Hepatitis

What is hepatitis?

Hepatitis is an inflammation of the liver that can be caused by viruses or toxic substances such as excessive alcohol, recreational drugs, and the prolonged use of certain medications.

The viruses that can cause liver infection are hepatitis A, B, C, D, E, and G.

Hepatitis B, C, D, and A can be transmitted sexually.

Some autoimmune diseases and obesity can also cause hepatitis.

Symptoms of hepatitis

The main symptoms of hepatitis include:

• Nausea
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Dark urine and pale stools
• Yellowing of the eyes and skin (jaundice)
• Headaches
• Fatigue.

The severity of the disease varies greatly and depends on the cause, but liver inflammation can become chronic and progress to more serious complications such as cirrhosis and liver failure. 

For this reason, a diagnosis of hepatitis should always be monitored by a healthcare professional so the disease can be properly treated.

Some forms of hepatitis resolve with rest and proper nutrition, while others require complex treatments to control their progression.

In cases of hepatitis B and A, prophylaxis (hepatitis vaccination) is available for people with frequent risk exposures, regardless of age.

If you have had a risk exposure involving unprotected sex, sexual acts where the condom broke, sharing needles, or non-sterilized piercing or tattoo equipment, it is important to get screened for hepatitis — especially if any typical symptoms appear between 15 and 45 days after exposure.

Hepatitis B

Hepatitis B is caused by the Hepatitis B Virus (HBV) and is transmitted sexually when there is an exchange of infected blood, semen, or other bodily fluids.

People infected with HBV may develop acute or chronic disease.

Chronic carriers of this virus can transmit the disease to others and may develop severe liver conditions such as malignant liver tumors.

Mothers infected with HBV can transmit the infection to their child.

What are the symptoms of hepatitis B?

Symptoms of acute disease may appear up to 90 days after infection and include:

• Fever;
• Fatigue;
• Loss of appetite;
• Vomiting and nausea;
• Abdominal pain;
• Dark urine and pale stools;
• Jaundice.

These symptoms may be moderate or severe, and in some cases, fulminant hepatitis may occur, leading to liver failure.

Many people naturally clear the infection at this stage, while others develop chronic disease, cirrhosis, or liver cancer.

How can you become infected with hepatitis B?

As mentioned earlier, transmission of this type of hepatitis occurs mainly through sexual contact when there is an exchange of infected bodily fluids.

You can contract hepatitis B through:

• Unprotected sexual intercourse;
• Sharing non‑sterilized needles or other equipment used for drug use, medications, hormones, or tattoos;
• Contact with infected blood;
• Sharing certain personal items that may contain blood (toothbrushes and razors);
• From mother to child during childbirth (vaginal or cesarean).

Hepatitis B is not transmitted through:

• Sharing food;
• Water;
• Sharing cutlery;
• Breastfeeding;
• Kissing or hugging;
• Coughing or sneezing.

Hepatitis B vaccine

The hepatitis B vaccine is highly effective (between 80% and 100%) in preventing infection.

It was introduced into the Portuguese National Vaccination Program universally in 1995. Since then, all babies receive the first dose at birth and then at 2 and 6 months of age, following a 3‑dose schedule. When administered in childhood, the vaccine has a very high efficacy rate (95% to 99%).

All adolescents who have not yet been vaccinated should begin the vaccination schedule as soon as possible, following the same 0, 2, and 6‑month scheme after the first dose.

The hepatitis B vaccine is also recommended and free for certain risk groups, such as:

• Healthcare professionals;
• Hemodialysis patients;
• People with hemophilia;
• Individuals living with someone who has hepatitis B;
• Students and faculty of Medicine, Dentistry, Nursing, and Health Technologies.

To prevent hepatitis B, in addition to vaccination, you should also:

• Use condoms in all sexual practices;
• Avoid contact with blood or other bodily fluids;
• Always practice safer sex;
• Use only sterilized and disposable needles (whether for substance use or aesthetic procedures);
• Avoid sharing toothbrushes, razors, and/or other sharp or piercing objects (such as those used in manicures or other aesthetic procedures);
• Get tattoos, piercings, or acupuncture only with disposable or properly sterilized equipment.

How to treat hepatitis B?

Treatment for hepatitis B depends on the duration of the infection and must always be monitored by a healthcare professional.

Acute infections may not require specific treatment, as the immune system can control the infection and eliminate the virus within about 6 months. Medication is used when symptoms appear, to reduce their severity and impact on the patient’s life.

In chronic infections, the person is treated with antiviral medication to control the infection. This medication does not cure the infection but reduces liver damage and decreases the risk of complications.

Post‑exposure prophylaxis is a medication that works similarly to PEP; it must be taken after a risk exposure to prevent HBV infection.

This prophylaxis is most effective within the first 12 hours after exposure and consists of two steps:

1. Administering intravenous immunoglobulin to stimulate the production of anti‑HBV antibodies;
2. Starting the vaccination schedule (3 doses) in unvaccinated individuals.

