When discussing sexual health and viruses, HIV tends to dominate the conversation. But there is another infection that is just as dangerous: viral hepatitis. Viral hepatitis is the most common chronic, bloodborne infection in the world. It causes more deaths worldwide than HIV/AIDS, malaria, or tuberculosis.
What makes the disease so dangerous is the inflammation that it causes in the liver. Inflammation is swelling that occurs when body tissue becomes injured or infected, such as when one sprains an ankle or catches food poisoning. But even as most inflammation is easy to treat, when the swelling is chronic—as with chronic viral hepatitis—it can prove fatal.
Because there are many types of hepatitis and modes for its transmission, the disease is easy to misunderstand. It can be caused by physical injury, bacterial infections, adverse drug interactions, or viruses. In popular culture, the disease is closely associated with heavy alcohol use—which has declined in the past 20 years—and Pamela Anderson and Natalie Cole, both of whom had hepatitis C (HCV).
But even as there are many ways that hepatitis can manifest, it must not be forgotten that it is usually caused by and spread through a virus. In the United States, hepatitis A, B, and C are the most common forms of viral hepatitis.
Before continuing, let’s take a look at what the liver does and why it is essential.
The liver is a major filtration system for the body, responsible for processing blood that comes through the stomach and intestines before passing it on to the rest of the body. It also makes cholesterol and proteins, regulates blood clotting, removes bacteria and toxins from the bloodstream, and creates and sends bile through the hepatic ducts to the gallbladder.
But keep in mind that there are crucial differences between hepatitis A, hepatitis B, and hepatitis C.
The Differences Between Hepatitis A, B, and C
- Hepatitis A is an acute virus that does not develop into a lifelong condition. Most people recover without treatment.
- Hepatitis A and B have vaccines that people can get to protect them from contracting the viruses.
- It is possible for people who contract acute hepatitis B or acute hepatitis C to develop chronic hepatitis versions of the viruses.
- Chronic hepatitis B, while manageable, is incurable.
- There is no vaccine to prevent hepatitis C; however, there is now a cure for chronic hepatitis C.
- Symptoms of viral hepatitis can include fatigue, nausea, easy bruising or bleeding, loss of appetite, dark urine, clay-colored stool, joint pain, and yellowing of the eyes and skin.
- Not everyone who is infected with hepatitis A, B, or C will develop symptoms. But even those who are asymptomatic are still able to transmit the viruses.
Keep reading to learn more about the differences between hepatitis A, B, and C.
Hepatitis C is a bloodborne pathogen caused by the hepatitis C virus (HCV). The Department of Health and Human Services calls HCV “a silent epidemic,” because it often has no symptoms and can go decades without detection, even as it inflicts cumulative and debilitating damage upon the liver. There are currently 2.5 to 4 million people living with the disease in the United States alone, making it the most common and deadliest form of hepatitis. It is also the most common bloodborne virus in the country, one of the leading causes of liver transplants, and one of the leading causes of death among people living with HIV.
The incubation period for HCV infection generally ranges from two weeks to six months. The disease can survive for up to three weeks outside of the human body.
Upon infecting the liver, hepatitis C makes copies of itself to infect other liver cells. This causes the liver to attack those infected cells, leading to a slow and chronic state of inflammation.
The virus was discovered 30 years ago. Because screening for HCV only began in 1990—and hygiene standards were less thorough than they are now—infections were once more common among those who received blood transfusions, tattoos, piercings, or donated organs. This made baby boomers (anyone born between 1945 and 1965) and veterans of the Vietnam War the largest population of people living with chronic hepatitis C.
Since 1992 and the change in standards of hygiene and detection, hepatitis C most frequently occurs through shared, non-sterilized drug injections, a problem that has been exacerbated by the opioid crisis. So, while baby boomers account for 75% of people currently living with chronic hepatitis C, adults under 40 years old account for the highest rate of new infections.
Transmission is also a risk factor in non-licensed tattoo settings and in prisons. While this is rare, sharing personal-care items, such as toothbrushes or razor blades, can also transmit hepatitis C because of the potential transference of contaminated blood through minute cuts and sores.
Mothers living with hepatitis C face a 6% to 7% chance of passing the disease onto their newborns, though the likelihood of transmission increases for women living with HIV. The risk of infection occurs only during birth. Hepatitis C cannot be passed through breastmilk, though mothers living with the virus are encouraged to deliver milk through bottles in order to avoid the possibility of exposing their newborns to cracked or bleeding nipples.
Although hepatitis C exists in semen and vaginal and menstrual fluid, the rate of infection via vaginal sex is extremely low, and it is almost nonexistent via oral sex. However, safer-sex precautions are encouraged for anyone engaging in rough sex, because it can cause bleeding, or anal sex, due to the likelihood of abrasions in the anal lining.
