When it comes to sexually transmitted infections (STIs), most people are aware of HIV, herpes, syphilis, gonorrhoea and chlamydia. Viral Hepatitis is a common occurrence but somewhat less talked about.
Gay, bisexual, and other men who have sex with men have a higher chance of getting viral hepatitis including Hepatitis A, B, and C, which are diseases that affect the liver. They are spread through blood, semen or other body fluids and can be spread through unprotected anal sex, oral sex or by sharing needles to inject drugs. Hepatitis A is spread through minute traces of faeces entering your body, which may occur during rimming. About 10% of new Hepatitis A and 20% of all new Hepatitis B infections in the United States are among gay and bisexual men. Even though a safe and effective vaccine for Hepatitis A and B is available, most men have not been vaccinated. Gay, bisexual, and other men who have sex with men also have a higher chance of getting Hepatitis C if they are involved in high-risk behaviours, such as injection drug use and other activities that result in blood sharing. While there is no vaccine for Hepatitis C, there are new, effective treatments. Hepatitis is particularly dangerous for people who are HIV positive.
This article focusses on Hep B and Hep C which are the most common infections amongst men who have sex with men.
What is Hepatitis?
Hepatitis means inflammation of the liver, a vital organ which breaks down harmful substances that enter the body, e.g.: drugs, medicines, alcohol. It stores substances such as vitamins and releases these as your body needs them. It produces proteins that help your body function properly, such as those that help heal wounds. When the liver is inflamed or damaged, its functioning can be affected. Hepatitis can be caused by heavy alcohol use, toxins, supplements, medications and certain medical conditions. But it is most commonly cause by a virus.
What are the symptoms?
The symptoms of viral hepatitis vary depending upon a person’s age and which type of hepatitis infection it is. There is also a difference between acute and chronic viral hepatitis. For acute hepatitis, symptoms, if they appear, will occur within several weeks to several months of exposure. Symptoms of chronic viral hepatitis can take decades to develop and people can live with an infection for years and not feel sick. When symptoms do appear with chronic hepatitis, it can be a sign of advanced liver disease. Symptoms for both acute and chronic viral hepatitis can include: fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured stools, joint pain, and jaundice. Hepatitis can be spread even if there are no symptoms.
How is the virus spread?
Hep B is spread when blood or body fluids such as semen from an infected person enters someone else’s body. The virus is 100 times more infectious than HIV and can last up to seven days outside the body.
Hep B can be spread by:
- Sex without a condom.
- Sharing personal hygiene equipment such as toothbrushes, razors and nail clippers
- Mother to child transmission at birth
- Getting tattoos or body piercings with non-sterile equipment.
Hep C is spread when the blood from a person infected with the virus enters the body of someone else. Hep C is more infectious than HIV and can last outside the body for up to four days.
Hep C can be spread by:
- Sex without a condom
- Sharing of injecting drug equipment
- Blood or blood product transfusions that occurred before 1992
- Non-sterile medical or dental interventions
- Mother to child transmission at birth
- Getting body piercings or tattoos with non-sterile instruments
How do you know if you have Hep B or Hep C?
Testing is the only way to be sure of your status. Blood tests are needed to assess infection as many people with either strain of the virus do not have symptoms.
In the case of Hep B, antibody tests can tell if you have been vaccinated or infected with the virus. Antigen tests show whether you currently have Hep B.
For Hep C, antibody tests are used to see if you have ever been infected. A positive test does not mean you are still infected and does not show whether you will develop chronic hepatitis C. A positive test must be followed by a PCR (polymerase chain reaction) test which will confirm whether you still have the virus in your body, as well as the amount of the virus present in your blood. A genotype test will determine the strain of Hep C, and this helps determine what treatment must be followed.
How can hepatitis be prevented?
Hepatitis can be prevented by:
- Using condoms during sex
- If you inject drugs, never share a needle with anyone else
- Hepatitis A and B can be prevented through vaccinations. Experts recommend that all gay and bisexual men be vaccinated for Hepatitis A and B. You will need to go to your private doctor as public clinics do not provide this service. The Hepatitis A and B vaccines can be given separately or as a combination vaccine. The vaccines are safe, effective, and require 3 injections over a period of 3 or 6 months. All 3 shots are needed for long-term protection. Booster shots, after a year, are sometimes advised.
There is currently no vaccine for Hepatitis C.
Is there a cure?
Curing Hep B is very difficult with current medications and patients with chronic Hep B need to be monitored all their lives. The need and type of therapy will be determined by the phase of the infection and the patient’s general health. Anti-viral therapy can manage the effects of the infection and prevent complications such as liver inflammation and organ failure. It also reduces the risk of liver cancer. It is important to take treatment as prescribed. Stopping treatment can result in a flare up of the infection. Not taking medication consistently can lead to infection by drug resistant forms of the virus.
Hep C can be cured in most patients with a course of antivirals taken for a year. It is important to complete treatment once started. Not taking medications properly can result in resistance to drugs. It is possible to become re-infected once cured so it is important to prevent further infection.