The liver is unusually stoic. It can sustain significant damage over many years and give almost no indication that anything is wrong, which is why chronic hepatitis is so often discovered by accident — on bloodwork ordered for something else entirely, during a life insurance medical, or at a blood donation clinic. By that point the infection may have been present for a decade or more.
Neither hepatitis B nor hepatitis C announces itself. There is no early ache, no change you would notice in the mirror, no symptom that would prompt a man to book an appointment. The only reliable way to find either one is to test for it, and the only way that happens is if someone thinks to look.
Two Different Viruses, Two Different Stories
Hepatitis B is transmitted through blood and through sexual contact. In adults, a substantial majority of infections clear on their own, sometimes after an illness with jaundice and fatigue and sometimes with no symptoms at all. A minority become chronic, and chronic hepatitis B carries a long-term risk of cirrhosis and liver cancer. It is also vaccine-preventable, and the hepatitis B vaccine has been part of routine immunisation programs in Canada for some time — though men who grew up before those programs, or outside the country, are often not covered.
Hepatitis C is transmitted almost entirely through blood-to-blood contact. The most common routes are shared injection drug equipment, including a single occasion decades ago that a man may barely remember, and unregulated tattooing or piercing. Blood transfusions before comprehensive screening was introduced in Canada in the early 1990s are another source. Unlike hepatitis B, the majority of hepatitis C infections become chronic rather than clearing, and there is no vaccine. What there is instead is a cure.
Why Screening Is Worth Doing
The case for testing rests on a simple point: both conditions are treatable, and treatment works far better before the liver is scarred. Cirrhosis, once established, does not reverse.
Screening is reasonable for any man who has ever injected drugs, even once and even long ago; who received a blood transfusion or medical care in a country with less rigorous blood screening; who has a tattoo or piercing from an unlicensed setting; who has a history of incarceration; or who has had multiple sexual partners or a partner with either infection. Age is also a consideration, since men born in certain decades carry a higher background rate of undiagnosed hepatitis C. If you are unsure whether any of this applies to you, that uncertainty is itself a good reason to ask.
The testing is a blood draw. Hepatitis B screening looks at a set of markers that distinguish current infection, past resolved infection, and vaccine-derived immunity — useful information regardless of the result, since a man who turns out to be neither infected nor immune can simply be vaccinated. Hepatitis C screening begins with an antibody test; a positive antibody result is followed by a second test that determines whether the virus is still present, since some people clear the infection and retain antibodies indefinitely.
What Treatment Looks Like Now
Hepatitis C treatment has been transformed. The older interferon-based regimens were long, difficult and often poorly tolerated, and their reputation still discourages men from testing. Current treatment is a course of oral antivirals taken daily for a matter of weeks, with generally mild side effects, and it cures the great majority of people who take it. Cure here means the virus is genuinely eliminated, not merely suppressed.
Chronic hepatitis B is managed rather than cured. Antiviral medication suppresses the virus and protects the liver, and ongoing monitoring watches for changes in liver function and screens for liver cancer. Both conditions also warrant practical attention to alcohol intake, since alcohol accelerates liver injury considerably in the presence of chronic viral hepatitis.
Dr. Raymond Nash can arrange hepatitis screening and vaccination and coordinate specialist referral where treatment is needed, at Grande Prairie Men’s Medical Clinic. Book at gpmm.clinic or call (587) 416-8296. This is general information and should not take the place of a personal medical assessment.