Hepatitis C is a viral liver infection that often goes undiagnosed due to its lack of obvious signs and symptoms. Only 20 to 30 percent of people experience symptoms in the 6 months after being infected with the hepatitis C virus, according to the Centers for Disease Control and Prevention. These symptoms resemble those of other viral infections, like the flu. For those in whom the disease persists, mild and often subtle symptoms can occur periodically over the course of several decades. The most obvious signs and symptoms of hepatitis C typically don't develop until the liver begins to fail due to severe scarring, known as cirrhosis. Between 5 and 20 percent of people with untreated hepatitis C eventually develop cirrhosis, according to CDC.
Initial Infection: Acute Hepatitis C
Acute hepatitis C refers to the first 6 months after infection with the virus. In the 20 to 30 percent of people who experience acute hepatitis C symptoms, they typically appear 1 to 3 months after infection and last 2 to 12 weeks. One of the most common symptoms is fatigue, which can interfere with daily activities like work, exercise and socializing. Other possible symptoms include body aches, low-grade fever, mild pain in the upper abdomen, nausea and poor appetite.
More severe, liver-related signs are less common, occurring in fewer than 25 percent of people with acute hepatitis C, according to the Infectious Diseases Society of America and the American Association for the Study of Liver Diseases. These might include jaundice -- yellowing of the skin or whites of the eyes -- and dark urine, both of which occur when the liver fails to adequately clear a substance called bilirubin.
Persistent Infection: Chronic Hepatitis C
If the body fails to clear hepatitis C within 6 months -- which is the case for 75 to 85 percent of infected individuals, according to CDC -- the disease is considered chronic. This means the infection will persist unless treatment is provided to clear the virus from the body. Chronic hepatitis C often causes no obvious symptoms. If symptoms do develop, they can be easily overlooked or attributed to another cause. However, there can be some telltale signs and symptoms indicating the virus is present in the body.
A November 2012 "Journal of Hepatology" research article noted that 52 percent of hepatitis C-positive participants reported moderate to severe fatigue. Persistent fatigue can interfere with motivation, physical functioning and social life. People with chronic hepatitis C might also experience mild physical symptoms that come and go periodically, often resembling the flu. These might include body aches, mild abdominal pain and nausea.
Other Signs and Symptoms: Mood, Mind and More
Hepatitis C can affect parts of the body other than the liver. One of the most common such manifestations is a condition called mixed cryoglobulinemia, which inflames blood vessels. Signs and symptoms might include a splotchy red rash on the lower legs, joint pain in the hands and feet, numbness or tingling in the arms or legs, and blood in the urine.
People with hepatitis C also report mood disturbances, although it's not clear whether these problems are directly related to the virus. A large U.S. study found that nearly 14 percent of people with hepatitis C had depression, according to the April 2012 "BMC Infectious Diseases" research report. Possible signs and symptoms of depression include persistent sadness or hopelessness, lack of energy and loss of interest in relationships or activities. Many people with hepatitis C also report experiencing impaired or slow thinking referred to as "brain fog," which often manifests as forgetfulness or difficulty concentrating.
Advanced Hepatitis C: Liver Failure
Untreated hepatitis C can eventually lead to cirrhosis over a period of 20 to 30 years, according to CDC. Often asymptomatic at first, cirrhosis can lead to liver failure as it progresses. Among the first signs may be weight loss and loss of muscle mass in the arms and legs with associated weakness. As the liver loses its ability to process toxins and blood flow through the scarred liver decreases, symptoms often become severe. Common signs and symptoms include:
- swelling in the abdomen and ankles
- prominent veins in the skin over the stomach
- poor appetite and/or stomach upset
- pain on the right side just below the ribs
- purple spots on the skin and easy bruising
- generalized itchiness
Buildup of toxins can also affect the nervous system, causing shakiness of the hands, personality changes, erratic sleep patterns, irritability, confusion and drowsiness. Severe brain toxicity related to liver failure sometimes leads to coma and death.
Warnings and Precautions
Hepatitis C cannot be diagnosed based on signs and symptoms. A blood test is the only way to know for sure if you've contracted hepatitis C. If you're experiencing signs or symptoms that might indicate hepatitis C -- or think you might have been exposed to infected blood or body fluids -- see your doctor for testing or contact your health department to find a local testing sites. CDC also recommends one-time hepatitis C screening for anyone born from 1945 through 1965 because most people with the illness are in this age group.
Seek emergency medical care if you experience sudden or severe symptoms, such as vomiting or spitting up blood, bloody or black stools, worsening abdominal pain, fever, dizziness or fainting, confusion or difficulty staying awake.
Medical advisor: Tina St. John, M.D.
- Centers for Disease Control: The ABCs of Hepatitis
- Hepatology: Fatigue Before, During and After Antiviral Therapy of Chronic Hepatitis C: Results From the Virahep-C Study
- Hepatitis C Online: Diagnosis of Acute HCV Infection
- Health and Quality of Life Outcomes: Validation of the Fatigue Severity Scale in Chronic Hepatitis C
- Polskie Archiwum Medycyny Wewnętrznej: Viral Hepatitis C
- AASLD/IDSA/IAS–USA: Management of Acute HCV Infection
- World Journal of Gastroenterology: Chronic Hepatitis C Virus Infection and Neurological and Psychiatric Disorders: An Overview
- Revista Brasileira de Psiquiatria: Depression Rather Than Liver Impairment Reduces Quality of Life in Patients With Hepatitis C
- Journal of Gastrointestinal and Liver Diseases: Extrahepatic Manifestations of Chronic HCV Infection
- American Family Physician: Cirrhosis and Chronic Liver Failure: Part I. Diagnosis and Evaluation