Hepatitis c symptoms in females

Hepatitis C information for women

There are a number of specific issues women need to consider regarding hepatitis C.

Mother to child transmission

Transmission of the hepatitis C virus from an infected mother to her unborn child is uncommon and only happens at the time of birth. In fact, it only happens in about 6 babies out of 100 who are born to mothers infected with hepatitis C. If a mother is also infected with HIV then the risk of passing on hepatitis C to the baby is higher.

Hepatitis C has not been found to cause problems during pregnancy.

Breast feeding is considered safe since there is no proof that breastfeeding can transmit hepatitis C – but it is recommended that if a woman’s nipples are cracked and bleeding that she doesn’t breastfeed her baby until the nipples are healed.

If you are infected with the hepatitis C virus, the usual amount of time before testing the baby is 18 months. This is because the baby will automatically get the mother’s antibodies and it takes this long before the baby’s body is able to clear out the mother’s antibodies.

If you are pregnant or planning to have a child and are hepatitis C positive, it is important to discuss the transmission risk with your consultant. Some medical providers will advise treatment of the woman’s hepatitis C before having a child.

Sharing of toothbrushes and shaving equipment is the only other situation where a child could be exposed to the virus via a parent who is living with hepatitis C.

Hepatitis C should have a minimal effect on you caring for your child. You can wash them, cook for them, you should feel comfortable doing everything a parent wants to do for their child.

Transmission during menstruation

Hepatitis C is a blood-borne virus, so is present in a woman’s menstrual blood if she is living with the virus. This is one of the few situations which sexual transmission of hepatitis C is possible between heterosexual couples. In an Italian study that demonstrated how unlikely sexual transmission was in a long term heterosexual relationship, all of the couples denied having sex during menstruation.

The impact of oestrogen on cirrhosis

Oestrogen is a hormone women produce primarily between puberty and the menopause. It has been shown to have anti-viral properties and has two known effects on hepatitis C:

  • It is believed to be the reason women have a higher rate of spontaneous clearance of the virus. This is where somebody’s immune system is able to clear the virus within the first six months of infection.
  • During chronic infection, oestrogen protects the liver and slows down liver damage. After the menopause, women produce less oestrogen so lose this protective effect. Post-menopausal women are at risk of more rapidly advancing cirrhosis.

Hepatitis C – including symptoms, treatment and prevention

Prevention

Exclusion from childcare, preschool, school and work is not necessary.

There is currently no vaccine for protection against hepatitis C virus infection. People with hepatitis C should ensure they are vaccinated against hepatitis A and hepatitis B.

There is no evidence that giving immunoglobulin (a solution containing human antibodies that is made from blood products) after exposure to hepatitis C will prevent infection.

Infected health care workers must comply with the requirements of their professional boards.

Everyone has a responsibility to help prevent the spread of hepatitis C and to take care of themselves and others. This means:

  • Not sharing or re-using any injecting equipment – not only needles but also syringes, filters, spoons, swabs and tourniquets.
  • Avoiding body tattooing or body piercing performed by those who are untrained and unregulated. Sterile technique under sterile conditions in premises which are regularly inspected by environmental health officers is recommended. Equipment, ointments, dyes and dye pot surfaces should be sterile. Ask about sterilising procedures.
  • Covering any open sores, cuts or abrasions with waterproof dressings.
  • Always using standard precautions if blood or body fluids must be handled. This will generally eliminate the risk of spreading of hepatitis C.
  • Safely disposing of found or used needles and syringes in a sharps safe or other sealable and puncture-proof container.
  • People with hepatitis C virus or at risk of infection with the virus should not donate blood, organs or other tissue. All donated blood and body organs are screened for hepatitis C virus.

For more information about Hepatitis C read the Get tested, get treated, eliminate Hepatitis C infographic.

Hepatitis C among Aboriginal and Torres Strait Islander people

There is a cure for hepatitis C.

Get Tested. Get Treated. For Yourself. For Your Family.

For more information contact your local Aboriginal health service or call the Hepatitis SA Helpline 1800 437 222.

Useful links

  • Handling blood and other body substances
  • Hepatitis B
  • Hepatitis SA
  • Hepatitis A, B, C, D and E summary
  • Clean Needle Program
  • Viral Hepatitis Support Nurses

1 – In South Australia the law requires doctors and laboratories to report some infections or diseases to SA Health. These infections or diseases are commonly referred to as ‘notifiable conditions’.

