Hepatitis A

Summary

Hepatitis A is an infection caused by a virus that can be sexually transmitted. Infection with hepatitis A results in inflammation of the liver (hepatitis).

Hepatitis A is transmitted when the feces (stool, shit) of a person infected with the virus comes into contact with the mouth of another person. The most common routes of transmission are sexual contact or ingesting contaminated food or water.    

Hepatitis A typically clears up on its own within two months of infection.

A simple blood test can determine if an individual currently has hepatitis A, has had previous exposure to hepatitis A, or has been vaccinated for hepatitis A.

No specific treatment exists for hepatitis A. Available treatments focus on managing symptoms. Hepatitis A is preventable with immunization.

Routine hygiene (washing hands thoroughly after toilet use) and correct and consistent use of barrier methods (condoms, oral dams) for sexual activity involving the anus can reduce the risk of hepatitis A transmission.

The words we use here – CATIE is committed to using language that is relevant to everyone. People use different terms to describe their genitals. This text uses medical terms, such as vagina and penis, to describe genitals. Cisgenderi people can often identify with these terms. Some transgenderii people may use other terms, such as front hole and strapless. CATIE acknowledges and respects that people use words that they are most comfortable with.

Key messages on hepatitis A for clients are available here.

What is hepatitis A?  

Hepatitis A is an infection caused by the hepatitis A virus, which is a virus of the Hepadnaviridae family. It can be sexually transmitted. The hepatitis A virus infects hepatocytes (a type of liver cell) and interferes with usual liver functions, causing inflammation of the liver (hepatitis).1,2,3

How is hepatitis A transmitted?  

Hepatitis A is found in the feces of an infected person. The virus is transmitted when the fecal matter of an infected person makes its way into the mouth of another person (fecal-oral contact) who has not been previously exposed to hepatitis A or who has not been vaccinated against hepatitis A. A person becomes immune to the virus after being infected.

Hepatitis A can also be transmitted if a person ingests food or water that has been contaminated with the feces of someone with hepatitis A.

Hepatitis A can be spread by sexual activities involving fecal-oral contact (such as rimming). The virus can also be transmitted by fingers (anal-finger contact), a penis if having anal intercourse, and sex toys if they have come into direct contact with infected feces during sex and then enter another person’s mouth. Handling a used condom after anal sex and then putting fingers in the mouth can also transmit hepatitis A.1,3,4,5,6

Who is at risk?  

Some specific populations are at increased risk of hepatitis A (if they have no immunity from prior infection or vaccination): people who inject drugs, men who have sex with men (MSM), and children in daycare (who are often in diapers or around other children who are in diapers and are not able to wash their own hands).

Individuals at increased risk of hepatitis A infection include those with close household or sexual contact with an infected person or those who travel to regions that have high prevalence rates of hepatitis A (due to poor sanitation).2,4,5

Symptoms  

Most adults infected with hepatitis A have some symptoms. Symptoms can appear two to six weeks after infection (the incubation period). Adults and older children may have an abrupt onset of the following symptoms: loss of appetite, nausea, abdominal pain, fatigue, fever, light-coloured stool, dark urine and jaundice (yellowing of the skin and/or eyes).

Children under the age of six may have no symptoms (asymptomatic) or display only mild symptoms.

Most adults will clear the infection on their own within two months. After the infection clears, a person has lifelong immunity from hepatitis A.3,4,5,7,8,9

Complications 

The majority of people who contract hepatitis A make a full recovery on their own. However, 25% of those who become infected with hepatitis A require hospitalization.

Some people experience prolonged jaundice and/or relapses over several months. 

Hepatitis A does not cause chronic liver disease.1,2

Testing and diagnosis (screening)  

A simple blood test can reveal if an individual currently has hepatitis A, has had hepatitis A in the past, or has previously received the vaccine.5

Notification of partners  

Hepatitis A is a reportable infection in Canada. This means that when an infection is confirmed by a clinic, doctor or laboratory, it must be reported to public health authorities. When someone has a confirmed hepatitis A diagnosis, the healthcare provider or public health nurse will ask them to contact or provide contact information for all people who may have been exposed during the period of infection, including sexual partners and people living in the same household.4 In an attempt to retain their anonymity, the name of the original client is not given to their sexual partner(s) when they are contacted.

