About hepatitis B

Hepatitis refers to inflammation of the liver. Hepatitis B is a contagious viral infection that causes liver disease. Infection ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis B can be either "acute" or "chronic."

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What is it?

Hepatitis refers to inflammation of the liver. Hepatitis B is a contagious viral infection that causes liver disease. Infection ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis B can be either "acute" or "chronic."

Acute hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis B virus. Acute infection can, but not always, leads to a long term “chronic” infection where the hepatitis B virus remains in a person’s body.

The likelihood of the infection becoming chronic depends upon the age at which someone becomes infected. The younger a person is the greater his or her chance of developing chronic hepatitis B will be. Approximately 90% of infected infants will develop chronic infection. Whereas adults and children aged over 5 have a much lower risk (6%–10%) of developing chronic infection. Hepatitis B is 50–100 times more infectious than HIV.

A hepatitis B vaccination can help protect you from getting the virus.

How is it spread?

Hepatitis B is usually passed from person to person through blood, semen (cum, including pre-cum) and vaginal fluids. It can be passed on through:

  • Unprotected penetrative anal or vaginal sex with a hepatitis B infected partner – this accounts for nearly two-thirds of adult acute hepatitis B cases.
  • Oral sex without a condom or dam.
  • Sharing sex toys if they are not washed or covered with a new condom before each person uses them.
  • Injecting drugs whilst sharing injecting equipment (needles, syringes, spoons) that has been used by someone infected with hepatitis B.
  • Needlestick or sharps injuries in health care settings.
  • Sharing personal care items that may have come into contact with a hepatitis B infected person’s blood, such as razors or toothbrushes/
  • Unsterilized tattoo or piercing equipment.

If you are pregnant and have hepatitis B, it’s possible to pass it to the baby during pregnancy or birth. The baby can be vaccinated after birth to help stop them getting the virus. 

Symptoms

Many people don’t know they are infected or may not have symptoms.
70% of adults will develop symptoms from the acute infection including:

  • Fever (high temperature)
  • fatigue,
  • loss of appetite,
  • nausea,
  • vomiting,
  • abdominal pain,
  • dark urine,
  • pale stools,
  • a rash, which may be itchy,
  • joint pain, and
  • jaundice (yellow color in the skin or eyes).

On average, symptoms appear 90 days (or 3 months) after exposure, but they can appear any time between 6 weeks and 6 months after being infected. Symptoms usually last a few weeks, but some people can be ill for as long as 6 months.

Some individuals with chronic infection have ongoing symptoms similar to acute hepatitis B, but most remain symptom free for as long as 20 or 30 years.

About 1 in 20 adults who get hepatitis B become “carriers”. This means the virus stays in the body and becomes a long-term infection, known as chronic hepatitis B. 

Chronic infections carry the same symptoms as acute Hepatitis C above, but most infected individuals remain symptom free for as long as 20 or 30 years and may not know they have the virus. They can still pass it on to other people and if it’s not treated it can eventually cause serious liver damage. 

If you have chronic hepatitis B, it’s important to take any treatment you are given and have regular liver check-ups. 

How does it affect you?

Most people who have hepatitis B will not have a long-term infection or any lasting health problems. 

About 15%–25% of people with chronic hepatitis B develop serious liver conditions, such as cirrhosis (scarring of the liver) or liver cancer. Even as the liver becomes diseased, some people still do not have symptoms, although certain blood tests for liver function might begin to show some abnormalities.

Diagnosis

Hepatitis B is diagnosed using a blood test.

The types of hepatitis B tests commonly used identify whether you:

  • are actively infected (acute or chronic)
  • have recovered from infection i.e., cleared it and are naturally immune
  • have not been infected but are susceptible to it and thus could benefit from vaccination to prevent being infected with the virus
  • are immune to hepatitis B because you have been vaccinated.

The tests we perform can indicate the first three scenarios. You will need to attend a clinic to test or confirm any vaccinated immunity.

If you test positive for hepatitis B, your physician can help you to manage the virus. 

