Hepatitis 

Hepatitis is a viral infection that causes inflammation of the liver. There are other causes of hepatitis, but this section will discuss only the viral forms that are transmitted through sexual contact. The three most common forms of hepatitis are lettered A, B, and C.

Hepatitis A is a virus that is transmitted through fecal- oral contamination. Usually we ingest something that has been contaminated with fecal material containing the virus. The most common scenario is ingesting contaminated water and food sources, as in a restaurant. Your little cutie waiter who unknowingly has the virus forgets to wash his hands in the bathroom and subsequently touches your chicken paillard -- and bang! You have gotten more than a meal. Gay men usually contract hepatitis A through oral- anal sex, or what is commonly referred to as rimming. Hepatitis A is a short- term illness that usually resolves on its own without long-term consequences.

After exposure to hepatitis A, symptoms usually develop two to six weeks later. They are usually mild and often mimic the "stomach fl u," with fever, body aches, abdominal pain, nausea, and a slight yellow tinge to the eyes (icterus) and skin (jaundice.) You are contagious during this period and can transmit the virus through contact with your stool. Symptoms usually last less than two months and there is no medical treatment for hepatitis A. The best thing to do is get plenty of rest and stay hydrated in order to avoid dehydration. Ten days into the disease, your body will develop antibodies to hepatitis A. Once you have this antibody you will be immune from ever contracting hepatitis A again. Currently, there is a hepatitis A vaccine available. I offer it to all my gay male patients in order to prevent them from developing this disease, especially those who are HIV positive. The vaccine is covered by most insurance and is given in two separate injections six months apart.

Hepatitis B is another type of virus that causes inflammation of the liver. Unlike Hepatitis A, hepatitis B is a more complex disease. For one, it is transmitted through blood and body fluids like semen. Hepatitis B is usually a self- limiting disease, which means that most patients go through the infection within three to six months. Approximately, one third of those infected have no symptoms, but those who do present like hepatitis A, with fever, nausea, vomiting, jaundice, and body aches. In most cases symptoms resolve and immunity is established due to the development of the Hepatitis B antibody. Some people are not so lucky. In 5 to 10 percent of cases, those who contract hepatitis B will go on to become chronic carriers. Patients who show signs of persistent infection beyond six months are considered carriers. This means you are still contagious and can transmit the virus to other men through unprotected sex. As a carrier, you are still prone to the effects of the virus on your liver. There is a small chance that the virus will go away in a percentage of patients who are carriers. For the most part these patients will become chronic carriers.

Chronic Hepatitis B is a disease that involves progressive damage to the liver, which can ultimately lead to cirrhosis. Cirrhosis is scarring of the liver so that bloodflow to the liver is impaired; this leads to build up of fluid in the body and failure of the liver cells to function. It is estimated that men who have sex with men are ten times more likely to contract Hepatitis B than the general population. So how do you avoid contracting it?

1. Always use condoms during anal sex.

2. Get vaccinated.

3. Do not share toothbrushes, razors, or nail clippers with other men.

4. Avoid biting and coming into contact with open sores or blood.

5. Be careful of tattoo parlors, and ensure that a new needle is used if you get a tattoo.

When a person first becomes infected with Hepatitis B, he may develop fever, fatigue, nausea, jaundice, and abdominal pain anytime between six weeks to six months from the time of exposure. However, it is possible to contract hepatitis B and pass the virus without ever having any symptoms. Usually a doctor detects the hepatitis B antibody on a routine screening. If this happens to you, consider yourself very lucky. It is estimated that 30 percent of those infected will not show any signs or symptoms of Hepatitis B.

Diagnosis of hepatitis B by your doctor usually involves a thorough physical exam and blood tests to assess liver function. The diagnosis is confirmed with detection of viral antibodies in the blood. Post- exposure prophylaxis is indicated for individuals who have been exposed to hepatitis B within less than two weeks. In these cases patients are given a dose of the hepatitis B vaccine and Hepatitis B immune globulin. The second and third doses of the vaccine are given at their usual intervals of one and six months later. In 95 percent of these cases protection against Hepatitis B is estimated.

For patients who have exceeded the two-week limit I recommend bed rest and hydration. Some doctors recommend maintaining a high- calorie diet despite symptoms of nausea, and to also avoid alcohol or anything else that might stress your liver, like acetaminophen, or Tylenol. As for herbal and nutritional supplements, consult your doctor before ingesting. In cases of chronic hepatitis B several combinations of drugs are available.

These are:

* Interferon: an injection that is given for at least six months

* Epivir: an antiviral medication

* Hepsera: this drug works well in people whose disease doesn't respond to epivir, but in high doses it can cause kidney problems

* Baraclude and Tyzeka: These are the newest drugs for hepatitis B

If your disease becomes chronic, a liver biopsy (tissue sample) may be obtained to determine the severity. A liver biopsy is also useful in monitoring the progression of liver disease and to diagnose cirrhosis. Individuals with chronic hepatitis B, especially those with cirrhosis, are at an increased risk of developing hepatocellular carcinoma, or primary liver cancer. Although this type of cancer is relatively rare in the United States, the fact remains that hepatitis B can result in cancer. Fortunately, there is now a combination hepatitis A and B vaccine available; it is administered, like the hepatitis B vaccine, three times over six months.

Hepatitis C is the third in a line of viral infections affecting the liver. Its effect on the gay community has been aggressive because co- infection rates with HIV have been increasing.

Hepatitis C is a complicated virus. First there are at least six different subtypes, and each responds differently to treatment. In the United States, type 1 is the most common and the hardest to treat. Although hepatitis C is not efficiently transmitted sexually, there is a correlation with persons at risk for infection through injection drug use who seek care at STD clinics and HIV facilities. The recreational drug crystal methamphetamine has certainly made its presence known in the gay community. This epidemic in and of itself has increased the incidence of unprotected sex and subsequent rise in hepatitis B as well as HIV.

Hepatitis C has affected nearly four million Americans. Although most patients have no symptoms at the onset, some do develop jaundice, nausea, vomiting, flu-like symptoms, and malaise. Diagnosis of hepatitis C is made through a blood test to detect the antibody, which usually appears within a few weeks after exposure. Hepatitis C can be a self- limiting disease in 15 to 45 percent of the cases, but most statistics show that chronic infection develops in 75 to 85 percent of people infected. In those cases work up includes blood test to check:

* Serum chemistries

* Liver- function tests

* Complete blood counts

* Hepatitis C viral load

* Hepatitis C genotype

In addition to these blood tests, people are referred for ultrasound of their liver and to a gastroenterologist for a liver biopsy for staging. Treatment for hepatitis C is complicated and currently consists of pegylated interferon and ribavirin. Interferon is given as a weekly injection for approximately forty- eight weeks, administered with oral ribavirin daily. The virus is eliminated through treatment in about 25 percent of cases with hepatitis C, type 1. The side effects from this combination therapy are numerous and range from:

* Flu- like symptoms

* Depression and suicidal thoughts

* Low blood counts, especially anemia

* Chronic fatigue