The client or the healthcare provider or public health nurse will attempt to contact these individuals and encourage them to be screened. The Public Health Agency of Canada (PHAC) recommends that all people contacted be screened to assess their immune status and/or to provide vaccine protection to those who are not immune.

Treatment  

There is no treatment for hepatitis A other than relieving symptoms. It is recommended that individuals with hepatitis A rest and reduce their activity levels. They are also advised to generally lead a healthy lifestyle, such as drinking plenty of water to avoid dehydration, eating healthy foods, and avoiding alcohol and street drugs.2,4

What about HIV?  

Being infected with hepatitis A does not increase the risk of transmission or acquisition of HIV. However, people who are HIV positive who become infected with hepatitis A may suffer from more severe hepatitis A symptoms and longer recovery times.

PHAC recommends that people who use drugs and HIV-positive men who have sex with men receive the hepatitis A vaccine.4

Prevention  

The hepatitis A vaccine is the most effective way to prevent the transmission of the virus. The vaccine is over 90% effective when given to people who have not been exposed to hepatitis A. The vaccine is recommended to individuals at risk for hepatitis A (such as those travelling to regions where there is a high prevalence of hepatitis A, individuals who are HIV positive, MSM, people who use drugs, and people living in the same household as someone from a region with a high prevalence of hepatitis A).

Proper sanitation and hygiene practices (such as washing hands after using the toilet) can help reduce the risk of transmission.

Barrier methods (such as gloves, oral dams and condoms) can reduce potential contact with the virus during oral-anal and finger-anal sexual contact and with sex-toy use involving the anus.  Washing hands after handling a barrier or sex toy can also help reduce the risk of transmission.

Footnotes

i Cisgender – someone whose gender identity aligns with the sex they were assigned at birth

ii Transgender – an umbrella term that describes people with diverse gender identities and gender expressions that do not conform to stereotypical ideas about what it means to be a girl/woman or boy/man in society

(Definitions taken from Creating Authentic Spaces: A gender identity and gender expression toolkit to support the implementation of institutional and social change, published by The 519, Toronto, Ontario.)

Credits

This fact sheet was developed in partnership with the Sex Information and Education Council of Canada (SIECCAN).

References

  1. Public Health Agency of Canada (PHAC). Hepatitis. Available at:  http://www.phac-aspc.gc.ca/hep/index-eng.php#a2. [Accessed December 23, 2015.]
  2. Centers for Disease Control and Prevention (CDC). Hepatitis A information for health professionals. Available at: http://www.cdc.gov/hepatitis/HAV/HAVfaq.htm#general. [Accessed December 23, 2015.] 
  3. AVERT. Hepatitis A, B & C. Available at: http://www.avert.org/hepatitis-b-c.htm#A. [Accessed December 23, 2015.]
  4. Public Health Agency of Canada (PHAC). Canadian Immunization Guide. Available at: http://www.phac-aspc.gc.ca/publicat/cig-gci/p04-hepa-eng.php. [Accessed December 23, 2015.]
  5. American Sexual Health Association. Hepatitis A. Available at:  http://www.ashasexualhealth.org/stdsstis/hepatitis/hepatitis-a/. [Accessed December 23, 2015.]
  6. B.C. Centre for Disease Control. Smart Sex Resource. Hepatitis A – Fact Sheet. Available at: http://smartsexresource.com/topics/hepatitis. [Accessed December 23, 2015.]
  7. Mayo Clinic. Diseases and Conditions – Hepatitis A. Available at: http://www.mayoclinic.org/diseases-conditions/hepatitis-a/basics/causes/con-20022163. [Accessed December 24, 2015.]
  8. BC Centre for Disease Control. Hepatitis A. Available at: http://www.bccdc.ca/health-info/diseases-conditions/hepatitis-a. [Accessed December 23, 2015.]
  9. World Health Organization (WHO). The global prevalence of hepatitis A virus infection and susceptibility: A systematic review. 2002. Available at: http://whqlibdoc.who.int/hq/2010/WHO_IVB_10.01_eng.pdf. [Accessed December 23, 2015.]
  10. Ontario Ministry of Health And Long Term Care. Hepatitis A. Available at: http://www.health.gov.on.ca/en/public/programs/hepatitis/hep_a.aspx. [Accessed December 23, 2015.]

Published: 2016