Hepatitis B & C
Viral hepatitis — transmission, testing and treatment
Hepatitis B and C are viral infections that cause inflammation of the liver. Together they affect an estimated 325 million people worldwide and are leading causes of liver cirrhosis, liver failure, and liver cancer. Both conditions are often silent for years, making testing and awareness critically important.
What are Hepatitis B and C?
Hepatitis B (HBV) is a DNA virus that infects liver cells. Most adults who contract hepatitis B clear the infection naturally within six months (acute hepatitis B). However, around 5-10% of adults develop chronic hepatitis B — a lifelong infection that, if untreated, can cause progressive liver damage, cirrhosis, and hepatocellular carcinoma (liver cancer). Hepatitis C (HCV) is an RNA virus with a similar predilection for the liver. Unlike hepatitis B, around 75-85% of people who are infected with hepatitis C develop chronic infection. However, unlike hepatitis B, hepatitis C can now be cured in the vast majority of cases with a short course of modern antiviral tablets — one of the great advances in modern medicine.
Transmission & Risk
Hepatitis B is transmitted through blood and bodily fluids. High-risk exposures include unprotected sexual intercourse with an infected person, sharing needles or drug equipment, needlestick injuries (an important occupational risk for healthcare workers), and mother-to-child transmission during childbirth. Hepatitis B is more infectious than HIV or hepatitis C. An effective vaccine exists for hepatitis B and is part of the UK childhood immunisation schedule. Hepatitis C is most commonly spread through blood-to-blood contact — primarily via sharing needles, syringes, or drug preparation equipment among people who inject drugs. Less commonly, it may be transmitted through unprotected sex, particularly in the context of blood exposure. There is no vaccine for hepatitis C.
Diagnosis & Screening
Both hepatitis B and C are frequently asymptomatic — many people are unaware they are infected for years or even decades. Symptoms, when they do occur, may include fatigue, jaundice (yellowing of the skin and eyes), abdominal pain, nausea, and dark urine. Because symptoms are often absent, testing is the only reliable way to diagnose these infections. Testing is available through GPs and sexual health clinics. NHS England runs targeted screening programmes for people at increased risk. Diagnosis involves a blood test: hepatitis B surface antigen (HBsAg) for hepatitis B, and HCV antibody followed by HCV RNA for hepatitis C. If infection is confirmed, further evaluation including liver function tests, viral load, and FibroScan (to assess liver stiffness and fibrosis) guides treatment decisions.
Prevention & Treatment Overview
Hepatitis B is preventable through vaccination — the hepatitis B vaccine is safe, highly effective, and available on the NHS for those at risk. Post-exposure prophylaxis (hepatitis B immunoglobulin combined with vaccination) can be given after a significant exposure. Harm reduction for people who inject drugs — including needle exchange services, which provide clean equipment — reduces transmission of both hepatitis B and C. Hepatitis C is now a curable condition. Direct-acting antiviral (DAA) therapies achieve cure rates of greater than 95% in just 8-12 weeks of treatment, with generally few side effects. Alcohol accelerates liver damage and must be completely avoided. Regular surveillance for liver cancer (via ultrasound scan every six months) is recommended for those with cirrhosis. Referral to a hepatologist is important for treatment initiation and ongoing monitoring.