Hepatitis

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Hepatitis A
Hepatitis B
Hepatitis C

Hepatitis is a viral infection that causes inflammation of the liver. There are three main types: A, B, and C. They all have similar symptoms but are caught in different ways and have different consequences for your long-term health. Hepatitis A and B are preventable by vaccination given by a short course of injections, which gives you protection over several years. Gay men can get the hep B vaccination free of charge at GUM clinics. Some clinics also offer vaccination against hepatitis A. Since a significant number of gay men are hepatitis B carriers, being vaccinated is highly recommended. There are no vaccines available against hepatitis C.

Hepatitis A

How do you get it?

Hepatitis A is found in shit and is acquired by getting shit in your mouth. This can happen through contaminated food or water (which is why you should always wash your hands after wiping your bum), or through sex acts such as rimming (arse-licking). Even just tonguing the outside of your partner's arsehole can be risky, more so if he has not showered beforehand. Fucking or fingering a guy's arse can also transmit hepatitis A, because it's easy to get a bit of shit on your fingers and then from your fingers to your mouth.

How do you prevent it?

The best way to prevent hepatitis A is by getting vaccinated. The vaccine is available at most GUM clinics. The vaccine is a short course of injections taken at set intervals (usually six months between injections). The number of injections you need will depend on your response to the vaccine, but it is usually two or three.

How do you know you've got it?

The symptoms appear two to six weeks after infection. These can include headache, fever, loss of appetite, nausea, vomiting, lethargy, and muscle and joint pains. Later your eyeballs and skin may become jaundiced (go yellow). Your piss can turn dark brown and your shit near white. Your liver (just below your stomach on the right side of your body) may become tender. Not everyone with hepatitis A will have such severe symptoms.

A sexual health clinic can test you for hepatitis A. They will usually ask questions about the sex you've had to see if this test is necessary. It is tested for by taking a blood sample.

How do you treat it?

The only treatment for hepatitis A is plenty of rest, a low-protein and high-carbohydrate diet, and avoiding fatty foods and alcohol. The illness clears up by itself within one to three months, causing no lasting damage. Once you have had hepatitis A you will be immune to catching it in the future.

Which sexual partners should I inform if I've been diagnosed with hepatitis A?

If you have jaundice (yellowing of the skin), anyone you've had sex with two weeks before the jaundice appeared, plus anyone you had sex with within a week of the jaundice appearing.

Hepatitis B

How do you get it?

The hepatitis B virus is in blood, cum, piss, spit and shit, as well as other body fluids of a person who's infected. The virus can be spread by sharing needles, sharing snorting straws, unprotected sex, or by getting blood or other infected body fluids in the mouth, eyes, or on to broken skin. It is much more infectious than hepatitis A or HIV.

How do you prevent it?

Using condoms can help prevent many cases of hepatitis B but the best way to prevent infection is by getting vaccinated. The vaccine is available from GUM clinics. The vaccine is a short course of injections taken at set intervals (usually a few months between injections). The number of injections you need will depend on your response to the vaccine but expect about three. This is to ensure the vaccine is boosted and that you remain immune to hepatitis B. This vaccine is not effective for everybody and some people will not be able to acquire full immunity to the virus.

How do you know you've got it?

If you catch hep B, you may not show any symptoms, but if you do they can include fatigue, nausea, vomiting, pain in the liver area, dark urine or light coloured shit, and fever. Many adults develop jaundice, which turns their skin and the whites of their eyes a yellowish colour.

While most people get over hepatitis B and cease to be infectious, about 10% remain long-term carriers who are able to pass on the infection for many years. hepatitis B has a long incubation period of one to six months. During this time, a person is infectious although this may not be obvious or easily detectable. When symptoms do appear, they are usually similar to those for hepatitis A. Sometimes, however, the symptoms may be mistaken for flu. Most people who have hepatitis B remain ill for one to two months, normally without needing hospitalisation. In extreme cases though, hepatitis B can lead to liver cirrhosis and cancer, and possibly death.

A sexual health clinic can test you for hepatitis B. They will usually ask questions about the sex you've had to see if this test is necessary. It is tested for by taking a blood sample.

How do you treat it?

