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Sexually Transmitted Infections (STI's) - Hepatitis A B & C
> WHAT CAUSES HEPATITIS?
Hepatitis means ‘inflammation of the liver’. It is caused by viruses that can be passed on during sex.

Different viruses cause different types of hepatitis, some more serious than others. The viruses are spread in different ways. Vaccinations can protect you against the two most common types of hepatitis, A and B. There is a combined vaccine that protects against both A and B.

---HEPATITIS A---

> WHAT CAUSES HEPATITIS A?
A virus found in shit causes Hepatitis A. It is spread when tiny amounts of shit get into your mouth.

> WHAT ARE THE SYMPTOMS OF HEPATITIS A?
Symptoms can be mild, so you may not realise you have hepatitis A. Up to six weeks after being infected you may feel mild flu-like symptoms. You can also:

• Have a fever or diarrhoea
• Feel sick or very tired
• Have dark coloured piss
• Have pale shit
• Lose weight
• You may feel sick when faced with tobacco smoke, fatty food and alcohol
• Your skin and the whites of your eyes can turn yellow

The illness can last for many weeks, taking many months to get your strength back. You’ll be most infectious before symptoms show.

> HOW IS HEPATITIS A PASSED ON?
The virus, contained in shit, needs to get into your mouth to infect you. Traces of shit can be left on your hands and on food prepared by an infectious person.

Especially abroad, water can also become contaminated. During sex shit can get on your fingers and in your mouth through:
• Rimming
• Fingering
• Fucking without condoms
• Handling used condoms and dildos

> HOW IS HEPATITIS A PREVENTED?
By getting vaccinated against hepatitis A. Or if you’ve not been vaccinated, by:
• Avoiding any sex which involves contact with shit.
• Using condoms for fucking.
• Washing hands after handling used condoms, dildos or fingering someone.
• Using a latex barrier between the arse and mouth of you and the man you’re rimming.
• Using latex gloves and water-based lube for arse play.

> HOW CAN I GET THE HEPATITIS A VACCINATION?
Sexual Health Clinics or your GP can give the vaccination. There are two types of vaccination against hepatitis A.

• One protects for only a few months. It’s called ‘immunoglobulin’ and is given to people travelling to countries where hepatitis A is common.
• The other protects for years. Gay men need this one (not ‘immunoglobulin’). The first injection protects for a year. A second injection given six months later increases your protection to 10 years. After 10 years a booster is needed.
• A blood test before being vaccinated shows if you’ve picked up the virus already. If you have, you’re now immune and don’t need the vaccine.
• Hepatitis vaccines are safe if you have HIV, but can briefly affect your viral load. So, the person vaccinating you needs to know if you have HIV and the doctor treating your HIV should be told you are being vaccinated.

> HOW IS HEPATITIS A TREATED?
• The treatment for hepatitis A is plenty of rest, which can mean many weeks off sick if you work.
• Your doctor will tell you for how long you should avoid drinking alcohol while your liver recovers.
• You’ll need to avoid recreational drugs.
• A blood test can show when you’ve fully recovered.

---HEPATITIS B---

Hepatitis B is very infectious and can easily be passed on during sex. Many people get it without realising. For others, it can mean months of feeling ill.

> WHAT CAUSES HEPATITIS B?
A virus that attacks the liver causes Hepatitis B. It is found in body fluids like blood, cum and spit.

> WHAT ARE THE SYMPTOMS OF HEPATITIS B?
Many people have no obvious symptoms, but you may get a flu-like illness which can be mild or more severe.

Other symptoms can include:
• Fever
• Headaches
• Feeling exhausted
• Having no appetite
• Being sick
• Feeling pain in your stomach

You may get jaundice, which means:
• Your skin and the whites of your eyes turn yellow
• Your shit goes a pale colour
• Your piss is dark-coloured

You can have the virus for between one and six months before showing any symptoms. The vast majority of people get over their symptoms, suffer no lasting damage and stop being infectious.

