The ABCs of Hepatitis

Did you know there are six types of hepatitis? We help you understand the different causes of liver inflammation so you can spot the signs and lower your risk.

by Colleen Travers Health Writer

At first glance, the definition of hepatitis seems pretty straightforward: an inflammation of the liver, which can cause a broad sliding scale of side effects, from self-limiting conditions like an upset stomach, to more serious chronic infections that can cause scarring in the liver.

However, there are actually five common strains of hepatitis viruses, from A to E, and they all affect a patient differently. “Lots of viral infections in the body can cause an elevation of liver-enzyme tests without even targeting the liver,” says Tarek Hassanein, M.D., founder of Southern California GI & Liver Centers in Coronado, CA. “However, there are viruses that are specific for the liver, and they are called hepatotropic viruses. These hepatotropic viruses are A, B, C, D, and E. They're totally different types of viruses that belong to different strains and families, but the common feature is that they target the liver as the primary site of infection and use the liver cells to replicate and increase in number.”

Here’s what to know about each of these hepatitis strains, including the possible causes, side effects resulting from the disease, and treatment options.

Hepatitis A

How do you get it?

Typically, hepatitis A is transmitted through food or water that got contaminated with the feces of someone with the virus. “We tell travelers to avoid street food for these reasons because food-handling hygiene may vary in other countries” says Natasha Bhuyan, M.D., a family-medicine physician in Phoenix. In the U.S., where there were nearly 28,985 cases of hepatitis A reported in 2019, hepatitis A is more commonly spread from person to person, such as through drug use or sex.

What are the symptoms?

Hepatitis A is usually a short-term infection that lasts about two months (compared to other forms of hepatitis, this does actually qualify as short-term!), according the World Health Organization (WHO). Symptoms include:

  • nausea and vomiting

  • diarrhea and/or clay-colored stools (meaning light or grayish, not your typical brown)

  • dark urine

  • pain or bloating in the belly area

  • jaundice (yellowing of the skin and eyes)

Can you prevent it?

“Luckily, there is a vaccine for hepatitis A for travelers or others at risk,” says Dr. Bhuyan. If you’re traveling to a developing country, check the Centers for Disease Control’s (CDC) Travelers’ Health website to see which vaccines are recommended. Other people who are at increased risk for hepatitis A infection include men who have sex with men; household members and others in close contact with children recently adopted from countries with high prevalence of hepatitis A; and people who have liver disease or clotting-factor disorders.

How is it treated?

Because of the nature of the virus, treatment is a bit of a good news/bad news situation: The shelf life of the disease is relatively short—though 10% to 15% of sufferers may have symptoms as long as six months; on the downside, dealing with symptoms until they improve is, well, unpleasant. “Hepatitis A is self-limited in its course, which means it will go away on its own without any treatment other than supportive therapies, including hydration, decreasing nausea with medications, and avoiding alcohol and certain foods that would trigger your upset stomach,” says Dr. Hassanein. A little more "good" news about hepatitis A: After people recover, they become immune to it—you can’t get hepatitis A twice.

Hepatitis B

How do you get it?

Hepatitis B is spread by contact with bodily fluids, so a person can contract it through sexual contact or IV drug use. An estimated 22,200 people contracted hepatitis B in the U.S. in 2017, according to the CDC.

What are the symptoms?

The virus may affect people differently. “Some people present with symptoms while others who are infected have no symptoms at all,” says Dr. Bhuyan. How long the virus lasts in the system also varies: Some recover from hepatitis B within six months, while in others it leads to a lifelong, chronic infection which may eventually cause cirrhosis of the liver or liver cancer. (Though this outcome is pretty uncommon: 95% of adults fully recover, according to the CDC.) Symptoms include:

  • jaundice

  • fever

  • fatigue

  • loss of appetite

  • nausea and vomiting

  • clay-colored bowel movements

  • dark urine

  • joint pain

Can you prevent it?

There is a vaccine to protect against hepatitis B (recommended for all infants and children, people at risk for infection by sexual exposure, healthcare workers, international travelers, and people with HIV or chronic liver disease), which can prevent chronic liver disease and liver cancer.

How is it treated?

Most people with acute hepatitis B recover, without any lasting liver damage. For people with chronic hepatitis B, it can be managed. “Hepatitis B can be suppressed with medication resolving the inflammation and the scarring of the liver, as long as the patient takes their medication for a very long period of time, sometimes throughout their entire lifetime,” says Dr. Hassanein. Like hepatitis A, you'll be immune to hepatitis B if you're able to clear the infection.

Hepatitis C

How do you get it?

Hepatitis C has been found to be the most common bloodborne infection in the U.S., largely infecting those over 50 years old, many of whom were infected before blood transfusions were screened for infections like this (and HIV). More than 3 million people in the U.S. are living with chronic hepatitis C, and most don't feel sick or even know they're infected; there are approximately 17,000 new cases every year. Hepatitis C is transmitted through blood infection—whether through shared needles, contaminated blood products, or sexual intercourse.

What are the symptoms?

Many people will be asymptomatic for a period of time while others will have severe fatigue, malaise, or yellow discoloration of the eyes and skin, says Dr. Hassanein. What’s more, the progression of the virus can be extremely concerning. “About 80 percent of people with hepatitis C will go on to have chronic liver disease,” say Dr. Bhuyan. “It's the top reason people in the U.S. get liver transplants.” Symptoms include:

  • fever

  • fatigue and/or malaise

  • dark urine

  • clay-colored stool

  • abdominal pain

  • loss of appetite

  • nausea

  • vomiting

  • joint pain

  • jaundice

Can you prevent it?

