Sexual Health Advice - Patient Information Leaflets
Hepatitis B
What is hepatitis and hepatitis B?
Hepatitis means inflammation of the liver. There are many causes of hepatitis. For example, alcohol excess and several different viruses can cause hepatitis. One virus that causes hepatitis is called the hepatitis B virus. This leaflet is only about hepatitis B.
How can you get hepatitis B?
From person to person (sometimes called ‘horizontal transmission')
Blood and other bodily fluids such as semen, vaginal secretions and saliva contain the virus in infected people. The main ways in which people become infected include:
- Share needles to inject drugs.
- Now, all blood donated in the UK is checked for the hepatitis B virus (and for certain other infections). So, the risk of getting hepatitis B from a blood transfusion is very small
- From needlestick accidents where the needle has been used on an infected person.
- There is a small risk of contracting the virus from sharing toothbrushes, razors, and other such items which may be contaminated with blood. Also, from using equipment which is not sterile for dental work, medical procedures, tattooing, body piercing etc.
- A bite from an infected person, or if their blood spills onto a wound on your skin, or onto your eyes or into your mouth.
From mother to baby (sometimes called ‘vertical transmission')
This usually occurs during childbirth. This is very common in some parts of the world where many people are infected with this virus but it is rare in the UK .
The virus is not passed on during normal social contact such as holding hands, hugging, sharing cups.
What are the symptoms and how does hepatitis B progress?
It is helpful to think of two phases of infection with hepatitis B virus. An acute phase when you are first infected, and a chronic (persistent) phase when the virus remains long-term in some cases.
Acute infection
In about half of cases, no symptoms or only mild ‘flu-like' symptoms develop in the acute phase. You may not be aware that you have been infected with hepatitis B. In particular, babies who are infected from their mothers during childbirth usually have no symptoms at first.
If you do get symptoms they may develop shortly after you first become infected with the virus (within 1 – 6 months which is the ‘incubation period'). Symptoms include:Symptoms of acute hepatitis B infection usually go after a few weeks as the immune system either clears the virus, or bring it under control. Rarely, an acute severe (‘fulminant') hepatitis develops which is life-threatening.
Following the initial ‘acute' phase:
- In more than 9 in 10 cases in adults, the virus is cleared from the body by the immune system within 3 – 6 months. In this situation you are no longer infectious and you are immune to further infection.
- In up to 1 in 10 cases in adults, the virus remains long-term (‘chronic hepatitis B infection'). This may occur whether or not you have symptoms in the acute phase.
- In more than 9 in 10 babies infected from their mothers, the virus remains long-term.
Therefore, there is a good chance of full recovery and clearing the virus for adults who become infected with hepatitis B. This is not so for new-born babies who usually remain infected.
Chronic infection
A chronic hepatitis B infection is one that persists long-term – more than six months. Of those people who develop chronic hepatitis B infection:
- Up to 2 in 3 people remain well. You can have the virus in your body but develop no damage or problems to the liver or other organs. This is called being a ‘carrier' and is sometimes called ‘chronic inactive hepatitis B'. You may not know that you are infected. However, even if you have no symptoms, you can still pass on the virus to others who may then develop problems. About 1 in 5 carriers eventually clear the virus from their body naturally, but this may be after several years.
- Some people develop persistent liver inflammation (sometimes called ‘chronic active hepatitis B') Symptoms include: muscle aches, tiredness, feeling sick, lack of appetite, intolerance of alcohol, pains over the liver, jaundice, depression. Symptoms vary in severity and some people have liver inflammation without having any symptoms.
- Some people develop cirrhosis. Cirrhosis is like a ‘scarring' of the liver which can cause serious problems, and ‘liver failure' when it is severe. Cirrhosis usually takes many years to develop after being infected with hepatitis B.
- A small number of people who develop cirrhosis can develop liver cancer after a further period of time.
How is hepatitis B diagnosed and assessed?
A simple blood test can detect if you are infected with the hepatitis B virus. This test detects a protein on the surface of the virus called hepatitis B surface antigen (HbsAg). The result is usually known within 3 days. If you are found to be infected (if you are HbsAg positive), then other tests may be advised to check on the severity of infection, liver inflammation and damage to the liver. You should be referred to a specialist to have these done.
Can hepatitis B be prevented?
If I am infected, how can I prevent passing on the virus to others?
If you have a current hepatitis B infection you should:
- Use condoms when having sex. Also, sexual partners may wish to be tested for hepatitis B, and immunised if appropriate.
- Not share any injecting equipment such as needles or syringes.
- Not donate blood or semen, or carry a donor card.
- Not share razors, toothbrushes or other items that may be contaminated with blood.
- Cover and cuts or wounds with a dressing.
- If any of your blood spills onto the floor or other surfaces following an accident, make sure it is cleaned away with bleach.
Immunisation
Anyone who is at increased risk of being infected with the hepatitis B virus should consider being immunised. These include:
- Workers who are likely to come into contact with blood products, or are at increased risk of needlestick injuries. For example nurses, doctors, dentists, medical laboratory workers.
- People who inject street drugs, and their sexual partners and children
- People who change sexual partners frequently
- People who live in close contact with someone infected with hepatitis B. This includes all prison inmates. Also, families who adopt or foster a child may be offered immunisation when the hepatitis B status of the child is not known. Remember you cannot catch hepatitis B from touching people or just normal social contact. So, household visitors and friends are not usually at risk. However, close regular contacts are best immunised.
- People who regularly receive blood transfusions.
- People who live or work in residential accommodation for those with learning difficulties may be at risk of scratching or biting by residents. People who attend day centres for people with learning difficulties may also be offered immunisation.
- Travellers to countries where hepatitis B is common who place themselves at risk when abroad. The risk behaviour includes sexual activity and injecting drug use. Also, if you need a medical or dental procedure in these countries where you are not sure of how sterile the equipment is.
Post exposure prevention
If you are not immunised and have been exposed to the virus you should see a doctor immediately. For example, if you are a health worker and you have a needlestick injury. You can be given an injection of antibodies called immunoglobulin as well as starting a course of immunisation. This may prevent infection from developing.
Preventing infection in new-born babies at risk
All pregnant women in the UK are offered a hepatitis B blood test. If the mother is infected, her baby is given injections of antibodies and also immunised straight after birth. The transmission of the virus to the baby is thought to mainly occur during childbirth and not during the pregnancy. With this treatment there is a good chance of preventing infection developing in the baby.
What is the treatment of hepatitis B?
Treatment for the acute phase
No treatment can clear the virus. If you develop symptoms when first infected, treatment aims to help ease symptoms until they settle and go. For example, drinking plenty of water to avoid dehydration. In rare cases, a severe hepatitis develops which may need specialist hospital care. There is no treatment that can prevent acute hepatitis B from becoming chronic.
Treatment for chronic infection
Not everyone with chronic infection needs treatment. It depends on how ‘active' the disease is. The main aim of treatment is to prevent active disease progressing to severe liver inflammation and cirrhosis. A liver specialist will advise on when treatment may help.
Antiviral treatment does not work in every case and side-effects can be troublesome. Newer medicines are continually being developed and it is best to seek expert liver specialist advice.