About 1 in 10 people who get the virus become ‘carriers’. This means they feel fine but stay infectious to others. ‘Carriers’ run a small risk of getting cirrhosis of the liver (which can lead to cancer).

About 1 in 100 people who get hepatitis B die from it.

> HOW IS HEPATITIS B PASSED ON?
The virus is usually in:
• Blood
• Cum
• Pre-cum

The virus is a lot more infectious than HIV, so it’s much easier to get or pass on through sex. It can be passed on through unprotected:
• Fucking and being fucked
• Sucking
• Rimming
• Sharing toothbrushes and razors (they could have infected blood on them).

The virus can be in spit and piss, so it’s possible it could be passed on through kissing and watersports (but this isn’t common).

> HOW IS HEPATITIS B PREVENTED?
By getting vaccinated against hepatitis B. Or if you’ve not been vaccinated, by:
• Using a condom for fucking
• Using condoms for sucking
• Using a latex barrier when rimming

• A blood test before you’re vaccinated shows if you’ve already had hepatitis B. If so, you’re now immune and don’t need the vaccine.
• The vaccinations are usually given as three injections over six months. You only get full protection if you have all the injections.
• The vaccine works for about 95% of people. The older you are (or if you have HIV), the less effective it can be. You might lose your protection sooner.
• A blood test after the last injection shows if the vaccine has worked.
• After five years you’ll need a booster injection.
• Hepatitis vaccines are safe if you have HIV, but can briefly affect your viral load. So, the person vaccinating you needs to know if you have HIV and the doctor treating your HIV should be told you are being vaccinated.

> HOW IS HEPATITIS B TREATED?
• You may need plenty of rest and, if you work, many weeks off sick.
• You may have to stop drinking alcohol for up to a year while your liver recovers. You’ll also need to avoid recreational drugs.
• If tests show you’re a ‘carrier’, drugs may be able to control the virus.

---HEPATITIS C---

> WHAT CAUSES HEPATITIS C?
• Hepatitis C is caused by a virus and can be very serious.
• Many people with untreated hepatitis C eventually develop some kind of liver disease.
• It is not as easy to get through sex as hepatitis A and B.

> WHAT ARE THE SYMPTOMS OF HEPATITIS C?
• Very few people notice any symptoms when first infected.
• Even over time symptoms are difficult to spot, taking years before you begin to feel ill.
• Extreme tiredness and depression can be symptoms.
• A blood test can show if you’ve been infected with the virus.

> HOW IS HEPATITIS C PASSED ON?
• The virus is in blood and is spread when infected blood gets into another person’s body.
• Anal sex without condoms can pass it on, as bleeding can happen during fucking (or fisting).
• Having HIV can make your blood more infectious for hepatitis C.
• People who inject drugs are at risk if they share injecting equipment.
• Blood donations are checked for hepatitis C.

> HOW IS HEPATITIS C PREVENTED?
• There’s no vaccine for hepatitis C.
• Using a condom and a water-based lubricant should stop the virus being passed on through bleeding during fucking. Latex gloves will help prevent
infection through fisting.
• Avoid sharing toothbrushes and razors with someone you know has the hepatitis C virus.
• If injecting drugs, not sharing injecting equipment takes away the risk.

> HOW IS HEPATITIS C TREATED?
• Infection is confirmed through a test which looks for hepatitis C antibodies (which can take up to 6 months to appear in the blood).
• Treatment lasting six to twelve months involves the drugs Alpha Interferon and Ribavirin.
• Hepatitis C may get worse quicker if you have HIV as well. If you have both infections you and your doctor may have to decide which illness needs
treating first, as HIV drugs and hepatitis C infection can both damage the liver.

*

Acknowledgement:
This information has been adapted from the Terrence Higgins Trust Resource: The Manual
http://www.tht.org.uk/publications/pubs_pdfs/themanual.pdf
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