STD Toolkit

Hepatitis

Symptoms:

  • Asymptomatic
  • Nausea/vomiting
  • Fatigue
  • Abdominal pain
  • Fever
  • Jaundice
  • Dark urine
  • Joint pain
  • Clay-colored stool

Definitive Diagnosis:

Hepatitis A (HAV): IgM antibody to HAV

Hepatitis B (HBV): Hepatitis B surface antigen positive, with IgM antibody to Hepatitis B core antigen to determine whether infection is acute or chronic

Hepatitis C (HCV): antibody to HCV and nucleic acid testing to detect HCV RNA

Hepatitis A - no routine testing guidelines. Usually transmitted by fecal-oral route and resolves on its own. Not necessary to test unless symptomatic.

Hepatitis B - routine testing should be done for sexually active MSM, pregnant women, and babies born to HBV positive women. Consider testing for individuals with HIV, injection drug users, those treated with immunosuppressive drugs, and household, sexual, and needle-sharing contacts of people with HBV. Pre-vaccination screening is recommended for household, sexual, and needle-sharing contacts of HBV+ persons.

Hepatitis C - routine testing should be done for HIV positive individuals, individuals born to a mother with HCV infection, injection drug users, intranasal drug users, recipients of an unregulated tattoo, those who had a blood transfusion before 1992, dialysis patients, those with signs of liver disease, and one time for adults born between 1945-1965.

See US Preventative Services Task Force for more information.

A hepatitis panel may include any or all of these tests. Please check with your laboratory for specifics of what tests are included.

Hepatitis A

IgM Antibody to Hepatitis A (anti-HAV) - specimen is serum.

Not Recommended:

Total Anti-HAV - specimen is serum. Does not differentiate between past and current infection.

Hepatitis B

Hepatitis B Surface Antigen (HBsAg) - specimen is serum. Positive test indicates the patient is infectious.

IgM Antibody to Hepatitis B Core Antigen (IgM Anti-HBc) - specimen is serum. Useful in determining acute or chronic infection.

Recommended, with reservations:

Total Hepatitis B Core Antibody (Anti-HBc) - specimen is serum. Once infected test will always be positive. 

Hepatitis B Surface Antibody (Anti-HBs) - specimen is serum. Indicates resolved infection.

Click here for more information on Hepatitis B testing interpretation. Please note that all tests interpreted together provide best indicators of diagnosis.

Hepatitis C

Recommended, with reservations:

HCV Enzyme Immunoassay (EIA) - specimen is serum. First line screening test, not definitive without follow up testing.

HCV enhanced chemiluminescence assay (CIA) - specimen is serum. First line screening test, not definitive without follow up testing.

HCV RNA Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) - specimen is serum. *Confirmatory Testing

HCV nucleic acid testing (NAT) - specimen is serum. Confirmatory test after positive screening.

Click here for more information on Hepatitis C testing. Please note that multiple tests interpreted together provide best indicators of diagnosis.

HCV Recombinant Immunoblot Assay (RIBA) -confirmatory test. No longer available in the U.S.A.

Persons diagnosed with HAV require only supportive care with no restrictions in diet or activity. Patients with HBV or HCV should be referred to a specialist or a specialist should be consulted for assistance initiating antiviral therapy.

For more information see Sexually Transmitted Diseases Treatment Guidelines, 2015.