What is hepatitis B?
The term ‘hepatitis’ means inflammation of the liver and is generally caused by several different viruses. As the name implied, hepatitis B is caused by the hepatitis B virus. Once the hepatitis B virus enters your blood stream, it travels to your liver, the main site of hepatitis B virus multiplication. The multiplication of this virus triggers a response from the body’s immune system.
There are two stages of hepatitis B infection: the first stage occurs within the first 6 months and is considered to be ’acute‘. The second occurs if hepatitis B virus tests are positive more than 6 months after infection, where a person is considered to have ’chronic‘ hepatitis B, which can last a lifetime. Once suffers reach this chronic stage, they must be diagnosed and receive appropriate monitoring and treatment, otherwise they are in danger of dying from cirrhosis (scarring of the liver), liver failure or liver cancer.
How do I contract hepatitis B?
Hepatitis in general can be caused by excessive consumption of alcohol, drugs and chemical. As hepatitis B is a viral infection, most people with hepatitis B get the infection by having unprotected vaginal, anal or oral sex with an infected person – blood and other bodily fluids, such as semen and vaginal secretions, contain the virus in infected people. Hepatitis B infection is considered acute in the first six months after contraction, and most infected people often do not realise that they are infected and can pass on the virus during sexual encounters. This is because the symptoms are often generalised, i.e. not specific to hepatitis B infection. About 30% of people living with chronic hepatitis B in Australia have not been diagnosed.
As the hepatitis B virus is spread through infected blood, any contact through a cut or wound in your body would allow the virus to enter your blood stream. This can happen through getting a bite from an infected person, or when their blood spills onto your eyes, mouth or open skin. Hepatitis B virus is also spread through transfusion of infected blood, sharing infected needles and/or any injecting equipment, including those used for dental work, tattooing, medical procedures, body piercing or even needle stick accidents. It is also possible to contract the hepatitis B virus through sharing toothbrushes, razors and other such items that may be contaminated with blood. The virus can actually live outside the body for more than one week.
The good news? The virus is not passed on through ordinary social contact including hugging, kissing or from sharing cups or cutlery as long as these activities do not involve contact with blood.
How do I know I contracted it? What symptoms should I look for?
The first time you contracted the hepatitis B virus, you may develop symptoms of acute hepatitis B, which include fever, vomiting, nausea, abdominal pains and feeling generally unwell. You may become jaundiced (look yellow) due to a build-up of the chemical bilirubin that is made in the liver and spills into the blood in some liver conditions. Accompanying jaundice due to hepatitis is dark urine (darker than usual) and pale stools/faeces (paler than usual). These symptoms usually clear after a few weeks as your immune system either fights the virus or brings it under control. But in about half of cases, acute hepatitis B infection results in no symptoms, or only mild flu-like symptom. This is why a lot of people are not aware that they have been infected with hepatitis B. This is usually the case with new born babies who are infected with hepatitis B from their mothers during childbirth usually have no initial symptoms.
Once the virus is cleared by the body’s immune system within 3-6 months, you cease being infectious and are immune to further infection. This happens in 90% of cases. In the remaining 10% of the case, the virus advances into a chronic phase as the virus remains in the body for longer than 6 months. This may occur regardless of whether you experience symptoms during the acute phase. This commonly occurs with infected newborn babies (who contracted the infection from their mothers) where the virus remains in their system usually for life. The chance of full recovery only exists for adults who became infected with hepatitis B, not babies.
Once your infection has advanced to the chronic state, it is possible for you to remain well. This happens in 67% of cases. Your body still hosts the virus but suffers no damage to your liver and/or other organs. In other words, you are just a carrier (chronic inactive hepatitis B). Most carriers don’t know that they are carriers and can still pass on the virus to others. About 20% of carriers eventually clear the virus from their body naturally, but this often takes several years. The rest of the 80% of carriers are carriers for life.
Some suffers of chronic hepatitis B are not so lucky. They develop persistent liver inflammation. They may experience symptoms of varying severity including muscle aches, tiredness, feeling sick, lack of appetite, intolerance of alcohol, pains over the liver, jaundice and depression – or they may not experience any symptoms at all. But either way, they suffer from chronic active hepatitis B.
Left untreated for many years, suffers of chronic active hepatitis B develop cirrhosis – a scarring of the liver, which may further develop into liver failure as it increases in severity. After a further period of a time, a small number of people with cirrhosis then develop liver cancer.
