When it comes to STDs, it doesn't get more confusing than hepatitis. At least with gonorrhea or syphilis, it's pretty straightforward. It's not like there's a syphilis A, B, and C, and not all of them are sexually transmitted and a few are curable, and Baby Boomers are more likely to get Syph-C, and wait, which is the one Steven Tyler had?
The disease isn't just confusing; according to the CDC, it's also on the rise. Hepatitis C (HCV) have almost tripled between 2010 and 2015. And those are just the reported cases. The CDC estimates that the majority of people with hepatitis C don't even realize they have it. The number of new infections each year could be as high as 33,900, and may kill more people annually in the United States than any other infectious disease. The outlook is just as grim for hepatitis A and B, with the number of infections rising in recent years, staggeringly so if you take into account unreported or missed diagnoses.
You have two choices: You can spiral into full-on panic mode, or you can take a deep breath, stop Googling (that's just throwing gas on the medical paranoia fire), and let us answer your burning questions.
What's the difference between hepatitis A, B and C? Are they all different diseases?
They're all diseases of the liver—an inflammation that can lead to fibrosis (scarring), cirrhosis, or liver cancer—and are caused by three different viruses that can be transmitted in different ways, sometimes but not always sexual.
"Sometimes but not always"? Are you kidding with that? That's like saying smoking sometimes but not always causes lung cancer. Does it or doesn't it?
Well, let's start with hepatitis C. The usual mode of infection is blood. So the most common way this virus gets spread is by sharing needles. That includes drug addicts and tattoo enthusiasts who maybe should be a little more careful about who they're getting matching tats with. But the problem is bigger than just the usual suspects. It might even be generational: A recent study in the American Journal of Preventive Medicine found that of the 3.5 million people infected with HCV, 80 percent of them are so-called "Baby Boomers" born between the years 1945 and 1965.
All that hippie sex they had at Woodstock?
Not even close. It's likely because the virus wasn't officially discovered until 1989, and it took until 1998 before the CDC came up with recommendations for how to prevent and control the disease, which included guidelines we now take for granted like "never reuse or share syringes." So a Baby Boomer could be completely tat free and may have never even tried an intravenous recreational drug, and they might be at a greater risk for HCV than their grandkids just because they got shots from their doctor during the last century.
So how is it "sometimes" sexually transmitted?
Not all sex is gentle lovemaking between monogamous partners. Philip R. Spradling, a medical officer at the CDC's Division of Viral Hepatitis, says the risk of contracting HCV from sexual contact is very low, but that risk increases if you have multiple sex partners, have other sexually transmitted diseases like HIV, and engage in "rough sex."
As in…like, I ask my partner to choke me or something?
No. We mean sex that occurs in orifices that might not be accustomed to penetration, like your anus, and sexual activity that's just enthusiastic enough that it causes tissue damage. Any sexual activity "in which the skin barrier is compromised increases the risk of transmission," Spradling says. That could be ripped genital tissue, or it could just be she's having her period and you both said, "Eh, what the heck, let's have sex anyway." In fact, you don't even have to be sexually intimate to pass along or catch HCV from somebody. Just sharing a razor could be enough to cause an infection if the person you're borrowing it from has the HCV virus. "Any activity that produces breaks in the skin or bleeding, even micro-abrasions, could result in hepatitis C transmission," Spradling says.
So we could be having unprotected sex and I'd be fine, but I borrow her razor because I forgot mine at home and now I've got HCV?
Theoretically, sure. We're not sure why you're into post-coital shaving with lady razors, but yes, your odds of transmission are higher with the razors.
So what about the others? Hepatitis A. Can I get that from infected blood, too?
Not usually. You're most likely to get the hepatitis A virus (or "HAV") from eating poop.
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Okay… um… why am I eating poop?
Well, it's not always on purpose. It could be from eating food that was prepared by an infected person who didn't bother to wash his or her hands. (No, seriously, it happens.) Or when somebody goes to the bathroom and doesn't wash their hands and then touches you. That happens way, way more than you probably want to think about. HAV is more common in countries without chlorinated water, which can kill the hepatitis A virus in a water supply. But in terms of sexual transmission, it is mostly a risk for those who practice sexual activities with a high vulnerability for HAV infection.
Yes. Among other things.
"Any rectal play from fingering, rimming, to scat puts you at higher risk for acquiring hepatitis," says Glenn Doupe, a registered nurse at Vancouver Coastal Health. "Transmission happens fairly easily through ingestion of microscopic amounts of fecal matter."
What about B? More blood or feces, or something else?
Nope. Just sex. Hepatitis B is a sexually transmitted virus found in blood, semen, vaginal fluids and saliva. It's between 50 and 100 times easier to transmit HBC sexually than HIV. But here's the good news: It's also the only STD with a vaccine.
Oh thank god. So if I get—
Oh, sorry, no, if you get HBC, there's no cure. The vaccine is to prevent infection, and ease the symptoms if you already have it. But hey, at least there's a vaccine! And it's been available for over thirty years, so it's not like it's in the "let's see if this works" trial stage.
We haven't talked about symptoms. What should I be looking for?
Well, here's the thing…there are rarely symptoms. For hepatitis A, you might have some mild flu-like symptoms, like nausea, fever, and diarrhea, but only about ten percent of infected people still have those symptoms six months later. So it could feel like a flu bug, and then it passes, and you're like, "Hey, that was a flu bug! Glad that's over!"
What about B and C?
HBV can cause abdominal pain, yellowing eyes, and dark urine. HCV can cause some fatigue and loss of appetite. But in both cases, symptoms are often nonexistent or disappear quickly. These aren't viruses with obvious symptoms that send people clamoring for a free clinic.
So how do I make sure I don't get hepatitis?
Avoiding sexual activity that involves feces or blood is a good start, or at least practice safe sex if you do. There are vaccinations that help prevent the spread of both hepatitis A and B, Spradling says. Twinrix is a popular option, which offers lifelong protection against the B virus and at least 25 years for adults for the A virus. If you believe this 2014 study from the University of California, San Francisco, your best bet for avoiding a sexual transmission of hepatitis C is by being in a monogamous, heterosexual, long-term relationship. Which seems way too obvious to be helpful. Isn't being in a monogamous, heterosexual, long-term relationship the best way to avoid any sexually transmitted disease? It's one step away from abstinence, right?
The study's author, Norah Terrault, a UCSF professor and the director of the Viral Hepatitis Center, says it's not because monogamous heterosexual couples are less likely to participate in "high-risk" practices like anal sex or having sex during menstruation. "Rather it means that sexual contact is inefficient means to transmit this virus," she says. "It may be related to the level of virus in the semen and vaginal secretions or the mucosal immunity of the partners. We don't really know precisely."
So if I get it—A, B, or C —I'm screwed?
Not necessarily. There's a cure for hepatitis C, assuming you can afford it—but the cost for treatment is $84,000, and few insurance companies will pay for it (yet)—and hepatitis A "does not cause chronic infection like B and C do, so it does not need a cure but it does have a vaccine," Spradling says. There remains no cure for chronic hepatitis B, but there's hope for the future. Jing-hsiung James Ou, a professor of molecular microbiology and immunology at the Keck School of Medicine of USC, is confident that "we'll see an effective treatment for hep B in my lifetime."
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