- it usually causes a short-term illness

- a vaccine is available against Hepatitis A (this is a simple injection to help your body build immunity to the specific infection)

- for short-term protection, an injection is available

- of longer term protection, a course of injections is available

Hepatitis B is found in:

* blood and body fluids - saliva, semen, vaginal secretions, urine, sweat and tears of infected people

* contaminated drug injecting equipment, including needles and syringes, water ampoules (sealed glass capsules) or glasses, filters and spoons etc

* some blood transfusions abroad

- it can lead to long term illness

- a vaccine is available against Hepatitis B

Hepatitis C - of which there are at least 6 types - each of those having many sub-types is found in:

* contaminated blood in transfusions or shared drug injecting equipment (as Hepatitis B above*)

* it can be passed on during sex

* this is considered more likely than was previously thought

* some blood transfusions abroad

* no vaccine is available for Hepatitis C yet, as there are so many different types and subtypes of the virus

* it can lead to long term illness

Hepatitis D requires Hepatitis B to survive:

* it is passed the same way

* vaccination against Hepatitis B will protect against Hepatitis D

* it can lead to long term illness

Hepatitis E - is found in contaminated drinking water, usually abroad - similar to Hepatitis A

* no vaccination is available yet

How long does it take to show in samples?

Hepatitis A

2-7 weeks

Hepatitis B

4 weeks - 6 months

Hepatitis C

5-12 weeks

Hepatitis D

up to 6 months

Hepatitis E

4-8 weeks

Where can I get a blood test?

* your GP can arrange the blood test for you or you can go to a GUM Clinic, where it is totally confidential. Click here for sexual health services in Bolton.

* if you GP is later asked to fill in insurance forms for you, there are often questions about sexually transmitted infections that they have to answer

* the choice is yours

How infectious is Hepatitis?

* Hepatitis B and C can be highly infectious - much more so than HIV / AIDS

* there are three different grades of 'infectiousness' for Hepatitis B, depending on the blood types of virus particles in the blood:

1. highly infectious - you could pass the virus through unprotected sex (sex without a condom), sharing a toothbrush or razor, drug injecting equipment (as Hepatitis B above*)

2. mildly infectious - you are less likely to pass the virus through unprotected sex (sex without a condom) but you cannot become a blood donor because your body (liver, kidneys etc) has only partially cleared the virus

3. not infectious - your blood tests tell the doctor that you have had 'Hepatitis' but you have cleared the virus particles and cannot give the disease to anyone else

What might I notice?

* you may notice nothing at all - many people don't even know they have Hepatitis until they have a blood test to check

* you may notice general 'unwellness' - like flu

* you may notice tiredness or fatigue

* your urine may be dark

* your bowel movements may be pale

* you may lose your appetite

* you may have abdominal tenderness and pain

* you may have a fever

* you might have night sweats

* you may itch and your skin take on a 'yellow tinge' - indicating jaundice

* the whites of your eyes may go yellow - indicating jaundice

* you may have morning headaches

* you may go off smoking or alcohol

What tests would I have?

* specific blood tests to check which Hepatitis virus you have

* if you become ill with Hepatitis you may have liver function tests (special blood tests) and liver biopsy - taking a tiny sample of liver tissues under local anaesthetic, which is sent to the laboratory to check the extent of any damage

If I have Hepatitis, what treatment is there?

* the main treatment is rest, peace and quiet - so don't tire yourself out by trying to do too much, physically

* eat a healthy diet - with plenty of fresh produce

* avoid alcohol and other drugs, unless prescribed by the doctor treating you

* some people benefit from aromatherapy and acupuncture to improve their general well-being

* you may be admitted to hospital

* if you have Hepatitis B or C you may be given a course of 'Interferon' injections

* your treatment depends upon how ill you are and which strain of the virus you have

* some people develop cirrhosis (pronounced 'si - ro - sis') of the liver - for which they are other causes

What is cirrhosis of the liver?

* cirrhosis is liver disease

* except for Hepatitis A, this is when blood is unable to flow freely through the liver and instead is diverted around it

* some people develop ascites (pronounced 'a - site - eez') - a swelling of the stomach (abdomen) with fluid - because the blood is unable to flow freely through the liver and does not contain enough protein

* ascites usually improves if salt is left out of the diet and the doctor prescribes a 'diuretic' which will make the body pass out salt and water through the kidneys, rather than the liver

* some people with severe ascites have to have the abdominal swelling 'drained' with a special instrument

* some people develop varices (pronounced va - ri - seez), enlarged blood vessels around the stomach and lower end of the gullet (oesophagus)

* varices can cause bleeding from around the stomach because the diverted blood is under pressure and the blood vessels sometimes 'burst' - this can be serious,  even 'life threatening'  

* lack of 'clotting factors' that are normally produced by the liver can also make the problems worse (internal bleeding becomes more likely)

* cirrhosis cannot be 'treated' or 'cured' as, by medical means - only its development stopped

* any cirrhosis caused as a result of Hepatitis will remain, even if the Hepatitis that caused it gets better

* some people with cirrhosis lead an entirely normal life

* other people with ascites or varices may need to have a liver transplant

* liver cancer may occur in people with long standing cirrhosis

What should I do after I finish the treatment?

