How to Know If You're At Risk for Hepatitis

Hepatitis is... confusing, admittedly. But even though it's not easy to understand at a glance, it's worth knowing about.

That's because, globally, more than 350 million people are currently infected by viral hepatitis — and less than half of those infected know they have it. In some instances, hepatitis patients can lead long lives that are undeterred by a positive status. But in other instances, left undetected and untreated, hepatitis can wreak havoc on your liver. That's why it's important to know your own hepatitis status, we well as understand what hepatitis is, exactly.

Below, get all your hepatitis questions answered. Including: What is hepatitis? How is it transmitted, exactly? Through sex? And, How to protect yourself against the infection?

What Is Hepatitis?

"Hepatitis is a broad term that is used to describe inflammation of the liver," explains Hwan Yoo, M.D. a board-certified gastroenterologist and internal medicine specialist at The Institute for Digestive Health and Liver Disease at Mercy Medical Center in Baltimore. There are a variety of different types of hepatitis as well as causes, he says, most of which are named for a different letter in the alphabet.

Hepatitis can be caused by environmental conditions (such as heavy alcohol use, toxins, medications, etc.), but hepatitis can also be caused by a virus, according to the Centers for Disease Control and Prevention.

Some types of hepatitis (see: Hepatitis A) are usually not a huge deal. However, if left undetected and untreated, other strains (such as Hepatitis C) can be more serious — in some instances, actually becoming life-threatening. The liver is in charge of filtering your blood, fighting off foreign invaders, and processing nutrients, according to Johns Hopkins Medicine, so when it liver becomes inflamed or damaged by a strain of hepatitis, those processes slow or stagnate, resulting in "dirty" blood, infection, and malnourishment. Yikes.

The Different Types of Hepatitis

"In the United States, Hepatitis A, Hepatitis B, and Hepatitis C are the most common strains of the virus," says Dr. Pearlman. But there are a variety of other strains, too. Learn all about them below.

Hepatitis A: Caused by the hepatitis A virus (this will be a common theme), this is the most harmless type of all. Typically a short-term disease, this virus presents with symptoms that typically last about 2 months before disappearing. This strain is incredibly contagious, but there's a hepatitis A vaccine (which most people get as infants) that has made the virus much less prevalent.

Hepatitis B: A version of viral hepatitis caused by the hepatitis B virus, Hep B can cause short- or long-term complications. It's an especially risky infection for infants. But the hepatitis B vaccine (which most people get as babies) has greatly decreased the instances of Hepatitis B, especially in the United States.

Hepatitis C: Hepatitis C is caused by the hepatitis C virus, and is the most common hepatitis infection. The virus can be acute (meaning short-term), or it can cause chronic conditions as severe as liver cirrhosis and cancer. There is no vaccine for this strain. But in individuals who have access to hepatitis testing and treatment, antiviral medication is effective more than 95 percent of the time.

Hepatitis D: Hepatitis D is caused by the hepatitis D virus. What sets this strain apart from others is that it can only occur if hepatitis B is present, explains Dr. Pearlman. (Co-dependent little viral fucker, indeed!) About 5 percent of people with Hepatitis B also develop this strain.

Hepatitis E: There is no vaccine for Hepatitis E, which is caused by the hepatitis E virus. But infection with this is pretty darn rare — especially in countries where everyone has access to clean water and food sources. The good news is that except for the rare occurrence of chronic hepatitis E in people with compromised immune systems, the majority of those who come into contact with the virus recover fully without any complications.

Autoimmune hepatitis: Yes, the fact that this hepatitis variation breaks the naming pattern is a hint that it's different. Autoimmune hepatitis isn't caused when a foreign invader enters the body, but from the body turning on itself. Specifically, when the body begins to make antibodies against your own liver tissue.

Alcohol hepatitis: As the name suggests, alcohol hepatitis is caused by drinking too much alcohol over and over and over again. The liver, the organ hepatitis infects, is responsible for metabolizing alcohol, but if you introduce your liver to more alcohol than it can process, the liver can become damaged.

Wait, Is Hepatitis an STD or STI?

Good question! Ultimately, it depends. (Also, here's the difference between an STD and STI.)

Autoimmune hepatitis and alcohol hepatitis cannot be transmitted through sexual activity. The other versions of viral hepatitis can be transmitted via sexual contact — however, the risk level of transmission varies between the strains. (And it's important to note that each strain can also be transmitted through other means.)

Hepatitis A: Hepatitis A is found in the poop and blood of an infected person. It is most commonly transmitted through contaminated food and water sources. For instance, if a chef with the virus has blood or feces on their hands and prepares your food, or if an unwashed/unpeeled fruit that was touched by a person with the virus (and contaminated hands) makes its way into your mouth However, the virus can also be spread through needle sharing or dirty injectable drugs equipment. When it comes to sexual transmission of Hepatitis A, it can be shared through rimming (aka anal-oral sex) or, any other sexual activity that results in fecal particles making their way into their mouth, whether intentionally or unintentionally (for example, cunnilingus, blow jobs, or scat play).

Hepatitis B: Hepatitis B can be spread through most bodily fluids, including blood, semen, vaginal secretion, anal secretion, and breast milk. As such, it can be transmitted during breastfeeding, as well as through drug-injection equipment. "It can also be transmitted through most kinds of sexual contact," says Dr. Pearlman. Actually, this is the strain of the virus most commonly dubbed an STI, she says.

Hepatitis C: Hepatitis C can only be spread when you come into contact with a Hepatitis C positive individual's blood. Usually this happens through drug equipment and other needle sharing. But in theory, it could also happen during unprotected period sex, or other kinds of play that feature blood. "It can also be spread from a mother to their unborn child, and was historically spread through blood transfusion or organ transplant decades ago before the virus was being screened for," adds Dr. Pearlman.

