During sex, rimming (mouth on anus/butt) is the activity most likely to pass Hepatitis A but contact with something that's touched the anus of an infected person can also transmit the virus. This means that sharing sex toys, kissing someone who's been rimming, and sucking the penis of someone who's just topped someone else can all lead to transmission of Hepatitis A.

Non-sexual transmission of hepatitis A occurs when someone with the virus doesn’t wash their hands after they have a bowel movement and tiny viral particles on their hands are spread to objects, water supplies, food, and directly to other people.

The symptoms of hepatitis A infection are fever, fatigue, nausea, vomiting, and stomach pain. Symptoms usually start about a month after someone becomes infected. Later symptoms include dark-colored urine, light-colored stool, itchy skin and jaundice (a yellow tinge to skin and white part of eyes). Once someone is infected with hepatitis A they cannot be infected again later.

There is a safe and effective vaccine for hepatitis A. The vaccine is recommended for all children when they turn one year old, and unvaccinated adults who are at risk for getting Hepatitis A. This includes men who have sex with men, people experiencing homelessness, and people who use drugs. Hepatitis A vaccine is given as a two dose series. For more information, visit the Centers for Disease Control.

When blood or body fluid from an infected person gets into the body of another person, hepatitis B can be passed. This can happen through:

• Sexual contact (oral, vaginal or anal sex)
• Needles (injecting drugs, tattooing, or the use of unsterilized medical or dental equipment),
• Personal items like razors or toothbrushes
• Pregnancy or birth (spread from infected mothers to their babies in the womb or during delivery)

The symptoms of hepatitis B vary. Many people do not have symptoms when they are infected. For those who do, fever, stomach pain, fatigue, decreased appetite, and nausea are most common. Some people will develop jaundice (a yellow tinge to skin and white part of eyes).

In most infants and children who are infected, and about five percent of adults, hepatitis B infection becomes chronic and can damage the liver. People with chronic hepatitis B can have no symptoms or they may have symptoms of ongoing liver inflammation, like fatigue or loss of appetite. If left untreated, hepatitis B can lead to serious liver damage, liver cancer and even death. Hepatitis B infection in someone who is HIV positive is more likely to turn into chronic infection. Fortunately, there are medications to treat hepatitis B and reduce the risks of chronic infection. 

There is a safe and effective vaccine for hepatitis B. The hepatitis B vaccine has been recommended in the United States for all children starting at birth since 1991. It is also recommended for all sexually active adults who have not previously received the vaccine. Hepatitis B vaccine is given as a three-dose series. For more information, visit the Centers for Disease Control.

When blood from an infected person enters the body of another person, hepatitis C virus can be passed. This can happen through:

• Shared needles, syringes or other equipment used to prepare or inject drugs
• Contaminated needles used for tattooing or body piercing
• Shared sharp objects like razors, toothbrushes or straws for snorting drugs, although this way of becoming infected is rare
• Sex with an infected person

Sexual transmission of hepatitis C is not common but it is possible and people living with HIV are at greater risk. Specific sexual practices, including anal sex without condoms, anal fisting, rough sex toy play, and using drugs with sex, have been shown to increase the risk of sexual transmission of hepatitis C. Having sex when sores or warts are present also increases risk.

The most important thing is to find a primary healthcare provider. Your primary healthcare provider can order any tests you need, explain your treatment options, and coordinate your treatment.

It’s important to avoid alcohol and other drugs like acetaminophen (the active ingredient in Tylenol and Vicodin) when you have hepatitis because they can further damage your liver. In general, you want to eat healthfully, get plenty of rest, and exercise moderately. Don't take any new medications, including herbal or over-the-counter drugs, without talking to your healthcare provider first.

If you know you have hepatitis B or C, you can protect others by using condoms during sexual activity; not donating blood, body organs, tissue or semen; covering any cuts or sores you have to prevent spreading infectious blood or secretions; not sharing personal hygiene items such as razors or toothbrushes and not sharing needles or any other works.

If you have hepatitis A, it’s important to wash your hands well so you can help keep other people healthy. It’s also best to avoid all sex until your healthcare provider says the illness is over. If you do have sex, make sure you and your partner avoid any anal contact, don’t share sex toys, and wash your hands before and after sex.