Pre-fix: A guide for people with Hep C or HIV who inject drugs


Beyond Hep C and HIV: other infections to know about

Sometimes it can be hard to tell the difference between problems related to injection drug use such as withdrawal and other illnesses like tuberculosis or hepatitis B or a sexually transmitted infection. This means you could miss an infection that needs treatment. To get the right diagnosis, try to talk with your health worker honestly about your drug use.  

The following are some common infections among people who use drugs and what to do about them.

Hepatitis B (Hep B)

What is it?

Hep B is a virus that affects your liver.

How do you get it?

Condomless sex and sharing needles and other injection equipment.

How do you know if you have it?

A blood test will show if you have Hep B. This test is different from the Hep C test.

How can you protect yourself and others from Hep B?

  • Ask your doctor to give you a Hep B vaccination to prevent you from getting Hep B. (You can get vaccinated for Hep A at the same time.)
  • Don’t share your injection equipment.
  • Don’t save or collect filters for doing a wash. (A wash is when filters are rinsed to get the drugs left in them to make another hit.)
  • Use condoms and dental dams for sex.
  • Avoid sharing personal items, such as razors and toothbrushes.


  • Sometimes people clear Hep B on their own and don’t need treatment.
  • Medications called antivirals are used to treat Hep B. There is no cure for Hep B but medications can slow down or prevent the virus from harming your body.

Tuberculosis (TB)

What is it?

  • TB is caused by bacteria that mostly affects your lungs but also can harm other parts of your body such as your kidneys, spine and brain.
  • There are two types of TB: “latent” TB, which means you have no symptoms and can’t give it to others; and “active” TB, which means you may feel sick and can pass it on to others.

How do you get it?

  • TB is spread through the air when someone who has active TB coughs, sneezes, spits or talks very close to you and you breathe in the bacteria.
  • One example of how it can be spread is through “shot-gunning” (inhaling and exhaling smoke) into someone else’s mouth.

How do you know if you have it?

Diagnosis of TB includes a skin test and chest X-ray.

How can you protect yourself and others from TB?

  • If you smoke or snort crack or cocaine, use your own pipe or straw.
  • If you smoke tobacco or pot, avoid sharing cigarettes or joints.
  • If you inject drugs, use new drug equipment and don’t share it.
  • If you sniff glue or other solvents, use your own bag.


  • If you have latent TB, your doctor can give you medications to keep it from becoming active.
  • If you have active TB, your doctor can give you medications that can cure it.


What is it?

Syphilis is a sexually transmitted infection caused by bacteria. If left untreated, syphilis can hurt your heart, brain, liver and other organs and can cause death.

How do you get it?

Syphilis is spread when your lips, mouth, genitals or ass comes into contact with someone who has syphilis sores. Sores can happen on your lips and inside your mouth, genitals and ass. Syphilis can also pass through sharing equipment to inject drugs and from a pregnant person to their unborn child.

How do you know if you have it?

A blood test for syphilis will tell you if you have it. The infection can take between two to 12 weeks to show up in your blood.

How can you protect yourself and others from syphilis?

  • Use condoms and dental dams when you are having sex.
  • If you inject drugs, use new drug equipment and don’t share it.
  • Get tested for syphilis if you find out you are pregnant.


  • Your doctor can give you antibiotics to treat syphilis.
  • If you also have HIV, it’s important to get treated quickly because syphilis may get worse faster if you have HIV.

Sexually transmitted infections

Other sexually transmitted infections (STIs), such as chlamydia, gonorrhea and genital herpes, can be painful or uncomfortable. It is also easier to pass HIV during sex if either partner has an STI. For more info about testing and treatment, talk to your local health worker, check out or the booklet STI: Sexually transmitted infections.

Abscesses, cellulitis and other infections

Some infections are related to problems injecting drugs, like when you miss a vein or when dirt or germs get inside your body while you are injecting. Abscesses and cellulitis are infections that form around the area where you inject. They can be painful to deal with and make you feel sick. Very serious infections can happen in your heart (called endocarditis) and your bones (called osteomyelitis). These infections happen when germs get into your bloodstream and travel throughout your body. They can be hard to treat and can kill you.

In general, to avoid infections in the skin where you inject:

  • Before you shoot, wash your hands and the injection site with soap and water. Use just water, alcohol pads or sani-wipes if that is all you have.
  • Use new injection equipment every time you use drugs.
  • Inject your drugs in as clean a place as you can find. There are germs on everything the needlepoint touches, including spit, fingers and clothes. The less it touches, the cleaner it is. Also, don’t lick the needle.
  • Use a different injection site each time you shoot – it helps save veins. Go back to sites you used only after they’ve had time to heal. Try to avoid dangerous injections sites on your body: groin, thighs, wrists, neck.

For more information on how to avoid infections when you inject drugs check out Safer injection.

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