Hepatitis C is a viral infection that affects the liver and can range from a mild illness to a serious condition. It is primarily spread through blood exposure, especially sharing needles among intravenous drug users. While most people develop a chronic infection, about 20% may clear the virus without treatment. Chronic hepatitis C can lead to liver disease, failure, and cancer over many years if left untreated. Prevention strategies focus on not sharing drug equipment and getting tested.

1. INFECTIOUS
DISEASES
HIV, HEP C, AND STDS

2. Hepatitis C

3. WHAT IS HEPATITIS?
“Hepatitis” means inflammation of the liver. The liver is a vital
organ that processes nutrients, filters the blood, and fights
infections. When the liver is inflamed or damaged, its function can
be affected.
Heavy alcohol use, toxins, some medications, and certain medical
conditions can cause hepatitis. However, hepatitis is most often
caused by a virus. In the United States, the most common types of
viral hepatitis are Hepatitis A, Hepatitis B, and Hepatitis C.

4. WHAT IS HEPATITIS C?
Hepatitis C is an infection of the liver that results from the Hepatitis C virus.
Acute Hepatitis C refers to the first several months after someone is infected.
Acute infection can range in severity from a very mild illness with few or no
symptoms to a serious condition requiring hospitalization. For reasons that are
not known, about 20% of people are able to clear, or get rid of, the virus without
treatment in the first 6 months.
Unfortunately, most people who get infected are not able to clear the Hepatitis C
virus and develop a chronic, or lifelong, infection. Over time, chronic Hepatitis C
can cause serious health problems including liver disease, liver failure, and even
liver cancer.

5. How is Hepatitis C spread?
Hepatitis C is usually spread when blood from a person infected with the
Hepatitis C virus enters the body of someone who is not infected. Today, most
people become infected with Hepatitis C by sharing needles, syringes, or any
other equipment to inject drugs. Before widespread screening of the blood
supply in 1992, Hepatitis C was also spread through blood transfusions and organ
transplants. While uncommon, poor infection control has resulted in outbreaks
in healthcare settings.

6. How is Hepatitis C spread?
While rare, sexual transmission of Hepatitis C is possible. Having a sexually
transmitted disease or HIV, sex with multiple partners, or rough sex appears to
increase a person’s risk for Hepatitis C.
Hepatitis C can also be spread when getting tattoos and body piercings in
unlicensed facilities, informal settings, or with non-sterile instruments. Also,
approximately 6% of infants born to infected mothers will get Hepatitis C. Still,
some people don’t know how or when they got infected.

7. How is Hepatitis C spread among people who inject drugs?
The Hepatitis C virus is very infectious and can easily spread when a person
comes into contact with surfaces, equipment, or objects that are contaminated
with infected blood, even in amounts too small to see. The virus can survive on
dry surfaces and equipment for up to 6 weeks. People who inject drugs can get
Hepatitis C from:
• Needles & Syringes. Sharing or reusing needles and syringes increases the
chance of spreading the Hepatitis C virus. Syringes with detachable needles
increase this risk even more because they can retain more blood after they are
used than syringes with fixed-needles.

8. How is Hepatitis C spread among people who inject drugs?
• Preparation Equipment. Any equipment, such as cookers, cottons, water, ties,
and alcohol swabs, can easily become contaminated during the drug preparation
process.
• Fingers. Fingers that come into contact with infected blood can spread
Hepatitis C. Blood on fingers and hands can contaminate the injection site,
cottons, cookers, ties, and swabs.
• Surfaces. Hepatitis C can spread when blood from an infected person
contaminates a surface and then that surface is reused by another person to
prepare injection equipment.

9. What are the symptoms of Hepatitis C?
Many people with Hepatitis C do not have symptoms and do not know they are
infected.
If symptoms occur, they can include: fever, feeling tired, not wanting to eat,
upset stomach, throwing up, dark urine, grey colored stool, joint pain, and
yellow skin and eyes.
If symptoms occur with acute infection, they can appear anytime from 2 weeks
to 6 months after infection. If symptoms occur with chronic Hepatitis C, they can
take decades to develop. When symptoms appear with chronic Hepatitis C, they
often are a sign of advanced liver disease.