People with multiple sexual partners are encouraged to use condoms as a safety precaution against HCV, because the risk of infection from the disease increases with exposure. Safer-sex practices are also encouraged for people who are living with HIV or another sexually transmitted infection, because the likelihood of infection after exposure increases for individuals with compromised immune systems.
People living with HIV are encouraged to get tested for hepatitis C because the two viruses, while different, share similar modes of transmission. Baby boomers, Vietnam War veterans, and anyone who has ever injected a drug, at any point in their life, are also encouraged to get tested for the virus.
Left undetected and untreated, about 70% of people infected with acute hepatitis C will develop chronic hepatitis C, a lifelong illness that may develop into a host of fatal conditions. Though it is costly to cure outright, newly developed treatments have greatly improved the mortality rates and quality of care for people living with the disease.
Newly developed treatments for hepatitis C include direct-acting antivirals (DAAs), which target HCV with a series of inhibitors that block its viral enzymes and proteins. This prevents HCV from replicating and reproducing itself or attaching onto liver cells. A combination of two of these drugs, sofosbuvir (Sovaldi) and daclatasvir (Daklinza), for example, shows a 90% cure rate and minimal side effects, especially when compared with the prospect of undergoing a liver transplant.
If you have questions or concerns about possible transmission, contact your health care provider immediately. The blood test for HCV is simple. Getting it could save your life.
Hepatitis B (HBV) is a bloodborne virus that is transmitted in the same way as hepatitis C: exposure to hepatitis B–infected blood through injections or wounds. Though it is less common than HCV, HBV has seen an increase in transmission due to the opioid crisis, particularly among adults under the age of 40. This increase in infections is also due to the low rate of vaccinations against the virus.
The hepatitis B vaccine comes in three spaced-out shots, each offering a greater degree of protection, with the third shot creating lifelong protection against the virus. Though receiving all three of the shots of the vaccine offers lifelong immunization, fewer than one-third of all adults in the United States have been inoculated.
At present, an estimated 850,000 people in the United States are living with chronic hepatitis B. According to the Centers for Disease Control and Prevention (CDC), due to a lack of detection and testing, this number may be as high as 2.2 million.
Recovery from acute hepatitis B is largely dependent upon age, with children exhibiting greater vulnerability to developing chronic hepatitis B, whereas adults are more likely to completely recover. However, one in 10 adults who contract the virus will develop chronic hepatitis, with one in 20 becoming carriers.
According to the World Health Organization, HBV is 50 to 100 times more contagious than HIV. While there is a vaccine for HBV, there is no cure for those who develop chronic hepatitis B, though detection and treatment help to fight its fatal complications. To help combat infection rates, the CDC has recommended administration of the first dose of vaccine to all newborns within 24 hours of their birth. Babies born to mothers living with HBV are recommended to receive the first dose within 12 hours of birth.
Though hepatitis A (HAV) is less dangerous than hepatitis B or hepatitis C, it is still an unpleasant experience. The virus is entirely vaccine-preventable. It is found in the feces of people living with HAV. It is spread by putting something in the mouth of an uninfected person that has been contaminated with the stool from a person with hepatitis A.
The modes of transmission include oral sex, oral-anal sex, eating contaminated food, or not washing one’s hands after using the toilet. Sewage contamination of water supplies and food is also a common source of transmission for the virus.
People infected with hepatitis A usually recover after four to eight weeks. HAV never develops past its acute infection phase and is rarely fatal unless one has a concurrent hepatitis C infection. After recovering from HAV, the body develops antibodies which prevent future infections. These antibodies do not protect individuals from hepatitis B or hepatitis C, which are caused by entirely different viruses.
It is important for gay men—or anyone who engages in anal sex—to receive the hepatitis A vaccination, especially because it is available in a dual formula that protects one from hepatitis B as well. This vaccination is called Twinrix and is delivered through a series of three shots, with each shot granting greater degrees of protection. The final shot of the Twinrix vaccination offers lifelong protection against hepatitis A and hepatitis B.
It is important to understand that though viral hepatitis is transmitted through many different modes—such as exposure to unsanitary conditions, needle sharing, or unprotected sex—the virus is not caused by those conditions. Though one can acquire alcoholic hepatitis through chronic heavy drinking of alcoholic substances, one cannot get viral hepatitis through anal sex unless one of the persons involved already has the virus. Similarly, just as hepatitis A can be transmitted through fecal matter, feces itself does not cause the virus.
These distinctions are essential to keep in mind when discussing any pathogenic infection, whether it is HIV, HCV, or chlamydia. For more information about hepatitis A, B, or C, visit TheBody’s resource pages: