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CATIE

Hepatitis A

Summary

Hepatitis A is an infection caused by the hepatitis A virus, which can be sexually transmitted. Hepatitis A infection can cause inflammation of the liver (hepatitis).

Hepatitis A is passed when feces (stool, shit, poo) of a person with the virus comes into contact with the mouth of another person. The most common routes of transmission are sexual contact or ingesting (eating or drinking) contaminated food or water.

Hepatitis A typically clears up on its own within two months of infection.

A simple blood test can determine if an individual currently has a hepatitis A infection or has immunity to hepatitis A (after recovering from a past infection or being vaccinated).

There is no specific treatment for hepatitis A.

Hepatitis A is preventable with vaccination.

Routine hygiene (washing hands thoroughly after toilet use), and correct and consistent use of condoms and oral dams for sexual activity involving the anus, can reduce the risk of getting or passing on hepatitis A.

The words we use here – CATIE is committed to using language that is relevant to everyone. People use different terms to describe their genitals. This text uses medical terms, such as vagina and penis, to describe genitals. Cisgenderi people can often identify with these terms. Some trans peopleii may use other terms, such as front hole and strapless. CATIE acknowledges and respects that people use words that they are most comfortable with.

Key messages on hepatitis A for clients are available here.

What is hepatitis A?  

Hepatitis A is an infection caused by the hepatitis A virus, which can be sexually transmitted.

The hepatitis A virus infects a type of liver cell called hepatocytes.  This infection can interfere with usual liver functions, causing inflammation of the liver (hepatitis).1,2

How is hepatitis A transmitted?  

Hepatitis A is found in the feces (stool, shit, poo) from people with hepatitis A. The virus is passed on when the feces of an infected person makes its way into the mouth of another person (fecal-oral contact) who is not immune. Even microscopic (very tiny, invisible) amounts of feces can transmit hepatitis A.

Hepatitis A can be spread by sexual activities involving fecal-oral contact. This includes direct contact between the mouth and anus (rimming). Hepatitis A can also be passed on indirectly when a finger, penis, or sex toy that has been in contact with one person’s anus, then enters another person’s mouth. Handling a used condom after anal sex and then putting fingers in the mouth can also transmit hepatitis A.

Hepatitis A can also be passed on when a person ingests food or water that has been contaminated with the feces of someone with hepatitis A.1,3–5

Who is at risk?  

Anyone can get a hepatitis A infection.

Some groups carry a higher burden of hepatitis A (it is more common). These include:

  • people who use drugs (injection and non-injection drugs)
  • gay, bisexual and other men who have sex with men (gbMSM)
  • children in daycare (who are often in diapers or around other children who are in diapers and are not able to wash their own hands)
  • individuals in close contact (sexual or non-sexual) with a person with hepatitis A
  • individuals from, or who have visited, regions where hepatitis A is common, or where sanitation systems (sewage, tap water) are poor      

People with chronic liver disease are at increased risk of severe symptoms or complications if they get hepatitis A.1–4

Symptoms  

Not everyone who gets hepatitis A experiences symptoms. Symptoms typically appear two to six weeks after getting the virus (the incubation period). The onset of symptoms may happen quickly.

Common symptoms include:

  • loss of appetite
  • nausea
  • abdominal pain
  • fatigue
  • fever
  • light-coloured stool
  • dark urine
  • jaundice (yellowing of the skin and/or eyes)

Children under the age of six often have no symptoms or display only mild symptoms.

Most people clear the infection on their own within two months.

After a person recovers from an infection, they are usually immune to hepatitis A for life.

A person also becomes immune if they are vaccinated against hepatitis A.1,4,6,7

Complications 

The majority of people who get a hepatitis A infection make a full recovery without any treatment.

However, some people develop complications that may require hospitalization. In rare instances, hepatitis A can cause liver failure or death.

Some people experience prolonged jaundice and/or recurring jaundice over several months.

Hepatitis A can sometimes cause chronic liver damage or disease, but this is uncommon.1–3

Testing and diagnosis

Blood tests can reveal if an individual currently has a hepatitis A infection or has immunity to hepatitis A. A person becomes immune if they previously recovered from a hepatitis A infection or were vaccinated. Hepatitis A tests look for antibodies in the blood.4

Notification of partners  

Hepatitis A is a reportable infection in Canada. This means that when an infection is confirmed by a clinic, healthcare provider or laboratory, it must be reported to public health authorities. When someone has a confirmed hepatitis A diagnosis, the healthcare provider or public health staff will ask them to contact or provide contact information for all people who may have been exposed during the period of infection, including sexual partners and people living in the same household. The name of the original client is not given to their sexual partner(s) when they are contacted by public health.

The healthcare provider or public health staff will attempt to contact these individuals and encourage them to be tested. The Public Health Agency of Canada (PHAC) recommends that all people contacted be tested to assess their immune status and/or to provide vaccine protection to those who are not immune.8

Treatment  

There is no specific treatment for hepatitis A. People with hepatitis A are usually advised to rest and reduce their activity levels. They are also advised to drink plenty of water, eat healthy foods, and avoid alcohol and drugs.2,3

What about HIV?  

