Sexual Transmission and Viral Hepatitis
Transmission of hepatitis A virus can occur from any sexual activity with an infected person and is not limited to fecal-oral contact. Measures typically used to prevent the transmission of other STDs (e.g., use of condoms) do not prevent hepatitis A transmission. Vaccination is the most effective means of preventing Hepatitis A transmission among persons at risk for infection.
Hepatitis A Vaccine Recommendations for Sexually Active Adults
CDC and the Advisory Committee on Immunization Practices (ACIP) recommend the hepatitis A vaccination for men who have sex with men. Sexually active adults are not considered at risk for hepatitis A unless they live with or are having sex with an infected person, inject drugs or have chronic liver disease.
Among adults, hepatitis B transmission occurs primarily among unvaccinated adults with risk behaviors for hepatitis B transmission, including having multiple sex partners and sex partners of people with chronic hepatitis B infection. Hepatitis B is easily transmitted through sexual activity. Sexual contact is the most common way hepatitis B is spread in the United States.
Among adults seeking treatment in STD clinics, as many as 10%–40% have evidence of past or current hepatitis B virus infection. Many of these infections could have been prevented through universal vaccination during delivery of STD prevention or treatment services. A study of adults diagnosed with acute hepatitis B found that 39% had sought care or been screened for an STD before they were infected with hepatitis B, indicating a significant missed opportunity to vaccinate at-risk persons when they first access STD prevention or treatment services.
Offering vaccination to all adults as part of routine prevention services in STD treatment facilities has been demonstrated to be effective at increasing vaccination coverage among adults at risk for hepatitis B infection since nearly all patients have behavioral risk factors for hepatitis B infection.
Hepatitis B Vaccine Recommendations for Sexually Active Adults
CDC and the Advisory Committee on Immunization Practices (ACIP) recommend the hepatitis B vaccination for
- Sexually active people who are not in long-term, mutually monogamous relationships (e.g., people with more than one sex partner during the previous 6 months)
- People seeking evaluation or treatment for a sexually transmitted disease
CDC also recommends hepatitis B testing and hepatitis B vaccination for
- Sex partners of people with hepatitis B
Although not common, hepatitis C can be transmitted through sexual activity. Having a sexually transmitted disease or HIV, sex with multiple partners, or rough sex appears to increase a person’s risk for hepatitis C. Case-control studies have reported an association between acquiring hepatitis C infection and exposure to a sex contact with hepatitis C infection or exposure to multiple sex partners. New research shows that gay men who are HIV-positive and have multiple sex partners may increase their risk for hepatitis C. There is no vaccine for hepatitis C. The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease, especially sharing needles or other equipment to inject drugs. Hepatitis C testing is recommended for anyone at risk for getting hepatitis C but is not based on sexual activity.
Scientific Guidelines and Recommendations
Healthcare Provider Resources