Symptoms hepatitis C

The first six months of hepatitis C infection is called the acute stage. You often do not notice symptoms. In this stage, it is possible for your body to clear the virus, but unfortunately the chances are small if you are HIV-positive. If the virus is still present after six months, it is called a ‘chronic infection’. You still don’t notice much of the virus. This changes after 10-30 years. The virus then causes severe liver damage.

Acute infection

Guidelines tell you should be tested regularly for hepatitis C by your HIV care provider. If he or she diagnoses you with an hepatitis C infection, there is a good chance that this has happened recently (acute infection). The acute stage of an hepatitis C infection generally lasts 6 months. After that, the infection is called a chronic infection.

Symptoms of an acute hepatitis C infection

‘Acute’ infection may sound serious but there are often no or only mild symptoms. If you do start having symptoms they are usually:

  • Loss of appetite
  • Nausea
  • Fatigue
  • Flu-like symptoms
  • Yellow white of the eyes, yellow skin (jaundice)
  • Dark urine
  • Light-coloured stools

Usually symptoms start around seven weeks after exposure to the virus. Some people already get symptoms after two weeks and others as late as 26 weeks after infection.

Genotypes

There are six major hepatitis C genotypes. Homosexual and bisexual men are mainly infected with genotype 1 or 4.

Spontaneous recovery

It is possible for your body to clear the virus without treatment in the acute stage. However, if you have HIV, the chance of this is very small. Most experts say there is a maximum chance of spontaneous recovery of 10 percent. People who are not HIV-positive have a 40 percent chance.

Chronic infection

After this six month period, the infection becomes ‘chronic’. If you do not get treatment for a chronic hepatitis C infection, liver fibrosis will set in and occasionally this will lead to cirrhosis. Fibrosis is the scarring of liver tissue. After a period of time, your liver may harden and shrink and will no longer function properly. This hardening and shrinkage of the liver is called cirrhosis. Not only does hepatitis C increase the risk of liver fibrosis and cirrhosis but also of liver cancer.

How soon does liver damage start?

The liver damage process may take 10 to 30 years. Care providers think that it starts much sooner in people living with HIV. The speed at which hepatitis C damages the liver also depends on:

  • Age: the younger you are the slower the process of damage will be
  • Alcohol consumption: even moderate drinking may speed up liver damage when combined with HIV/hepatitis C
  • Lifestyle: if you regularly push your body to the limits (for example by using drugs) this will have a negative effect
  • Having other infections such as hepatitis B

It is usually a curable disease

Treatment of an hepatitis C infection is constantly improving. There are more medications becoming available which can cure even the most difficult to treat chronic infections.

Hepatitis C – symptoms, treatment, prevention

Hepatitis C is treated with anti-viral medications with the objective of having no hepatitis C virus detected in the body after completion of a 12-week course of treatment.
The type of anti-viral medication used will depend on:

  • Hepatitis C genotype
  • Degree of liver damage
  • Previous treatment for hepatitis C.

Until recently, treatment for chronic hepatitis C usually involved taking two main medicines:

  • Pegylated interferon – a medication given by injection that encourages the immune system to attack the virus
  • Ribavirin – an antiviral medication that stops the virus replicating.

However, newer hepatitis C medications that make treatment more effective are now available in New Zealand. These newer medications are known as direct-acting antivirals (DAAs) and are taken orally as tablets. Some of these DAAs are given with pegylated interferon and ribavirin but in most cases they can be taken on their own or in combination with other new medicines.
With the availability of the newer medications, the chances of a cure are much higher. Combinations of medications now have a cure rate of more than 90%.
Side effects of treatment that involves pegylated interferon (flu-like symptoms – headache, fatigue etc) are quite common. The new tablet DAAs, however, have fewer side effects and are generally better tolerated by most people.
As well as treatment with medications, it is important for chronic carriers to make healthy lifestyle choices. This includes:

  • Maintaining a healthy diet, especially avoiding fatty foods
  • Avoiding alcohol
  • Avoiding taking any unnecessary medications
  • Maintaining a good level of physical fitness
  • Having a good social support system.

It is also recommended that chronic hepatitis C carriers are immunised against hepatitis A and hepatitis B as infection with these viruses can accelerate chronic liver disease.
Surgery is sometimes necessary to treat complications of liver disease, and some patients with advanced liver disease may be candidates for liver transplantation.