Hepatitis D: Again, Hepatitis D is only a risk for individuals who currently have Hepatitis B. It can also be spread through bodily fluids of an infected person, such as urine, feces, blood, and penile, vaginal, and anal secretions. So, yes, this can be spread through sexual contact as well.

Hepatitis E: Like Hepatitis A, Hepatitis E is primarily transmitted through the accidental ingestion of fecal particles of a person with the virus. (Yes, even if it's in microscopic amounts!) "It is primarily transmitted by ingesting contaminated water or from eating under-cooked foods like pork, venison, or shellfish," says Pearlman. But it can also be transmitted through anal-oral sex, she says. Luckily, this is considered an acute version of the virus, meaning it usually goes away on its own and is not super severe.

The Most Common Hepatitis Symptoms

For starters, it's important to remember that the absence of noticeable symptoms is not an indication of a negative hepatitis status. "As with many other viruses and sexually transmitted illnesses, many people with viral hepatitis won't have any symptoms at all, or won't present with symptoms until decades after initial infection," explains Dr. Pearlman. So, the only true way to know your hepatitis status is to get tested (more on that below).

So what are the symptoms of hepatitis when they do occur? Acute viral hepatitis common symptoms include things like the following, according to the CDC:

• generalized fatigue
• loss of appetite
• nausea
• abdominal pain
• low-grade fever

In the instances that the virus becomes chronic or severe, the symptoms can also include jaundice and dark urine, both a result of liver dysfunction, says Dr. Pearlman. "If not properly managed, consequences can include advanced liver disease or cirrhosis, or even death," adds Dr. Yoo.

Viral Hepatitis Testing and Treatment

Testing for Hepatitis A and E are only recommended for individuals experiencing symptoms, according to Dr. Pearlman. Testing recommendations for Hepatitis B and C are dependent on risk factors like drug use and prevalence of anal sex in your sex life. Regardless, the good news is that getting tested for viral hepatitis is pretty damn easy. (You can even test for some types of hepatitis using at-home STI testing.)

"Basically, diagnosis is done with a blood test," says Dr. Yoo, which can be done at most health centers and/or STI testing centers. After getting a sample, the healthcare provider will send the vile(s) to the lab to check if the virus is present, whether or not it's acute (short-term) or chronic (longer-term and serious), and whether an individual is contagious. Results typically take just one to two days.

If you do test positive for a strain of viral hepatitis, your doctor may prescribe an ultrasound, transient elastography, MRI, or CT scan to determine how severe the damage to the liver is, he adds. (

The specific strain and severity of the hepatitis you have will impact how the provider chooses to treat the virus.

"Hepatitis A cures usually without treatment," says Dr. Yoo. But your provider may prescribe medications to help quell the symptoms of the virus.

Hepatitis B, Hepatitis C, and Hepatitis D all have different medications that can be taken. "For Hepatitis B and D, usually the treatment involves controlling the virus and not getting rid of it entirely," he says. "But for Hepatitis C there is treatment that can get rid of (eradicate) the virus." In the rare instances that Hepatitis C has resulted in liver disease, some Hepatitis C patients may be put on the liver transplant list.

There are currently no recommended treatments for Hepatitis E, but, luckily, it usually resolves on its own.

How to Protect Yourself Against Hepatitis

Get vaccinated.

Currently, there are only vaccinations to prevent hepatitis A and hepatitis B, says Dr. Pearlman. (But because hepatitis D can only occur in individuals with hepatitis B, the hepatitis B vaccine has helped to reduce the spread of hepatitis D, too.)

The Hepatitis A vaccine is recommended for all children over the age of 12 months. It's a two-dose vaccine that involves two injections, six months apart. It can also be administered to teens and adults who did not previously receive the jabs.

The Hepatitis B vaccine can be administered in a 2–4 shot series. Typically, the sequence is given to children between when they are 6 and 18 months of age. But older children, teens, and adults who were not given the vaccine as a young tot can opt into the vaccine, too.

Getting vaccinated as an adult is especially important if you're going to be traveling to a country where hepatitis is more prevalent. (Use this map to check out whether your next destination is a hepatitis hotspot.)

Use clean needles.

Whether you're injecting gender-affirming hormones or other medication, or drugs, be sure that every time you bring a needle or syringe to your skin it should be a fresh needle, suggests Dr. Pearlman.

If you need help accessing clean equipment, check out the American Addiction Centers, which can help connect you to a needle or syringe exchange program near you.

Use barrier protection during sex.

As you learned above, viral hepatitis strains can be transmitted during a variety of sex acts. So, "barrier protection when sexually active with others is a good protection method," according to Dr. Pearlman. The specific barrier you use will depend on the sex acts in your romp repertoire.

You'll want to opt for an external or internal condom for penetrative vaginal or anal intercourse, as well as to cover your toys during sex toy sharing. Sex gloves and finger cots can come in (ha!) handy during fingering, fisting, and other forms of hand sex. Dental dams and condoms are the move if you're exploring analingus, cunnilingus, or head. And if you're doing any sort of anal play, be sure to wash your hands thoroughly afterward.

Get curious about your relationship with alcohol.

This final tip is specifically for alcohol hepatitis. If you notice that you've been drinking more than usual, take a minute to consider signs your sasual drinking could be a problem.

If you decide you'd like to cut back on the booze, the U.K. National Health Service recommends opting for lower strength drinks when you do drink, setting a drinking budget or drink limits, and trying to take several drink-free days each week. (

If you decide you'd like to quite altogether, you might attend an in-person or online Alcohol Anonymous meeting, or seek out help from the Substance Abuse and Mental Health Services Administration hotline at 1-800-662-HELP (4357).