Hepatitis B

Hepatitis B is irritation and swelling (inflammation) of the liver due to infection with the hepatitis B virus (HBV).

Causes, incidence, and risk factors

Hepatitis B infection can be spread through having contact with the blood, semen, vaginal fluids, and other body fluids of someone who already has a hepatitis B infection. Infection can be spread through: Blood transfusions (not common in the United States)

Shared personal items (such as toothbrushes, razors, and nail clippers) with an infected person

The hepatitis B virus can be passed to an infant during childbirth if the mother is infected. Risk factors for hepatitis B infection include: Being born, or having parents who were born in regions with high infection rates (including Asia, Africa, and the Caribbean)

virus occurs because of the way the body responds to the infection. When the body's immune system detects the infection, it sends out special cells to fight it off. However, these disease-fighting cells can lead to liver inflammation.

Symptoms
After you first become infected with the hepatitis B virus: You may have no symptoms

You may feel sick for a period of days or weeks

Direct contact with blood in health care settings

Being infected with HIV

You may become very ill (called fulminant hepatitis)

Being

Sexual contact with an infected person

on hemodialysis Having multiple sex partners

Tattoo or acupuncture with unclean needles or instruments

If your body is able to fight off the hepatitis B infection, any symptoms that you had should go away over a period of weeks to months. Some people's bodies are not able to completely get rid of the hepatitis B infection. This is called chronic hepatitis B.

Men having sex with men

Shared needles during drug use

Most of the damage from the hepatitis B

Many people who have chronic hepatitis B have few or no symptoms. They may not even look sick. As a result, they may not know they are infected. However, they can still spread the virus to other people. Symptoms may not appear for up to 6 months after the time of infection. Early symptoms may include:

The following tests are done to identify and monitor liver damage from hepatitis B:

have an active infection Hepatiti s E surface antigen (HBeAg) -- a positive result means you have a hepatitis B infection and are more likely to spread the infection to others through sexual contact or sharing needles

Albumin

level Liver function tests Prothro mbin time

The following tests are done to help diagnose and monitor people with hepatitis B: Antibod y to HBsAg (Anti-HBs) -- a positive result means you have either had hepatitis B in the past, or have received a hepatitis B vaccine

Appetite Fatigue

loss

Fever, low-grade Muscle and joint aches Nausea and vomiting Yellow skin and dark urine due to jaundice People with chronic hepatitis may have no symptoms, even though gradual liver damage may be occurring. Over time, some people may develop symptoms of chronic liver damage and cirrhosis of the liver.

Patients with chronic hepatitis will need ongoing blood tests to monitor their status.

Treatment
Acute hepatitis needs no treatment other than careful monitoring of liver and other body functions with blood tests. You should get plenty of bed rest, drink plenty of fluids, and eat healthy foods. In the rare case that you develop liver failure, you may need a liver transplant. A liver transplant is the only cure in some cases of liver failure. Some patients with chronic hepatitis may

Antibod y to hepatitis B core antigen (Anti-HBc) -- a positive result means you had a recent infection or an infection in the past

Signs and tests

Hepatiti s B surface antigen (HBsAg) -- a positive result means you

be treated with antiviral medications or a medication called peginterferon. These medications can decrease or remove hepatitis B from the blood and reduce the risk of cirrhosis and liver cancer. Liver transplantation is used to treat severe, chronic hepatitis B liver disease. Patients with chronic hepatitis should avoid alcohol and should always check with their doctor or nurse before taking any over-thecounter medications or herbal supplements. This even includes medications such as acetaminophen, aspi rin, or ibuprofen.

become infected with hepatitis B develop chronic hepatitis. Less than 5% of adults who are infected with the hepatitis B virus develop the chronic condition. Chronic hepatitis B infection increases the risk for liver damage, including cirrhosis and liver cancer.

Other complications may include: Chronic persistent hepatitis

Cirrhosi

s Fulmina nt hepatitis, which can lead to liver failure and possibly death

Calling your health care provider

Call your health care provider if: You develop symptoms of hepatitis B

Expectations (prognosis)
The acute illness usually goes away after 2 - 3 weeks. The liver usually returns to normal within 4 - 6 months in almost all patients who are infected. Some people develop chronic hepatitis. Almost all newborns and about 50% of children who

People who have chronic hepatitis B can transmit the infection. They are considered carriers of the disease, even if they do not have any symptoms.