Currently there is no vaccine against the hepatitis C virus. So, to avoid the spread of the disease and other blood borne illnesses, people should:

  • Cover cuts and scratches with appropriate dressings
  • Hygienically dispose of blood-stained items such as bandages and sanitary napkins
  • Avoid sharing personal items that may be contaminated with blood (such as toothbrushes and razors)
  • Avoid sharing drug-injecting equipment
  • Avoid tattooing, acupuncture or body piercing where the equipment is not known to be adequately sterilised
  • Practice safe sex
  • People with the hepatitis C virus should advise their dentist or any other health professional that they are carriers of the virus.

Further information

It is very important to get a full explanation of the condition from a doctor. Most local hospitals have a public health unit that can also supply information and advice. The Hepatitis Foundation of New Zealand provides support and information services: The Hepatitis Foundation of New Zealand Freephone: 0800 33 20 10
Website: www.hepfoundation.org.nz Dhawan, V.K. (2016). Hepatitis C (Web Page). Medscape Reference: Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/177792-overview
Hepatitis Foundation of New Zealand (Date not stated). Hepatitis C (Web Page). Whakatane: The Hepatitis Foundation of New Zealand. http://www.hepatitisfoundation.org.nz/hepatitis-c/
Ministry of Health (2017). Hepatitis C (Web Page). Wellington: New Zealand Government Ministry of Health. https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/hepatitis-c
O’Toole, M.T. (Ed.) (2013). Hepatitis C. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed). St Louis, MI: Elsevier Mosby.
Last Reviewed – August 2017

Treatment of hepatitis c has improved over the years. Newer medicines have shorter treatment cycles and fewer side effects. Some of these treatments have the potential to even cure the disease.

Most recently, the Food & Drug Administration approved a pill that is a combination of glecaprevir and pibrentasvir (brand name: Mavyret). It has one of the shortest treatment cycles. Treatment dosage and length of treatment cycle depends on stage of disease. The shortest treatment cycle (8 weeks) is for people who have hepatitis c but have not been treated for it and do not have cirrhosis of the liver. It can treat all types of hepatitis c.

There are a number of other medications approved for treatment of hepatitis C. these include:

  • Elbasvir and grazoprevir (brand name: Zepatier)
  • Sofosbuvir and ledipasvir (brand name: Harvoni)
  • Sofosbuvir, velpatasvir, and voxilaprevir (brand name: Vosevi)
  • Daclastasvir (brand name: Daklinza)
  • Ombitasvir-paritaprevir-dasabuvir-ritonavir (brand name: Viekira Pak)
  • Ombitasvir-paritaprevir-ritonavir (brand name: Technivie)
  • Sofosbuvir-velpatasvir (brand name: Epclusa)
  • Simeprevir (brand name: Olysio) and peginterferon (injection)
  • Sofosbuvir (brand name: Sovaldi) and peginterferon (injection)
  • Ribavirin (liquid, tablet, or capsule)
  • Interferon (injection)

Your treatment plan for hepatitis c will depend on many factors. These include what type of hepatitis you have, whether you have cirrhosis of the liver, and your stage of disease. You and your doctor will decide on the best plan.

How should I take care of myself if I have hepatitis C?

Good health habits are essential for those who have hepatitis C. You should especially avoid of alcohol and other medicines and drugs that can put stress on the liver. You should eat a healthy diet and start exercising regularly. Your family doctor can help you plan a diet that is healthy and practical.

Talk to your doctor about any medicines that you are taking, including over-the-counter medicine. Many medicines, including acetaminophen (brand name: Tylenol) are broken down by the liver. Because of this, they may increase the speed of liver damage. You should also limit alcohol use. It also speeds the progression of liver diseases like hepatitis C. An occasional alcoholic drink may be okay, but check with your doctor first.

What are the side effects of drug treatment?

Common side effects for some treatments for hepatitis C may include the following:

  • nausea
  • vomiting
  • fever
  • fatigue
  • depression.

Side effects are usually worst during the first few weeks of treatment. They become less severe over time. If you are having trouble dealing with the side effects of your medicine, talk to your doctor. He or she can suggest ways to relieve some of the side effects. For example, if your medicine makes you feel nauseated, it may help to take it right before you go to sleep.

Do I have to have drug treatment?

