Martin Jones, MSC, RGN, CNS.
Coordinator, Sexual Health, Eastbourne Downs Primary Care TrustThis third and final Factfile in the series on sexually transmitted infections concerns viral STIs that are blood-borne: human immunodeficiency virus (HIV), hepatitis A, hepatitis B and hepatitis C. Sexual contact is not their only mode of transmission but is the focus here.
An estimated 41 200 cases of HIV infection exist in the UK, of which about a third are undiagnosed. Since AIDS was first identified in the early 1980s, there have been 15 000 UK deaths associated with HIV (PHLS, 2003).
The main route of hepatitis A transmission is faeco-oral - via food, water and close personal contact. Sexual transmission has been reported in gay men via oral-anal (rimming) and digital-anal (fisting) contact (AGUM/MSSVD CEG, 2002) and rarely in other groups. Up to 50% of those infected with hepatitis A are asymptomatic, or have mild, non-specific symptoms.
Hepatitis B may be transmitted through blood-to-blood, mother-to-child or sexual contact. It is estimated to be 100 times more transmissible than HIV. This means that sexual activities such as oral sex and deep kissing, considered to be 'safer' sex in the context of HIV transmission, probably carry a higher risk of hepatitis B transmission.
The main route for hepatitis C transmission in the UK is through use of contaminated needles by injecting drug users. Sexual transmission rates are thought to be rare (about 0.2-2% per year of relationship, or 2-11% of partners in long-term relationships). These rates increase if the index patient is HIV infected.
- Sub-Saharan Africa is the most affected region of the world, with high rates of infection in some countries
There are two phases to acute hepatitis A infection, prodromal illness and icteric illness.
- This phase lasts for three to 10 days.
- Jaundice (mixed hepatic and cholestatic) associated with anorexia, nausea and fatigue
Association for Genitourinary Medicine and Medical Society for the Study of Venereal Diseases Clinical Effectiveness Group. (2002) National Guideline for the Management of the Viral Hepatitis A, B and C. Available at: www.agum.org.uk
BBCi. (2003) Botswana's boys' bleak future. Available at: http://news.bbc.co.uk/1/hi/world/africa/2801187.stm (accessed on May 8, 2003)
British HIV Association (BHIVA) Writing Committee. (2001) BHIVA Guidelines for the Treatment of HIV-infected Adults with Antiretroviral Therapy. Available at: www.bhiva.org
Hecht, F.M. (2002) Use of laboratory tests and clinical symptoms for identification of primary HIV infection. AIDS 16: 1119-1129.
National AIDS Manual (NAM). (2002) AIDS Reference Manual (25th edn). London: NAM Publications.
Public Health Laboratory Service (PHLS). (2003) HIV and sexually transmitted infections. Available at: www.phls.org.uk