important in establishing the pattern of your disease. 

 

Hepatitis B surface antiGEN (HBsAg) 

This is a test to find out if you have a current infection. HBsAg is the earliest sign of the virus and disappears from your blood as the infection clears. 

A positive result indicates infection. if the antigen is not found (negative result), this shows that either you have never been exposed to hepatitis B or that you have recovered from the infection and rid yourself of the virus. 

The term ‘surface’ refers to the outer surface of the virus itself. 

 

Hepatitis B surface antiBODY (Anti-HBs) 

This is to detect the protective antibody in your blood that reveals whether you have had previous exposure to hepatitis B. 

The presence of the antibody anti-HBs (positive result) indicates that you are immune to hepatitis B due to vaccination or recovery from past infection, and are no longer infectious to others. 

 

Hepatitis B e-antiGEN (HBeAg) 

This test is used to confirm the presence of HBeAg, which only appears in the blood when the virus is present and is a sign that you are infectious (able to infect others). 

What happens after this antigen is found will depend on how quickly your immune system produces antibodies called anti-HBe. 

The appearance of an antibody and subsequent elimination of the virus to a very low level is known as ‘seroconversion’. 

The rate at which this occurs will vary from person to person and can take months or years. 

Unfortunately, some people lose HBeAg but continue to have a virus that is replicating, and are still at risk of disease progression.

 

Anti-HBe 

This is the test that looks for the anti-HBe antibody produced in response to the hepatitis B e antigen (although anti-HBe is also present in people recovering from acute hepatitis B infection). 

In chronic hepatitis B, a positive result suggests that only low levels of the virus are likely to be present in your blood. 

 

Anti-hepatitis B core antiGEN (Anti-HBc) 

The anti-hepatitis B core antigen is an antibody to the ‘core’ part of the hepatitis B virus, the hepatitis B core antigen. 

However, this antibody does not provide the protection usually associated with antibodies and is found in people with acute infection, in chronic carriers and in people who have cleared the infection. 

Doctors will use the results of other tests to interpret the presence of anti-HBc in your blood. 

 

HBV DNA 

This important test does not look for antigens or antibodies but can indicate how active the virus is, and among other things monitors the success of antiviral medication. 

It shows the amount of virus in your blood, known as your ‘viral load’. 

The higher your viral load, the more active your infection will be. 

Active virus replication, where the virus is making lots of copies of itself, is known as positive HBV DNA. 

Doctors will be looking for a very low amount or no trace of the virus as a marker of your response to antiviral medication. 

 

Hepatitis C (HCV) 

As with hepatitis B, a number of tests will be carried out when you are suspected of having hepatitis C (HCV) or after the virus has been diagnosed. They will be used to follow its progression and to check on your response to treatment. 

 

Anti-HCV 

An anti-HCV test looks for any trace of antibodies in your blood. if they are found, this shows that you have been exposed to the hepatitis C virus. This test is unable to reveal whether you have an active viral infection. 

 

HCV-RNA 

An HCV-RNA test detects the hepatitis C virus in your blood and indicates whether this is an active infection. 

Evidence of HCV viral RNA is a ‘positive’ result while no sign will be ‘negative’. 

This test may also be used as a follow-up to your treatment to see if you have eliminated the virus from your body. 

 

HCV viral load (quantitative HCV) / PCR (polymerase chain reaction) 

This test measures the number of viral load in your blood. Doctors will usually perform these tests over the course of your treatment. 

Measuring your viral load during and after treatment will show whether this therapy is working. 

 

Viral genotyping 

Viral genotyping is carried out to identify the types of hepatitis C virus. 

There are six major types, known as ‘genotypes’, with multiple subtypes (e.g. 1a or 1b). 

The most common, in the Western World, is genotype 1.  

Genotype tests are ordered before treatment is started to give doctors an idea of the length of time and/or type of treatment, as well as the likely success of your therapy. 

Genotype 1 is the most unresponsive to treatment including interferon, with genotype 2 being the most responsive. New direct-acting antivirals are improving treatment response.

