Viral Hepatitis in the GU setting

Question 1

Types of Hep virus in GUM setting

Answer 1

A,B,C,D,E are all relevant in the GUM setting

Question 2

Definition of Hepatitis

Answer 2

An inflammation of the liver but not a diagnosis by itself

May be acute or chronic

Question 3

Hep A - epidemiology

Answer 3

300-500 cases/yr –> Faecal-oral which can be transmitted during sexual practices involving bum —> Large outbreaks among urban MSM 1990s. Extremely hardy virus –> risk from sex venues/toys

Question 4

Hep B - epidemiology

Answer 4

400million carriers worldwide–> 500-1000 cases/yr in uk. MSM and IDUs at risk–> need to trace contacts. Major case of primary liver cancer. May develop drug resistance

Question 5

Hep C

Answer 5

170million worldwide –> 216,000 in UK (60,000 diagnosed) –> 5000-10,000 cases/yr. M:F/2.4:1. >85% IDU related. Acute infection is mild and underdiagnosed –> chronic infection in 55-85%. Genotypes 1 & 3 predominate. MSM and IDU + vertical transmission–> much higher if HIV co-infected

Question 6

Hep D

Answer 6

Passenger virus on HBV –> decreasing prevalence

Makes HBV infection more severe and progressive and increases the HCC risk

Question 7

Hep E

Answer 7

Similar to Hep A
Pigs involved –> bad for pregnant women
About 200 cases/yr

Question 8

Hep A - presentation

Answer 8

Acute hepatitis only which is rarely fatal. Supportive treatment, post-exposure prophyaxis for contact –> vaccination is effective
IgM confirms acute infection and IgG confirms past infection

Question 9

Hep C and HIV

Answer 9

Co-infection make Hep C worse and more resistance to treatment and worsen the side effects of HAART –> transmission more likely

Question 10

Issues of sexual transmission of Hep viruses

Answer 10

A much bigger risk of transmission with traumatic sexual practices (fisting etc)–> think about faecal contamination. HIV increases severity and transmission of everything else and most things increase the transmission of HIV