Hepatitis B Symptoms: What to Expect From Acute and Chronic Infections

Hepatitis B is a liver condition caused by the hepatitis B virus. The hepatitis B virus passes from person to person through contact with blood and bodily fluids. People often get exposed to the hepatitis B virus through sex, needle sharing, and needlesticks. Hepatitis B can also pass down from parent to child during pregnancy. 

There’s no cure for hepatitis B, but there are treatments that can keep people healthy. Over 1 million people in the U.S. are living with hepatitis B. If you’ve been diagnosed with hepatitis B, here’s what you should know about hepatitis B symptoms. 

What is acute hepatitis B?

There are two types of hepatitis B infection: short-term and long-term infection. 

Short-term infection is also called “acute hepatitis B infection.” When someone comes in contact with the hepatitis B virus, they develop acute hepatitis B. Most of the time, the immune system can fight off the virus and people recover completely.

People can develop severe liver disease with a short-term hepatitis B infection. But this isn’t common. People are more likely to have more serious symptoms if they’re older, already have a liver condition, or have a weakened immune system. 

What are the symptoms of acute hepatitis B? 

Many people who get sick with acute hepatitis B don’t have any symptoms. Only about 1 out of 3 adults with a short-term infection feel sick. The most common acute hepatitis B symptoms people experience are: 

• Fever

• Fatigue

• Yellowing of the eyes or skin (jaundice)

• Loss of appetite

• Nausea and vomiting

• Abdominal pain

• Dark urine

• Light colored stools

• Joint pain

It can take several weeks — or even months — for these symptoms to appear. Symptoms usually go away on their own after a few weeks. 

People with severe illness can have symptoms of liver failure. This includes bleeding, swelling, and confusion. These people need care in a hospital where they can receive medication to help fight off the virus and other therapies to protect their liver.

What is chronic hepatitis B infection?

Some people can’t fight off the hepatitis B virus. These people develop chronic hepatitis B, which is a long-term infection. Only about 5% of adults who get sick with acute hepatitis B develop a long-term infection. 

Children are much more likely to develop chronic hepatitis B if they’re exposed to the virus. About 90% of infants and 50% of young children exposed to hepatitis B go on to develop a long-term infection.  

What are the symptoms of chronic hepatitis B? 

Chronic hepatitis B lasts for a person’s lifetime. But most people don’t have any symptoms for years or even decades. 

People with chronic hepatitis B are also at risk of developing other medical conditions, like:

• Inflammation of the arteries (polyarteritis nodosa)

• Kidney disease 

• Aplastic anemia

Does chronic hepatitis B cause cirrhosis?

Some people with chronic hepatitis B can develop liver damage and scarring (fibrosis). Over time, if fibrosis isn’t treated or gets worse, most of the healthy liver gets replaced with scar tissue. This is called “liver cirrhosis.” 

Scarred liver can’t perform its normal functions. So people with liver cirrhosis can develop symptoms like: 

• Easy bruising and bleeding

• Leg swelling (edema)

• Abdominal swelling (ascites)

• Yellowing of the skin (jaundice)

• Itching

• Weight loss

• Fatigue 

• Confusion

• Trouble sleeping

Over time, some people with cirrhosis develop liver failure. Liver failure is a life-threatening medical condition that needs treatment in a hospital. 

Not everyone with chronic hepatitis B develops cirrhosis. And not everyone with cirrhosis develops liver failure. A person’s risk for cirrhosis or liver failure depends on genetic features of the hepatitis B virus. 

Does chronic hepatitis B cause liver cancer?

People with chronic hepatitis B sometimes develop liver cancer. The risk is higher if someone has already developed liver cirrhosis. Some genetic features of the virus also increase the chance of developing liver cancer. 

People who are at high risk of developing liver cancer may need to have a liver ultrasound   every 6 months to look for signs of tumors. 

How long can you live with hepatitis B without knowing it?

People can live with a chronic hepatitis B infection for decades and never know it. Some people only learn about it when they start having symptoms of liver damage. By the time many people start experiencing symptoms, they’ve already developed more serious liver damage, like cirrhosis.

Since most people don’t have symptoms, the CDC recommends that people get tested for hepatitis B. If people find out they have hepatitis B and start treatment early, they have a better chance of never developing liver damage and cancer. 

Is there a vaccine for hepatitis B?

There are vaccines for hepatitis B. These vaccines are very effective and will keep you from getting short-term and long-term hepatitis B infections. 

The CDC recommends the hepatitis B vaccine for everyone 60 years old and younger, including babies. People older than 60 years old can also get the vaccine if they want to.  

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Written by:

Christine Giordano, MD

Christine Giordano, MD, is board-certified in general internal medicine. She received her medical degree from Rutgers New Jersey Medical School and completed residency at Thomas Jefferson University.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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