Hepatitis B and hepatitis C are both blood-borne liver infections that can spread through sex, but two differences matter most. Hepatitis B is vaccine-preventable and usually controlled with lifelong antivirals rather than cured. Hepatitis C has no vaccine yet is now curable for most people with a short course of pills. A blood test tells them apart.
vaccine-preventable; no cure once chronic
curable >95% with 8–12 wks of pills
| Item | Value |
|---|---|
| Hepatitis B | managed — vaccine-preventable; no cure once chronic |
| Hepatitis C | curable — curable >95% with 8–12 wks of pills |
The bottom-line difference
Both viruses attack the liver and both can travel through blood and sexual contact, so on paper they look similar. They split on prevention versus cure. Hepatitis B has a safe, effective vaccine but no cure once it goes chronic, and most people manage it with daily medicine for years. Hepatitis C has no vaccine, but oral pills now clear the virus in the large majority of people. You can't feel the difference; the symptoms overlap so much that a lab test is the only reliable way to know which one you have.
What each one is
Hepatitis B
Hepatitis B is a liver infection caused by the hepatitis B virus (HBV), and it's vaccine-preventable CDC. It spreads mainly through blood and through sex. Doctors split it by duration: an acute infection is the short-term illness in the first six months after exposure, and a chronic infection is one that lasts beyond six months, sometimes for life. Whether it clears or sticks depends heavily on the age at which someone is infected, which sets hepatitis B apart from almost any other STI.
Hepatitis C
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), spread when blood from an infected person enters someone else's bloodstream CDC. Like hepatitis B, the first six months count as acute. But most people who catch HCV go on to develop a chronic, lifelong infection, and that chronic infection is now curable, with treatment clearing the virus in more than 95% of people.
Symptoms compared
Both infections are usually silent, which frustrates anyone trying to self-diagnose. With hepatitis B, many people have no symptoms at all, and most people with chronic HBV stay asymptomatic. When acute symptoms do show up, they're nonspecific: fatigue, fever, poor appetite, nausea, abdominal pain, dark urine, clay-colored stools, joint pain, and jaundice, a yellowing of the skin and whites of the eyes that signals the liver is struggling.
Hepatitis C is even quieter. Most infections cause no symptoms; jaundice appears in only about 20–30% of acute cases, and vague symptoms like fatigue, poor appetite, abdominal pain, and dark urine show up in roughly 10–20% CDC. Chronic hepatitis C frequently causes nothing noticeable for two decades or more, quietly scarring the liver in the background. You can read more about the full picture of hepatitis b symptoms if you want the detail for that one.
How to tell them apart
You can't reliably distinguish hepatitis B from hepatitis C by how you feel. The symptom lists overlap almost completely, and both spend most of their course causing nothing. A test settles it. A few discriminating features matter clinically:
- Chronicity behaves differently. Caught in adulthood, hepatitis B becomes chronic in under 5% of people; most adults clear it. With hepatitis C, most people who get infected end up with chronic, lifelong infection.
- Age is decisive only for hepatitis B. Infected in infancy, HBV becomes lifelong in about 90% of people, which is why the birth-dose vaccine is so important WHO. Hepatitis C doesn't hinge on age the same way.
- Prevention differs. A vaccine prevents hepatitis B; there is no vaccine for hepatitis C.
- The endpoint differs. Hepatitis B is controlled but not cured for most; hepatitis C is curable for almost everyone.
Hepatitis B vs hepatitis C at a glance
| Feature | Hepatitis B (HBV) | Hepatitis C (HCV) |
|---|---|---|
| Spread | Blood and sexual contact | Blood-to-blood contact |
| Vaccine | Yes, vaccine-preventable | No vaccine |
| Becomes chronic | Under 5% of adults; ~90% of infants | Most people who are infected |
| Typical symptoms | Often none; possible fatigue, jaundice, dark urine | Often none; jaundice in ~20–30% of acute cases |
| First test | Triple panel: HBsAg, anti-HBs, total anti-HBc | HCV antibody, then NAT for HCV RNA if positive |
| Treatment | Antivirals suppress the virus (often lifelong) | Oral pills cure >95% in 8–12 weeks |
| Cure? | Controlled, not cured for most | Yes, curable for almost everyone |
Testing
The two infections use different blood panels because they answer different questions. Hepatitis B testing is a triple serologic panel: HBsAg, which flags active infection; anti-HBs, which shows immunity or recovery; and total anti-HBc, which marks past or current infection CDC. The CDC's 2023 guidance recommends screening all adults aged 18 and older at least once in their lifetime, and pregnant people each pregnancy CDC, 2023.
Hepatitis C testing starts with an HCV antibody test; if that's positive, an automatic nucleic acid test (NAT) for HCV RNA confirms whether the infection is current CDC. The CDC recommends one-time screening for all adults 18 and older plus every pregnancy, and the USPSTF gives a Grade B recommendation for one-time screening of adults aged 18–79 USPSTF. Getting checked is straightforward. Depending on what's suspected it may involve a blood draw, and screening is free or low-cost at health departments, Planned Parenthood, and Title X clinics. You can get tested at any of those, and if you're unsure about how soon to check after a possible exposure, read when to test after exposure so you don't test too early to catch it.
Treatment compared
This is where the paths diverge most. Acute hepatitis B usually needs only supportive care while the body fights it off. Chronic hepatitis B has no cure, but FDA-approved antivirals, tenofovir or entecavir, suppress the virus and cut the risk of liver cancer AASLD. Most people take these medicines for life, and clearance happens in only about 2–5% of people even after a decade of treatment, so the goal is control rather than eradication. This care is managed by a specialist.
Hepatitis C is a different story. An 8–12-week course of oral direct-acting antiviral (DAA) therapy cures more than 95% of people, and the cure holds in over 99% of people followed five years out AASLD/IDSA. The simplified regimens are concrete: glecaprevir/pibrentasvir for eight weeks, or sofosbuvir/velpatasvir for twelve weeks, with specialist guidance recommending treatment for essentially everyone with HCV, not just advanced cases. For the full picture of how that works, see the hepatitis c cure guide.
Can you have more than one at once?
Yes. Because hepatitis B and hepatitis C share routes of transmission, blood exposure and, for HBV, sex, a person can carry both at the same time, and either can coexist with HIV. Co-infection makes liver damage progress faster and complicates treatment, so clinicians often test for all the relevant viruses together when one is found. If you test positive for one, your provider will typically check for the others rather than assume you have only a single infection.
When to see a clinician
Get checked if you've ever shared needles or other injection equipment, had unprotected sex with a partner whose status you don't know, were born to a parent with hepatitis, or simply haven't had a lifetime screening yet. The CDC recommends one for every adult regardless of risk. See a clinician promptly if you develop jaundice, persistent fatigue, dark urine, or right-upper-abdominal pain. Acute hepatitis B reports have held roughly steady at about 2,200 a year while hundreds of thousands more live with undiagnosed chronic HBV CDC, and roughly 2.4 million Americans live with chronic hepatitis C, most unaware. A single test is often the only thing standing between a silent infection and timely care.