That’s damn scary. Am I at risk?
Generally sexually active people are at risk of contracting any kind of STI, including hepatitis B. You are at a higher risk of contracting hepatitis B if you inject drugs, have HIV infection or are on immunosuppressive therapy. You are also at risk if you are un-vaccinated and have parents from regions of the world with high rates of chronic hepatitis B.
Shit. I think I have a high risk of contracting hepatitis B. What do I do now? Can I do anything?
OK, don’t panic. If you are not immunised and think you’ve been exposed to the virus, go to your doctor immediately. Learning if you are infected is the key to early diagnosis and appropriate treatment. The best way to determine whether you have hepatitis B is to test for it. A simple blood test can detect a protein on the surface of the virus called hepatitis B surface antigen, aka HbsAg. In addition, your doctor may give you an injection of antibodies called immunoglobulin as well as starting a course of immunisation, which may prevent infection from developing. Yes, hepatitis B can be prevented through vaccination. For adults, the hepatitis B vaccine is given as a series of 3 shots over a period of 6 months. The entire series is needed for long-term protection, and booster doses are not currently recommended.
If you test positive for HBsAg, you are deemed to be infected with hepatitis B. You will need to have other tests to check on the severity of infection, liver inflammation and damage to the liver. This includes: a blood test to assess how active the virus is as if it is multiplying rapidly it is more likely to cause liver damage, a blood test to assess the level of inflammation of the liver and how well it is working, an ultrasound scan of the liver and a biopsy to show the extent of any inflammation and scarring of the liver (cirrhosis) and other specialised blood tests being developed which assess the development and severity of cirrhosis.
My test result is positive. Oh shit.
Relax; it is not a death sentence. If you got hepatitis B, then treatment for acute phase is usually not to clear the virus from your body, but to ease the symptoms until the infection clears completely. Remember 90% of cases usually recover from acute hepatitis B naturally.
There is unfortunately no treatment that can prevent acute hepatitis B from advancing to chronic hepatitis B. Once your infection has advanced to the chronic stage, treatment works to delay and/or prevent further complications from developing by limiting the activities of the virus.
Treatment with medicines is usually continued for many years. There are currently two types of treatment: the interferon treatment, which is a medicine similar to the substance produced naturally in your body, which is also called interferon. It is basically an immune system booster and subsequently allows your body to fight infections. It works to fight infections by boosting your immune system. This treatment is usually given as an injection every week. The other type of treatment involves antiviral medicines, sometimes used in combination. As the name suggests, these work by stopping multiplication of the hepatitis B virus in the body. Your doctor will recommend which treatment is most suitable for you and monitor your progress through regular blood tests.
These medicines often have side effects, which may necessitate a change in medicines for some people by taking a lower dosage/strength. It is also possible for some people to develop resistance to their treatment medicine, which also necessitate a change in treatment. For those with cirrhosis (advanced ‘scarring’ of the liver), liver transplantation may be an option as the outlook following a liver transplant can be very good. However, it is still possible for the new liver to eventually become damaged by the persisting (chronic) hepatitis B infection.
The treatment of hepatitis B is a developing area of medicine. New medicines continue to be developed and the information above is very general. Your doctor should be able to provide more accurate information about the outlook for your particular situation.
If you have a current hepatitis B infection you should avoid having sex with anyone until they have been fully immunised and tested to see that the immunisation has worked. You should not donate blood, semen or carry a donor card, not share razor or injecting equipment or any other equipment that may be contaminated by blood. If you have a cut or wound, you must cover them with a dressing, and if your blood spills onto the floor or other surfaces, it must be cleaned away with bleach. You are also advised to eat a normal, healthy and balanced diet. Ideally, anybody with inflammation of the liver should not drink alcohol as it increases the risk and speed of cirrhosis (scarring of the liver) development.
Do I have to tell my partner?
Yes, absolutely. Your sexual partner should be tested and treated even if they do not have symptoms. If they are not treated, they risk passing the infection back to you and to others. If uninfected, they can be vaccinated to protect them from contracting hepatitis B.
Should I just like you know stop having sex altogether? But that’s not possible!
If you are infected with hepatitis B and your partner is undergoing the immunisation program for hepatitis B, you need to abstain from all kinds of sexual activities. But if you must have sex, then you must always use protection during sexual encounters.
Ideally, you don’t have any kind of sex to avoid hepatitis B or any kind of STI. We always say that abstinence is the best protection!