It can take up to 3 months before hepatitis B shows up on a test. This is called the window period. If you test negative for hepatitis B during the window period, you may be advised to take another test later.

When should I take a test?

We recommend you get tested for Hepatitis B if you have any of the following risk factors:

  • People born in regions of the world with hepatitis B prevalence >2%.
  • U.S.-born people not vaccinated as infants whose parents were born in regions with hepatitis B prevalence >8%.
  • People with current or past injection drug use.
  • People who share needles, or sexual contacts of people with known HBV infection.
  • People currently or formerly incarcerated in a jail, prison, or other detention setting.
  • People with HIV infection.
  • People with current or past hepatitis C virus infection.
  • Men who have sex with men.
  • People with current or past sexually transmitted infections, or multiple sex partners.
  • Current or former household contacts of people with known HBV infection.
  • People on maintenance dialysis, including in-center or home hemodialysis and peritoneal dialysis, or who are pre-dialysis.
  • People with elevated alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels of unknown origin.
  • Children to pregnant people with known or suspected hepatitis B.

Treatment

For most people, hepatitis B goes away without treatment. This can be in a few weeks or can take a few months. You may be offered painkillers or medicine to stop you feeling sick and may be offered a check-up with a liver specialist.

It can also help to: 

  • Get plenty of rest. 
  • Drink plenty of water. 
  • Eat a healthy, balanced diet. 
  • Avoid alcohol and recreational drugs to help your liver get better. 
  • Keep cool and wear loose clothes if you have an itchy rash. 

If your body clears hepatitis B, you can’t get it again – but you can still get other types of hepatitis. You may be offered a hepatitis A vaccine. 

If you have chronic hepatitis B: 

  • You may be offered antiviral medicine and medicine to help with any symptoms, but not everyone needs treatment. 
  • Treatment can’t cure chronic hepatitis B but can help to manage it.  
  • You will need to see a liver specialist for regular check-ups. 

A small number of people may need a liver transplant.

People with hepatitis B should be monitored and reviewed regularly by a Hepatitis specialist for signs of liver damage and evaluated for possible treatment. If you test positive for hepatitis B visit a physician that has expertise in managing hepatitis B.

There is no medication available to treat acute hepatitis B. During this short-term infection, rest, a good diet, and lots of water / fluids, usually suffice.

Several medications have been approved for chronic hepatitis B treatment, and new drugs are in development. However, not every person with chronic hepatitis B needs to be on medication, and the drugs may cause side effects in some patients. Your specialist will advise you.

Contacting partners

If you are diagnosed with hepatitis B you will need to inform previous sexual partners or partners whom you shared injectable equipment with as they may also be infected. It is important for them to get medical advice and support as soon as possible.

Previous sexual partners should get hepatitis B testing, and consider hepatitis B vaccination.

Telling your current sexual partners means they can decide whether to get vaccinated – and you can both take steps to lower the chance of passing on the virus. 

After treatment

To lower the chance of passing on the virus, avoid sex until told you’re no longer infectious or until sexual partners have been vaccinated. 

Once you recover from hepatitis B and have cleared it, you develop antibodies that protect you from the virus, usually for life. An antibody is a substance found in the blood that the body produces in response to a virus. Antibodies protect the body from disease by attaching to the virus and destroying it.

If you have been infected with hepatitis B it is possible you may also have been infected with another STI: any STI if you became Hep B infected by sex and/or hepatitis C and HIV if you were infected from sharing injecting equipment. Therefore, we advise you to have a full sexual health screen including chlamydia, gonorrhea, syphilis, hepatitis C and HIV.

If you are infected with hepatitis B you should avoid alcohol because it can cause additional liver damage. You should also check before taking any prescription pills, supplements, or over-the-counter medications, as these can potentially damage the liver as well. You should have hepatitis A vaccinations and avoid donation of semen, organs, or blood (even if you have cleared Hep B and become naturally immune to the virus).

Prevention

There are some things you can do to lower your chance of getting hepatitis B. 

