Hepatitis
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Hepatitis C Symptoms: Signs and Symptoms of Hepatitis C

Medically reviewed by Callie Miller, MHS, RDN, LD

Fact checked by Anh Tran, BHSc, MPH

Written by Donna Schwontkowski, MS, BS on November 23rd, 2016

Being an almost invisible disease, hepatitis C symptoms are usually not visible or existing until the patient enters the later stages (1, 2). Hepatitis is a liver inflammation that if not treated in time, can turn out to be extremely serious (3, 4). Most importantly, hepatitis C is considered the most serious condition out of all three hepatitis viruses (5, 6): A, B, and C. So, how do you recognize the symptoms of Hepatitis C?

Signs and Symptoms of Hepatitis C

Hepatitis C Symptoms

Approximately 70% percent of hepatitis C patients do not notice any signs of Hepatitis C when the infection is acute (7, 8). If they develop the symptoms, they usually come as mild signs and are very flu-like (9). Such symptoms include tiredness, soreness, joint pain, nausea, poor appetite, fever, stomachache, itchy skin, jaundice or yellow skin discoloration and dark urine (10, 11).

When a person is at the stage of acute hepatitis C, they are very likely to develop chronic hepatitis C infection (12), which means that they will experience more severe symptoms as the infection worsens. If the virus remains in the patient’s body for longer than 6 months, this turns to a chronic case (13). However, there are cases where people had this infection for 15 years, without ever suspecting it or experiencing severe symptoms (14, 15).

Summary: Hepatitis C is the most serious out of all the hepatitis viruses (A and B) if left untreated. About 70% of hepatitis C patients don’t notice any signs or symptoms in acute infections. Mild symptoms may occur that are often flu-like, such as fatigue, soreness, joint pain, nausea, poor appetite, fever, jaundice, or dark urine. Chronic hepatitis can develop if left untreated for longer than 6 months.

According to the report of the Centers for Disease Control and Prevention, people with acute hepatitis C rarely experience the symptoms (16). The results show that even 80% of the total number of patients that suffer from acute hepatitis C do not experience any sign that would indicate they have this disease (17). In most cases, patients start experiencing the symptoms long after they are infected by the virus (18). Still, in cases where acute hepatitis causes symptoms in patients, they can be both mild and severe and include fever, tiredness and poor appetite (19, 20). Additionally, people who are infected with the virus may experience nausea, vomiting, stomachache, joint and muscle pain, urine abnormalities, bowel movement abnormalities, and jaundice (21, 22). The early symptoms of this condition are most commonly occurring around 6 to 7 weeks after exposure to the virus (23, 24).

It could take 6 months to 15 years for a patient to become aware of their condition, as was reported by the National Digestive Diseases Information Clearinghouse (25). The main reason for this is that the time it takes for the virus to get to the liver and cause damage can be long (26, 27).

Summary: In most cases, patients aren’t aware they have the condition until 6 months to even 15 years after exposure. Mild or severe symptoms can occur around 6-7 weeks after exposure. Symptoms include fever, fatigue, poor appetite, nausea, vomiting, joint and muscle pain, urine and bowel abnormalities, or jaundice.

Hepatitis C is transmitted through an infected blood that enters the body of a healthy person (28). This usually happens through sharing a needle during injecting an IV drug or when a child is being born from a mother that already has the disease (29, 30). Additionally, many patients were reported as being infected with the virus because of an accidental needle injury. At this moment, blood banks test the blood, so the risk of being infected from a transfusion is set to a minimum (31, 32).

Summary: Hepatitis C is transmitted through infected blood via unsterilized needles or medical equipment, or when a child is born to an infected mother. Blood is tested before being used in blood transfusions to rule out the virus.

In order to list the symptoms of this condition, we first need to separate the disease stages into acute, chronic and end-stage hepatitis C.

Symptoms of Acute Hepatitis C

In the case of acute hepatitis C, the time between the moment when the person is infected to the manifestation of the first symptoms can be from 2 weeks to 6 months after the exposure (33). The period when the person is infected with the virus is called the incubation period (34). According to the Centers for Disease Control and Prevention, the average time for the symptoms to occur is 6 to 7 weeks.

As we said, 80% of the people with acute hepatitis do not experience the symptoms in this stage. However, for the remaining 20% of patients, the main symptoms of acute hepatitis C include (35):

  • Gastrointestinal problems such as nausea, abdominal pain, vomiting and clay-colored feces
  • Unexplained weight loss
  • Decreased appetite
  • Fever
  • Fatigue
  • Dark urine
  • Jaundice
  • Joint pain

The number of patients who develop only this type of infection is low, with about 15 to 20% of exposed patients never developing chronic hepatitis C infection (36). In these cases, the acute infection in the patient’s body clears spontaneously within 6 months.

