In the first six months of 2019, an increase in hepatitis A has been noted among men who have sex with men (MSM). 79 patients have now been reported in the Netherlands.

Hepatitis A is an acute infection transmitted by the faecal-oral route. Transmission occurs through contaminated food, water or through human-to-human contact, including sexual contact. The chance of transmission is high, especially in locations where several men have sex with each other.

The first complaints are often; general malaise, fever, loss of appetite, nausea and abdominal pain. After a few days, jaundice may develop with sometimes dark urine and putty-colored stools. Hepatitis A can cause a fairly mild clinical picture, but can also have a very serious course, especially in people who already have hepatitis B or C or other liver diseases, the risk of a serious course is increased.

Hygiene measures
To prevent hepatitis A from spreading further, we advise MSM:
1. Wash hands with soap and water after going to the toilet, before eating/cooking and before and after sex (or take a shower);
2. Do not share sex toys;
3. Using condoms or latex gloves when fucking, rimming, fingering, fisting, etc.

Vaccination
Unfortunately, many men have not yet been vaccinated against hepatitis A. If patients are not vaccinated and may be at risk, they can be vaccinated through the GGD. This is possible via the special hepatitis A consultation hour for MSM. Men can make an appointment for this online or by telephone on 020-5555 464. They can also go to the walk-in consultation hours of the GGD Amsterdam go on Thursdays from 5:00 PM to 7:30 PM. It costs about €70 for two vaccinations. Depending on their insurance, they can declare this.

shigella
In addition to hepatitis A, Shigella is also more common in MSM and there is currently an outbreak. Shigella is contracted in the same way as hepatitis A. The symptoms usually start with; fever, cramps in the abdomen and watery diarrhea. After a few days, someone with shigellosis may experience diarrhea that may contain mucus or blood, muscle aches, headaches, and skin rashes.

Treatment is usually not necessary. An immunocompromised patient can be treated with ciprofloxacin 2 x 500 mg, for 7 days. An adult with shigellosis who feels well can work as usual once the diarrhea has passed. Patients who work in healthcare, with small children or in food preparation (for example in a restaurant or butcher's shop) must first consult with the GGD/company doctor before they start working again.