10. How would you know if you have Hepatitis C?
The only way to know if you have Hepatitis C is to get tested. Doctors use a blood test,
called a Hepatitis C Antibody Test, which looks for antibodies to the Hepatitis C virus.
Antibodies are chemicals released into the bloodstream when someone gets infected.
Antibodies remain in the bloodstream, even if the person clears the virus.
A positive or reactive Hepatitis C Antibody Test means that a person has been infected with
the Hepatitis C virus at some point in time. However, a positive antibody test does not
necessarily mean a person still has Hepatitis C. An additional test called a RNA test is
needed to determine if a person is currently infected with Hepatitis C. A liver biopsy is the
best way to determine how HCV is affecting your liver. Unfortunately, simple blood tests
are not as reliable. Although it may be scary, talk to your healthcare provider about the
importance of a liver biopsy to find out whether you will benefit from these medicines.

11. How can Hepatitis C be prevented?
Although there is currently no vaccine to prevent Hepatitis C, there are ways to
reduce the risk of becoming infected with the Hepatitis C virus.
• Do not share any equipment used to inject drugs with another person. Always
use new, sterile needles, syringes and preparation equipment—cookers, cottons,
water, ties, and alcohol swabs—for each injection.
• Do not use personal items that may have come into contact with an infected
person’s blood, even in amounts too small to see, such as razors, nail clippers,
toothbrushes, or glucose monitors.
• Do not get tattoos or body piercings from an unlicensed facility or in an
informal setting.

12. How can Hepatitis C be prevented?
• Set up a clean surface before placing down injection equipment.
• Do not divide and share drug solution with equipment that has already been
used.
• Avoid using syringes with detachable needles to reduce the amount of blood
remaining in the syringe after injecting.
• Thoroughly wash hands with soap and water before and after injecting to
remove blood or germs.
• Clean injection site with alcohol or soap and water prior to injecting.
• Apply pressure to injection site with a sterile pad to stop any bleeding after

13. Hepatitis C and Health Care Personnel
What is the risk for HCV infection from exposure to HCV-contaminated blood?
After a needlestick or sharps exposure to anti-HCV positive blood, a recent report of data from more than 1,300
potentially exposed HCP estimated the risk of HCV infection as approximately 0.2% for percutaneous injuries
and 0% for mucocutaneous exposures [24]. A range of 0-10% has been reported in earlier studies [MMWR 2001];
variability may be in part explained by mechanism of injury and HCV RNA status of anti-HCV positive sources. If
the HCP does become infected, follow updated guidelines from the American Association for the Study of Liver
Disease (AASLD) and the Infectious Diseases Society of America (IDSA) (www.hcvguidelines.orgExternal ) for
management and treatment of hepatitis C.

14. Hepatitis C and Health Care Personnel
Other than needlesticks, do other exposures, such as splashes to the eye, pose a risk to health care personnel for HCV
transmission?
Although a few cases of HCV transmission via blood splash to the eye have been reported, the risk for such
transmission is expected to be very low. Avoiding occupational exposure to blood is the primary way to prevent
transmission of bloodborne illnesses among health care personnel. All health care personnel should adhere to
Standard Precautions. Depending on the medical procedure involved, Standard Precautions may include the
appropriate use of personal protective equipment (e.g., gloves, masks, and protective eyewear).
Should HCV-infected health care personnel be restricted in their work?
There are no CDC recommendations to restrict a health care worker who is infected with HCV. The risk of
transmission from an infected health care worker to a patient appears to be very low. All health care personnel,
including those who are HCV positive, should follow a strict aseptic technique and Standard Precautions,
including appropriate hand hygiene, use of protective barriers, and safe injection practices.

15. Healthcare Personnel & Exposure
Healthcare employees have contact with infected patients and their body fluids. A particularly important factor is
repeated performance of exposure prone procedures (EPPs) that may cause injuries to employees.
Injuries to medical and health staff from sharp or pointed objects are among the most frequently reported occupational
accidents in healthcare. The results of epidemiological studies indicate that approximately 80% of staff in the health care
field have been affected by needlestick injuries (NSI).
Many such injuries go unreported. The risk of seroconversion after an injury depends on factors including the type of
injury (deep cuts or pricks), the quantity of infectious material transferred, the virus load in the index patient and
possibly genetic factors in the injured person.
Although HCV infection as an occupational disease is statistically rare, the consequences for the employee and the health
system are considerable.

