Dear Dr. Eva,

I have been told that I have hepatitis C and also that I need to get shots to protect me from hepatitis A and hepatitis B. This does not make sense to me. If I have hepatitis C now, doesn’t that mean I already had A and B?

Just Diagnosed

Dear Just Diagnosed,

Your question makes total sense and shows how confusing medical terminology sometimes can be. Hepatitis A, B, and C are not different stages of one disease: they are three different infections caused by three very different viruses. They are called A, B, and C for the order in which they were discovered. There are now hepatitis viruses named all the way up to hepatitis G, but only A, B, and C are important in causing human illness.

‘’Hepatitis” just means liver irritation. Hepatitis can be caused by infections, chemicals, legal and illegal drugs, and by some over-the-counter herbal products. The commonest form of chemical hepatitis is caused by drinking alcohol. This is alcoholic hepatitis, which can progress over a period of years to alcoholic cirrhosis (liver failure) and death. Hepatitis can also be caused by excess fat in the liver. This is called “fatty liver” and is caused by overweight or alcohol use. Any type of chronic hepatitis can eventually lead to liver failure (cirrhosis), cancer of the liver, and death. People with any type of hepatitis should avoid liver irritants, particularly alcohol and acetaminophen (Tylenol).

Hepatitis A is transmitted through feces (bowel movements). Among gay men, it is often transmitted by rimming (oral-anal sex). In other social groups, hepatitis A is most often transmitted by an infected person who prepares food without first washing their hands well. That is why hepatitis A outbreaks are often traced to restaurants. The severity of illness from hepatitis A varies. Hepatitis A can make some people very ill for several weeks, but other people can be infected with hepatitis A and recover from it without ever feeling sick. After recovering from hepatitis A, a person is immune, meaning they can never be infected with hepatitis A again. Unlike types B and C, hepatitis A never becomes a long-term infection. There is a vaccine to prevent hepatitis A. It is given as two shots, six months apart. The hepatitis A vaccine is especially recommended for gay men, international travelers, food service workers, and health care workers. Since you may have had hepatitis A without knowing it, it is a good idea to get a blood antibody test to see if you are already immune before taking the vaccine.

Hepatitis B is transmitted through blood and other body secretions including ejaculate (cum) and vaginal secretions, as well as through feces. It is most easily transmitted by unsafe sex and sharing needles. Hepatitis B often causes severe illness and can lead to death. However, the same as with hepatitis A, some people never show any signs of infection. Most people recover from hepatitis B, but 6% to 10% become chronically infected. In the last few years, effective treatment has become available for chronic hepatitis B, but it must be taken continuously (like HIV treatment). There is currently no cure available for hepatitis B. The treatment stops the progression of cirrhosis and decreases the risk of liver failure and cancer. There is a vaccine to prevent hepatitis B. It is given as three shots over a six month period. Since some people have had hepatitis B without knowing it, it is a good idea to get a blood antibody test to see if you are already immune before starting the vaccine series.

Hepatitis C is transmitted mainly through blood contact, by sharing needles, and through contaminated blood products, but it is also sometimes transmitted sexually. Hepatitis C does not cause severe illness at the time of infection, but it often becomes a chronic infection. Like hepatitis B, chronic hepatitis C infection can cause cirrhosis, liver cancer, and death. Hepatitis C can now be cured with a several-month course of anti-viral medicines similar to the medicines used to treat HIV. Unfortunately, so far there is no vaccine to prevent hepatitis C.

Getting vaccinated against hepatitis A and B is a smart idea for all sexually active adults and for everyone who travels outside North America and Europe. There’s really no downside to these vaccines. In fact, both vaccines are now given to infants as part of routine immunization. Hepatitis B vaccine was the first vaccine known to prevent a form of cancer, hepatoma (liver cancer).

Eva Hersh is a family physician. Send your comments and questions to her by email at publisher@baltimoreoutloud.com.

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