Hepatitis A

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Hepatitis A (HAV or Hep A) is a highly contagious infection that can cause inflammation or swelling of the liver. You get hepatitis A by coming into contact with the faeces (poo) of an infected person, or by consuming contaminated food, drink or ice. It can also be transmitted through sexual contact, particularly oral-anal sex (rimming). Hepatitis A is uncommon in Australia.

Acute hepatitis A may last only a few weeks, but some people are seriously ill for up to six months. Hepatitis A usually does not cause long-term damage. People with hepatitis A fully recover, and it does not cause chronic hepatitis.  

The best way to prevent getting hepatitis A is to be vaccinated. It is recommended that sex workers receive the hepatitis A/hepatitis B vaccination. Vaccination is free if you are eligible.

Signs and Symptoms

If symptoms do occur, it will usually be within 15-50 days of exposure. If left untreated, complications can include chronic liver disease, liver scarring and liver failure. 

Hepatitis A can be asymptomatic (show no symptoms), but approximately 70-80% of adults with hepatitis A experience symptoms.

When symptoms of hepatitis A are present, they can include:

  • Fatigue, fever, and generally feeling unwell
  • Loss of appetite, nausea, vomiting, and diarrhoea
  • Abdominal pain
  • Pale-coloured faeces (poo) and dark urine
  • Jaundice (yellowing of the skin and whites of the eyes)
  • Diarrhoea

Symptoms usually last less than two months. People with pre-existing liver damage may be more susceptible to complications, but most people fully recover from hepatitis A.

Transmission

Hepatitis A is transmitted when even tiny amounts of faeces from a person carrying the virus enter another person’s mouth.

People carrying hepatitis A can transmit the virus about a week after exposure and before they show any symptoms.

Following hepatitis A infection, most people develop lifelong immunity and can no longer transmit or get the virus.

Hepatitis A can be transmitted through:

  • Rimming (oral-anal sex) without dams or other barriers
  • Oral contact with fingers, condoms or sex toys that have been in or near the anus of an infected person, especial after fingering or fisting
  • Consuming contaminated food or water
  • Sharing contaminated food, or eating utensils, that carry the virus
  • Touching nappies, linen and towels soiled with traces of faeces

Prevention

Vaccination is the most effective form of protection against hepatitis A. 

  • Sex workers are eligible to be vaccinated for free, but your doctor may charge a consultation fee for the visit. You can check this when you make your appointment.
  • Public sexual health clinics can vaccinate you for free, regardless of Medicare eligibility.

You can take other prevention measures as well: 

  • Use condoms, dams, or gloves for anal play and wash your hands thoroughly after play
  • Change and dispose of condoms, dams, finger cots or gloves before switching to other services
  • Use dams, plastic wrap or a cut-up condom as a barrier when providing rimming services (oral-to-anal contact)
  • Put condoms on butt plugs and dildos, and change them between anal and oral sex 
  • Wash towels and bed linen in warm soapy water
  • Wash your hands with soap and water after going to the toilet, and before preparing food
  • Avoid sharing utensils, food, drinks and cigarettes

While alcohol-based hand sanitisers do have some effect, washing with warm water and soap is more effective in preventing hepatitis A transmission. 

It is always recommended that you always change condoms when going from anal to vaginal or oral sex.

Testing

Here’s some information about testing for hepatitis A. You can view a list of sex worker-friendly sexual health clinics at our Where To Test page.

Testing method

  • Hepatitis A testing is done through a blood sample.
  • You can get tested at your GP or a sexual health clinic. 

When to test

  • Hepatitis A can be detected two weeks after you are first infected.
  • Hepatitis A is not part of a routine sexual health screening, so you may need to ask for a test if you suspect you have it

Other info

  • Sexual health clinic testing is often bulk billed. If you don’t have Medicare and the test will most likely be free! 
  • If you see a GP, you may pay a fee or be bulk billed.

Treatment

There is no medical treatment for hepatitis A, but the infection should go away on its own. It is recommended that you rest, drink plenty of water and fluids, take ibuprofen for fever, avoid alcohol and eat a well-balanced, low-fat diet until your symptoms go away.

About 85% of people with hepatitis A recover within three months, and almost all recover within six months.

Once you have had and cleared hepatitis A, you will become immune to it, meaning you cannot get it again.

How might this impact my work? 

Practical considerations

  • You may not feel well enough to work.
  • Doctors recommend avoiding sexual contact until after you stop having symptoms, as hepatitis A is highly infectious. 
  • If you cannot afford to take this time off work, you can also consider doing non-contact/online or phone sex work during this time. 
  • Jaundice (yellow skin or eyes) is a visible symptom and may raise questions or concerns with clients.
  • You may decide not to drink alcohol at work or participate in ‘party bookings’ to limit liver strain. 

Legal and reporting considerations

  • Some states and territories may have laws that criminalise sex working or having sexual contact while you have a BBV or STI. Check out our BBV, STI and the Law resource or contact your local sex worker peer organisation for more information. 
  • Hepatitis A is a nationally notifiable disease in Australia, which means that diagnosed cases of hepatitis A are anonymously reported to state or territory health departments.

There may be contact-tracing requirements in your jurisdiction. You can contact your local sex worker organisation or clinician for support.

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