Learn about
Hepatitis
Hepatitis B and C are viral infections of the liver that can be sexually transmitted and are major causes of chronic liver disease globally. Hepatitis B (HBV) is 50–100 times more infectious than HIV, preventable through a highly effective vaccine, and manageable with antivirals in chronic infection. Hepatitis C (HCV) is less commonly transmitted sexually but is now curable in over 95% of cases with direct-acting antiviral (DAA) therapy. Both conditions are typically asymptomatic for years while causing progressive liver damage — making testing essential regardless of symptoms.
Hepatitis Symptoms
Acute hepatitis B and C (within weeks to months of infection) may cause fatigue, nausea, abdominal pain (right upper quadrant), dark urine, pale stools, and jaundice (yellowing of skin and eyes). However, most adults with acute HBV infection — and the vast majority of those with HCV — have no symptoms at all, or symptoms mild enough to be dismissed as a passing illness. Chronic hepatitis B and C are almost universally asymptomatic until advanced liver disease develops — at which point symptoms reflect cirrhosis or liver failure, not the viral infection itself. There is no reliable way to know your hepatitis status without testing.
Hepatitis Transmission
Hepatitis B is transmitted through blood, semen, vaginal fluids, and other body fluids. Primary routes in the US include unprotected sexual contact (particularly anal sex), sharing injection equipment, and mother-to-child transmission during birth. HBV can survive on surfaces for up to 7 days at room temperature, meaning shared razors, toothbrushes, or needles carry real transmission risk. Hepatitis C is primarily bloodborne — sharing needles, syringes, or other injection equipment is the dominant transmission route. Sexual transmission of HCV is uncommon but documented, particularly in MSM with HIV and in settings involving mucosal trauma or blood exposure during sex.
Hepatitis Treatment
Hepatitis B: Acute HBV in adults is managed supportively — most adults clear it spontaneously. Chronic HBV is treated with antivirals including tenofovir (TAF or TDF) or entecavir, which suppress viral replication and significantly reduce the risk of cirrhosis and liver cancer progression. Treatment is not required for all people with chronic HBV — decisions are individualised based on viral load, liver function, and degree of liver damage. Hepatitis C: DAA therapy (direct-acting antivirals, typically an 8–12 week oral course) cures over 95% of HCV infections with minimal side effects. All people diagnosed with HCV should be offered treatment regardless of liver disease stage or lifestyle factors. HCV treatment is not the same as HBV treatment — do not confuse the two.
Hepatitis Health Risks
Chronic HBV and HCV are the leading causes of cirrhosis and hepatocellular carcinoma (liver cancer) globally. The WHO estimates 820,000 deaths per year from HBV-related complications and approximately 290,000 from HCV-related disease. Cirrhosis develops silently — patients may have normal energy and no symptoms until liver function is critically impaired. People with chronic HBV have a 15–25% lifetime risk of dying from cirrhosis or liver cancer without treatment. HCV-related cirrhosis and cancer risk is similarly significant, particularly with alcohol use or HIV coinfection. Early antiviral treatment dramatically reduces these risks in both conditions.
Hepatitis Prevention
Hepatitis B is vaccine-preventable — the HBV vaccine induces protective immunity in over 95% of recipients and is recommended for all adults who have not been previously vaccinated. The standard schedule is three doses (0, 1, and 6 months), though accelerated and two-dose schedules are available. Consistent condom use substantially reduces sexual HBV transmission. For HCV, there is no vaccine — prevention relies on avoiding shared injection equipment, using harm reduction services (needle exchanges, opioid agonist therapy), and consistent condom use in high-risk sexual contexts. All pregnant people should be screened for both HBV and HCV, and all adults should have at least one HCV test per CDC guidelines.
Hepatitis Diagnosis
Hepatitis B diagnosis uses a panel of blood tests: HBsAg (surface antigen) indicates current infection; HBsAb (surface antibody) indicates immunity from vaccination or prior resolved infection; HBcAb (core antibody) indicates prior infection. HBV DNA (viral load) quantifies active replication and guides treatment decisions. The CDC recommends hepatitis B screening for all adults aged 18–79 at least once. Hepatitis C is diagnosed by HCV antibody test (screening), followed by HCV RNA PCR if reactive (confirms active infection — a reactive antibody test alone may reflect past cleared infection). The CDC recommends at least one HCV test for all adults born 1945–1965, and annual testing for people who inject drugs or have ongoing risk factors.
Hepatitis Complications
Cirrhosis — scarring that replaces normal liver tissue — is the primary complication of chronic HBV and HCV. Cirrhosis reduces liver function and can progress to hepatic decompensation (ascites, variceal bleeding, hepatic encephalopathy) and liver failure requiring transplant. Hepatocellular carcinoma develops in people with cirrhosis and, in HBV, even without cirrhosis. People with chronic HBV require lifelong liver cancer surveillance (ultrasound every 6 months). HBV coinfection with HIV accelerates liver disease progression. Perinatal HBV transmission to infants has up to 90% risk of developing chronic infection — prevented by neonatal vaccination and HBIG at birth.
Hepatitis Post-Diagnosis Advice
If diagnosed with chronic HBV: discuss antiviral treatment with a hepatologist or infectious disease specialist. Not everyone needs treatment immediately, but everyone needs monitoring. Avoid alcohol — it accelerates liver damage. Get vaccinated against hepatitis A if not already immune. Inform sexual partners and household contacts so they can be tested and vaccinated. Notify your provider if you become pregnant. If diagnosed with HCV: start DAA treatment as soon as possible — cure rates exceed 95% and treatment prevents further liver damage and transmission. Avoid alcohol during and after treatment. Get tested for HBV and HIV if not recently done — coinfections affect management. Confirm cure with an HCV RNA test 12 weeks after completing treatment (SVR12).
Hepatitis Myths & Facts
Myth: Hepatitis is always caused by alcohol or drug use. Fact: Hepatitis B and C are viral infections — alcohol use is a risk factor for progression but not required for infection.
Myth: You can tell if someone has hepatitis by how they look or feel. Fact: Most people with chronic hepatitis are asymptomatic for years. Testing is the only way to know.
Myth: Hepatitis C cannot be cured. Fact: Modern DAA therapy cures over 95% of HCV infections in 8–12 weeks.
Myth: If I was vaccinated for hepatitis, I'm protected against all types. Fact: The hepatitis B vaccine does not protect against hepatitis C (and vice versa). There is no vaccine for HCV.
Hepatitis FAQ
Can Hepatitis B and C be cured?
Hepatitis C is now curable in over 95% of cases — a remarkable advance. A single oral course of direct-acting antivirals (typically 8–12 weeks) eliminates the virus in most people, with minimal side effects. Hepatitis B is not currently curable in most cases, but it can be effectively managed with long-term antiviral therapy that suppresses the virus, prevents cirrhosis progression, and reduces liver cancer risk. Vaccination prevents HBV infection entirely.
Should I get tested for hepatitis even without symptoms?
Yes — this is exactly the point. Chronic hepatitis B and C cause no symptoms for years or decades while damaging the liver. By the time symptoms appear, significant liver disease may already be present. The CDC recommends at least one hepatitis B and C test for all adults, with more frequent testing for people with ongoing risk. Testing takes a simple blood draw and provides information that's essential for your long-term liver health.