Dear Dr G,I understand that you are outlining various viral infections that can be prevented by vaccination during the month of May.Personally, as a Hepatitis B carrier, I am somewhat confused about the ABC of viral hepatitis and their impact on my sexual health.I contracted hepatitis as a child from my mother.All my life, I have been told to be cautious about my liver function and to take precautions when engaging in sexual activity.After I got married, I became paranoid about transmitting the virus sexually to my wife.I often tried to read up more about other forms of hepatitis and the role I play in preventing transmission of the virus to my wife and children.Apart from vaccination and the use of barrier protection during intercourse, I often worry about other ways I can prevent transmission of my disease.I wish to put Dr G on the spot to outline the ABC of hepatitis and how they impact sexual health.What exactly are hepatitis viruses, and how are they transmitted?Are hepatitis A, B, and C all different, or are they just different strains of the same virus?How do these viruses affect sexual and reproductive health?Looking forward to your answers.Yours truly,Hepatitis Howard Viral hepatitis is a major public health problem worldwide and is responsible for significant illness, liver failure, and death. The three most important forms are hepatitis A, hepatitis B, and hepatitis C. These viral infections primarily target the liver, causing inflammation. Although they share similar effects on the liver, they differ in their modes of transmission, disease progression, and long-term complications. Viral hepatitis is also closely linked to sexual and reproductive health because some forms are transmitted through sexual contact, can affect fertility and pregnancy, and may be passed from mother to child. Hepatitis A is caused by an RNA virus that spreads mainly via the faecal–oral route, often through contaminated food or water or poor sanitation. After entering the body through the digestive tract, the virus travels through the bloodstream to the liver. The pathogenesis of hepatitis A is mainly immune-mediated, meaning that liver damage occurs when the immune system attacks infected liver cells. This inflammatory response leads to symptoms such as fever, fatigue, nausea, abdominal pain, loss of appetite, dark urine, and jaundice. Unlike hepatitis B and C, hepatitis A does not usually become chronic because the immune system can generally clear the infection completely. Although hepatitis A is not commonly considered a sexually transmitted infection, it can spread through sexual practices involving oral–anal contact. Poor hygiene and close physical contact during sexual activity may increase the risk of transmission. Hepatitis B is caused by a DNA virus that is transmitted through blood and body fluids, including semen and vaginal secretions. It spreads through unprotected sexual intercourse, contaminated needles, blood transfusions, and from mother to child during childbirth. After entering the body, the virus infects liver cells and replicates within them. The virus itself causes little direct damage, but the immune system attacks infected hepatocytes, resulting in inflammation and liver injury. In some individuals, especially infants infected at birth, the immune response fails to eliminate the virus completely, leading to chronic infection. Chronic hepatitis B can progress to fibrosis, cirrhosis, liver failure, and hepatocellular carcinoma. Hepatitis B has major implications for sexual and reproductive health because it is highly infectious through sexual contact. Individuals with multiple sexual partners or those who do not use protection are at greater risk of acquiring the infection. The virus may also coexist with other sexually transmitted infections, increasing transmission rates. One of the most serious reproductive health concerns is vertical transmission from mother to baby during delivery. Infants infected at birth are much more likely to develop chronic hepatitis B, which can later lead to severe liver disease. Chronic HBV infection may also interfere with reproductive hormones and contribute to infertility and sexual dysfunction. Hepatitis C is caused by an RNA virus that spreads mainly through blood exposure, particularly through shared needles, unsafe injections, and contaminated blood products. Sexual transmission is less common than with hepatitis B, but it can occur, especially among individuals with multiple sexual partners, HIV coinfection, or traumatic sexual practices. After infecting hepatocytes, the virus mutates rapidly, allowing it to escape immune detection and persist in the body. The continuous immune response against infected cells causes chronic inflammation and progressive liver damage. Over time, this can result in fibrosis, cirrhosis, and liver cancer. The reproductive and sexual health effects of hepatitis C are also important. Pregnant individuals with HCV can transmit the virus to their infants, especially if they have high viral loads or coinfection with HIV. Chronic liver disease associated with HCV may affect hormone production and lead to menstrual disturbances, infertility, reduced libido, and complications during pregnancy. In the past, some antiviral treatments for hepatitis C were unsafe during pregnancy, although newer therapies are more effective and safer when given before conception. In conclusion, hepatitis A, B, and C are serious viral infections that affect the liver through immune-mediated inflammation and hepatocyte injury. Hepatitis A usually causes an acute, self-limiting illness, while hepatitis B and C can become chronic and lead to cirrhosis and liver cancer. These infections are strongly connected to sexual and reproductive health because they may spread through sexual contact, affect fertility and pregnancy outcomes, and be transmitted from mother to child. Effective prevention through vaccination, safe sexual practices, antenatal screening, and early treatment remains essential in reducing the burden of viral hepatitis and protecting reproductive health. WHO Director-General Tedros Ghebreyesus once said, “Viruses know no borders.” When Dr G is put on the spot to outline the sexual health implications of hepatitis A, B, and C, his response is always: “Knowledge creates borders for these viruses!”