The choice is up to you and your doctor. The decision to use drug therapy can be hard to make because of the potential side effects. Your doctor will closely monitor your symptoms and the amount of the virus in your body. He or she will also consider your overall health. This includes looking at blood test results. All are important factors to consider before you and your doctor start drug treatment for your hepatitis C.

How will I know if my treatment works?

The goal of treatment is to reduce the amount of the hepatitis C virus in your blood to levels that can’t be detected after 24 weeks of therapy. The amount of the virus in your blood is called your viral load. At the end of your treatment, your doctor will need to measure your viral load and find out how healthy your liver is. He or she may repeat many of the same tests that were done when you were first diagnosed with hepatitis C.

If your blood has so few copies of the virus that tests can’t measure them, the virus is said to be undetectable. If it stays undetectable for at least 6 months after your treatment is finished, you have what is called a sustained virologic response (SVR). People who have an SVR have a good chance of avoiding serious liver problems in the future.

Treatment may not reduce your viral load. You may not have an SVR after treatment. If that’s true, your doctor will discuss other treatment options with you. For example, if 1 round of treatment did not decrease your viral load enough, your doctor may recommend a second round. Even if treatment doesn’t keep you from having active liver disease, lowering your viral load and controlling chronic liver inflammation may help you feel better for a longer time.

Viral Hepatitis

What is hepatitis?

Hepatitis refers to inflammation of the liver. Inflammation is a tissue’s reaction to irritation or injury which generally results in swelling and can cause pain.

There are many causes of hepatitis. Viral hepatitis is caused by a virus and can either be acute (lasting less than six months) or chronic (lasting more than six months). Viral hepatitis can be spread from person to person. Some types of viral hepatitis can be spread through sexual contact.

There are five known hepatitis viruses which are categorized by the letters A through E.

Several viruses are known to cause hepatitis. Common forms of viral hepatitis include:

  • Hepatitis A: According to the Centers for Disease Control and Prevention, there were about 2,007 instances of acute hepatitis A infections in the U.S. in 2016. This form of hepatitis does not lead to a chronic infection and usually has no complications. The liver usually heals from hepatitis A within several months. However, occasional deaths from hepatitis A have occurred due to liver failure, and some people have required a liver transplant for acute hepatitis A infection. Hepatitis A can be prevented by vaccination.
  • Hepatitis B: Around 22,000 new cases of hepatitis B occurred in 2017, and around 900,000 people are living with the disease in the US. Approximately 95% of adults recover from hepatitis B and do not become chronically infected. However, a few cases cause a life-long, chronic infection. The earlier in life hepatitis B is contracted, the more likely it is to become chronic. People can carry the virus without feeling sick but can still spread the virus. Hepatitis B can be prevented by getting a vaccine.
  • Hepatitis C: Hepatitis C is one of the most common causes of liver disease in the U.S., and used to be the number one reason for liver transplant. About 75% to 85% of patients with hepatitis C develop a chronic liver infection. Roughly 2.4 million people in the U.S. are estimated to have chronic hepatitis C infection. It often does not show any symptoms. No vaccine is yet available to prevent hepatitis C.
  • Hepatitis D: Hepatitis D only happens to people who are infected by the hepatitis B virus. If you are vaccinated against hepatitis B, you will be protected against hepatitis D virus.
  • Hepatitis E: This type of hepatitis is spread by ingesting contaminated food or water. Hepatitis E is common throughout the world. Even though vaccines exist, they are not available everywhere.

Healthcare providers might not be able to identify the virus causing hepatitis as one of these. Other viruses, such as CMV, EBV, and HSV can also cause hepatitis.

Most people recover from hepatitis, and the disease is often preventable. However, it is still considered a serious health risk because it can:

  • Destroy liver tissue.
  • Spread easily from person to person.
  • Weaken the body’s immune system.
  • Cause the liver to fail.
  • Cause liver cancer.
  • Cause death (in rare cases).

How does someone get or spread hepatitis?

Hepatitis A can be spread through food or drinking water carrying the virus through bits of fecal matter from an infected person. (This is called the fecal-oral route.) You can also get hepatitis A from sexual contact.

A person can get hepatitis B in many ways, including:

  • Having sex with an infected person.
  • Sharing dirty needles.
  • Being in direct contact with infected blood.
  • Getting needle stick injuries.
  • Being transferred from mother to unborn child.
  • Being in contact with an infected person’s body fluids.