Hepatitis C

Hepatitis C is caused by the Hepatitis C Virus (HCV). This infection can be transmitted sexually, although this is not the main route — except in the case of anal intercourse (which carries a higher risk of transmission) and in people living with HIV.

The highest risk of transmission occurs in situations where blood enters the body directly, such as sharing non‑sterilized equipment for injecting drugs.

The risk of mother‑to‑child transmission during pregnancy is quite low (around 6%), and breastfeeding is generally safe, since transmission would require direct blood exchange through cuts on the nipple and the child’s mouth.

Because it is often asymptomatic, many people do not know they are infected and may unknowingly transmit the virus.

To find out whether you are infected with the hepatitis C virus, you should get tested if you have had any risk behavior and/or if symptoms characteristic of the infection appear.

The main test for diagnosing hepatitis C is the detection of antibodies against HCV (anti‑HCV). To reach a definitive diagnosis, additional tests must be performed in a hospital setting.

You can get tested in various places such as health centers, pharmacies, or laboratories, but many people prefer to do it through different NGOs and associations. Search for those available in your area using our mapping tool.

What are the symptoms of hepatitis C?

Symptoms are often mild and non‑specific, which is why people at risk should get tested - they may be infected and transmitting the disease without realizing it.

The infection may be acute and appear between two and twelve weeks after exposure. Symptoms are usually mild and include:

• Fatigue;
• Nausea, vomiting;
• Fever;
• Muscle or joint pain;
• Loss of appetite;
• Weight loss;
• Jaundice;
• Dark urine and pale stools.

Chronic infection is the most common form and is defined by active viral replication for at least 6 months. Symptoms may be mild and non‑specific during the first years.

Chronic hepatitis is associated with:

• Extreme fatigue;
• Mild cognitive difficulties.

When untreated, hepatitis C can lead to cirrhosis and liver cancer.

How can you become infected with hepatitis C?

You are at risk of becoming infected with hepatitis C if:

• You have shared equipment for injecting drugs;
• You have or have had unprotected sexual intercourse;
• You have had a tattoo done with non‑sterilized equipment;
• You have used personal items belonging to others that may contain blood (toothbrushes, razors, manicure or pedicure tools).

HCV can also be transmitted from mother to child during pregnancy or childbirth.

How to prevent it?

The hepatitis C virus has many variations and mutations known as subtypes or genotypes — for this reason, there is no vaccine for hepatitis C. Prevention relies on avoiding contact with infected blood.

Sharing contaminated needles and syringes remains the main route of infection.

What you should avoid:

• Using injectable substances with non‑sterilized equipment;
• Sharing toothbrushes, razors, and other objects that may contain blood;
• Getting tattoos and piercings with non‑sterile equipment;
• Having unprotected sex.

How to treat hepatitis C?

There is now a cure for hepatitis C. Around 90% of chronic hepatitis cases are resolved with treatment, which consists of a combination of antiviral medications taken under medical supervision for several weeks.

When treatment side effects are very severe, it may be necessary to suspend therapy.

In cases where complete cure is not achieved, treatment at least reduces symptom severity and prevents severe liver disease. When the disease causes extensive liver damage leading to cirrhosis, the patient may require a liver transplant.

People infected with HCV should avoid alcohol and medications that are toxic to the liver to support healing and prevent further damage.

Hepatitis A

Hepatitis A is a viral infection caused by HAV, a virus with seven known genotypes.

This virus is particularly resistant to heat and can remain infectious for months at room temperature and for 30 minutes at 60°C.

Since its main route of transmission is fecal‑oral, these characteristics make proper sterilization of certain foods and water essential — for example, through UV light, formaldehyde, or chlorine.

The average incubation period ranges from 15 to 50 days. 

How can you become infected?

HAV enters the body primarily through the mouth, and infection can occur through:

• Sexual practices involving unprotected anus‑to‑mouth contact;
• Consumption of contaminated food or water, especially in places with poor sanitation. 

After entering through the mouth and replicating in the liver, the virus is excreted in the stool of the infected person, even if they show no symptoms. 

What are the symptoms of hepatitis A?

HAV infection may be asymptomatic or, on the contrary, cause severe symptoms such as:

• Fever;
• General malaise;
• Nausea and vomiting;
• Abdominal pain;
• Loss of appetite;
• Dark urine;
• Jaundice.

Hepatitis A vaccine

Vaccination against hepatitis A is not included in the Portuguese National Vaccination Program. However, it is recommended for people traveling to endemic areas where the disease is highly prevalent or where sanitation is poor. It is also recommended for individuals who engage in unprotected anal‑rectal sexual practices.

In addition to vaccination, it is advised to:

• Maintain personal, household, and family hygiene;
• Properly clean susceptible foods;
• Wash hands and the perianal and genital areas frequently before and after sexual contact.