Hepatitis B -- the "hidden" STD

by Laurie B. Rosenblum, MPH

Hepatitis B is a fairly common, but serious, sexually transmitted disease. However, unlike the other sexually transmitted diseases, there is a vaccine which provides strong protection if you have not already been exposed.

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 percent chance of recovering fully from HBV within several months. If she doesn't recover, like Joe, she will become a chronic carrier of HBV. They then have to cope with a lifelong illness that may cause liver damage. Hepatitis also puts them 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.

Hepatitis B is a common, yet serious, disease characterized by inflammation of the liver. It is spread by the highly infectious hepatitis B virus, often through unprotected sexual contact. Hence, HBV is considered a sexually transmitted disease (STD). Although there are other types of hepatitis, they 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 become chronic (long-term) carriers. They 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 are chronic carriers.

The good news is that HBV is preventable.

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.

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 percent 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 on to other people. This explains why 30 to 40 percent of people with HBV, like Joe, are not sure how they got it.

When symptoms are present, they may be mild and flu-like, and include appetite loss, nausea, vomiting, diarrhea, fatigue, fever, and joint or muscle aches. Some people also have dark urine, light stools, or jaundice.

The only way to know whether you have HBV is to have a blood test which detects the antibody to HBV in the blood.

There is no treatment specifically for acute HBV, other than treating the individual symptoms such as nausea, vomiting, and diarrhea. About 90 percent of adults clear the virus from their system within six months and then become immune to it. The other 10 percent 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 the liver.

Currently, there is only one antiviral medication -- interferon -- which has 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 percent of people with chronic HBV are able to take interferon, and only about a third of them experience significant long-term benefit[s]. However, according to Raymond Chung, MD, a liver specialist at the Massachusetts General Hospital in Boston, "it is anticipated that other effective medications will soon be available."

A safe, effective vaccine is now available. The HBV vaccine is recommended by the U.S. Centers for Disease Control and Prevention for all newborns, infants, sexually active 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. In most cases, the HBV vaccine provides lifelong immunity.

However, the vaccine is only effective prior to contracting HBV; it is of no use to those who are already infected. Therefore, it is recommended that the following measures are taken:

Use Condoms:

Be sure to practice safer 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.