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Hepatitis A

A Vaccine-Preventable Liver Infection

Hepatitis A can be transmitted sexually and causes acute liver inflammation. Vaccination provides excellent protection, especially important for men who have sex with men and travellers to endemic regions.

What is Hepatitis A?

Hepatitis A is a highly contagious viral infection affecting the liver. Unlike Hepatitis B and C, it does not cause chronic infection but can cause significant acute illness lasting several weeks. The virus is transmitted through the faecal-oral route, including during certain sexual practices. Hepatitis A is entirely preventable through vaccination.

Symptoms

  • Fatigue and malaise
  • Nausea and vomiting
  • Abdominal pain (especially upper right)
  • Loss of appetite
  • Low-grade fever
  • Jaundice (yellowing of skin and eyes)
  • Dark urine
  • Pale or clay-coloured stools
  • Joint pain
  • Symptoms appear 2-6 weeks after exposure

Causes

  • Faecal-oral transmission of Hepatitis A virus (HAV)
  • Oral-anal sexual contact (rimming)
  • Contaminated food or water
  • Close contact with infected person
  • Sharing drug preparation equipment
  • Travel to countries with poor sanitation
  • Men who have sex with men (higher risk group)
  • Contact with infected household members

Who Is at Risk?

  • Men who have sex with men
  • People who use recreational drugs
  • Travellers to endemic areas
  • People with chronic liver disease
  • Healthcare workers
  • Laboratory workers handling HAV
  • People experiencing homelessness
  • Close contacts of infected individuals

Potential Complications

  • Acute liver failure (rare, more common in older adults)
  • Prolonged cholestatic hepatitis
  • Relapsing hepatitis
  • Severe illness requiring hospitalisation
  • Higher risk of complications if pre-existing liver disease
  • Can be fatal in people with chronic liver conditions

How We Diagnose

Hepatitis A is diagnosed through a blood test that detects IgM antibodies against the virus, indicating recent infection. We can also test for IgG antibodies which show past infection or vaccination immunity. Testing is recommended if you have symptoms after potential exposure or want to check your immunity status before vaccination.

Treatment Options

There is no specific antiviral treatment for Hepatitis A. Management is supportive: rest, adequate hydration, avoiding alcohol and hepatotoxic medications, and a nutritious diet. Most people recover fully within 1-2 months. Severe cases may require hospitalisation. Prevention through vaccination is far preferable to treatment.

Prevention

Hepatitis A vaccination (highly effective)
Good hand hygiene, especially after toilet use
Avoid oral-anal contact if partner may be infected
Use dental dams during rimming
Safe food and water practices when travelling
Vaccination after exposure may help—contact NHS services
Immunoglobulin for high-risk exposures

Frequently Asked Questions

Is Hepatitis A an STI?

Hepatitis A is not traditionally classified as an STI but can be sexually transmitted, particularly through oral-anal contact. It's included in sexual health screening for at-risk groups, especially men who have sex with men, where outbreaks have occurred.

How effective is the Hepatitis A vaccine?

The vaccine is highly effective, providing protection in over 95% of people after a single dose. A second dose at 6-12 months provides long-lasting immunity, likely lifelong. It can also prevent infection if given within 2 weeks of exposure.

Can I get Hepatitis A more than once?

No, once you've recovered from Hepatitis A, you have lifelong immunity. Similarly, completed vaccination provides long-term protection. If you've had confirmed Hepatitis A before, you don't need vaccination.

How long am I infectious with Hepatitis A?

You're most infectious from about 2 weeks before symptoms appear until about 1 week after jaundice develops. You should avoid sexual contact and food preparation during this time. Some people remain infectious for longer.

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