 

Some issues about testing 

When testing for hepatitis B or C, there are some things you may consider. 

Public knowledge about hepatitis is slowly improving but widespread ignorance about who gets hepatitis and how it is transmitted remains. 

 

It is a good idea to discuss your concerns with a health professional or counsellor, who is trained to help you cope with hepatitis and any social difficulties that come with it, such as: 

 

Insurance

In the UK, according to the Association of British Insurers, insurance companies must only ask information that is relevant to the insurance being requested and cannot ask whether tests or counselling have been undertaken when there has been a negative result. However, an insurance company is allowed to ask about positive test results or if treatment is being taken.

A positive test result may mean a life insurance policy or a mortgage linked to a life policy could be refused or the premium much increased. if this happens, it is worth talking to your doctor, as many consultants are willing to write to a mortgage or insurance company stating your health and life expectancy.

An insurance company may contact your doctor asking them to complete a medical report before accepting your application. Your doctor must obtain your consent before completing the report and is only allowed to disclose information relevant to your application. Your doctor can choose not to answer any questions they find inappropriate.

When purchasing travel insurance, you should inform your insurance company of any pre-existing conditions (including hepatitis B) and confirm that your policy will cover them. Failure to do so may result in your policy being void, this means you will not be insured and may have to pay for any medical treatment or losses you incur. You may need to contact a specialist insurance company that provides medical travel insurance.

If you are in the UK, the British Liver Trust and the Hep C Trust have a list of companies that are happy to cover people with liver disease. if you are not in the UK, they can guide you towards similar organisations elsewhere.

 

Confidentiality

Most drug agencies and sexual health clinics offer confidential testing and your general practitioner/family doctor can also arrange testing for you. 

if your test is positive, the clinic will forward your result to your doctor so they can arrange on-going care and treatment.

Any doctor who diagnoses viral hepatitis is legally required to report this information [UK Guidelines, 2008], in confidence, to local public health doctors responsible for preventing the spread of infection. 

These public health doctors work under the strictest guidance about confidentiality. National data is then reported anonymously to help monitor the spread and to inform the prevention and treatment of hepatitis.

 

Whom to tell 

It is often difficult deciding whom to tell. It may help you to remember that a positive result may affect your family and sexual partner(s), and they should also think about being tested. At a minimum, if you are HBsAg positive your sexual partner will need to be vaccinated if they are negative. 

 

Who can I talk to?

It is a good idea to talk about your own concerns with a professional. This might be a doctor, health advisor, counsellor or perhaps a drug worker. 

Clinical nurse specialists, trained to help people cope with hepatitis and its symptoms, are based at some hospitals. 

The British Liver Trust and Hepatitis C Trust’s websites can guide you towards help and support. They also have links in other countries. (www.britishlivertrust.org.uk and www.hepctrust.org.uk) 

There are similar support groups online and in other countries around the world.

Ignorance about viral hepatitis among the general public can sometimes cause problems. So, it is a good idea to be selective of whom you inform of your illness, at least to begin with. 

There will be helpful people involved in your day-to-day life that you may find it useful to tell. These include someone you trust at work or someone able to do regular errands for you. It might just be a person who is always willing to listen to your problems. 

Think about who these people are and make a list of them. Letting them know about your illness will help to build your support base as you progress with your treatment.

 

Who else do I need to inform?

if you are having any other medical treatment or visiting the dentist you must let the practitioner know that you have viral hepatitis, so they can take precautions to protect themselves and other patients.

You have no legal obligation to inform your employer. However, you do have a legal duty to safeguard your own health and safety and that of others while at work. 

The type of work that you do will influence the level of risk to others. 

Working with your employer means you can prevent others being infected. if you do decide to tell your employer they are obliged to keep this information confidential and not to pass this on without your consent.

 

What other tests are there?

Other tests to confirm the diagnosis include:

* LFTs (liver function tests) especially if you become ill with hepatitis; 

* liver biopsy, where a small sample of liver tissue is taken to check the extent of any damage;

* liver ultrasound — not invasive like biopsy, and useful to image the liver. Other enhanced technologies are improving on this imaging and may remove the need for a biopsy.

