Dr Laura Waters is an HIV and sexual health consultant at the Mortimer Market clinic and the Boyz Doc. Dr Laura answers your questions every two weeks in Boyz. If you have a question for Dr Laura please email her at firstname.lastname@example.org.
Dear Dr Laura,
I’m a 24 year old guy, sexually active with a number of regular partners. I’ve heard people talking about getting the hepatitis vaccination but I don’t really know much about it and I’ve heard scare stories too. Can you explain the benefits and different types please, and how do I get it?
‘Hepatitis’ refers to anything that inflames/irritates the liver, including alcohol and drugs (prescribed, herbal and recreational). There are several hepatitis viruses; I’ll focus on those that can be transmitted sexually:
Hepatitis A: a ‘faeco-oral’ virus meaning it can be passed on through contaminated food/water or any sexual activity that puts mouths near bums. There was a 2017 outbreak amongst men who have sex with men in Europe (including the UK). Symptoms include fever, aches and jaundice (yellow skin/eyes); it’s rarely very serious and is self-limiting meaning your body clears the virus leaving you immune. There is a vaccine available.
Hepatitis B: a ‘blood-borne’ virus found in blood and sexual fluids – gay men are a group at higher risk. Most adults who get hep B have no symptoms (if they do they’re similar to hep A) and clear the virus themselves; about 1 in 20 don’t clear the virus (chronic infection, which can lead to serious liver disease) and will need monitoring/treatment. There is a vaccine available.
Hepatitis C: also ‘blood-borne’. The main routine of infection worldwide is injecting drug use and it was considered difficult to transmit sexually; over the last decade, however, we’ve learned that sexual transmission between gay men, particularly those with HIV, is more common than we thought. It’s hard to know the precise risk because there’s overlap between higher risk sex (group sex, fisting, shared sex toys) and drug use (chemsex). About 1 in 5 people clear the virus themselves and there are very effective, short-term treatments for those who don’t. There is no vaccine and if you’ve had hep C you CAN get it again.
Hepatitis D: only affects people with hep B; no vaccine.
Hepatitis E: similar to hep A, mainly transmitted through contaminated water, but can be transmitted sexually; no vaccine.
If you are at higher risk of hep A or B – and as a gay man you are – you can get both vaccines at any sexual health clinic or your GP. Hep A is 2 doses, 6-12 months apart, Hep B is 3-4 doses, usually over 6-12 months; most clinics will check your response to hep B vaccine (blood test) and then you need a booster at 5 years – you are then immune for life. It’s different if you are HIV positive as you’re more likely to lose your immunity for both hep A and B; speak to your clinic for more advice.
There have been global shortages of both Hep A and B vaccines. Hep A vaccine supplies have now been secured for sexual health and HIV services and Public Health England advise that all gay men attending these clinics are vaccinated unless there is reliable evidence (from medical records or a blood test) that you’ve had the infection or vaccination before. Hep B vaccine supplies are almost back to normal and again, you should be able to access vaccine from all sexual health services.
You mentioned scare stories… Both vaccines are very safe and the benefits of being protected against infection outweigh any small risks; both are given as an injection into your upper arm. Any side effects from hep A or B vaccines are usually mild, happen within a few days and include temporary soreness, redness and swelling at the injection site. It is common to feel tired after a vaccination, up to 1 in 100 people get flu like symptoms and up to 1 in 10,000 get an allergic reaction – if you get allergy symptoms such as rash or swelling you should seek urgent medical advice and shouldn’t have the vaccine again. You can ask the clinic for a patient information leaflet when you attend for vaccination or you can read more about vaccine side effects on the NHS website.
Hep A vaccine is very effective with almost everyone developing strong immunity – for most people (over 90%) the immunity remains strong after many years so no further vaccination is recommended unless you have an impaired immune system. More than 95% of people get good immunity after a course of hep B vaccine and as long as you have a 5-year booster no further doses or checks are needed unless you have HIV or another condition that affects your immune system.
Before the 2017 hep A outbreak, several sexual health clinics had stopped offering vaccination but since the big rise in cases, all clinics should provide it. Also, If you have close contact with someone with hep A, getting vaccinated quickly can prevent you developing the infection.
So, hep A and B are completely preventable, gay men are at higher risk, and if you have not been vaccinated you should attend a sexual health service to get the vaccines and talk about prevention of sexually transmitted infections.
While you’re there ask about the HPV (human papilloma virus) vaccine – all gay men aged 45 or under are entitled to a course of 3 vaccinations. It is safe and significantly reduces your risk of genital warts and anal pre-cancer/cancer.