Viral hepatitis

Expert reviewer, Professor Martin Wiselka, Consultant in General Medicine and Infectious Diseases
Next review due January 2022

Hepatitis is when your liver becomes inflamed. It can be caused by several different things, but when it’s caused by infection from a virus it’s called viral hepatitis. Hepatitis can cause symptoms such as sickness, losing weight, jaundice and tiredness. It can occasionally lead to serious and life-threatening illness. Some people with viral hepatitis go on to develop a long-term infection which can damage their liver.

The most common types of viral hepatitis are hepatitis A, B and C. Other types include hepatitis D and E, but they’re less common.

Young couple comforting each other

Symptoms of viral hepatitis

You may not have any symptoms, so you may not know that you’re infected. Around eight in 10 people with hepatitis C will have no symptoms. You may also have some mild symptoms that aren’t very specific.

If you have symptoms of an acute infection, they can appear anytime between two weeks to six months after you’ve been infected. An acute infection is one that lasts for a short time and then gets better. If you develop chronic (long-term) viral hepatitis, the symptoms can take many years to develop.

General symptoms of all types of hepatitis include:

  • a fever
  • feeling very tired (fatigue)
  • not feeling like eating (loss of appetite)
  • feeling sick and being sick
  • pain at the top and to the right of your abdomen (tummy)
  • dark-coloured urine and grey-coloured stools
  • pain in your joints
  • yellow skin and whites of your eyes (jaundice)

Symptoms often develop in the following way.

  • After you’ve been infected, the virus first spreads without causing any symptoms.
  • Some non-specific symptoms may then start, including losing weight, itchiness of the skin, sickness and tiredness, fever and abdominal pain. After three to 10 days, your urine gets darker and this is followed by jaundice. Many people find their general symptoms like sickness and tiredness get better as the jaundice gets worse.
  • After this, you’ll have a recovery phase, which usually lasts two to four weeks, as the jaundice fades.

Diagnosis of viral hepatitis

Your GP will ask you about any symptoms and examine you. Your doctor may ask you about any travel abroad or your lifestyle. This is because different types of hepatitis are spread in different ways, such as through contact with someone who is infected or from infected food or water in certain countries.

Your GP will ask to take a sample of your blood. This will be sent to a laboratory for testing. Blood tests can check how well your liver is working and see whether you have any specific antibodies, which may suggest you have a hepatitis infection. Antibodies are made by your immune system, which help your body to fight infection.

Usually, blood tests are all that’s needed to diagnose viral hepatitis; however, you may be asked to have the following.

  • An ultrasound scan of your liver.
  • FibroScan - this non-invasive device measures the ‘hardness’ (or stiffness) of your liver via a technique called transient elastography (TE). It’s very similar to having an ultrasound scan.
  • A liver biopsy. This is when a small sample of tissue from your liver is removed and looked at in a laboratory. However, this is usually only performed if a diagnosis is still uncertain after the non-invasive tests listed above have been done.

Treatment of viral hepatitis

The treatment you need will depend on the type of hepatitis you have.

Hepatitis A

There isn’t a specific treatment for hepatitis A. You’ll have supportive care, which means treating your symptoms and helping you to stay as well as possible while your body fights the infection. You might be admitted to hospital if your infection is severe.

You may be given anti-sickness medicines and will be encouraged to rest and drink plenty of fluids. It’s a good idea to not drink any alcohol or take too much paracetamol while you’re recovering, as these can both affect your liver. Eating a healthy, balanced diet should help too.

Acute hepatitis B  

If you have acute hepatitis B, your body will probably fight the infection without needing any specific treatment. You’ll have supportive care, which means treating your symptoms and helping you to stay as well as possible while your body fights the infection.

You may be given anti-sickness medicines and will be encouraged to rest and drink plenty of fluids. It’s a good idea to not drink any alcohol while you’re recovering, as this can affect your liver. If your skin is itchy:

  • wear loose clothes
  • keep cool
  • don’t have hot baths or showers

If you develop a severe infection, you may be treated with antiviral medicines. These work by stopping the virus multiplying in your body.

Chronic hepatitis B  

If you have chronic hepatitis B (you’ve had the infection for more than six months), you should be treated by a specialist. This is usually a hepatologist or infection specialist.

Treatment for chronic hepatitis B doesn’t usually cure it, but instead works to put off, or prevent, complications from developing. Depending on how severe the infection is and your general health, your doctor may give you antiviral medicine to fight the virus. The three medicines used to treat hepatitis B are:

  • peginterferon alfa – you’ll need to have this as an injection once a week for 48 weeks
  • entecavir – this is a once-a-day tablet
  • tenofovir disoproxil – this is a once-a-day tablet

Hepatitis B can be passed on to other people when body fluids, such as blood and semen, are shared. Your doctor will give you specific advice, but while you have hepatitis B you should not have unprotected sex.

Hepatitis C

If you have hepatitis C, your GP will refer you to a specialist. The aim of treatment is to cure the disease and prevent complications from developing. Around nine out of 10 people with hepatitis C can now be cured with a straightforward course of medicine (tablets) lasting eight to 16 weeks.