Hepatiti s B symptoms do not go away in 2 or 3 weeks, or new symptoms develop

Hepatitis B is fatal in about 1% of cases.

Complications
There is a much higher rate of hepatocellular carcinoma in people who have chronic hepatitis B than in the general population.

You belong to a high-risk group for hepatitis B and have not yet received the HBV vaccine.

Prevention

All children should receive their first dose of the hepatitis B vaccine at birth, and complete the series of three shots by age 6 months. Children younger than age 19 who have not been vaccinated should receive "catch-up" doses. People who are at high risk, including health care workers and those who live with someone who has hepatitis B should get thehepatitis B vaccine. Infants born to mothers who either currently have acute hepatitis B, or who have had the infection should receive a special vaccination that includes hepatitis B immune globulin and a hepatitis B immunization within 12 hours of birth. Screening of all donated blood has reduced the chance of getting hepatitis B from a blood transfusion. Mandatory reporting of the disease allows state health care workers to track people who have been exposed to the virus. The vaccine is given to

those who have not yet developed the disease. The hepatitis B vaccine or a hepatitis B immune globulin (HBIG) shot may help prevent hepatitis B infection if it is given within 24 hours of exposure. Lifestyle measures for preventing transmission of hepatitis B: Avoid sexual contact with a person who has acute or chronic hepatitis B.

containing 1 part household bleach to 10 parts water. Hepatitis B (and hepatitis C) viruses cannot be spread by casual contact, such as holding hands, sharing eating utensils or drinking glasses, breast-feeding, kissing, hugging, coughing, or sneezing.

Use a condom and practice safe sex.

Avoid sharing personal items, such as razors or toothbrushes.

Trichomoniasis Trichomoniasis is a sexually transmitted infection caused by the parasite Trichomonas vaginalis. Causes, incidence, and risk factors Trichomoniasis is found worldwide. In the United States, the highest number of cases are seen in women between age 16 and 35. Trichomonas vaginalis is spread through sexual contact with an infected partner. This include penis-to-vagina intercourse or vulva-to-vulva contact. The parasite cannot

Do not share drug needles or other drug equipment (such as straws for snorting drugs).

Clean blood spills with a solution

survive in the mouth or rectum. The disease can affect both men and women, but the symptoms differ between the two groups. The infection usually does not cause symptoms in men and goes away on its own in a few weeks. Symptoms Women: Discomfort with intercourse Itching of the inner thighs Vaginal discharge (thin, greenishyellow, frothy or foamy) Vaginal itching Vulvar itching or swelling of the labia Vaginal odor (foul or strong smell) Men: Burning after urination or ejaculation Itching of urethra Slight discharge from urethra Occasionally, some men with trichomoniasis may develop prostatitis or epididymitis from the infection. Signs and tests In women: A pelvic examination shows red blotches on the vaginal wall or cervix. A wet prep (microscopic examination of discharge) shows the infection-causing organisms in vaginal fluids. A pap smear may also diagnose the condition. In men: The disease can be hard to diagnose in men. Men are

treated if the infection is diagnosed in any of their sexual partners. Men may also be treated if they have ongoing symptoms of urethral burning or itching despite treatment for gonorrhea and chlamydia. Treatment The antibiotic metronidazole is commonly used to cure the infection. A newer drug, called Tinidazole may be used. You should not drink alcohol while taking the medicine and for 48 hours afterwards. Doing so can cause severe nausea, abdominal pain, and vomiting. Avoid sexual intercourse until treatment has been completed. Sexual partners should be treated at the same time, even if they have no symptoms. Expectations (prognosis) With proper treatment, the outcome is likely to be excellent. Complications Long-term infection may cause changes in the tissue on the cervix. These changes may be seen on a routine Pap smear. In such cases, treatment should be started and the Pap smear repeated 3 to 6 months later. Treatment of trichomoniasis helps prevents the spread of the disease to sexual partners. Trichomoniasis is common among persons with HIV. Calling your health care provider Call for an appointment with your health care provider if

any unusual vaginal discharge or irritation is noted. Also call for an appointment if you suspect that you have been exposed to the disease. Prevention A monogamous sexual relationship with a known healthy partner can help reduce the risk of sexually transmitted infections, including trichomoniasis. Other than total abstinence, condoms remain the best and most reliable protection against sexually transmitted infections. Condoms must be used consistently and correctly to be effective.