• The first six months of infection with hepatitis C is called the acute phase. Around 20-25% of people will clear the virus naturally during this time. (This percentage is lower for people who also have HIV.)
• People who don’t clear the infection will enter the chronic (or long-term) phase and can pass hepatitis C on to others.

Many people who get hepatitis B notice no symptoms, or have ones so mild that they’re easily missed. But after some weeks or months the infection can cause:

• loss of appetite  
• nausea or vomiting 
• extreme tiredness  
• fever  
• stomach pain 
• swelling in the legs or abdomen
• jaundice, where your skin and the whites of your eyes turn yellow, your urine turns dark and your faeces turn pale.

Thys symptoms are manifestation of acute hepatitis. Symptoms can last for several weeks and it can take months to get back to normal.

Most people make a full recovery but up to 1 in 20 become ‘carriers’ with chronic (long-term) infection. They usually feel fine but stay infectious to others, with a small risk of going on to develop liver disease. If liver damage develops because of longstanding infection, the person is said to have chronic hepatitis.

Around 1 in 100 people get a more serious illness which can be fatal if it’s not treated.

The virus can be passed on in these body fluids:

• blood 
• semen 
• pre-cum 
• vaginal secretions.

It’s passed on through:

• oral, vaginal or anal sex without a condom 
• rimming 
• sharing sex toys 
• sharing injecting drug equipment, such as needles and syringes, which can carry infected blood 
• childbirth, from a mother to her baby.

It can be found in saliva but there are no proven cases of it being passed on through kissing. Infections from bites are rare.

Avoid sharing razors, toothbrushes, nail scissors, hair clippers and tweezers because traces of blood on them can pass on hepatitis B. This includes dried blood as the virus can survive for at least a week outside of the body.

You can protect yourself by getting vaccinated. This is especially important if you belong to one of the high-risk groups. You’re high risk if you:

• have close contact with someone with the infection
• are a gay man or have sex with men who have sex with men (MSM)
• inject drugs
• travel to parts of the world where the infection is common.

There is a vaccine which can protect you against both hepatitis A and B.

If you’re in a high-risk group for hepatitis B you can usually get vaccinated for free by your doctor or at your sexual health clinic.

You may need a booster injection of the vaccination after five years.

If you have hepatitis B, tell people you live with or recently had sex with to urgently ask their doctor about vaccination. Avoid sex until told you’re no longer infectious.

Although not as effective as being vaccinated, you can also cut the risk by:

• using condoms for penetrative sex 
• a latex barrier (such as a condom cut into a square) for rimming.

If you’re a carrier, you may want to tell a partner and explain that you’re infectious. That allows them to decide if they want to take precautions (such as getting vaccinated) or are happy to take any risk.

That way they cannot accuse you of infecting them without them knowing the risk was there.

Cases are generally diagnosed by GPs, not sexual health clinics. If you had sex with someone recently or you share your house with others, they can be vaccinated to stop them getting the infection – they should see a doctor straight away.

Avoid sex until you are told you’re no longer infectious or until your partners have been vaccinated.

A blood test will confirm whether you have the virus.

In most cases no treatment is needed for acute hepatitis B. It may take a while for you to recover and you may want to take some time off work.

You should also:

• avoid recreational drugs to allow your liver to get better
• avoid alcohol until your liver recovers
• avoid smoking because of the health problems it causes
• eat a healthy balanced diet.

If you have chronic hepatitis B, you may need treatment to slow down the replication of the virus. However, treatment cannot usually cure chronic hepatitis B. A small number of carriers go on to get liver disease (and a small number of those get liver cancer), and may need a liver transplant.

If your body clears hepatitis B, you’re immune and cannot get it again – but you can still get other types of hepatitis.

If you live with HIV

HIV infection doesn’t affect the Hepatitis B treatment regimen. However, if you are immunosuppressed, the recovery may take longer.

If you are coinfected with HIV and HBV, it may lead to more rapid progression of Hepatitis B to liver cancer. It is, therefore, important to start treatment as soon as possible.

It’s recommended for all MSM living with HIV to get vaccinated for HBV. Depending on your CD4 cell level, you may experience a weaker response to the vaccine, and therefore, it’s recommended to check your immunity for HBV after a vaccination.

Some HIV medicines are effective at treating both HIV and HBV. You can discuss it with your HIV specialist.

Certain medications for HIV can have unwanted interactions with drugs used for HBV treatment. So, your doctor should be aware of your HIV status and choose the proper treatment. You can verify HIV and non-HIV drug interactions at www.hiv-druginteractions.org/checker.

If you don’t live with HIV

HBV infection is not associated with greater risk of getting HIV.