Tuesday, November 22, 2011

what is hepatitis? . REALLY??

Today's topic is not a comfortable one for general conversation.  Perhaps that makes the post even more important in the educational sense, even if it's not especially fun or sexy to write.  It's time to tackle a growing health threat that might not commonly be considered a sexually transmitted disease, although it certainly can be spread through sexual activity.  The topic is viral hepatitis.

Alphonse Gabriel Capone
STDs are a subject that carry a certain personal poignancy.  Back in the 1930's, my paternal Grandfather suffered from the same sexually transmitted disease as infamous mobster Al Capone.  Grandpa Eugene had Neurosyphilis, an infection of the brain or spinal cord that occurs in people who have had untreated syphilis for many years. Eugene died in a sanatorium from the disease, an unpleasant reminder that modern illnesses like HIV aren't the first sexually transmitted diseases that can become life threatening.

Let us start with a disclaimer of sorts - This post is about communicable diseases that can be life threatening.  While we are educated individuals who have worked in health care and related fields, we don't wish to present ourselves as medical experts.  We are simply individuals who have done our "homework" on this topic, and the quotes we will share from expert sources are a few of the fruits of that labor.

As we've stated, we are NOT physicians, and the contents of this post should NOT be used to replace a frank discussion of this subject with your own health care provider.  It's extremely important to be open and honest with your health care provider about sex, even more important if you are not monogamous, or if you live an alternate lifestyle including BDSM activities.

Ok, ready?

Let's start with the basics as told by the Centers for Disease Control and Prevention (CDC):
"Hepatitis" means inflammation of the liver and also refers to a group of viral infections that affect the liver . The most common types are Hepatitis A, Hepatitis B, and Hepatitis C.  Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation. An estimated 4.4million Americans are living with chronic hepatitis; most do not know they are infected. About 80,000 new infections occur each year.
One of the most disturbing aspects of viral hepatitis is the fact that many of the individuals who carry the disease have not been diagnosed and are simply not aware they are sick.  Responsible individuals who might otherwise protect future partners with simple measures like wearing condoms and using disposable gloves for fisting and serious anal play, are still likely to spread the virus if they are unaware they are infected.  Thinking about that, I am very much reminded of the earlier stages of the AIDS epidemic.

Here are some more specific facts about hepatitis as an STD from the CDC:
STDs and Viral Hepatitis
Hepatitis A
Transmission of Hepatitis A virus (HAV) during sexual activity occurs due to fecal-oral contact or contamination. Measures typically used to prevent the transmission of other STDs (e.g., use of condoms) do not prevent HAV transmission. Vaccination is the most effective means of preventing HAV transmission among persons at risk for infection.
Hepatitis B
Among adults seeking treatment in STD clinics, as many as 10%–40% have evidence of past or current Hepatitis B virus (HBV) 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 HBV, indicating a significant missed opportunity to vaccinate at-risk persons when they first access STD prevention or treatment services.
Hepatitis C
Although not common, Hepatitis C virus (HCV) can be transmitted through sexual activity. The factors found to be associated with sexual transmission of HCV are sex with multiple partners, presence of other STDs, or sex with trauma. Case-control studies have reported an association between acquiring HCV infection and exposure to a sex contact with HCV infection or exposure to multiple sex partners. Surveillance data also indicate that 15%–20% of persons reported with acute HCV infection have a history of sexual exposure in the absence of other risk factors.

Leave it to a Government agency to make important information more than a little difficult to understand.  Not only is that embarrassingly dry to read, it includes really odd language like "surveillance data". 

To put all that into more easily understood language, here's a nice summation of current knowledge regarding hepatitis as an STD, courtesy of the ubiquitous Wikipedia:
Studies show the risk of sexual transmission in heterosexual, monogamous relationships is extremely rare or even nil.  The government does not recommend condom use to prevent hepatitis C transmission in long-term mutually monogamous relationships. However, for not well understood reasons, the risk of transmission is higher if one has multiple sex partners and condom use is recommended. Vaginal penetrative sex is believed to have a lower risk of transmission than sexual practices that involve higher levels of trauma to anogenital mucosa (anal penetrative sex, fisting, or use of sex toys).  For these reasons, condom use is highly recommended for those who engage in anal sex play or other sex acts likely to cause bleeding or damage mucosal linings.
Like it or not, it's always good to be properly armed with information . . .

Pamela Anderson
One example of a celebrity who potentially contracted hepatitis from sexual activity is Pamela Anderson (aka Pamela Anderson Lee or Pamela Lee.)   Like my darling Serafina, Pamela is originally from Canada.

Anderson has publicly stated that she contracted the Hepatitis C virus from former spouse and Mötley Crüe drummer Tommy Lee.  The most likely source of Anderson's infection is from sharing tattoo needles, but it's not impossible to imagine that it could have just as easily been transmitted during sexual activity.

Let's be sure we are clear - fear of contracting hepatitis is no reason to become celibate or avoid sexual activities you enjoy.  Abstinence is no real answer.  With that in mind, please remember it's just necessary to play a little smarter.

Vaccinations are available for types A and B, and they appear to be a good choice for individuals who have multiple partners.  This is especially true for individuals who enjoy activities like rimming and anal sex that are more likely to spread this virus.  Condom use is suggested for at risk individuals, and dental dams should be considered for rimming.

For more information, or to get answers on any further questions you may have on this topic, we strongly suggest a frank discussion with your health care provider.

1 comment:

  1. some further information on hepatitis as it relates to AIDS -
    AIDS and Hepititis from the CDC:
    HIV/AIDS and Viral Hepatitis

    Hepatitis B Testing and Vaccination
    Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) are bloodborne viruses transmitted primarily through sexual contact and injection drug use. Because of these shared modes of transmission, a high proportion of adults at risk for HIV infection are also at risk for HBV infection. HIV-positive persons who become infected with Hepatitis B virus (HBV) are at increased risk for developing chronic HBV infection and should be tested. In addition, persons who are co-infected with HIV and HBV can have serious medical complications, including an increased risk for liver-related morbidity and mortality. To prevent HBV infection in HIV-infected persons, the Advisory Committee on Immunization Practices recommends universal Hepatitis B vaccination of susceptible patients with HIV/AIDS.
    Hepatitis C and HIV/AIDS Co-Infection
    About one quarter of HIV-infected persons in the United States are also infected with Hepatitis C virus (HCV). HCV is a bloodborne virus transmitted through direct contact with the blood of an infected person. Thus, coinfection with HIV and HCV is common (50%–90%) among HIV-infected injection drug users. HCV is one of the most important causes of chronic liver disease in the United States and HCV infection progresses more rapidly to liver damage in HIV-infected persons. HCV infection may also impact the course and management of HIV infection. The U.S. Public Health Service/Infectious Diseases Society of America guidelines recommend that all HIV-infected persons be screened for HCV infection.


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