 

What is the chance of developing a chronic disease or of developing liver cancer?

The chance of developing chronic infection and remaining infectious for life is approximately 10 per cent if you have Hepatitis B and 70 per cent if you have Hepatitis C.

There is then a 10-30 per cent chance of developing cirrhosis, followed by a 10 per cent chance of developing liver cancer over many years to decades. These statistics need to be read cautiously as every individual is different.

 

What might I notice if I have viral hepatitis?

With short-term viral hepatitis infection, you may notice one or more of the following (though many may be absent): 

* tiredness or “flu-like” symptoms; 

* nausea; 

* stomach ache; 

* diarrhoea; 

* skin rash; 

* yellow eyes/skin (jaundice); 

* light-coloured stools; 

* dark coloured urine; 

*  enlarged liver / abdominal tenderness; 

* dry mouth, skin and other signs of dehydration; 

* loss of appetite; 

* unintended weight loss.

With long-term viral hepatitis infection, you may notice one or more of the following (though many may be absent):

* the same symptoms as with acute infection; 

* muscle and joint ache; 

* pain and/or discomfort, on the right side of the abdomen; 

* referred pain: pain or discomfort in the right shoulder blade; 

* lethargy/ general malaise (extreme tiredness); 

* signs and symptoms of cirrhosis (liver damage) (below); 

* signs and symptoms of liver cancer.

Many people living with viral hepatitis may not attribute symptoms to this, and without being diagnosed with a test not really know they are infectious or have a risk of disease.

 

What is cirrhosis of the liver?

Cirrhosis (pronounced sirrosis) is an end stage of liver disease when the whole of the liver is scar tissue (cirrhosis), that develops as a result of chronic hepatitis in the minority of patients who progress to this. if the liver “decompensates” (fails), without supportive treatment and liver transplant, there is a high risk of mortality. 

Generally, cirrhosis is irreversible. Treatment aims to prevent ongoing deterioration and subsequent complications by removing the original cause (e.g. a virus). In successfully treated patients, a reversion of cirrhosis has been seen. Liver cancer may occur in people with long standing cirrhosis. Approximately 80 per cent of the world’s liver cancer relates to infection with Hepatitis B and C. 

 

What can happen if I develop cirrhosis?

It usually requires years of chronic liver damage for cirrhosis to occur. 

In some cases, complications are the first indication that there is anything wrong; and as liver function deteriorates, one or more of the following complications may appear:

* oedema (fluid retention, usually in the legs); 

* ascites (fluid retention within the abdomen); 

* bruising;

* bleeding; 

* finger and nail changes; 

* palmar erythema (blotchy palms on the hands) 

* portal hypertension (a type of high blood pressure); 

* peritonitis (inflammation of the tissue covering the gut); 

* oesophageal varices (varicose veins in the passage from the mouth to the stomach); 

* gastropathy (stomach disease); 

* splenomegaly (enlarged spleen); 

* jaundice (yellowing of eyes and skin); 

* pruritis (itchy skin); 

* gallstones; 

* sensitivity to medication; 

* hepatic encephalopathy (brain disease) – the buildup of toxins in the brain can decrease mental function and cause coma; 

* confusion; 

* personality changes; 

* memory loss; 

* trouble concentrating; 

* a change in sleep habits; 

* insulin resistance and Type 2 diabetes; 

* gynaecomastia — male breast changes; 

* hypogonadism — resulting in testicular shrinkage, impotence (the inability to get and keep an erection that’s sufficient for intercourse) and loss of male sex drive; 

* immune system dysfunction and increased risk of infection; 

* hepato-renal syndrome — a type of kidney failure; 

* hepato-pulmonary syndrome — a type of lung failure; 

* hepatocellular (liver cells) carcinoma (cancer); 

* fetor hepaticus (characteristically foul breath); 

* coma; 

* liver failure and eventually, death.

