The Ins and Outs of Gay Sex (17 page)

HEPATITIS B AND C
   Before HIV, hepatitis B was probably the most dangerous viral infection gay men faced.
Hepatitis C is a relatively newly identified virus and most often causes post-transfusion hepatitis.
Although two different viruses, many of their characteristics are similar.
Both are
passed between partners in semen, blood, and other bodily fluids and both have significant risk for becoming chronic.
Unlike hepatitis A, hepatitis B and C can, in less than 1 percent of cases, progress to liver failure and death.
The incubation period between infection and the appearance of symptoms ranges from two weeks to six months, and like hepatitis A, most men are infectious before they realize they have the disease.

For men with HIV, hepatitis B and C can be lethal.
They are more likely to enter a state of chronic infection with progressive liver destruction.
Hepatitis B becomes chronic in less than 2 percent of men with normal immune systems, but if HIV is present, 90 percent of infections become chronic.
Hepatitis C is far more dangerous and becomes chronic in 90 percent of men with
normal
immune systems, and 20 percent eventually develop cirrhosis.

Isolation is not required to prevent transmission of hepatitis B or C, but safe-sex practices are a must.
Many physicians advise abstinence until your hepatitis resolves.

HEPATITIS TREATMENTS
   No specific drugs treat acute hepatitis.
See your doctor regularly so that your liver function and nutritional status can be monitored.
If nausea is a problem, try eating bigger meals in the morning, since nausea tends to worsen throughout the day.
In severe cases, doctors prescribe medications to stop your vomiting.
Intravenous fluids might be necessary.
Rest is crucial.
Occasionally hospitalization is required for closer monitoring and nutritional support.
Stay away from steroids, which are of no benefit and may even be harmful.

Avoid drugs and alcohol, which further tax your liver, until you’re
fully
recovered.
This may seem intuitive, but I have seen men who notice their eyes are no longer yellow and assume they’re cured.
They’ve been out of circulation for too long and venture outside for a bit of fresh air—only
to end up in a bar toasting their recovery.
The next morning their eyes are yellow again!
Not a good thing.

If hepatitis virus persists in your blood for more than six months, you probably have a chronic infection.
Most doctors will advise a liver biopsy followed by a course of interferon injections.
Although the side effects can be severe, interferon provides the best chance of eliminating or alleviating the chronic infection.
In HIV-negative men, interferon is more successful in treating hepatitis B than C.
Never embark on interferon therapy without a thorough understanding of its many risks and benefits.

IMMUNIZATION
   Like many other viral illnesses, immunization against some forms of hepatitis is now available.
Immunization falls into two categories:
that which prevents infection immediately after exposure and that which delivers long-lasting protection.
Immune globulin contains antibodies against either hepatitis A or B (so be sure you get the right one); getting the injection immediately after exposure to an infected person will usually prevent you from contracting the disease.
One patient I had refused immunization, saying, “I’ll take my chances because I don’t want to get AIDS from the shot.”
This is an old queens’ tale, because immune globulin poses no risk of AIDS transmission.

Immunization providing lasting immunity to either hepatitis A or B is also available, and again it is type specific.
For hepatitis A, a single injection provides immunity to most men with minor side effects (a sore arm).
A booster shot administered six to twelve months after the primary inoculation heightens your immunity.

Hepatitis B vaccine is genetically engineered so your risk of developing acute hepatitis from it is zero.
Low-grade fever and a sore arm are the most frequent complaints.
You’ll need three vaccinations spread over six months.
Over 95 percent of people who receive all three shots become immune, and a booster is recommended at one year.
If you are exposed to hepatitis B and have not had a prior immunization, you should receive both immune globulin and vaccine.

Men who have sex with men should receive prophylactic immunization against both hepatitis A and B—unless a prior infection already has left them immune.
Unfortunately, there is no vaccine available against hepatitis C.

HIV is not the only viral sexually transmitted disease.
Most are far more prevalent
and
far more contagious than HIV.
Safe sex may not protect you from them, and they may not be curable.

Be honest with your doctor.


Once you are infected, the virus may be in your body for life.


Seek treatment at the first sign of an outbreak.


If you have one STD, chances are you have another.


Just because you see your doctor for HIV doesn’t mean that you’ve been checked for other STDs.


Do not treat venereal warts yourself with over-the-counter medications.


Get a Pap smear.


Get vaccinated against hepatitis.