Key points
- Vaccination is the most effective way to prevent hepatitis A and hepatitis B.
- CDC recommends hepatitis B screening for all adults 18 and older at least once in their lifetime and periodic testing for people with risk factors, including people with sexually transmitted infections (STIs) or multiple sex partners.
- CDC recommends one-time hepatitis C testing of all adults 18 and older and periodic testing for people with risk factors.
Risks
Certain adults are at increased risk for viral hepatitis infection. Based on the type of hepatitis, CDC provides risk management considerations for clinicians in assessing certain populations.
Sexually active adults and hepatitis A
Transmission of hepatitis A virus (HAV) can occur from any sexual activity with a person infected with the virus. It is not limited to fecal-oral contact. People who are sexually active are considered at risk for hepatitis A if they are men who have sex with men (MSM) (General 6.2; populations & settings), live with or are having sex with a person with HAV infection, or inject drugs. In 2020, CDC published recommendations for prevention of hepatitis A that identify all groups recommended for vaccination, including hepatitis A vaccination for MSM.
Sexually active adults and hepatitis B
Hepatitis B can also be transmitted through sexual activity. Unvaccinated adults who have multiple sex partners or have a sex partner with hepatitis B are at increased risk for acquiring HBV infection.
Among adults seeking treatment in STI 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.
STI treatment facilities can offer vaccination to all adults as part of routine prevention services. This approach has helped to increase vaccination coverage among adults at risk for HBV infection.
Injection drug use and hepatitis B
Sexually active adults and hepatitis C
Although not common, hepatitis C can be transmitted through sexual activity. Having an STI or HIV, having sex with multiple partners, and engaging in anal sex appear to increase a person's risk for hepatitis C.
Preventing viral hepatitis
For hepatitis A, vaccination is the most effective means of preventing transmission.
For hepatitis B, vaccination is the most effective means of preventing transmission. Furthermore, CDC recommends universal screening for all adults 18 and older at least once in their lifetime and recommends periodic risk-based testing for people who have multiple sex partners or who have a history of STIs.
The Advisory Committee on Immunization Practices (ACIP) in 2022 recommended hepatitis B vaccination among all adults aged 19–59 years and adults aged 60 years and older with risk factors. Adults aged 60 years and older without risk factors but seeking protection may be vaccinated.
For hepatitis C, avoiding behaviors that can spread infection, such as sharing needles or other equipment to inject drugs, is the best way to prevent transmission. There is no vaccine for hepatitis C.
CDC recommends one-time hepatitis C testing of all adults 18 and older and periodic testing for people with risk factors.
While there is no vaccine for hepatitis C, there is safe and effective treatment. The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) recommend timely direct-acting antiviral (DAA) medications to most people diagnosed with hepatitis C.
Resources
These resources from CDC provide further guidance and information on viral hepatitis and sexual transmission.
Scientific guidelines and recommendations
- Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations — United States, 2023
- This MMWR provides CDC’s recommendations for universal hepatitis B screening and testing.
- This MMWR provides CDC’s recommendations for universal hepatitis B screening and testing.
- Universal Hepatitis B Vaccination in Adults Aged 19–59 Years: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022
- This MMWR describes ACIP’s recommendations for universal hepatitis B vaccination.
- This MMWR describes ACIP’s recommendations for universal hepatitis B vaccination.
- Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the ACIP
- This MMWR provides recommendations for the prevention of hepatitis A.
- This MMWR provides recommendations for the prevention of hepatitis A.
- Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the ACIP
- This MMWR provides recommendations for the prevention of hepatitis B.
- This MMWR provides recommendations for the prevention of hepatitis B.
- CDC Recommendations for Hepatitis C Screening Among Adults
- This MMWR provides recommendations for hepatitis C screening.
- This MMWR provides recommendations for hepatitis C screening.
- AASLD – HCV Testing and Linkage to Care
- This site provides recommendations for hepatitis C testing and linkage to care.
- This site provides recommendations for hepatitis C testing and linkage to care.
Health care provider resources
Patient resources
The Hepatitis B and Sexual Health resource provides clinicians with information on the transmission, spread, symptoms, treatment, and prevention of hepatitis B in sexually active adults.