All you need to know about Hepatitis B-A Sexually Transmitted Disease
What Hepatitis B is
Hepatitis B is a viral infection that is considered as one of the Sexually Transmitted Diseases. Because of its nature, it is a lifelong disease that changes over time and the chronic type of Hepatitis B infection cannot be cured. It is worth mentioning that reactivation is possible even in patients who have lost hepatitis B surface antigen (1).
In 2017 there were 6102 hepatitis B notifications in Australia, the majority of which were males 54% vs 46% females. In that year, the notification rate of hepatitis B was highest among the age group of 30-39 years. During the years 2013-2017, there was a noticeable decline in the annual notification rate by 13%. Although the notification rates among groups of 30-39 and 40 years and over were stable, there was a significant decline in the notification rates of Hepatitis B between the ages 15-29, which is due to the successful vaccination programs in infancy and adolescence. In the years 2013-2017, there was a decline of 37% in the notification rate of hepatitis B among the Aboriginal and Torres Strait Islander population. It is worth mentioning that this population had a notification rate of Hepatitis B that was more than twice as high as in the non‑Indigenous population (2).
There were over 450 deaths in Australia caused of Hepatitis B in 2017. In the same year, more than 233.000 people were living with chronic hepatitis B in Australia (2).
Ways of infection with Hepatitis B
Like many other Sexually Transmitted Diseases, Hepatitis B in adolescents and adults in Australia is transmitted in several ways but the main ways are sexual contact and drug injection. However, according to the national data, most people living with chronic hepatitis B in Australia were born overseas and were infected with hepatitis B at birth or in early childhood.
Are you at risk for Hepatitis B?
Sexual contact with an infected person increases the risk of Hepatitis B infection. Additionally, like all the Sexually Transmitted Infections, having multiple partners, or being a sex worker increases the risk for Hepatitis infection. People who inject drugs have an increased risk of Hepatitis infection. The epidemiological data highlight that there are geographic and ethnicity differences of Hepatitis infections in Australia. The highest prevalence of Hepatitis B was noticed among people born in Northeast Asia (2).
An additional risk factor for Hepatitis B infection is a history of a transfusion-dependent illness. Needle-stick injury as an occupational exposure of doctors, nurses, and other paramedical specialties, increase the risk of being infected with Hepatitis B. On top of that, tattoos and body piercing under nonsterile techniques can lead to Hepatitis B infection (3).
In 2016, the National Prison Entrants’ Bloodborne Virus and Risk Behaviour Survey was conducted, and the results showed that there was a prevalence of Hepatitis B positive of over 3% among male respondents, while for women it was 0% but the female sample was small.
According to the guidelines, screening for Hepatitis B is recommended to every pregnant as part of the routine antenatal screening for Sexually Transmitted Diseases. In the past, many newborns were infected by their mothers, but nowadays this phenomenon is almost eliminated at least in the developed countries (2).
Symptoms of Hepatitis B infection
Clinical symptoms of acute hepatitis, vary from nausea or fatigue to more marked symptoms and jaundice. The incubation period can be followed by symptoms like nausea, fever, anorexia, fatigue, and body aches. On the other hand, fulminant hepatitis is followed by the vomiting, fever, abdominal pain, and jaundice, and in some cases by disorientation, confusion, and coma.
Among patients with chronic hepatitis, a significant percentage is asymptomatic or have nonspecific symptoms like fatigue. In more severe cases of chronic Hepatitis B or when cirrhosis occurs, you can notice symptoms like jaundice, and stigmata of progressed-stage liver disease like gynecomastia, palmar erythema, splenomegaly, and others. Additionally, advanced cirrhosis can be characterised by ascites, peripheral edema, encephalopathy, and gastrointestinal bleeding (4).
Complications of untreated Hepatitis B
In some cases of acute hepatitis B or acute reactivation of chronic infection, Hepatitis B can potentially develop into life-threatening hepatitis.
Several diseases can potentially occur in patients with Hepatitis B infection including HIV, metabolic syndrome, Hepatitis A infection, Hepatitis C, and Hepatitis D (1).
An important percentage of 8-38% of the patients who have untreated chronic Hepatitis B infection with inflammation (hepatitis), develop liver cirrhosis during the first 5 years. In addition, patients with chronic infection and elevated alanine aminotransferase have the highest risk of developing either Hepatocellular carcinoma or liver cirrhosis. Here is a list of the factors increasing the risk of developing cirrhosis/ Hepatocellular carcinoma (5)
Age over 40 years old
Elevated Hepatitis B levels combined with long-lasting infection
Increased alcohol consumption
Asian African origin
First- degree relative who has Hepatocellular carcinoma
Diabetes or metabolic syndrome
Hepatitis B test
The acute type of hepatitis B is clinically diagnosed and can be identified by the blood test detection of HBsAg, high serum aminotransferases and symptoms related to Hepatitis B infection. In addition, the blood test might show an anti-HBc IgM detection and HBV DNA is present. Another marker that can be found in the blood test is HBeAg mainly in the most acute phase of infections, however, it is not of great importance. On the other hand, the chronic infection can be detected based on the persistence of HBsAg for more than half a year. The usual way of chronic Hepatitis B is through lab-blood tests and not clinical symptoms. In the case of past HBV infection, this is defined by the detection of IgG anti-HBc and anti-HBs (3).