Having a hepatitis A infection does not increase the risk of getting HIV or passing it on to someone else. However, people living with HIV who get a hepatitis A infection may experience more severe symptoms or take longer to recover.3

Prevention  

The hepatitis A vaccine is the most effective way to prevent getting hepatitis A. The vaccine is over 90% effective when given to people who have not been exposed to hepatitis A. PHAC recommends vaccination for individuals at higher risk of getting hepatitis A.

Correct and consistent use of condoms reduces the risk of transmitting hepatitis A during sexual activities involving the anus. There are two types of condoms available. The external condom (sometimes called the “male” condom) is a sheath made from polyurethane, latex or polyisoprene that covers the penis during sex. The internal condom (sometimes called the insertive or “female” condom) is a pouch made of polyurethane or a synthetic latex material called nitrile that can be inserted into the vagina or rectum.

Some trans men may cut a condom or oral dam to fit their genitals.

The use of condoms or oral dams can reduce the risk of hepatitis A during oral sex or rimming.

When sharing a sex toy, cleaning the sex toy and putting a new condom on it between each use can reduce the risk of passing on hepatitis A.

Washing hands after handling a condom, glove, oral dam or sex toy can also help to reduce the risk of transmission.

Proper sanitation and hygiene practices (such as washing hands after using the toilet) can also help reduce the risk of transmission.

The notification, testing and treatment of all sexual partners of an individual with hepatitis A all help to prevent its spread.1,3,8–10

Notes

i Cisgender – someone whose gender identity aligns with the sex they were assigned at birth

ii Transgender – an umbrella term that describes people with diverse gender identities and gender expressions that do not conform to stereotypical ideas about what it means to be a girl/woman or boy/man in society

(Definitions taken from Creating Authentic Spaces: A gender identity and gender expression toolkit to support the implementation of institutional and social change, published by The 519, Toronto, Ontario.)

Credits

This fact sheet was developed in partnership with the Sex Information and Education Council of Canada (SIECCAN).

Resources

Condoms for the prevention of HIV transmission – fact sheet

Safer Sex Guide – client resource

Viral STI basics – client resource

Oral Sex – client resource

Sexually Transmitted Infections – booklet (Public Health Agency of Canada)

References

  1. Public Health Agency of Canada. Hepatitis A. 2018. Available at: https://www.canada.ca/en/public-health/services/diseases/hepatitis-a.html [Accessed Mar 12, 2023.]
  2. Centers for Disease Control and Prevention. Hepatitis A Q&As for Health Professionals. Available at: https://www.cdc.gov/hepatitis/HAV/HAVfaq.htm#general [Accessed Mar 12, 2023.]
  3. Public Health Agency of Canada. Hepatitis A vaccine: Canadian Immunization Guide. 2018. Available at: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-6-hepatitis-a-vaccine.html [Accessed Mar 12, 2023.]
  4. American Sexual Health Association. Hepatitis: Fast Facts. Available at: https://www.ashasexualhealth.org/hepatitis/ [Accessed Mar 12, 2023.]
  5. BC Centre for Disease Control. Hepatitis A: SmartSex Resource. 2022. Available at: https://smartsexresource.com/sexually-transmitted-infections/stis-conditions/hepatitis-a/ [Accessed Mar 12, 2023.]
  6. American Liver Foundation. Hepatitis A. 2022. Available at: https://liverfoundation.org/liver-diseases/viral-hepatitis/hepatitis-a/?gclid=Cj0KCQjwk7ugBhDIARIsAGuvgPZn7TXiLLF-lklQGMIdW8YkTmfPNx-1YdtJpKOt-nM4f9tmsZTxsL8aAtxGEALw_wcB [Accessed Mar 12, 2023.]
  7. Canadian Liver Foundation. Hepatitis A: Risks, Symptoms, Treatment & Support. Available at: https://www.liver.ca/patients-caregivers/liver-diseases/hepatitis-a/?gclid=Cj0KCQjwk7ugBhDIARIsAGuvgPY1Mmlj6zhvPo6ONJuNkRf2xauC161BtZfyABwoWhr9pNBM44ufkiIaAmp4EALw_wcB [Accessed Mar 12, 2023.]
  8. Public Health Agency of Canada. Surveillance of hepatitis A. 2018. Available at: https://www.canada.ca/en/public-health/services/diseases/hepatitis-a/surveillance.html [Accessed Mar 12, 2023.]
  9. Centers for Disease Control and Prevention. Hepatitis A Vaccine Information Statement. 2021. Available at: https://www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-a.html [Accessed Mar 12, 2023.]
  10. Nelson NP, Link-Gelles R, Hofmeister MG, et al. Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel. U.S. Department of Health and Human Services Morbidity and Mortality Weekly Report. 2022 Nov 2;67(43):1216–20.

Published: 2023

Author: Miller D