Symptoms of Hepatitis D

Hepatitis D is a serious liver infection caused by a virus that is transmitted through blood or bodily fluids. It can only be contracted if a person has had the hepatitis B virus and is uncommon in the United States.

Common symptoms of hepatitis D include fatigue, fever, nausea, pain in the upper abdomen, dark-colored urine, and jaundice (yellowing of the eyes and skin). For most people, symptoms start to appear several weeks after they’ve been infected with the virus, but for others, there may not be any noticeable symptoms for months, years, or ever.

This article discusses the various symptoms associated with hepatitis D, along with potential complications from the infection.

How is Hepatitis D Transmitted? - Illustration by Katie Kerpel

Verywell / Katie Kerpel

Symptoms of Acute Hepatitis D

Hepatitis D symptoms can vary depending on whether the infection is acute (short-term, lasting several weeks or months) or chronic (long-term, lasting months or years).

Some of the most common symptoms of acute hepatitis include:

These signs typically appear three to seven weeks after the initial infection, and for many people, the body’s immune system is able to start healing and fight off the infection.

For others, there may not be any symptoms at all, and they may not realize they’ve contracted the virus.

Symptoms of Chronic Hepatitis D

With chronic hepatitis D, there are usually fewer noticeable symptoms until serious complications from the infection start to develop. These symptoms include:

  • Weakness
  • Fatigue
  • Unexplained weight loss
  • Abdominal swelling
  • Ankle swelling (edema)
  • Itchy skin
  • Jaundice (yellowing of the skin and eyes)
  • Muscle or joint pain

These signs could appear several months or years after the initial infection.

How Is Hepatitis D Transmitted?

Hepatitis D is not an easily transmitted virus like the common cold or flu. In fact, a person can only get the hepatitis D virus if they already have another form of viral hepatitis known as hepatitis B.

People can get hepatitis B and D at the same time (known as a coinfection), or they can get hepatitis D separately after first getting hepatitis B (known as a superinfection).

Hepatitis D can be transmitted in two main ways:

  • Exposure through skin puncture: Hepatitis D can be transmitted through activities in which the skin is broken or punctured. This includes exposure to the infection through a syringe, tattooing needle, razor, or body piercing tool.
  • Contact with infected blood or bodily fluids: The virus can be contracted through contact with blood, semen, or vaginal/front hole secretions. For example, exposure can happen during sexual intercourse, contact with blood or an open sore, and (in rare cases) childbirth.

Even though the virus can be present in saliva, hepatitis D is not believed to be transmitted through activities like coughing, sneezing, hugging, handholding, kissing, eating contaminated food, or sharing utensils.

Infection Without Symptoms

It’s important to note that it’s possible to unknowingly infect another person with hepatitis D before your symptoms appear, which is known as being “asymptomatic.”

Risk Factors

If the body’s immune system isn’t able to successfully fight the hepatitis D infection, it’s considered to be chronic. As chronic hepatitis D progresses, or if the infection is undiagnosed and untreated, the chances of complications like cirrhosis, liver failure, or liver cancer are higher.

Certain circumstances and activities may increase the risk for hepatitis D complications.

During Childbirth

Because hepatitis D is transmitted when a person comes into contact with infected blood or bodily fluids, the virus can be transmitted to a baby during childbirth. Experts say this type of transmission is rare, but it is possible.

Unprotected Anal Sex

Hepatitis D can be transmitted through unprotected sexual contact with another person who has the virus, particularly if it leads to blood exposure. It is more likely in men who have unprotected anal sex with other men.

Following safe sex practices and using an external condom properly can help lower the risk of transmitting hepatitis D through sexual activity.

Alcohol and Nicotine

Alcohol use is harmful to the liver. This is why experts recommend avoiding alcohol if you have chronic hepatitis D, because it puts an additional strain on the liver and increases the chances for developing cirrhosis.

Evidence also suggests that cigarette smoking can increase damage to the liver. Toxic chemicals in cigarettes can cause further liver inflammation and damage in people with hepatitis D, including an increased risk for developing a form of liver cancer known as hepatocellular carcinoma.

Needles and Syringes

Because viral hepatitis is transmitted through exposure to blood, sharing needles or syringes is one of the most common ways to be infected. Transmission can also happen via unsterile medical devices, tattooing tools, or sharp personal care items like razors.

People who inject drugs, get tattoos, or are exposed to syringes should take additional precautions to prevent the accidental spread of infection.

To reduce your risk of exposure to hepatitis D and other viral infections, experts recommend never sharing needles, syringes, or razors with other people.

Untreated Symptoms

Though hepatitis D is not as common in the United States as it is in other countries, experts consider it to be one of the most severe forms of viral hepatitis if left untreated.

Early diagnosis of chronic hepatitis D can lower your chances of developing serious complications. Understanding that there are certain activities that may increase the risk of hepatitis D transmission can help prevent the infection in the first place.


Expert organizations like the American Association for the Study of Liver Diseases recommend hepatitis D screening for anyone who currently has hepatitis B, as well as for people who use injectable drugs, people with HIV, men who have sex with men, and people traveling from countries where hepatitis D is common.

When to See a Healthcare Provider

Recognizing the signs of infection is crucial in diagnosing hepatitis D and avoiding any serious complications.

If you notice symptoms such as fever, fatigue, nausea, pain in the upper abdomen, dark-colored urine, or jaundice, it’s important to contact a healthcare professional as soon as possible and accessible. They’ll be able to run blood tests to determine the diagnosis.


Hepatitis D is a serious viral infection that causes inflammation of the liver. It’s transmitted through contact with blood and other bodily fluids. Symptoms include fever, nausea, pain, and yellowing of the eyes and skin. It’s key to seek a diagnosis as soon as symptoms become noticeable.

A Word From Verywell

If you notice any alarming symptoms, like your skin or eyes developing a yellow tint, it’s important to visit a healthcare provider as soon as possible. Early detection as soon as symptoms appear is crucial. Getting a hepatitis B vaccine can protect you against contracting hepatitis D, so you might consider requesting one from your healthcare provider or pharmacist if you believe you may be at risk for the virus.

Frequently Asked Questions

  • What medications help with hepatitis D symptoms?

    A drug known as pegylated interferon-alpha may be prescribed to help your immune system control the hepatitis D virus. Prescription or over-the-counter medications may be recommended to help manage the symptoms of hepatitis D such as pain, nausea, and vomiting. Avoiding ingredients that are tough for the liver to process—like Tylenol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin—is important.

  • Are the symptoms of hepatitis D and B similar?

    Hepatitis D and hepatitis B are caused by viruses that inflame the liver, and can be transmitted through bodily fluids or blood. They both cause similar symptoms like weakness, fatigue, nausea, fever, joint pain, abdominal pain, yellowing of the eyes or skin, vomiting, and dark urine.

  • How common is hepatitis D?

    It’s estimated that 12 million people worldwide have hepatitis D. It is more common outside of the United States.

16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Cristina Mutchler
Cristina Mutchler is an award-winning journalist with more than a decade of experience in national media, specializing in health and wellness content.