Possible Hepatitis Exposure?

[nick11285]

Hello Doctor,

I'm a 28 year old gay male.  Approximately 5 years ago, I engaged in unprotected anal intercourse (both receptive and insertive.  Ejaculation occurred outside of the body, no blood was visible, and I wouldn't have deemed the sex as "rough" although it was somewhat painful.  I've tested negative for HIV twice (most recently June of 2013), and the handful of subsequent anal experiences have involved the use of a condom.  I've also received unprotecte oraI sex on several occasions.  Howver, I haven't been tested for any other STDs due to a lack of symptoms.  

I recently took a blood test for my work's insurance, and my ALT level was 52 with all other liver indicators such as AST, albumin, and alkaline phosphatase being well within the normal range.  This could quite possibly be due to imbibing some cocktails and beers approximately 48 hours before the blood test, but I'm also concerned that I could have contracted any one of the hepatitis viruses.  Is this a valid concern and should I be tested or am I worrying needlessly?  Any advice would be greatly appreciated.

[Edward W Hook, MD]

Welcome to our Forum.  I'll be pleased to comment.  There are many possible causes of your modest elevation in ALT.  Hepatitis is one, ingestion of substances such as alcohol is another and from there the list goes on and on.  Irrespective of what might be going on, the first step is a blood test to screen for viral hepatitis.  As a man with other male partners, viral hepatitis is a possibility and, if you do not have hepatitis a preventable health problem.  

My suggestion would be to see your regular doctor and request a hepatitis screen which would include testing for hepatitis A, B, and C, all of which are a bit more common among MSM than heterosexuals.  If the test is positive, you can discuss next steps with your doctor.  Next steps can be quite variable, depending on the results of testing and are too varied to go into until you have a result.  The other important reason for getting a hepatitis screen is because if you have not had hepatitis a or B, there are superb vaccines available which are recommended and highly effective.

I hope these comments are helpful as a starting point.  EWH

[Edward W Hook, MD]

I agree, there is no reason to worry about hepatitis of any sort.  It is time for you to stop worrying about this exposure and move forward.  Your minimal elevation of your ALT is not an SI of any sort.  EWH

[nick11285]

Good news, Dr. Hook!  My viral hepatitis panel came back normal (negative for hepatitis A, B, and C).  However, my ALT increased slightly from 52 to 63.  Could I still have contracted viral hepatitis but have been tested too soon for it to be detected?  I've had no further unprotected rectal encounters since the the one mentioned previously.  There have been a few instances where I've been the insertive partner during oral encounters.  Based on the other posts I've discovered on the site, it seems that it would have been highly unlikely for me to have contracted HBV in such a manner.  Would you concur?

Thank you again!  Nick

[Edward W Hook, MD]

The risk of hepatitis C from a single receptive rectal sex encounter is quite low but not zero.  Hepatitis C IS transmitted in this way but not nearly so easily as hepattiis B.  EWH

[nick11285]

Thank you for the timely response, Dr. Hook.  As a quick follow up question, do you believe I'm at a high risk of contracting hepatitis C from the one unprotected anal encounter.  I understand that hepatitis B is commonly transmitted sexually, but the Internet has provided me with conflicting viewpoints and assertions as to the sexual transmission of hepatitis C.  

Thank you again,

Nick