There are two types of treatment for hepatitis B. Interferon injections can be given over a four-month period to boost the immune system so it will aggressively attack the virus. Antivirals may also be used. These are oral drugs that interfere with the virus' ability to reproduce. Some of these drugs are the same as those used to treat HIV.

Along with treatment, it is recommended that you rest and avoid alcohol.

Which sexual partners should I inform if I've been diagnosed with hepatitis B?

You should inform nyone you've had sex with, or shared a needle with if you have injected drugs, up to two weeks before any jaundice appeared and up until your blood tests are negative. If you don't have symptoms, it will depend on what stage of hepatitis B you have and the level of risk involved, so talk to your health adviser about this.

Hepatitis C

How do you get it?

Hepatitis C is not as easily passed on as hepatitis A or hepatitis B, but it can be the most damaging form of the disease. The hepatitis C virus is present primarily in blood (including dried blood) and can also be present in cum.

Until recently, unprotected sex was not thought to be a route of transmitting the virus. However, some studies suggest that gay men, and in particular HIV-positive gay men, are getting hepatitis C sexually.1 However, this does not mean negative guys are not at risk from unprotected sex and further research is needed.

Studies have shown a number of ways that hep C could be transmitted. These are:

Sharing needles for injecting drugs, including steroids, with someone who has hep C.
Being fisted by a man with hep C who has cuts or sores on his hand and isn't wearing a glove.
Being fisted by a man who has just fisted another man with hep C and who hasn't put on an unused latex glove or thoroughly washed his hands between partners.
Using a dildo or other sex toy that has just been used on a man with hep C and which hasn't been thoroughly cleaned, or had a new condom put on it.
Sharing a drug snorting straw, banknote or bullet with someone with hep C, as small specks of infected blood could be on the straw, banknote or bullet.
Fucking without condoms with a man who has hep C.

How do you prevent it?

Hep C was only discovered in 1989 and so not as much is known about it as the other forms of hepatitis. You can reduce the risk of getting hep C by:

Using a condom when you fuck or get fucked.
Using a new sterile syringe and needle for injecting steroids or recreational drugs.
Making sure the man fisting you is wearing an unused latex glove. If you don't have any latex gloves, make sure the man fisting you doesn't have cuts or sores on his hands and has washed his hands thoroughly if he has just fisted someone else.
Using a new condom on your dildo if it's been used on someone else.
Using your own drug snorting straw, banknote or bullet.

How do you know you've got it?

Hepatitis C produces many of the same symptoms as hepatitis A and B, although most people do not notice any symptoms when they are first infected.

A sexual health clinic can test you for hepatitis C. They will usually ask questions about the sex you've had to see if this test is necessary. It is tested for by taking a blood sample.

How do you treat it?

In about four out of every five cases the body will be unable to clear hepatitis C on its own. It can be treated with an antiviral drug alongside immune-boosting injections of interferon. Treatment can take over 48 weeks and is not always successful on the first attempt. Treatment is more effective early on so if you've been at risk, getting tested regularly is recommended. Hepatitis C treatments are likely to be less successful if you have HIV. The side effects of the drugs used to treat hepatitis C can be severe and include depression.

People with hepatitis C should stay away from drugs, fatty foods and especially alcohol. This is essential, since many people develop intolerance to alcohol following damage to their liver.

In 2009, about 300 gay men were diagnosed with hepatitis C at sexual health clinics in the UK.2

Which sexual partners should I inform if I've been diagnosed with hepatitis C?

You should inform anyone you've had sex with, or shared a needle with if you have injected drugs, up to two weeks before any jaundice appeared and up until your blood tests are negative. If you don't have symptoms, it will depend on what stage of hepatitis C you have and the level of risk involved, so talk to your health adviser about this.

References:

1 Taylor LE, Holubar M, Wu K, Bosch RJ, Wyles DL, Davis JA, Mayer KH, Sherman KE, Tashima KT. Incident hepatitis C virus infection among US HIV-infected men enrolled in clinical trials. Clinical Infectious Diseases, 2011;52(6):812-818.

2 Health Protection Agency (HPA). Total numbers of STI diagnoses and other episodes of care seen at genitourinary medicine clinics by gender and sexual orientation, UK and England: 2000 - 2009. Health Protection Agency, 27 August 2010.