Still, the remaining 80 percent of patients develop complications from the condition, where the acute hepatitis c turns to chronic hepatitis c.

Summary: The main symptoms of acute hepatitis include gastrointestinal issues, unintended weight loss, low appetite, fever, fatigue, dark urine, jaundice, or joint pain. On average, symptoms start to occur 6-7 weeks after exposure. Only about 20% of patients with acute hepatitis C experience symptoms.

Symptoms of Chronic Hepatitis C

It is common for people to be first diagnosed with the hepatitis C virus when they get examination for other health problems, completely unrelated to hepatitis C. This usually happens because the majority of patients are asymptomatic when in the acute stage of hepatitis C, up until the moment where the liver is severely damaged, which is sometimes decades after the incubation period (37).

Still, considering that this condition is extremely serious since it causes long-term health problems such as liver cancer, failure, and damage. The untreated condition can even lead to the death of the patient.

Five to twenty percent of all patients who develop chronic hepatitis C develop an irreversible liver scarring called cirrhosis (38). When this happens, the liver cannot function as it is supposed to and this can last up to 3 decades. Because of this, one to five percent of all patients dies from the hepatitis C infection.

Summary: The majority of patients are asymptomatic during acute hepatitis C stages. If hepatitis C is left untreated, it turns into chronic hepatitis C. This puts the patient at risk for cirrhosis (irreversible liver scarring), and liver cancer, failure, or damage.

The symptoms of chronic hepatitis C can vary depending on the damage type of the liver. When it comes to cirrhosis in a patient, they can experience (39):

  • Fatigue
  • Itchiness
  • Abdominal bloating
  • Spider angiomas under the skin
  • Swelling in the legs, ankles, and feet

The abdominal bloating symptom is most often a result of a fluids buildup in the body.

When it comes to liver cancer, this condition usually develops after the developing of cirrhosis in a patient. When this happens, the patient may experience the following symptoms (40):

  • Jaundice
  • Swollen abdomen
  • Abdominal pain
  • Tenderness
  • Easy bruising

Summary: Symptoms of chronic hepatitis C vary depending on how damaged the liver becomes. Patients with cirrhosis experience fatigue, itchiness, abdominal bloating, spider angiomas under skin, and swelling of the legs, ankles, and feet. Patients with liver cancer may experience jaundice, swollen abdomen, abdominal pain and tenderness, and bruising.

Symptoms of End-Stage Hepatitis C

When chronic hepatitis C is not treated for any reason, the condition may progress to an extremely serious stage of this condition (41). Regardless of the cases where patients do not experience symptoms or do not connect them with hepatitis C, not treating your condition is a serious problem. End-stage hepatitis C or as also referred to as HCV induced end-stage liver disease can be fatal for many patients (42).

The final stage of hepatitis C is characterized by (43):

  • Severe skin itching called pruritus
  • Abdominal swelling
  • Fatigue, even extreme
  • Weakness and wasting of the body called cachexia
  • Hemorrhaging and veins enlargement
  • Gastrointestinal bleeding
  • Cognitive decline due to toxins accumulated in the patient’s bloodstream
  • Mild cognitive impairments
  • Coma

Hepatitis C is a serious condition that, if not treated, can lead to fatal outcome i.e. death. Therefore, you must be careful when using injections that may lead to infection and of course, make sure that if you experience any of the symptoms above are not signs of hepatitis C.

Summary: Untreated chronic hepatitis C can progress to a very serious stage, referred to as end-stage hepatitis C or induced end-stage liver damage. This can be fatal for many patients. Symptoms include severe itching, abdominal swelling, fatigue, weakness, hemorrhaging, gastrointestinal bleeding, cognitive decline or impairments, or even coma.

Donna Schwontkowski, MS, BS

Dr. Donna’s has a doctorate in chiropractic medicine. She specializes in nutrition and herbology in her practice and has taught thousands of...Read more

Anh Tran, BHSc, MPH

Anh has a Master of Public Health degree from Boston University School of Public Health. In her previous roles, she has had...Read more

Callie Miller, MHS, RDN, LD

Callie Miller is a Registered Dietitian Nutritionist specializing in sports nutrition & fitness, family health, and pediatrics. She has a passion for...Read more

Evidence Based

This article is based on scientific evidence, and written, fact-checked & medically reviewed by health experts.

Throughout this article, you’ll find scientific references (highly trusted peer-reviewed scientific papers, links denoted by the numbers in the parentheses (1, 2, 3)).