Hepatitis

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What is Hepatitis?

Hepatitis means inflammation of the liver. There are various causes - infections, alcohol, some types of medication, toxins and poisons.

This leaflet is about the viral infections which cause hepatitis and which can be passed on when you make love.

How can Viral Hepatitis be transmitted?

Viral hepatitis is caused by a group of viruses (A-G) which can all be passed on sexually as well as by other means. Hepatitis E,F+G are all rare in the UK and will not be discussed further here.

Hepatitis A: This virus is present in the digestive tract and in faeces (shit), and is mainly acquired by swallowing- usually in food, but rimming is also an important route of transmission. Basically, if faeces gets in your mouth then this is a route of transmission. This can happen during sex that involves fingering, licking (rimming), anal sex or handling condoms which have been used for anal sex. Recently, reports of Hepatitis A in gay and bisexual men have been increasing.

Hepatitis B: This is an important health concern for gay and bisexual men - up to 6% in the UK are carriers. Carriers (who usually have no symptoms) will show traces of the virus in all their body secretions; spread can therefore occur by sharing body fluids in any way, including sex or needlesharing. It is about 30 times more infectious than HIV, so activities which are relatively low risk for HIV may transmit the Hepatitis B virus quite easily.

Hepatitis C: This virus can be passed on sexually, but this route is very inefficient compared with blood spread. It is most easily acquired by needlesharing- injecting drug users are the most at risk.

Hepatitis D: Hepatitis D ("Delta") is really a "passenger" virus which can only cause infection if you are already infected with the Hepatitis B virus.

What are the symptoms?

Symptoms may appear up to six months after contact with the infection. But don't wait until symptoms appear if you know you have been in contact with someone who has hepatitis, as it is possible to offer preventive treatment if you seek medical advice early enough.
However, most people who get any of the hepatitis types described above will get no symptoms at all. If problems occur, they usually include mild fever, tiredness, loss of appetite, abdominal discomfort and yellowing of the skin and eyes. After a few weeks, the majority of people recover completely. A variable proportion of people with Hepatitis B and C become carriers - although appearing outwardly healthy, they are still infectious and may develop problems with liver inflammation during the course of the illness. HIV positive people are more likely to become carriers.

What is the treatment?

As with most infections, management depends on rest and good general health measures whilst waiting for the infection to subside. This will be checked in the blood tests, which ensure that the liver is returning to normal. It is sometimes (but not always) necessary to come into hospital. Alcohol and some types of medication should be avoided during the recovery period. In the small number of people who go on to develop liver problems as a result of becoming a carrier, a drug called Interferon can offer some benefit.

Prevention

Both Hepatitis A and B can now be prevented with vaccination:

Hepatitis A: If you discover that a recent partner has this infection, you can protect yourself by receiving Human Normal Immunoglobulin. A vaccination for Hepatitis A is now available, as this infection can be acquired through sexual contact, particularly rimming. It consists of two injections, six months apart.

Hepatitis B: This is highly recommended for all gay men. After first having a blood test to check that you are not naturally immune, it is given in a course of three (painless!) injections spaced out over a six month period. You should have your immunity levels checked out again after the course, as only about 90% of people respond and this is the best guide to timing of your booster dose (generally required every 3-5 years). An accelerated vaccination course is also available, over two months, which is slightly less effective, but gives more rapid protection.

Vaccination for Hep A and Hep B is free by appointment at the GUM Clinic, Edinburgh.

For further information on this and a range of other important sexual health issues, contact the GUM Clinic or Gay Men’s Health.

GUM Clinic, Level 4, Lauriston Building, Royal Infirmary of Edinburgh. Phone (0131) 536 2103
Gay Men’s Health, 10a Union Street, Edinburgh. Phone (0131) 558 9444

> Hepatitis A
> Hepatitis B
> Hepatitis C

Images courtesy of the Steve Retson Project

Last updated 20th May 2004

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