Hepatitis B—the "Hidden" STD
Anne and Joe, both lawyers in their late 30s, have been dating seriously for six months. After having mild flu-like symptoms for a month, Anne was diagnosed with hepatitis B. Joe immediately went to be tested, and to his surprise discovered that he is a chronic carrier of hepatitis B (HBV). Although Anne most likely contracted the virus from Joe, he's not sure how he got it. However, he vaguely remembers that one of his previous girlfriends had symptoms similar to Anne's for a few months.
Anne has a 90% chance of recovering fully from HBV within several months. If she doesn't recover, like Joe, she will go on to develop chronic hepatitis B. Anne would then have to cope with a lifelong illness that may cause liver damage. Chronic hepatitis also puts people at high risk for liver failure and liver cancer. Because Joe is already a chronic carrier, all of his future sexual partners should get vaccinated for HBV before having sex and should at least practice safe sex.
What Is Hepatitis B?
Hepatitis B is a common, yet serious, disease characterized by inflammation of the liver. It is caused by the highly infectious hepatitis B virus, and often contracted through unprotected sexual contact. Hence, HBV is considered a sexually transmitted disease (STD). Although there are other types of hepatitis, these are not as easily transmitted via sexual contact.
Most people who contract HBV recover within six months. However, a small percentage of them cannot clear the virus from their body and develop chronic hepatitis B. They may experience ongoing liver damage that can lead to cirrhosis (scarring of the liver), liver failure, or liver cancer. More than 200,000 Americans get HBV every year, and more than one million people in the US are chronic carriers.
Chronic hepatitis B consists of two possible states: chronic carrier or chronic active. Carriers do not have active disease, but HBV can reactivate at any time. Patients with chronic active form of the virus have continuing liver inflammation. Those with either chronic carrier or chronic active hepatitis are contagious to others and are at risk for cirrhosis and liver cancer. Patients with chronic active are at much higher risk for cirrhosis and liver cancer than are chronic carriers, but long-term carriers of hepatitis B are also at increased risk for these diseases.
The good news is that HBV is preventable.
How Is Hepatitis B Spread?
Hepatitis B is transmitted through contact with infected body fluids, such as blood, semen, and vaginal secretions, most often via unprotected sex. It can also be transmitted through blood from cuts or open sores and by sharp objects contaminated with infected blood (such as hypodermic needles, ear or body piercing, tattooing, razors, or toothbrushes). Mothers can pass it on to their newborns at birth or soon after. HBV is 100 times more contagious than the HIV virus that causes AIDS.
What Are the Symptoms of Hepatitis B?
Hepatitis B is often referred to as a "silent infection" because many people have no symptoms at all. Often, these people don't realize they are ill; in fact, most babies and children who get HBV don't seem sick at all. Many adults don't develop symptoms at first, but about 50% experience some symptoms after an incubation period of 40 to 140 days. Whether or not they have symptoms, a person with HBV can pass the virus onto other people. This explains why 30%-40% of people with HBV, like Joe, are not sure how they got it.
When symptoms are present, they may vary from mild and flu-like to severe. Common symptoms include appetite loss, nausea, vomiting, diarrhea, fatigue, fever, and joint or muscle aches. Some people also have dark urine, light stools, or jaundice.
How Is Hepatitis B Diagnosed and Treated?
The only way to know whether you have HBV is to have a blood test that detects the HBV antigen or antibody in your blood.
There are no specific treatments for acute HBV, other than treating the individual symptoms such as nausea, vomiting, and diarrhea. About 90% of adults clear the virus from their system within six months and then become immune to it. The other 10% become chronic carriers.
There is no cure for chronic HBV. If you are chronically infected you may or may not have symptoms. Either way, the virus is in your blood, which means that it can be transmitted to others while steadily attacking your liver.
Currently, there are four medications which have been approved by the FDA as treatment for chronic HBV. Interferon has been shown to help normalize liver enzymes, which reduces the possibility of liver damage. However, less than 50% of people with chronic HBV are able to take interferon, and only about a third of them experience significant long-term benefits. Peginterferon-alpha2a leads to a greater suppression of the virus and may replace conventional interferon as a first line treatment. Lamivudine (Epivir-HBV) is an HIV drug that is now available to treat hepatitis B infection. This drug is in a class of medications called nucleoside reverse transcriptase inhibitors. Adefovir, another HIV drug, can be used in cases of lamivudine resistance.
How Can I Prevent Hepatitis B?
A safe, effective vaccine for HBV is now available. The HBV vaccine is recommended by the US Centers for Disease Control and Prevention for all newborns, infants, teenagers, and anyone at high risk because of their lifestyle or job. High-risk populations include physicians, dentists, nurses, laboratory technologists, and staff and residents of institutions. The vaccine consists of a series of three shots given over six months. In most cases, the HBV vaccine provides lifelong immunity.
After possible exposure to hepatitis B, immune globulin and the vaccine may be given to prevent hepatitis B or lessen it’s severity if it occurs (called post-exposure prophylaxis). However, the most effective preventive measure is to avoid exposing yourself to the virus. To do that, take the following measures:
- Use condoms—Be sure to practice safe sex using a latex condom when having vaginal, anal, or oral sex.
- Shield yourself from possible transmission—Be careful when handling body fluids. Wear protective gloves and use bleach when cleaning up blood. Do not share needles, razors, or toothbrushes.
- Take immediate action if you are exposed—If you find out that you've been exposed to HBV, get an injection of hepatitis B immune globulin as soon as possible—no later than two weeks after the exposure. Also make sure you are vaccinated against hepatitis B, and that the first shot of the three-shot series is given right away.
Hepatitis B Foundation
Immunization Action Coalition
National Digestive Diseases Information Clearinghouse (NDDIC)
Sex Information and Education Council of Canada
Last reviewed October 2007 by Rosalyn Carson-DeWitt, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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