  • Get a vaccination if you have a higher chance of getting the virus.  
  • Use condoms when you have vaginal/frontal, anal or oral sex. 
  • Use dams for oral sex including rimming. 
  • Don’t share drug injecting equipment, or things like razors or toothbrushes with other people. 

If you are exposed to hepatitis B and have not been vaccinated, you can get treatment called hepatitis B immunoglobulin (HBIG) to help stop you getting the virus. It works best if you get it within 48 hours of contact with the virus. 
 

Vaccine

Hepatitis B vaccination 

If you have a high chance of being in contact with the virus, you should get the hepatitis B vaccine. If: 

  • You live with or have close contact with someone who has hepatitis B. 
  • You are, or a sexual partner is, a man who has sex with other men. 
  • You share drug injecting equipment. 
  • You have HIV or hepatitis C. 
  • You have liver or kidney disease. 
  • You have more than 10 sexual partners a year. 
  • You have recently been sexually assaulted. 

If you are travelling to a country where hepatitis B is common, check if a vaccine is advised.

Hepatitis B: Myths vs Facts 

There are different types of hepatitis. They all affect the liver, but they are not all the same, so it can be confusing to work out what’s true and what’s not. Here are the Hep B facts. 


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Myth

There’s no treatment for hepatitis B.

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Fact

Most adults don’t need treatment for hepatitis B because their immune system fights off the infection and clears it from the body. But about 1 in 20 adults become “carriers”, meaning the hepatitis B stays in the body becoming a long-term infection known as chronic hepatitis B. There’s no cure for chronic hepatitis B, but there is treatment available to manage symptoms and to help stop the virus causing liver damage. 


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Myth

You would know if you had hepatitis B.

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Fact

Many people with hepatitis B have it without knowing. You can have it without symptoms, but it’s also easy to think symptoms are another illness, like flu. Because most people recover in a few weeks or months, it’s possible to have it without ever knowing. But if you have chronic hepatitis B without knowing, eventually it can start to damage your liver – and you can pass the virus on to others. If you have a higher chance of getting hepatitis B it’s a good idea to get tested for hepatitis B and to consider getting vaccinated. 


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Myth

Hepatitis B can be cured with complementary medicine.

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Fact

There’s no evidence that hepatitis B can be cured with complementary medicine or herbal remedies. For most people, your immune system can clear the virus from the body on its own, but some people may need medical treatment to manage long-term infection. 


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Myth

Your sex life is over if you have hepatitis B.

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Fact

If you have long-lasting (chronic) hepatitis B, it’s likely that you’ll be able to pass it on to other people for the rest of your life. But if sexual partners are vaccinated against hepatitis B, they will be immune, and you won’t be able to pass it on to them. If a partner isn’t vaccinated, it’s a good idea to let them know you have hepatitis B, so you can decide together what level of risk is acceptable and take steps to avoid passing the virus on to them. 


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Myth

If you’ve had hepatitis A or C, you won’t get hepatitis B.

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Fact

If you’ve had one type of hepatitis, you won’t be immune to other types. 


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Myth

You can get hepatitis B from kissing.

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Fact

Hepatitis B can be found in saliva (spit). In theory, there is a chance that very long, deep kissing with someone who has hepatitis B could pass on the virus, but there are no known cases of hepatitis B where it’s certain this has happened. And you can’t get hepatitis B from coughs or sneezes, holding hands or sharing food, drink, or cutlery. It is possible, but very rare, for hepatitis B to be passed on through biting. 


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Myth

If a partner has hepatitis B, you’ll get it too.

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Fact

Just because a partner has hepatitis B doesn’t mean you will get it too. The best way to help protect yourself is by getting a hepatitis B vaccination as soon as you can. Hepatitis B is very infectious and can live in dried blood for up to one week, so it’s important not to share personal items like toothbrushes, razors, or hair clippers until you have been vaccinated. It’s also best to try and avoid having sexual contact until you have been vaccinated.


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