Inflammation of the liver - hepatitis - has many causes, including several viruses. One of these is hepatitis C. There is currently no vaccine, so it's important to avoid infection. What is it? Hepatitis C is an infection with the hepatitis C virus. Although there is no vaccine to protect against infection, there is effective treatment available. Infection with the virus is often referred to as a hidden epidemic. Estimates suggest about 200,000 people are infected with hepatitis C in England, but eight out of ten are unaware they have it. This is because it can take years, even decades, for symptoms to appear. Even if you have no symptoms, you can still pass on the virus to others. How's it spread? Hepatitis C virus is usually transmitted through blood-to-blood contact. One common route is through sharing needles when injecting recreational drugs - around 35 per cent of people with the virus will have contracted it this way. Similarly, having a tattoo or body piercing with equipment that has not been properly sterilised can lead to infection. Before 1991, blood transfusions were a common route of infection. However, since then all blood used in the UK has been screened for the virus and is only used if not present. It can be passed on through sharing toothbrushes and razors Hepatitis C can be sexually transmitted, but this is thought to be uncommon. A minority of people have been infected through bodily fluids such as saliva, but this is rare. It can be passed on through sharing toothbrushes and razors. If someone needs a blood transfusion or medical treatment while staying in a country where blood screening for hepatitis C is not routine, or where medical equipment is reused but not adequately sterilised, the virus may be transmitted. In up to 50 per cent of cases, however, the origin of the infection is never found. It's believed that the virus can't be transmitted through normal social contact such as touching and sharing cups - you can't catch hepatitis C from toilet seats either. Symptoms In most cases, the initial infection doesn't cause any symptoms. When it does, they tend to be vague and non-specific. Possible symptoms of hepatitis C infection include: fatigue weight loss loss of appetite joint pains nausea flu-like symptoms (fever, headaches, sweats) anxiety difficulty concentrating alcohol intolerance and pain in the liver area The most common symptom experienced is fatigue, which may be mild but is sometimes extreme. Many people initially diagnosed with chronic fatigue syndrome are later found to have hepatitis C. Unlike hepatitis A and B, hepatitis C doesn't usually cause people to develop jaundice. In about 75 per cent of cases, the infection lasts for more than six months (chronic hepatitis C). Most of these people have a mild form of the disease with intermittent symptoms of fatigue or no symptoms at all. About one in five people with chronic hepatitis C develops cirrhosis. Those with chronic hepatitis C infection should be seen by a hospital liver specialist who may recommend antiviral drug treatments either as single drug therapy or as combination therapy. Treatment Whether treatment is needed, and if so which type, depends on a number of factors. These include blood tests to identify which strain of hepatitis C infection is present and how well the liver is functioning, and a liver biopsy to establish whether cirrhosis is occurring. Hepatitis C is treated with a combination of pegylated interferon alpha and ribavirin. Prevention There are a number of ways to reduce the risk of the infection being transmitted. Those most at risk of contracting the infection are injecting drug users, who should never share needles or other equipment. Practising safe sex by using condoms is also important. People with hepatitis C infection aren't allowed to register as an organ or blood donor. If you think you could have been in contact with the hepatitis C virus at any point in the past, you can have a test to find out if you've been infected. You should ask you GP. Local drug agencies and sexual health clinics (sometimes called genito-urinary medicine or GUM clinics) may also offer testing. For further information, visit the NHS hepatitis C website. There is also a hepatitis C information line on 0800 451451 (textphone 0800 085 0859). The lines are open from 10am to 10pm, seven days a week.