Currently, there is no vaccine to protect against hepatitis C. Remember, too, that injection drug use is currently the most common means of transmission in the U.S.

How is it treated?

Years ago a diagnosis of hepatitis C offered little hope of survival; today there are (expensive) antiviral medications to help control and cure the disease.

Hepatitis D

How do you get it?

What makes hepatitis D unique? You can’t get it unless you have hepatitis B. “Without the presence of hepatitis B, the hepatitis D virus is unable to spread,” says Stephen Loyd, M.D., medical director of JourneyPure, an addiction treatment center in Murfreesboro, TN. Transmitted either via mother to infant at birth, or through contact (via sex or shared drug use) with infected blood or other bodily fluids, those who become infected with both hepatitis B and D are more likely to develop a serious liver condition, according to WHO. Rates of hepatitis D have been falling since the 1980s, thanks to hepatitis B immunization.

What are the symptoms?

Most people with acute hepatitis D have symptoms, and those include:

  • feeling tired

  • nausea and vomiting

  • poor appetite

  • pain over the liver, in the upper part of the abdomen

  • dark urine

  • light-colored stool

  • jaundice

People with chronic hepatitis D, however, may not have symptoms for years after infection, until complications develop. Symptoms of cirrhosis include:

  • weakness and feeling tired

  • weight loss

  • swelling of the abdomen

  • edema (swelling of the ankles)

  • itching skin

  • jaundice

Can you prevent it?

There’s no vaccine for hepatitis D, but getting the hepatitis B vaccine can help protect against both virus strains.

How is it treated?

There are only experimental treatments offered for hepatitis D so far, says Dr. Bhuyan, making controlling the virus difficult. (Similar to hepatitis B, antiviral medications may be given as a way to control inflammation and may possibly be successful, but only on a patient-by-patient case.)

Hepatitis E

How do you get it?

Similar to hepatitis A, the hepatitis E virus is most often transmitted through drinking infected water (as you might find while traveling in developing countries) that contains the feces of an infected person, an issue in areas that lack proper sanitation systems, says Dr. Bhuyan. However, it can also be spread in developed countries by eating uncooked or undercooked animal products.

What are the symptoms?

In general, the virus lasts about two to eight weeks and doesn’t need any specific treatment aside from ones—like hydration or nausea medication—to reduce the severity of symptoms, says Dr. Hassanein. Some people who get hepatitis E might never feel sick. However, pregnant women in particular can become extremely ill if they get hepatitis E. Symptoms include:

  • nausea and/or vomiting

  • abdominal pain

  • diarrhea

  • fatigue

  • occasional itching

Can you prevent it?

There’s no vaccine to prevent hepatitis E. If you’re traveling, you know it’s always best to practice good hygiene habits. Opt for bottled water over tap or well water and ice, skip unpasteurized dairy products, and avoid eating from street vendors or rare meat (especially pork and venison) or undercooked eggs.

How is it treated?

While hepatitis E usually resolves on its own, you can rest, get adequate nutrition and fluids, avoid alcohol, and check with your doc before taking any medications, like acetaminophen, that can damage the liver. A vaccine’s been developed in China, but isn’t available elsewhere yet.

Alcoholic Hepatitis

In addition to the five types of viral hepatitis, there is also alcoholic hepatitis that results from overconsumption of alcohol in chronic drinkers. It’s a toxic form of hepatitis that can lead to permanent damage to the liver, causing cirrhosis or liver failure. Alcoholic hepatitis has the same symptoms as viral strains but can also lead to fluid buildup in the abdomen, confusion and behavioral changes (including poor work performance, violent behavior, and social disruptions), and kidney failure on top of the risk of liver damage (since liver damage can block blood flow to the kidneys). “Alcoholic hepatitis is an extremely severe and sometimes deadly disease,” says Dr. Loyd. “Symptoms will not improve unless a person stops drinking entirely.”

  • Hepatitis A outbreaks in U.S.: Centers for Disease Control and Prevention. (2019). “Widespread person-to-person outbreaks of hepatitis A across the United States.” cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm
  • Hepatitis basics: Centers for Disease Control and Prevention. (2019). “What Is Viral Hepatitis?” cdc.gov/hepatitis/index.htm
  • What is hepatitis?: World Health Organization. (2019). “What is hepatitis?” who.int/features/qa/76/en/
  • Chronic hepatitis C stat: U.S. Dept. of Health & Human Services. (n.d.) "Hepatitis C." hhs.gov/opa/reproductive-health/fact-sheets/sexually-transmitted-diseases/hepatitis-c/index.html
  • Alcoholic liver disease: John Hopkins Medicine. (n.d.). “Alcoholic Liver Disease: Introduction.” hopkinsmedicine.org/gastroenterology_hepatology/_pdfs/liver/alcoholic_liver_disease.pdf
Colleen Travers
Meet Our Writer
Colleen Travers

Colleen Travers is a writer, editor, and digital content strategist with over a decade of experience in the health, wellness, and fitness industries. She's been an editor for sites such as FitnessMagazine.com and DoctorOz.com and has written online for The Huffington Post, Reader's Digest, Fitbit, Shape, MindBodyGreen, Fit Pregnancy, and more.