* it depends upon how severely your liver has been damaged

* be guided by the doctor treating you but you will probably be able to lead a perfectly normal lifestyle and simply have regular blood tests by your GP to monitor your health

What about my partner?

* be as open and honest as possible with other people, for their protection

* they should be tested as soon as possible against the virus - they would be strongly advised to have the vaccination against Hepatitis B, although if you have Hepatitis C there is no vaccine yet

* your partner may have another germ or a different 'strain' of the virus that might affect you

* if you find it hard to tell your partner - a Health Advisor at a GUM Clinic or your doctor may be help you explain things more easily to them, they may feel angry or frightened and have lots of questions

What about sex?

* be advised by the doctor treating you

* you may decide on other forms of intimacy - rather than sex

* if you do have sex, condoms and extra lubricant are strongly advised

- Hepatitis is much easier to catch than HIV

What about oral sex?

* Hepatitis B and C can be present in saliva if there are bleeding gum, cuts or sores in the mouth or cut / chapped lips eg gums often bleed when newly brushed, so suck a mint before 'wet' kissing to freshen your mouth instead

* it is important to protect yourself and your partner, even if you both have or have had the virus

* Hepatitis A can pass by unprotected 'rimming' (anal licking)

* for oral sex to a man - the use of flavoured or non spermicidal condoms is wise and they are designed for this purpose

* or oral sex to a woman

What about anal sex?

- this is 'high risk sex'

- Hepatitis can be passed this way

- condoms and extra water based lubricant  should always be used

What about condoms?

* a correctly used condom - before any genital contact, can help to protect you from infection

What complications can come from having Hepatitis?

* some people become chronic (long term - more than 6 months) carriers of the infection and can pass the virus on for several years

* severe scarring of the liver can occur - leading to cirrhosis

* the blood supply in the liver may become blocked, which can lead to one type of high blood pressure

* the immune system may be weakened

* some people become unable to tolerate alcohol

* some people develop cancer of the liver after having Hepatitis

* some people become very ill and die from liver failure

How can I avoid getting Hepatitis?

* have the vaccine

* take time to get to know your partner, as well as they will let you

* the careful and consistent use of condoms, even with another method of birth control is wise, as protection against infection

* don't share needles or injecting equipment, syringes, filters, water ampoules (sealed glass capsules) or glasses, spoons etc

* enjoy other forms of intimacy, rather than penetrative sex

* never assume that a clean looking person is clear of infection

Mother to baby infection:

* if the mother is infected, the baby can be vaccinated against Hepatitis B shortly after birth - to prevent it getting the infection

* breastfeeding is good for the baby - but be advised by the doctor treating you

* the baby remains 'at risk' if you have Hepatitis C

Some general points about Hepatitis:

* have the Hepatitis B vaccination as soon as possible if you are looking after someone with Hepatitis or if you know you are 'at risk' - then you know you have some protection, even if you make a mistake with the following hygiene suggestions

* Hepatitis is not caught by social contact ie shaking hands, hugging etc

* the germs are passed in blood and blood stained body fluids - so, as long as you are careful with those, you minimise the risk the infection

* Hepatitis can be a serious illness and is not one to be taken lightly

* you still have to be very careful if the person has Hepatitis C, as there is no vaccination

* Hepatitis B virus can remain active in dried blood for over a week

* Hepatitis is harder to destroy than HIV, which dies in the air in a fairly short time

* Take precautions and develop good habits of hygiene

The vaccine:

* see your doctor within 36-hours, if you feel you have been put 'at risk' of Hepatitis B

* two injections can be given straight away (one a vaccine and the other 'antibodies'), then the vaccination course continues - two more injections over 6 months for Hepatitis B

If you have Hepatitis:

* you do not need to have your own dishes and cutlery, as long as they are washed properly in hot soapy water - to kill the virus

* but in the early days of the illness, it may be sensible to keep your own dishes and cutlery separate - so that no-one else can use them before they are washed

* blood, urine and faeces (bowel waste) are highly infectious and need extremely careful handling (this includes handling babies nappies)

Cut and spills:

* cover cuts or open areas (eg psoriasis or eczema skin conditions) with waterproof plaster before cleaning anything

* wear rubber glovers before dealing with infectious matter (don't let other people use the same gloves)

* wash your hands in hot soapy water after you finish and dry them on your own towel, which no-one else should be allowed to use

* use disposable cloths to mop anything up - and dispose of them in a double wrapping of plastic

* use household bleach to disinfect  and then dry any contaminated areas, with separate disposable cloths

* always wash hands with hot soap and water, after using the 'loo'

Women with Hepatitis:

* should dispose of sanitary towels carefully in double plastic wrapping, if throwing them out - and then wash hands with hot soap and water after doing so

* tampons can be flushed down the 'loo', as can some sanitary towels

If you get involved in fights or with human bites:

* the infected blood should be mopped up, as above

* wounds on either party, should be squeezed immediately and made to bleed in order to clean out any infected matter as quickly as possible - then follow the normal procedures for wound care and see a doctor

* either party should get the vaccination, if they are not already protected

Other things to be careful about, where blood contamination can occur:

* don't share towels or nail files

* don't share toothbrushes, razors or blades with other people - gums may bleed, razors may cut skin - however careful you are

* it is safer to suck a mint to freshen your breath when indulging in 'deep wet kissing', than to brush your teeth just before you have sex or kiss - as gums often bleed