Drinking alcohol can make complications more likely, so while you have hepatitis C it’s important not to drink alcohol at all.

If you have acute hepatitis C, you may not need treatment, as your body may fight the infection on its own. If you agree, your doctor will monitor you for at least six months to see whether your body fights the infection. You may also be given antiviral medicines and medicines to treat any symptoms.

Chronic hepatitis C can also be treated with antiviral medicines. Which antiviral medicines you have and how long you need to take them for will depend on the specific type of hepatitis C virus you have. Always read the patient information that comes with your medicine and take it as prescribed by your doctor.

Hepatitis C can be passed on to other people when blood is shared, such as when using needles and syringes that have been contaminated with blood from an infected person. Your doctor will give you specific advice about how you can prevent other people from getting the virus.

Hepatitis D

Hepatitis D can only develop if you also have hepatitis B. The main treatment is antiviral medicines which can cure the infection.

Hepatitis E

Hepatitis E is usually a mild infection which gets better without treatment. In some people it can develop into a more serious infection which can damage the liver.

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Complications of viral hepatitis

Possible complications, and how likely you are to get them, differ from one type of viral hepatitis to the next.

  • Hepatitis A. Around two in 10 people find that symptoms of severe itching, diarrhoea and weight loss come and go over several months. A very small number of people develop liver failure.
  • Hepatitis B. Chronic hepatitis B can cause complications such as liver failure, cirrhosis (scarring of the liver) and cancer of the liver.
  • Hepatitis C. Chronic hepatitis C can cause complications such as cirrhosis (scarring of the liver), joint pain and arthritis and skin problems. Around one in three people who are treated with peginterferon develop severe depression.

Prevention of viral hepatitis

There are two main things you can do to reduce the likelihood of getting viral hepatitis.

  • Avoid the things that put you at risk of getting infected.
  • If it’s appropriate and there is a vaccine, you can be immunised to protect you from the infection.

Hepatitis A

Hepatitis A virus is in the stools (faeces) of an infected person. Microscopic amounts can get onto objects they touch or into food and drinks. If you put these in your mouth or get the virus on your hands and then touch your mouth, you can become infected. You can reduce your risk of getting the virus by washing your hands well, drinking safe water and preparing food safely. This is important because hepatitis A virus can survive on the ends of your finger tips for up to four hours.

There is a vaccination against the hepatitis A virus. If you’re travelling to a country where the hepatitis A virus is common, you should have the vaccinations before you travel.

Hepatitis B

Hepatitis B is spread through contact with an infected person’s blood or other bodily fluids including vaginal fluid and semen. It can be spread by:

  • sharing needles and drug equipment when injecting drugs – this could be through drug use, or a ‘needlestick injury’ when handling needles and syringes, for example, if you’re a healthcare worker
  • having sex with an infected person without using a condom
  • having a body piercing, tattoo, medical or dental treatment using unsterilised, or poorly sterilised, equipment
  • sharing toothbrushes or razors that have been contaminated with infected blood

There is a vaccine to protect against hepatitis B, so if you think you’re at risk of getting it, talk to your GP or practice nurse about immunisation. If you need protection straightaway because you may have been infected, you can also have an injection of immunoglobulin. This can be given at the same time as the vaccine and it can give you protection from the virus until the vaccine starts to work.

A map showing world hepatitis B distribution

Hepatitis C

The hepatitis C virus is spread by contact with small amounts of infected blood. This usually happens through sharing needles and syringes when using drugs, or from needlestick injuries in healthcare workers. There is also a small chance of the virus being spread through unprotected sex with someone who is infected.

There isn’t a vaccine available to protect you against hepatitis C.

For more information or detailed advice about vaccination against viral hepatitis speak with your GP. There’s also a lot of useful information online, for example, from the Travel Health Pro site of the National Travel Health Network and Centre (NaTHNaC) – see our section ‘Other helpful websites’ for contact details.

Frequently asked questions

  • Viral hepatitis can sometimes pass from mother to baby during pregnancy and birth, but whether that could happen depends on which type of hepatitis you have.

    More information

    It’s very unlikely for hepatitis A to pass from you to your unborn child, but it’s possible for hepatitis B, C and D to be passed on during pregnancy or birth. Hepatitis B is the most likely type to pass from you to your baby. If you have hepatitis C or D, then you can pass it on to your baby, but it’s unusual for this to happen.

    If you have hepatitis B, you may be advised to take antiviral medicines in the last three months of your pregnancy, which can help to reduce the chances of passing it to your baby. When your baby is born, they will be given a course of hepatitis B vaccinations. Some babies also have immunoglobulin alongside the vaccine to help fight the infection. These usually work well to reduce the chances of your baby getting the infection.

    If you have viral hepatitis and you’re pregnant, or think you may be, talk to your midwife or obstetrician as soon as you can.

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  • Reviewed by Alice Windsor, Specialist Health Editor, Bupa Health Content Team, January 2019
    Expert reviewer, Professor Martin Wiselka, Consultant in General Medicine and Infectious Diseases
    Next review due January 2022