 

Can cirrhosis be caused by something other than viral hepatitis?

Yes. The two other main causes of cirrhosis are alcoholism and obesity. 

 

What treatment is there if I develop hepatitis?

Treatments for acute and chronic viral hepatitis are different: 

Acute hepatitis (duration of less than six months) may respond well to simple symptom relief and, if possible, the avoidance of any type of medication.

An affected liver cannot eliminate drugs efficiently so chemical build up and eventual overdose may occur. 

Nausea, vomiting and abdominal pain are best treated as gently as possible, with rest and an adequate intake of fluid.

 

Sedatives and tranquillisers must be avoided, along with alcohol; all of which can have serious negative effects on an inflamed liver. 

Aromatherapy and acupuncture may help to improve general wellbeing and a healthy, well-balanced diet containing plenty of fresh produce, are recommended. However, hospital admission and intravenous fluids may be required. 

Chronic hepatitis (duration of six months or more) may be treated successfully in a proportion of patients with antiviral medication, such as interferon, or direct-acting antivirals that interfere with a virus’ ability to replicate. 

Each person is assessed individually, depending on severity and lifestyle factors.

However, even with treatment, cure is not always possible. 

 

If I have one strain of viral hepatitis what happens if I get another?

If you have one type of viral hepatitis, it can be very serious if you catch another. It increases the risk of developing complications, which could be life-threatening. 

 

What about my partner?

Your partner is potentially at risk, therefore:

* for their protection, it is essential that you are as open and honest as possible with them and with other close family and friends, about your condition; 

* you may need to consider protected sex;  

* your partner(s) must be tested and vaccinated or treated, as appropriate; 

* if you have Hepatitis C there is no vaccine for them to take;

* they may have other infections or a different type of viral hepatitis that they are unaware of, which might affect you; 

* telling them can be awkward, in which case a health advisor at a sexual health clinic, or your doctor or nurse can help you explain what viral hepatitis is and their potential risks.

They may feel angry and frightened and will probably have many questions that you may need help to answer. 

Your healthcare professional can help you do that if you don’t feel equipped to do so yourself. 

 

Does hepatitis affect the baby if a woman has it when she’s pregnant?

Yes. Viral hepatitis can affect the baby, so:

* babies born to women who have viral Hepatitis B should be vaccinated shortly after birth; 

* there is no vaccine against hepatitis C, so the baby may be at risk if the mother has this;

* the doctor treating the mother should advise about breast-feeding or using formula after the baby is born. 

 

Where can I have a blood test for hepatitis?

There are several places you can visit to have a blood test for hepatitis, including:

* your local sexual health clinic; 

* your doctor’s surgery can arrange for you to have the blood test; 

* some private sexual health clinics that offer hepatitis tests.

 

How soon can I have sex after being told that I have viral hepatitis?

This question is best answered by the physician looking after your health, who has access to your blood test results, but depends on a few factors,

* first, the person you have sex with should be protected as much as possible and they should have blood tests to assess their risk – i.e. whether they are ‘naïve’ to the virus (unaffected by it), whether they have the virus, or whether they are immune; 

* until you know that you are not infectious towards other people, if you do have penetrative sex, you should inform your partner of potential risk and use barrier protection (e.g. a condom) correctly during sex; 

* you may choose to avoid sexual contact with new partners until you are no longer infectious or until your partner is protected against the virus that you carry. 

 

What about oral sex and hepatitis?

Unprotected oral sex carries transmission risks, in particular:

* Hepatitis A and E are easily transmitted through unprotected oral sex with an infected person; especially if anilingus (anal rimming/licking) is performed; 

* Hepatitis B and C could be transmitted via blood-contaminated saliva and into wounds in the mouth.

See the section on Safer Sex.

 

What about anal sex and hepatitis?

Unprotected anal sex is the highest risk sexual activity of all, especially for HIV and Hepatitis B and C transmission. 

Tiny tears occur during anal stretching, which is sufficient to allow virus particles to pass from one person to another. Condoms and extra lubricant should always be used. 

See the section on Safer Sex.