An infected mother has a high chance of giving hepatitis B to her child during or after birth. All pregnant women should be tested for hepatitis B. Within 12 hours of birth, infants born to mothers with hepatitis B need to receive treatment with hepatitis B antibody and hepatitis B vaccine. This can prevent transmission of hepatitis B from mother to the baby.

A person can get hepatitis C from:

  • Sharing dirty needles.
  • Being in direct contact with infected blood.
  • Getting needle stick injuries.
  • Having sex with an infected person (less common).

Blood products are currently tested for hepatitis B and C, so it is not likely that a person will get hepatitis from receiving them. However, blood transfusions or organ transplants before 1992 might have not been tested for hepatitis (in particular, hepatitis C). If you received a procedure before 1992, you might want to get tested for hepatitis.

Additionally, “baby boomers,” born in the U.S. between 1945 and 1965, are at increased risk of having hepatitis C. If you are part of this group, you should be screened for hepatitis C even in the absence of risk factors listed above. The US Preventive Services Task Force expanded the one-time screening population for hepatitis C to adults from the ages of 18-79, but this recommendation has not been finalized.

You can get hepatitis D from:

  • Being passed from mother to child during childbirth.
  • Having contact with infected body fluids or blood.

You can only get hepatitis D if you have hepatitis B. Hepatitis D is not common in the U.S.

You can get hepatitis E by eating or drinking food or water contaminated with the virus (the fecal-oral route). You can also be infected from under-cooked foods like pork, venison, or shellfish. Hepatitis E is uncommon in the U.S. but can occur after travel to a country where this infection is common. Hepatitis E can be particularly dangerous and even fatal in pregnant women.

What are the symptoms of hepatitis?

The most common symptoms of hepatitis include:

  • Dark urine.
  • Stomach pain.
  • Yellow skin or eye whites, called jaundice.
  • Pale or clay-colored stool.
  • Low-grade fever.
  • Loss of appetite.
  • Fatigue.
  • Feeling sick to your stomach.
  • Aching joints.

Contact your healthcare provider as soon as possible if you have any or a combination of these symptoms.

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What is the treatment for acute hepatitis C?

Acute hepatitis C is typically an infection of short duration and is treatable. Acute infection can clear on its own without treatment in about 25 of every 100 people. If treatment is needed, acute hepatitis C is treated with the same medications used to treat chronic hepatitis C. Treatment does reduce the risk that acute hepatitis C will become a chronic infection, however the optimal treatment and when it should be started remains uncertain. Healthcare providers often recommend getting rest, drinking plenty of fluids, and eating a healthy diet.

What is the treatment for chronic hepatitis C?

Several medications are available to treat chronic hepatitis C, including newer treatments that have been found to be more effective and have fewer side effects than previous treatment options. The latest treatment options for hepatitis C are antiviral medications. Most of the time, antiviral medication treatments involve daily medication for 12 weeks and depending on the specific medications being used, these have minimal side effects. Talking with your provider about treatment options is important. The costs of these treatment options vary but may be quite high, so all of those in need of treatment may not be able to afford or access it. Many pharmaceutical companies have programs that offer medication assistance and support. Talk to your healthcare provider about possible options.

At present, there is no vaccine available for hepatitis C. A person with hepatitis C should avoid alcohol and should check with his or her healthcare provider before taking any supplements or over-the-counter medications (as some of these products can damage the liver).

I was treated for hepatitis C. When can I have sex again?

After a person has been treated for hepatitis C, there is no waiting period to have sex again. Heterosexual and homosexual persons, especially those with concurrent HIV infection, a new partner, or with more than one partner, should protect themselves and their partners against transmission of the hepatitis C virus by using a condom, even if you have been treated for hepatitis C.

I was treated for hepatitis C. Can I get it again?

It is possible to become re-infected with hepatitis C if exposed to high-risk situations such as injection drug use. However, with a proper course of treatment under the guidance of a qualified healthcare provider, hepatitis C can be “cured.” This means that the virus is not detected in the blood when measured with a blood test three months after treatment has been completed. This is also referred to as a sustained virologic response to antiviral medications.

What happens if I don’t get treated?

For about 15 to 25 of every 100 people who get hepatitis C, the virus will clear on its own without treatment and they will not develop chronic infection. The reason for this is currently unknown. For others, lack of treatment could result in liver damage, liver cancer, or, in rare cases, death.

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