Treatment for Hepatitis B
In 2017, it is estimated that only about 64% of the people living with chronic hepatitis B in Australia were diagnosed. Moreover, 18% of them were receiving care and 8% of them received antiviral therapy. According to Australia’s Second National Hepatitis B Strategy, there is a target of 80% of all people living with chronic hepatitis B to be diagnosed, and 15% of them to receive treatment (6).
The treatment for chronic hepatitis B is based on the person’s viral load and doctors try to control the viral replication. This can limit the liver damage due to immune-mediated inflammation and fibrosis and at the same time, it will prevent the development of liver cirrhosis and limit the risk of liver failure and hepatocellular carcinoma (7).
The treatment of hepatitis B is mainly an oral antiviral therapy taken on a long-term basis. In some cases, pegylated interferon is used (8).
Take away message
Hepatitis B is a vaccine-preventable disease; thus, the role of vaccination is crucial for limiting the spread of the disease. Hepatitis B can be controlled but not cured. Research has shown that treatment for chronic Hepatitis B can reduce the risk of developing liver cancer by over 50%.
Peters MG. Hepatitis B Virus Infection: What Is Current and New. Top Antivir Med. 2019;26(4):112-116.
Kirby.unsw.edu.au. 2019. HIV, Viral Hepatitis And Sexually Transmissible Infections In Australia: Annual Surveillance Report 2018 | UNSW – The Kirby Institute For Infection And Immun ity In Society. [online] Available at: <https://kirby.unsw.edu.au/report/hiv-viral-hepatitis-and-sexually-transmissible-infections-australia-annual-surveillance> [Accessed 4 August 2020].
Krajden M, McNabb G, Petric M. The laboratory diagnosis of hepatitis B virus. Can J Infect Dis Med Microbiol. 2005;16(2):65-72. doi:10.1155/2005/450574
Liang TJ. Hepatitis B: the virus and disease. Hepatology. 2009;49(5 Suppl):S13-S21. doi:10.1002/hep.22881
Johan Westin, Soo Aleman, Maria Castedal, Ann-Sofi Duberg, Anders Eilard, Björn Fischler, Christian Kampmann, Karin Lindahl, Magnus Lindh, Gunnar Norkrans, Stephan Stenmark, Ola Weiland & Rune Wejstål (2020) Management of hepatitis B virus infection, updated Swedish guidelines, Infectious Diseases, 52:1, 1-22
Australian Government Department of Health. Second national hepatitis B strategy 2014-2017. Canberra: Department of Health; 2014.
Ashm.org.au.2012. [online] Available at: <https://ashm.org.au/resources/Hep_B_and_Primary_Care.pdf> [Accessed 19 August 2020].
User, S., 2017. Hepatitis B – Australian STI Management Guidelines. [online] Sti.guidelines.org.au. Available at: <http://www.sti.guidelines.org.au/sexually-transmissible-infections/hepatitis-b> [Accessed 19 August 2020].
Hepatitis B FAQs
Hepatitis B is a virus that infects the liver; whilst there is a free vaccination available in Australia, it is still a major problem and a common cause of death in several parts of the world. It’s important to note that you may be more at risk of having been exposed to Hepatitis B if you’ve recently been travelling. You might be surprised at some of the common tourist destinations where Hepatitis B is still a serious issue. The virus is spread through blood, semen and vaginal excretions. It travels to the liver through the bloodstream and once in the liver, it uses your vital healthy cells in this hard working organ to multiply causing a response in your immune system.
Hepatitis B can go unnoticed, but most adults experience common symptoms such as fever, tiredness, vomiting/nausea, abdominal pain and jaundice (yellow skin tones). Most people recover from the virus, but the infection can develop into Chronic Hepatitis B in a small percentage of cases. With time Chronic Hepatitis B can cause scarring of the liver, liver failure and it also commonly leads to liver cancer. In fact, in 2012 the National Liver Cancer Prevention Policy, stated that the rate of deaths from liver cancer was increasing faster than any other form of cancer in Australia and they cited untreated Hepatitis B as a major contributor to that rate.
Again a simple blood test will show whether a person has the antibodies produced in response to the presence of the Hepatitis B virus. Your Stigma Health Pathology Referral will allow you to have a blood test performed at the Pathology centre of your choice.
To begin with patients undergo regular liver function tests every six months and unless the liver is showing damage there is no treatment required. If the liver is damaged a treatment plan should be devised by a gastroenterologist AKA someone who specialises in diseases of the digestive system. If you have not been vaccinated for Hepatitis B it would be a good idea to talk to your doctor about getting the immunisation.
IMPORTANT: If you believe you may have been exposed to Hepatitis B in the last 72 hours do not proceed with a normal STI test, visit a doctor, hospital or specialty clinic ASAP so you can receive preventative post-exposure prophylaxis (PEP).