16. HIV

17. WHAT IS HIV?
"HIV" stands for Human Immunodeficiency Virus.
● H - This particular virus can only infect human beings.
● I - Immunodeficiency - HIV weakens your immune system by destroying important cells that fight
disease and infection. A "deficient" immune system can't fully protect you.
● V - A virus can only reproduce itself by using a cell in the body of its host.
At the end of 2012, about 1.2 million people in the United States were living with HIV. Some groups of
people in the United States are more likely to get HIV than others because of many factors, including the
status of their sex partners, their risk behaviors, and where they live.
When people get HIV and don't take medicine to treat HIV, they will typically progress through three
stages of disease one after the other: 1) acute HIV infection; 2) clinical latency, and 3) acquired
immunodeficiency syndrome (AIDS).
There are also different types of HIV. It is possible, though rare, for people living with HIV to get
infected with more than one type of HIV; this is called superinfection.

18. FACTS
● Occupational transmission of HIV to health care workers is extremely rare.
● CDC recommends proper use of safety devices and barriers to prevent
exposure to HIV in the health care setting.
● For workers who are exposed, CDC has developed recommendations to
minimize the risk of developing HIV.
Health care workers who are exposed to a needlestick involving HIV-infected
blood at work have a 0.23% risk of becoming infected. In other words, 2.3 of every
1,000 such injuries, if untreated, will result in infection. Risk of exposure due to
splashes with body fluids is thought to be near zero even if the fluids are overtly
bloody. Fluid splashes to intact skin or mucous membranes are considered to be
extremely low risk of HIV transmission, whether or not blood is involved.

19. STAGES OF HIV INFECTION
When people get HIV and don't receive treatment, they will typically progress
through three stages of disease. Medicine to treat HIV, known as antiretroviral
therapy (ART), helps people at all stages of the disease if taken the right way,
every day, and treatment can slow or prevent progression from one stage to the
next. Treatment can also dramatically reduce the chance of transmitting HIV.
Stage 1: Acute HIV infection
Within 2 to 4 weeks after infection with HIV, people may experience a flu-like illness, which may last
for a few weeks. This is the body's natural response to infection. When people have acute HIV
infection, they have a large amount of virus in their blood and are very contagious. But people with
acute infection are often unaware that they're infected because they may not feel sick right away or
at all. To know whether someone has acute infection, either a fourth-generation or nucleic acid
(NAT) test is necessary.

20. STAGES OF HIV INFECTION
Stage 2: Clinical latency (HIV inactivity or dormancy)
This period is sometimes called asymptomatic HIV infection or chronic HIV infection. During this phase,
HIV is still active but reproduces at very low levels. People may not have any symptoms or get sick
during this time. For people who aren't taking medicine to treat HIV, this period can last a decade or
longer, but some may progress through this phase faster. People who are taking ART the right way,
every day, may be in this stage for several decades. It's important to remember that you can still
transmit HIV to others during this phase, although people who are on ART and stay virally suppressed
are much less likely to transmit HIV than people who are not virally suppressed. At the end of this
phase, your viral load starts to go up and your CD4 cell count begins to go down. + As this happens, you
may begin to have symptoms as the virus levels increase in your body, and you move into Stage 3.
Stage 3: Acquired immunodeficiency syndrome (AIDS)
AIDS is the most severe phase of HIV infection. People with AIDS have such badly damaged immune
systems that they get an increasing number of severe illnesses, called opportunistic illnesses.

21. PREVENTION STRATEGIES
To prevent transmission of HIV to health care workers in the workplace, health
care workers must assume that blood and other body fluids from all patients are
potentially infectious. They should therefore follow these infection control
precautions at all times:
● Routinely use barriers (such as gloves and/or goggles) when anticipating
contact with blood or body fluids.
● Immediately wash hands and other skin surfaces after contact with blood or
body fluids.
● Carefully handle and dispose of sharp instruments during and after use.

