Viral hepatitis B infection is a major worldwide health problem. The hepatitis B virus (HBV) is the cause of this potentially fatal liver infection. Blood, semen, and vaginal secretions are among the bodily fluids that are frequently employed for its transmission. Over 95% of immunocompetent adults infected with HBV can recover from the infection spontaneously.
How Hepatitis B Affects Women Differently
Women are affected by hepatitis in different ways depending on their life stage. Pregnant women could run a significant risk of infecting the baby with hepatitis B. Pregnancy difficulties are also exacerbated by hepatitis B.
Modes of transmission
Hepatitis B can be transmitted through a variety of routes from infected individuals to non-immune individuals. The following are the main ways that hepatitis B is spread:
- Horizontal transmission: This refers to the spread of hepatitis B via intercourse or contact with mucosal surfaces. In regions with low to moderate prevalence, unprotected sex and injectable drug use are the main ways that the disease is spread.
- Vertical transmission: The virus can spread vertically from the mother to the neonate during the perinatal period. In regions with a high incidence, it is the most common mode of transmission.
Unprotected intercourse (vaginal, oral, or anal) is considered sexual contact, whereas any contact with an infected patient’s blood, semen, saliva, or vaginal secretions is considered mucosal contact.
Early Symptoms of Hepatitis B in Women
Hepatitis B infection can be asymptomatic initially but can cause symptoms like fever, skin rash, arthralgia, arthritis, fatigue, abdominal pain, nausea, and anorexia. Extrahepatic manifestations include polyarteritis nodosa, glomerular disease, and aplastic anemia. Careful history-taking is crucial for diagnosis.
Advanced Symptoms and Complications
Advanced liver damage-specific symptoms, such as hepatic encephalopathy, disorientation, coma, ascites, gastrointestinal bleeding, coagulopathy, or infections, are frequently observed in situations of severe liver damage. Patients with chronic hepatitis B may experience acute hepatitis symptoms, known as chronic active hepatitis, or they may have a chronic inactive infection.
HBV infection has the risk of developing into a chronic state, in contrast to hepatitis A and hepatitis E. Patients with chronic hepatitis B are at risk for developing cirrhosis and associated effects, portal hypertension, or hepatocellular carcinoma (HCC). Therefore, it is strongly advised that individuals infected with HBV be continuously monitored and referred to a professional. An urgent liver transplant evaluation at a liver transplant clinic is necessary for fulminant liver failure caused by HBV infection.
Management and treatment
Acute hepatitis B infection is self-clearing in 95% of healthy adults, but management is supportive in most cases. Patients with severe acute disease and protracted acute severe disease require antiviral treatment. Management of chronic hepatitis B includes identifying HIV, hepatitis C, and hepatitis D coinfection, virus replication status, and disease severity. Non-invasive tests are useful for patients with normal alanine transferase, but liver biopsy is necessary for those with elevated or fluctuating alanine transferase.
FDA-approved medications for chronic hepatitis B include interferons, nucleoside analogs, and nucleotide analogs. Entecavir and tenofovir are preferred for acute HBV infection due to their higher resistance.
Oral nucleus (t)ide therapy has been shown to suppress viral replication and decrease the viral burden. However, antiviral medications are not recommended for patients in the immune-tolerant phase of hepatitis B infection.
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Summary
Healthcare providers should take caution in treating hepatitis B patients due to their high transmission rate. Proper preventative measures, vaccination, and patient education are crucial. Improved awareness and educational programs are needed to improve patient identification, reduce disease transmission, and reduce complications.
References
Tripathi, N., & Mousa, O. Y. (2023). Hepatitis B. In StatPearls. StatPearls Publishing.
Terrault, N. A., Lok, A. S. F., McMahon, B. J., Chang, K. M., Hwang, J. P., Jonas, M. M., Brown, R. S., Jr, Bzowej, N. H., & Wong, J. B. (2018). Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology (Baltimore, Md.), 67(4), 1560-1599. https://doi.org/10.1002/hep.29800
Alter, M. J., Hadler, S. C., Margolis, H. S., Alexander, W. J., Hu, P. Y., Judson, F. N., Mares, A., Miller, J. K., & Moyer, L. A. (1990). The changing epidemiology of hepatitis B in the United States: Need for alternative vaccination strategies. JAMA, 263 (9), 1218–1222. https://doi.org/10.1001/jama.1990.03440090060034.
