GAY & BISEXUAL MEN - Hepatitis Prevention
Hepatitis is inflammation of the liver. Gay and bisexual and other men that have sex with men have an increased risk of hepatitis due to some viral infections.
What is hepatitis A
Hepatitis A is caused by the Hepatitis A virus and is found in the faeces of someone with hepatitis A infection. This means it can be spread through some sexual practices, such as oral-anal sex (rimming), digital-anal sex and sharing sex toys. The virus can also spread through contaminated water or food, usually through poor hand washing.
How can Hepatitis A affect me?
Hepatitis A can be unpleasant, but it's not usually serious and most people make a full recovery within a couple of months. Symptoms usually develop around four weeks after becoming infected, although not everyone will experience them.
Symptoms can include fever, feeling tired and generally unwell, joint and muscle pains, loss of appetite, stomach pain, jaundice, itchy skin, dark urine and pale faeces.
Some people may not have any symptoms and may not recognise they have become infected.
With Hepatitis A there are usually no long term problems, however it can occasionally last for many months and, in rare cases, it can be life-threatening if it causes the liver to stop working properly (liver failure).
Should I be tested for Hepatitis A?
You would only be tested for hepatitis A if you were unwell with symptoms of hepatitis. It is not possible to have chronic infection with Hepatitis A so there is no need for a test if you are well.
What is Hepatitis B
Hepatitis B is an infection of the liver caused by the Hepatitis B virus which is found in the blood and body fluids of someone with Hepatitis B infection. Hepatitis B infection is more common in certain countries.
Hepatitis B is 100 times more infectious than HIV. It can be spread by:
- Having unprotected anal, vaginal or oral sex or using sex toys
- Injecting drugs and sharing needles and other drug equipment, such as spoons and filters. It can also be transmitted by sharing equipment to snort drugs.
- Having a tattoo, piercing or medical or dental treatment with unsterilised equipment
- A needlestick injury
- Sharing toothbrushes or razors contaminated with infected blood
How can Hepatitis B affect me?
Many people have mild or no symptoms and don't recognise that they have become infected. Symptoms can include fever, feeling tired and generally unwell, joint and muscle pains, loss of appetite, stomach pain, jaundice, itchy skin, dark urine and pale faeces. In rare cases, it can be life-threatening if it causes the liver to stop working properly (liver failure).
The vast majority of people infected with Hepatitis B in adulthood are able to fight off the virus and fully recover within one to three months. Most will then be immune to the infection for life.
People who also have Hepatitis C or HIV are at greater risk of chronic infection and becoming carriers.
Those with chronic infection may have no symptoms for years but the liver is slowly being damaged. Although treatment can help, there's a risk that people with chronic Hepatitis B could eventually develop serious problems such as scarring of the liver (cirrhosis) or liver cancer.
If you have chronic infection you can pass the virus on to others.
Should I be tested for Hepatitis B?
Because it is possible to have chronic infection with Hepatitis B without having any symptoms testing is recommended if you have ever been at risk. Testing is done by a blood test.
What is hepatitis C?
Hepatitis C is caused by the Hepatitis C virus and is found in the blood someone with hepatitis C infection. It is spread by blood to blood contact. The hepatitis C virus is highly infectious; this means you can get the virus even if you have been in contact with a very small amount of it. It can be passed on through open cuts, wounds or scratches but cannot be passed on through unbroken skin. In the UK the virus is often passed on by the sharing of drug injecting. To date the increased incidence of hepatitis C in men who have sex with men is thought to be confined to men who experience sex associated with trauma or injury, men using recreation drugs (including taking recreational drugs during sex, known as 'ChemSex', men who are HIV positive or have a history of an infection called lymphogranuloma venereum).
There are an estimated 39,000 people currently living in Scotland with a chronic (long term) hepatitis C infection and more than half of these people are undiagnosed.
How can hepatitis C affect me?
Many people have no symptoms at all and may never know they have the virus. About one in five people infected with hepatitis C will clear the virus, in its acute form, within two to six months. About 80% of people who are infected with hepatitis C will develop a chronic infection.
Chronic hepatitis C can be very different for each individual; many find some of their symptoms come and go and some may find they have the symptoms of tiredness, weight loss, loss of appetite or feeling sick, discomfort in the liver area, inability to tolerate alcohol, joint and muscle ache, itchy skin, jaundice and flu like symptoms including fever chills and night sweats.
Should I be tested for Hepatitis C?
Because it is possible to have chronic infection with Hepatitis C without having any symptoms testing is recommended for men who are HIV positive and in HIV negative men where there is an additional risk factor (e.g. multiple or anonymous partners, sex associated with trauma or, injury, history of recreational drug use or rectal lymphogranuloma venereum infection). Hepatitis C is a curable condition and some men merit regular testing.
How can I protect myself against Hepatitis A, B and C?
As Hepatitis A, B and C are can be passed on during sex using a condom for oral, vaginal and anal sex and a dam when licking/sucking the genitals or anus) will reduce your chances of becoming infected. It will also reduce your chances of other sexually transmitted infections. Condoms and dams are available free of charge from all sexual health services and many other places – just ask your local sexual health clinic. Sexual Health D&G offer a condoms by post service.
If having rough or extreme sex and / or using drugs reduce your risk by:
- not sharing needles and syringes to inject drugs since this poses the highest risk of hepatitis C infection in any situation
- not sharing notes or straws that are used to snort drugs
- not sharing tubs of lube or sex toys. The hepatitis C virus is fairly robust and can survive potentially for up to 48 hrs on the surface of a sex toy or a tube or lube.
The increased risk of sexual transmission of hepatitis C under the influence of drugs is also due to the greater length of time that sex can go on for and as a result the increased likelihood of blood to blood contact through damage to the skin or membranes. The highest risk sexual activity is unprotected fisting. Damage to the cuticles (skin around the finger nails) is very common, as is damage to the lining of the rectum. Knowing this may influence the decisions some men make about the type of sex they have.
The good news is that there are vaccines that can give most people protection against the Hepatitis A and Hepatitis B viruses. There is no vaccine for hepatitis C but testing is crucial to identify men who are chronically infected. Up to one in five of those chronically infected may develop serious liver disease and a small proportion of these go on to develop liver cancer. Hepatitis C treatment is becoming increasingly effective with nine out of ten patients being cured of their infection.
Is the vaccine safe?
Hepatitis A and B vaccines have been available for many years and have a very good safety record. Like many other vaccinations there can be mild soreness and redness around the site of the injection. Much less common are flu-like symptoms. Serious side effects including allergic reactions are very unusual. Vaccination is available from Sexual Health clinics.