Hepatitis B

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​​Hepatitis B (HBV or Hep B) is a blood-borne viral infection (BBV) that can cause long-lasting liver damage. It is transmitted through blood and sexual fluids, including semen, vaginal, and anal fluids. Hepatitis B can be acute (less than six months) or chronic (a lifelong illness that can be managed with antiviral medication). Adults have a 95% chance of recovering and developing natural immunity after infection. Hepatitis B is asymptomatic in many cases but can cause liver scarring and liver cancer if left untreated. Vaccination is the best way to prevent hepatitis B infection.

Signs and Symptoms

Hepatitis B is often asymptomatic. If symptoms do occur, they will usually start 2 to 3 months after infection with the virus and may last from 6 weeks to 6 months. If left untreated, it can cause liver scarring and liver cancer. 

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

  • Abdominal pain or liver pain (top right side of the abdomen)
  • Loss of appetite, nausea and vomiting
  • Weight loss
  • Jaundice (yellowing of the skin and eyes)
  • Rashes
  • Pale-coloured faeces and dark urine
  • Fatigue, fever and feeling generally unwell
  • Muscle, abdominal, and joint pain

Transmission

Hepatitis B can be transmitted through

  • The exchange of blood and sexual fluids, including semen, vaginal and anal fluids
  • Sharing syringes or injecting equipment
  • Sharing piercing, cutting and tattooing equipment or not using sterilised equipment
  • Sharing personal care items such as toothbrushes, razors, or hair and nail clippers
  • Sharing sex toys
  • Any BDSM activity that involves blood
  • Parent to baby during childbirth (administration of the hepatitis B vaccine within 12 hours of birth can significantly reduce the risk of transmission to the baby)

The biggest group of people with chronic hepatitis B have had it from birth or infancy.

You cannot catch hepatitis B through: 

  • being coughed or sneezed on by infected people  
  • consuming contaminated food and drink 
  • contact with saliva, kissing, breast milk or tears

Prevention

You can prevent the transmission of hepatitis B by

  • Getting vaccinated.
  • Using condoms, gloves, and dams to prevent contact with blood, semen, and anal or vaginal fluids.
  • Not sharing skin piercing equipment, tattooing equipment, or personal care items like hair and nail clippers, razors, or toothbrushes with other people.
  • Always use sterile syringes and injecting equipment and dispose of them safely. You can use this website to find your nearest Needle Syringe Program (NSP).
  • Always wash hands thoroughly if contact has occurred with someone else’s sexual fluids or blood.
  • Always use bleach or isopropyl alcohol cleaning products when cleaning up surfaces contaminated with sexual fluids or blood.
  • Viraclean is effective against hepatitis B.
  • Cover cuts, abrasions and wounds with waterproof dressings to reduce the likelihood of blood-to-blood contact
  • Be gentle when you brush your teeth before bookings, and/or avoid brushing teeth within a few hours of a booking. This helps prevent cuts or abrasions to the gums that may cause bleeding.

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

Vaccination

  • Vaccination against hepatitis B is available and provides lifelong immunity.
  • Babies in Australia have been vaccinated against hepatitis B since the year 2000, so many younger sex workers already have immunity. 
  • Sex workers who are not immune should consider having the combined hepatitis A/hepatitis B vaccination. 
  • Sex workers can 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.
  • If you do not know if you were vaccinated, you can request a blood test to check your immunity.
  • If you weren’t vaccinated against hepatitis B as a child, talk to your doctor about whether you need a catch-up vaccine.

If exposed to the sexual fluids or blood of someone with hepatitis B and you are not sure you’ve been vaccinated, see a doctor as soon as possible. Post-exposure care is available. 

Testing

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

Testing method

  • You will be given a blood test to see if you have contracted hepatitis B
  • You can get tested at your GP or a sexual health clinic

When to test

  • There is no specific timeframe for testing 
  • Hepatitis B infection is usually undetectable until about four weeks after infection
  • National STI guidelines recommend including hepatitis B in sexual health screening for sex workers, but not all healthcare providers do. It can be helpful to confirm this when you are getting tested.

Other Info

  • Because many people do not have symptoms when they get hepatitis B, they may never be diagnosed
  • Public sexual health clinic testing is bulk billed. If you don’t have medicare 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 medication available to treat acute hepatitis B. However, it is often short-lived and will go away without treatment. Instead, your doctor might recommend rest, proper nutrition and plenty of fluids while your body fights the infection. 

Chronic Hepatitis B is not curable but is manageable with medication. Here’s what you need to know about treating it.

  • Chronic hepatitis B can be managed with oral antiviral medications that reduce the risk of developing liver disease in the long term.
  • The most common treatment consists of taking one pill a day, which is usually a lifelong treatment.
  • Treatment is given via a weekly injection for up to twelve months in some cases. This treatment can be very effective for certain patients but can have serious side effects.
  • Each treatment has different benefits, and your specialist will discuss which one is best for you.

Costs and other information 

  • People with chronic hepatitis B who do not have any signs of current liver damage often do not need treatment but do need liver screening and monitoring through regular blood tests.
  • Antivirals for treating hepatitis B are available on the Pharmaceutical Benefits Scheme (PBS). 
  • Your GP can tell you more about what costs to expect. 
  • Public sexual health clinics can provide treatment for hepatitis B, regardless of your medicare eligibility.

In the past, people who seemed well despite chronic infection were labelled “healthy carriers”. However, this term is inaccurate as people with chronic hepatitis B:

  • risk transmitting hepatitis B to others such as close contacts, sexual partners and unborn babies
  • have nearly a one in four risk of dying from cirrhosis, liver cancer or liver failure

Specific resources and services are available for people living with hepatitis B via Hepatitis Australia.

How might this impact my work? 

Practical considerations

  • Some antiviral medications can compromise the effectiveness of oral contraceptives (‘the pill’). Discuss this with your doctors when developing your treatment plan
  • As hepatitis B targets the liver, you may decide not to drink 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 with STIs and/or BBVs. There may also be laws about BBV and STI prevention that apply to everyone. See our BBV, STI and the law resource for more information on your jurisdiction and/or contact your local sex worker organisation to find out more information.
  • Hepatitis B is a national routine notifiable condition, which means that diagnosed cases of are confidentially reported to the Commonwealth health department. You can find more information on the requirements for your jurisdiction on our BBV, STI and the Law resource.

Contact tracing of previous sexual partners (also known as ‘partner notification’) is a consideration for some BBV and STI. It should be done with consideration of the unique transmission risk and privacy needs of sex workers. Your local sex worker peer organisation can advise on any partner notification process to ensure that it is appropriate for your circumstances.

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