 

How can I avoid catching hepatitis?

There are vaccinations against Hepatitis A and Hepatitis B, which confer protection for many years when the full course is taken correctly. 

Protection against Hepatitis B also gives you protection against Hepatitis D, since it requires ‘B’ to cause disease. 

if you have not been vaccinated against these strains for travelling to countries where they are endemic (common), it is advisable to do so several weeks before you travel. This also applies if you are looking after someone who has the virus. 

It is also advisable to have the vaccination if you:

* have multiple partners of either sex (particularly males who have sex with other males); 

* share drug injecting or snorting equipment; 

* want to give blood at some time; 

* or if you plan to have tattoos or body piercing performed on you. 

There is not, however, nor is there likely to be for quite some time, a vaccination against Hepatitis C (which is becoming increasingly common around the world). So, sensible precautions against it remain important. 

 

However, some things do require you to take active precautions:

Cuts and spills:

* cover cuts or other open areas (e.g. psoriasis or eczema skin conditions) with waterproof plaster before cleaning any mess up; 

* see ‘Universal Precautions’.

Women with hepatitis: 

* should dispose of their sanitary towel carefully in double plastic wrapping when throwing it out then wash their hands thoroughly, with soap and water; 

* tampons can be flushed down the toilet, as can some types of sanitary towel (check the label and local recommendations to avoid blocking the drains); 

* dildos and other sex toys should NOT be shared. 

Contact sports, fights and/or human bites   

People involved with contact sports, or fights, should assume they are at increased risk of infection if blood-to-blood contact occurs and the infection status of the other party is not known: 

* don’t assume there is no risk; any spilt blood should be treated as infectious unless you are reliably informed otherwise, as below for ‘Universal Precautions’ (p195); 

* wounds, on either party, should be squeezed immediately and made to bleed out, so that any infected matter is removed as quickly as possible – then follow the normal wound care procedures; 

* you should seek medical advice as soon as possible if you are not already protected against Hepatitis B, and obtain the vaccination within 24-36 hours; 

* two injections can be given straight away (one a vaccine and the other antibodies) before the vaccination course continues – with two more injections over six months, followed by a blood test to check if you’ve developed protection; 

* if you cannot see your usual doctor, go to ER / A&E at the hospital and explain what has happened to you, as soon as possible. 

NOTE: Professional boxers are routinely screened for HIV and Hepatitis B & C before fights, but at present amateur boxers, and many other sports people, are not. 

 

If you have viral hepatitis

You don’t need to have your own dishes or cutlery, as long as whatever you use is washed carefully with hot soapy water afterwards, to kill any active virus particles;

* however, in the early days of infection it may be sensible to keep your dishes and cutlery separate so that no one else can use them before they are washed and more is known about your status; 

* blood, urine and faeces (poo) are highly infectious and need extremely careful handling (this also includes handling infected babies’ nappies). 

 

If you are babysitting

People do not always disclose infection status openly. Although it is not commonly thought about, any open wounds, cuts or sores on your hands should be covered with waterproof plaster before changing a baby’s nappy.

If the baby is known to have viral hepatitis, the mother or father should inform you and extra precautions should be employed for the care of, and disposal of known infectious waste. 

It is good hygiene, in general, to employ extra precautions, routinely, if baby is not your own;

* protective gloves should be worn before changing soiled nappies; 

* soiled nappies should be gathered with care, wrapped, sealed and placed in a clinical waste bag. This is a specific plastic bag for household waste for incineration — not recycling; 

* hands should be washed thoroughly in hot, soapy water when you finish.

 

Your local council

In the UK, viral hepatitis used to be a ‘notifiable disease’. This meant that the 

Heath Protection Agency had to be notified when someone was diagnosed with viral hepatitis. 

