Onset of infection is usually insidious and characterized by mild abdominal discomfort, loss of appetite, and fatigue. Hepatitis C Infection is primarily by bloodborne exposure, although perinatal and sexual transmission also are possible. Patients may be asymptomatic or report nausea, vomiting, abdominal discomfort, or flulike symptoms. Many patients remain chronically infected. Hepatitis D Bloodborne exposure is the primary route of infection, although sexual transmission is possible.
Perinatal transmission is rare.
Infection occurs only in conjunction with hepatitis B, either as a coinfection or as a superinfection. Onset is usually abrupt with symptoms similar to hepatitis B. With hepatitis B coinfection, the course of hepatitis B can be more aggressive. As a superinfection to hepatitis B, it can cause an acute exacerbation of hepatitis B. Hepatitis E Infection occurs through oral-fecal exposure. The clinical course is similar to hepatitis A, including full recovery. This infection is more common in underdeveloped countries.