22. PREVENTION STRATEGIES
Safety devices have been developed to help prevent needlestick injuries. If used
properly, these types of devices may reduce the risk of exposure to HIV. Many
percutaneous injuries, such as needlesticks and cuts, are related to the disposal of
sharp-ended medical devices. All used syringes or other sharp instruments should be
routinely placed in “sharps” containers for proper disposal to prevent accidental
injuries and risk of HIV transmission.
Although the most important strategy for reducing the risk of occupational HIV
transmission is to prevent occupational exposures, plans for postexposure
management of health care personnel should be in place. CDC issued updated
guidelines in 2013 for the management of health care worker exposures to HIV and
recommendations for postexposure prophylaxis (PEP):
Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure
Prophylaxisexternal icon.

23. PREVENTION STRATEGIES
Occupational exposure is considered an urgent medical concern and should be managed
immediately after possible exposure—the sooner the better; every hour counts. The CDC
guidelines outline considerations in determining whether health care workers should
receive PEP (antiretroviral medication taken after possible exposure to reduce the chance
of infection with HIV) and in choosing the type of PEP regimen.
For most HIV exposures that warrant PEP, a basic 4-week, two-drug regimen is
recommended, starting as soon as possible after exposure (within 72 hours). For HIV
exposures that pose an increased risk of transmission (based on the infection status of the
source and the type of exposure), a three-drug regimen may be recommended. Special
circumstances, such as a delayed exposure report, unknown source person, pregnancy in
the exposed person, resistance of the source virus to antiretroviral agents, and toxicity of
PEP regimens, are also discussed in the guidelines.

24. PREVENTION STRATEGIES
Occupational exposure is considered an urgent medical concern and should be managed
immediately after possible exposure—the sooner the better; every hour counts. The CDC
guidelines outline considerations in determining whether health care workers should
receive PEP (antiretroviral medication taken after possible exposure to reduce the chance
of infection with HIV) and in choosing the type of PEP regimen.
For most HIV exposures that warrant PEP, a basic 4-week, two-drug regimen is
recommended, starting as soon as possible after exposure (within 72 hours). For HIV
exposures that pose an increased risk of transmission (based on the infection status of the
source and the type of exposure), a three-drug regimen may be recommended. Special
circumstances, such as a delayed exposure report, unknown source person, pregnancy in
the exposed person, resistance of the source virus to antiretroviral agents, and toxicity of
PEP regimens, are also discussed in the guidelines.

25. STD’s

26. WHAT ARE STD’S?
Sexually transmitted diseases (STDs), also known as sexually transmitted
infections or STIs, are very common. Millions of new infections occur every year
in the United States.
STDs are passed for one person to another through sexual activity including
vaginal, oral, and anal sex. They can also be passed from one person to another
through intimate physical contact, such as heavy petting, though this is not very
common.
STDs don’t always cause symptoms or may only cause mild symptoms, so it is
possible to have an infection and not know it.

27. WHAT ARE STD’S?

28. TYPES OF STD’s
● Bacterial Vaginosis: Any woman can get bacterial vaginosis. Having bacterial
vaginosis can increase your chance of getting an STD.
● Chlamydia: A common sexually transmitted disease (STD) that can be easily
cured. Left untreated, it can make it difficult for a woman to get pregnant.
● Gonorrhea: Anyone who is sexually active can get gonorrhea. Gonorrhea can
cause very serious complications when not treated, but can be cured with
the right medication.
● Hepatitis: Viral hepatitis is the leading cause of liver cancer and the most
common reason for liver transplantation.

29. TYPES OF STD’s
● Herpes: Genital herpes is a common STD, and most people with genital
herpes infection do not know they have it.
● Human papillomavirus (HPV): The most common sexually transmitted
infection in the United States. Some health effects caused by HPV can be
prevented with vaccines.
● Pelvic Inflammatory Disease (PID) can lead to serious consequences
including infertility.
● Syphilis is a sexually transmitted disease (STD) that can have very serious
complications when left untreated, but it is simple to cure with the right
treatment.
● Trichomoniasis: Most people who have this, do not have any symptoms.