This changed in 2010 and clinically infectious waste is disposed of in the same way as other household waste. 

if you are concerned, you can contact your local council’s Environmental Health Department for guidance about safe disposal of infectious material – examples of which include:

* soiled dressings, heavily soiled bedding (if you are unable to ‘hot-wash’ it thoroughly in a washing machine), incontinence sheets, or anything 

you have used to mop up any spills of blood, vomit, faeces and any other infected matter that is being thrown out; 

* soiled waste should be kept separately in special containers, before being collected for incineration (to be burnt). 

 

Other things to be careful about include:

* don’t share towels or nail files; 

* don’t share toothbrushes, razors or blades with other people (however careful you are, gums may bleed and razors may cut skin); 

* don’t share food by hand, always use utensils to serve it onto your plate and eat off that; 

* don’t eat communally from one plate or bowl, especially if food is being eaten by hand; 

* don’t share drinking utensils – pour contents from bottles/cans into a cup or glass to share contents; 

* don’t share drug injecting equipment – needles, syringes, water ampoules (sealed glass capsules) or glasses, filters, spoons etc.; 

* always wash hands with soap and hot water after going to the toilet and dry thoroughly; 

* suck a mint to freshen your breath before deep wet kissing instead of brushing your teeth (gums may bleed leaving blood stained saliva and raw areas of damaged tissue); 

* before acupuncture, electrolysis, body piercing or ‘stone insertion’ (whereby stones are inserted under the skin of the penis, as practiced in some cultures to enhance sexual pleasure), check that the therapist uses disposable needles and/or sterilises their equipment thoroughly; 

* tattooing – as above but also ensure that the ink has not been used with a previous customer (risking ‘pooling’ of virus particles that can spread through shared ink); 

* even though they will be taking universal precautions and treating everyone the same, inform your Dentist if you have or have had viral hepatitis because if your liver is affected at the time, without knowing, there may be problems stopping any bleeding; 

* and, anyone else who needs to know. 

 

NOTE: 

Hepatitis B and C are much more infectious and more easily spread than HIV – and most other infections – so you may be at risk if you share cigarettes, ‘spliffs’, notes used to snort cocaine, hubble-bubble (water pipes), glasses, mugs, cutlery, apples, etc. with an infectious person;

 * if sharing such items, the state of both mouths is important and whether there is blood in the saliva because (if shared immediately) a tiny amount is sufficient to spread viral hepatitis or HSV (Herpes Simplex Virus).

Hepatitis B is endemic (very common) in large parts of the world. 

We now live in multi-ethnic, highly mobile communities and it is evident that viral hepatitis is more prevalent than previously thought. 

* 30-70 per cent of intravenous drug users in the UK are said to be positive to Hepatitis C virus and many also have HIV infection;

* the same will be true in other countries and with more people travelling to and from the areas of the world where Hepatitis B is endemic, potential risk should always be assumed.

 

Universal precautions for dealing  with blood and body fluid spills in a non-clinic setting (blood, urine, faeces, saliva, vomit)

Equipment required:

* disposable gloves; 

* disposable paper, cloth, towels or newspaper to soak up the initial spill; 

* plastic bag; 

* household bleach; 

* bucket.

Action to be taken:

* put on disposable protective clothing – disposable latex gloves or kitchen gloves (and plastic apron, if available); 

* place disposable paper towels, cloth or newspaper over the spill to soak up the initial spill; 

* put this paper into a plastic bag; 

* dispose of gloves; 

* before touching bottle of bleach, put on new gloves; 

* pour neat bleach over the area of the spill and leave to soak for five minutes; 

* soak this up with more disposable paper towels, cloth or newspaper;

* add a dash of bleach to bucket of water (ratio 1:1000) to dilute bleach solution and wash the area with disposable cloth; 

* dry the area with another disposable cloth and leave for the air to complete the drying process; 

* double bag the rubbish and disposable gloves before putting it out in the household waste – not for recycling; 

* wash hands thoroughly after removing gloves; 

* if you have not already been vaccinated against Hepatitis B, arrange to do so now (as above); 

* if you are accidentally exposed to contaminated blood or body fluid, and have not been vaccinated against Hepatitis B, seek medical advice regarding immediate vaccination (as above).

 

What about using condoms?

See the section on Safer Sex

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