When And How To Test For Hepatitis B and C – Help From The CDC

It is important to remember that the majority of patients with sexually transmitted diseases are asymptomatic.

Therefore, taking a sexual history can be very important. Please see my post How To Take A Sexual History – Help From The Centers For Disease Control And Prevention (CDC)
Posted on November 29, 2018 by Tom Wade MD.

The above post contains a script from the CDC that you can use to take your sexual history.

What follows are resources from the CDC on when and how to test for Hepatitis B and Hepatitis C infection.

Please see also my post on Dx And Rx Of STDs – Help From The Curbsiders.

Testing and Public Health Management of Persons with Chronic Hepatitis B Virus Infection:

On September 19, 2008, CDC published updated and expanded guidelines for testing for chronic Hepatitis B virus (HBV) infection and recommendations for public health evaluation and management for chronically infected persons and their contacts. Serologic testing for Hepatitis B surface antigen (HBsAg) is the primary way to identify persons chronic HBV infection.

Testing for HBsAg now is recommended for:

  • persons born in geographic regions with HBsAg prevalence of ≥2%
  • US born persons not vaccinated as infants whose parents were born in geographic regions with HBsAg prevalence of ≥8%
  • injection-drug users
  • men who have sex with men
  • persons with elevated ALT/AST of unknown etiology
  • persons with selected medical conditions who require immunosuppressive therapy

Testing continues to be recommended for:

  • pregnant women
  • infants born to HBsAg-positive mothers
  • household contacts and sex partners of HBV-infected persons
  • persons who are the source of blood or body fluid exposures that might warrant postexposure prophylaxis (e.g., needlestick injury to a health care worker)
  • persons infected with HIV

Testing Recommendations for Hepatitis C Virus Infection

CDC’s Testing Recommendations for hepatitis C virus infection are outlined below. Testing should be initiated with anti-HCV. For those with reactive test results, the anti-HCV test should be followed with an HCV RNA.

Persons for Whom HCV Testing Is Recommended

  • Adults born from 1945 through 1965 should be tested once (without prior ascertainment of HCV risk factors)
  • HCV testing is recommended for those who:
    • Currently injecting drugs
    • Ever injected drugs, including those who injected once or a few times many years ago
    • Have certain medical conditions, including persons:
      • who received clotting factor concentrates produced before 1987
      • who were ever on long-term hemodialysis
      • with persistently abnormal alanine aminotransferase levels (ALT)
      • who have HIV infection
    • Were prior recipients of transfusions or organ transplants, including persons who:
      • were notified that they received blood from a donor who later tested positive for HCV infection
      • received a transfusion of blood, blood components, or an organ transplant before July 1992
  • HCV- testing based on a recognized exposure is recommended for:
    • Healthcare, emergency medical, and public safety workers after needle sticks, sharps, or mucosal exposures to HCV-positive blood
    • Children born to HCV-positive women

Note: For persons who might have been exposed to HCV within the past 6 months, testing for HCV RNA or follow-up testing for HCV antibody is recommended.

Persons for Whom Routine HCV Testing Is of Uncertain Need

  • Recipients of transplanted tissue (e.g., corneal, musculoskeletal, skin, ova, sperm)
  • Intranasal cocaine and other non-injecting illegal drug users
  • Persons with a history of tattooing or body piercing
  • Persons with a history of multiple sex partners or sexually transmitted diseases
  • Long-term steady sex partners of HCV-positive persons

Persons for Whom Routine HCV Testing Is Not Recommended 

(unless they have risk factors for infection):

  • Health-care, emergency medical, and public safety workers
  • Pregnant women
  • Household (nonsexual) contacts of HCV-positive persons
  • General population

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