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Hepatitis A is the most common of the seven known types of viral hepatitis. Infection with the hepatitis A virus leads to inflammation of the liver, but complications are rarely serious.
How hepatitis A is spread
The hepatitis A virus (HAV) is found in the faeces of someone infected with the virus. It only takes a tiny amount of faeces getting inside another person’s mouth to cause hepatitis A infection. Personal hygiene, such as careful hand washing, can minimise the risk of the virus being passed on.
HAV is a common infection in many parts of the world where sanitation and sewage infrastructure is poor. Often people become infected with HAV by eating or drinking contaminated food or water.
Hepatitis A is also classed as a sexually transmitted disease (STD) because it can be passed on sexually, particularly during activities such as anilingus (rimming). The washing of genital and anal areas before sex, and the use of condoms or dental dams can help to prevent this risk.
Hepatitis A can affect all age groups. Once a person is exposed to the virus it takes between 2 and 6 weeks to produce symptoms.
Signs and symptoms of hepatitis A
It is possible to experience mild or no symptoms whatsoever, but even if this is the case the person’s faeces will still be infectious to others. Many people who become infected with HAV will have symptoms that include:
• A short, mild, flu-like illness;
• nausea, vomiting and diarrhoea;
• loss of appetite;
• weight loss;
• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);
• itchy skin;
• abdominal pain.
The infection usually clears in up to 2 months, but may occasionally recur or persist longer in some people. Once a person has been infected and their body has fought off the virus they are permanently immune. Occasionally symptoms may be severe and require monitoring in hospital.
There are rarely any complications with hepatitis A infection. Permanent damage to the liver is very unlikely, but in extremely rare cases the infection can be fatal, particularly in older people.
Where to go for help
If you have any symptoms or you are worried you may have been infected with hepatitis A, you should discuss your worries with a doctor. They may be able to run tests themselves, or else will refer you to someone who can.
Some countries have specific sexual health clinics that can help you directly. Check our help and advice page or your local telephone directory to see if you have a clinic near you.
What does a positive test result mean?
HAV is tested for using a blood test. A positive test result means the patient has either had a past infection or is currently infected. The type of antibody detected in the test will indicate whether the infection is current or has been cleared. A patient who tests positive may be asked about recent contacts and sexual partners that may need to be tested too. A patient who has already had the infection and fought it off is naturally immune to HAV.
What does a negative test result mean?
A negative test result means the patient is not infected with Hepatitis A. If the patient is believed to be at high or ongoing risk of infection, a doctor may advise immunisation.
Treatment for hepatitis A
There is no specific treatment for HAV and most people fight off the virus naturally, returning to full health within a couple of months. The doctor will advise avoiding alcohol and fatty foods as these can be hard for the liver to process and may exacerbate the inflammation.
Patients should get plenty of rest and eat a nutritious diet. They should also ensure they do not spread HAV by washing their hands after using the toilet and before preparing food. Patients with more severe symptoms may be monitored in hospital for a short period.
Hepatitis A immunisation
Hepatitis A immunisation is given in a series of injections. The first single injection in the arm gives protection for a year. The second booster injection at 6 to 12 months extends protection for up to 10 years.
The hepatitis A vaccine may be routinely recommended for young children living in areas with high incidence of hepatitis A, and anyone travelling to countries where hepatitis A is endemic. In addition, immunisation may be recommended for people whose sexual practices are likely to put them at risk.
Immunisation may also be recommended to prevent hepatitis A developing if a person suspects they have been exposed to the virus.
Someone who is infected with hepatitis A should limit the amount of alcohol they drink. Their doctor may also offer dietary advice.
The doctor will advise about any precautions necessary to avoid infecting others with the virus.
Hepatitis B is similar to hepatitis A in its symptoms, but is more likely to cause chronic long-term illness and permanent damage to the liver if not treated.
How hepatitis B is spread
The hepatitis B virus (HBV) is very common worldwide, with more than 350 million people infected. Those with long term HBV are at high risk of developing liver cirrhosis or liver cancer.
Hepatitis B is most frequently passed on through the exchange of bodily fluids with an infected person. HBV is estimated to be 50 to 100 times more infectious than HIV.1
HBV can be spread in the following ways:
• By unprotected (without a condom) penetrative sex (when the penis enters the anus, vagina or mouth) with someone who is infectious. Also by sex that draws blood with someone who is infected.
• By sharing contaminated needles or other drug-injecting equipment.
• By using non-sterilised equipment for tattooing, acupuncture or body piercing.
• From an infected mother to her baby, most commonly during delivery. Immunisation of the baby at birth prevents the transmission of hepatitis B.
• Through a blood transfusion in a country where blood is not screened for blood-borne viruses such as HBV.
Hepatitis B cannot be spread through sneezing, coughing, hugging or coming in contact with the faeces of someone who is infected.