Hepatitis A, B and C: What's the Difference, and Which Spread Through Sex?

“Hepatitis” just means inflammation of the liver. Hepatitis A, B and C are three separate viruses that can cause it. They have different routes of spread, different outcomes, and different protection.

What is the difference between hepatitis A, B and C?

• Hepatitis A: spreads when someone swallows the virus, even in very small amounts. It is usually a mild, short-term illness and does not become chronic. A vaccine exists.
• Hepatitis B: spreads through blood, semen or other body fluids. It can be a short-term illness or become a lifelong infection. A vaccine exists.
• Hepatitis C: spreads mainly through blood. Most people who are infected develop a lifelong infection. There is no vaccine, but it can be cured.

How does each type spread?

Hepatitis A is mainly spread by the fecal-oral route, through person-to-person contact or contaminated food or water. The CDC’s STI guidelines say transmission during sex “probably results from fecal-oral contact.” The CDC lists men who have sex with men among the groups at increased risk.

Hepatitis B spreads through contact with infected blood and body fluids. The CDC lists sexual contact among its primary routes, alongside childbirth and sharing injection equipment. The CDC’s STI guidelines list unprotected sex with an infected partner as a primary risk factor.

Hepatitis C spreads when blood from a person with the virus enters someone else’s body. Sex is a less common route. The CDC’s STI guidelines say it “is not efficiently transmitted through sex” but can occur, and the WHO points to sexual practices that lead to exposure to blood. More detail is in how do you get hepatitis C.

Can you get hepatitis from oral-anal sex (rimming)?

Yes, hepatitis A can spread this way. The WHO says the virus “can also be transmitted through close physical contact (such as oral-anal sex) with an infectious person,” and MedlinePlus lists oral-anal sex among the types of close contact that can spread it. Washing hands, and safer sex practices for oral-anal sex, help, but vaccination is the best protection.

Hepatitis B can also be passed on during oral, vaginal or anal sex without a condom or dam, according to the NHS.

Do they cause the same symptoms?

Often there are none. The CDC says not everyone with hepatitis A or hepatitis B has symptoms, and early hepatitis C can cause “a very mild illness with few or no symptoms.” When symptoms do appear, the CDC lists similar ones for A and B: dark urine, clay-colored stools, fatigue, fever, joint pain, loss of appetite, nausea, stomach pain, vomiting and yellow skin or eyes (jaundice). Because the viruses look alike, only a blood test shows which one it is.

Which ones become chronic?

• Hepatitis A: never. The CDC says it “does not result in chronic infection or chronic liver disease.” Most people recover fully.
• Hepatitis B: sometimes. The CDC describes acute hepatitis B as a short-term illness in the first 6 months, which can lead to a lifelong infection. The NHS says most adults do not have lasting problems after a short-term infection, and that babies, children and people with weakened immune systems are more likely to have chronic infection.
• Hepatitis C: often. The CDC says most people who are infected develop a lifelong infection, and fewer than half clear the virus within 6 months without treatment.

Which have vaccines, and can hepatitis C be cured?

Hepatitis A and hepatitis B can be prevented with vaccines. The CDC calls vaccination the best way to prevent either one, and for hepatitis A says you need every shot in the series to be fully protected. A combined hepatitis A and B vaccine also exists for adults at risk for either infection. A clinician or pharmacist can tell you whether you are already covered.

There is no vaccine for hepatitis C. But the CDC says hepatitis C is curable, and the CDC’s hepatitis C page says treatment cures more than 95% of people. Hepatitis B treatment is different: the CDC says medicines for chronic hepatitis B “aren’t a cure” and only help some people.

What should I do next?

You can’t tell the types apart by symptoms alone, so blood tests are what tell them apart. See hepatitis B and C testing for which tests exist, or my partner has hepatitis B if you’re worried about a partner.