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Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Hepatitis B Treatment, Living with Hepatitis B

If Hepatitis B Is Sexually Transmitted, How Come My Partner Isn’t Infected?

Image courtesy of Canva

I thought hepatitis B was sexually transmitted? I just tested positive, but my partner tested negative, we’ve been together for years, what gives?

This question is a common one. Hepatitis B can be transmitted sexually, so why do some people — who were not vaccinated — never get hepatitis B from their sexual partners?

It comes down to factors, such as the type of sexual activity partners engage in, the viral load (HBV DNA) of the infected partner, and who is on the receiving end of infectious body fluids, especially blood (which contains the most virus), and semen.

Having one partner infected, while the other is not, can add more stress to an already traumatic hepatitis B diagnosis. “It was very confusing and made me question how was it possible I was the only one infected,” said a woman who tested positive while her husband tested negative. “I thought it was possibly a mistake, maybe I was a biological anomaly, which of course I was not.”

Let’s look at the factors that may play a role in transmission of hepatitis B infection through sexual activity.

Viral load: Semen, vaginal fluids and blood all contain the hepatitis B virus (HBV), and the higher the viral load in the blood of an infected individual, the more infectious they are considered to be. Having an undetectable viral load might reduce or eliminate the chance of transmitting the virus to someone during unprotected sex; research is still trying to assess whether a person with an undetectable viral load in the blood is able to transmit the virus through sex. This is a good reason for individuals living with hepatitis B to talk to their doctor about the benefits of starting antivirals if they have detectable HBV viral load in their blood; treatment which lowers the viral load in the blood might also serve as a prevention measure for transmitting the virus.

Once an individual tests positive for hepatitis B surface antigen (HBsAg), they should encourage their partners to get screened for hepatitis B, and vaccinated if they are still susceptible to the virus.

The timing of sexual activity: An infected person who is menstruating is more likely to transmit hepatitis B infection to an unvaccinated partner, because menstrual blood can contain higher levels of HBV than vaginal secretions. That is why dental dams and condoms are recommended to provide a reasonable barrier against exposure, during that time of the month.

The type of sexual activity: Certain sexual activities are far more efficient at transmitting hepatitis B virus than others. Oral sex appears to have a lower rate of hepatitis B transmission than vaginal sex. Anal sex carries a higher risk of transmission because of tears in the skin that can occur during penetration, which increases the likelihood of transmission of HBV to an unvaccinated partner.

Fingering carries a lesser risk, unless the infected partner is menstruating while the other partner has bruises or cuts on their hands that could allow entry of hepatitis B virus from the body fluid into the bloodstream. In such cases, gloves are highly recommended.

The hepatitis B status of the other partner: The “uninfected” partner could have already been infected and cleared the virus, or vaccinated as an infant. When a person is first diagnosed with hepatitis B, doctors often test his or her partner for only the hepatitis B surface antigen (HBsAg), which indicates a current hepatitis B infection. If they are negative for HBsAg, they are advised to receive the hepatitis B vaccine as soon as possible. However, this does not mean that they were never infected.

Testing for the hepatitis B surface antibody (also known as anti-HBs or HBsAb), and hepatitis B core antibody (HBcAb) is the only way to identify a past recovered infection or prior vaccination.

Hepatitis B is often called the “silent” infection because many people who get hepatitis B may not experience any of the alarming symptoms (like fever or jaundice). As a result, many individuals may never realize they were infected. A partner who tested negative for HBsAg, may actually have been infected in the past and cleared the infection and now has protective hepatitis B surface antibodies to forever safeguard them from infection. If they’re vaccinated without proper screening, then tested for HBsAb after vaccination, they will test positive for surface antibodies, without ever knowing that their antibodies resulted from a past infection, not immunization.

Bottom line, if one partner is diagnosed with hepatitis B and the other is not, it might seem unusual, but it is not uncommon. Just like any other virus, there is not a 100% chance of transmission with exposure. The undiagnosed partner should get tested using the 3-panel blood test (HBsAg, HBsAb, and HBcAb) and immediately vaccinated if they are still vulnerable to a hepatitis B infection (HBsAb negative).

The is safe, effective, and provides lifelong protection.

Take a quiz to find out how much you know about hepatitis B transmission: click here.

Hepatitis B Advocacy, Hepatitis B Prevention

Facing the Threat of Hepatitis B Following Sexual Coercion or Assault

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Image courtesy of tuelekza at FreeDigitalPhotos.net.
Image courtesy of tuelekza at FreeDigitalPhotos.net.

By Christine Kukka

Around the world, the most common way hepatitis B is spread is through sex — and sometimes it’s not consensual.

In the United States, sexual transmission of hepatitis B accounts for nearly two-thirds of acute or new cases in adults. According to a U.S. Centers for Disease Control and Prevention (CDC) report, about one in five women and one in 71 men reported experiencing rape at some point in their lives. And abusers rarely use condoms.

One of the hardest things to talk about is the relationship between how hepatitis B is spread and sexual assault or coercion – defined as anytime a woman, man or child is forced to submit to sex either through rape or assault, or with a partner who refuses to use a condom.

About one in 20 women and men (5.6% and 5.3% respectively) experienced sexual violence, such as sexual coercion or unwanted sexual contact in the 12 months prior to the CDC’s survey; and 13 percent of women and 6 percent of men reported they had experienced sexual coercion at some time in their lives. Among women, most abusers were intimate partners, family members or acquaintances. Among males, most perpetrators were acquaintances.

Research suggests these figures under-estimates the true prevalence of sexual violence around the world, which endangers public health on many levels. There is the mental trauma victims experience and there is the spread of sexually-transmitted infections, such as hepatitis B and HIV.

Hepatitis B is 50- to 100-times more infectious than HIV and can be passed through the exchange of body fluids, such as semen, vaginal fluids and blood. The CDC recommends the following steps to protect against hepatitis B following sexual assault.

When the perpetrator has hepatitis B (is positive for the hepatitis B surface antigen-HBsAg):

  • If the victim has never been vaccinated, he or she should receive the hepatitis B vaccine series and also receive a dose of HBIG (hepatitis B antibodies).
  • If the victim has been vaccinated in the past, he or she should immediately get a hepatitis B vaccine dose (called a booster dose.)

When the perpetrator’s hepatitis B status is not known:

  • If the victim has not been immunized against hepatitis B, he or she should received the hepatitis B vaccine series.
  • If the victim has already been vaccinated against hepatitis B, no treatment is needed.

In South Africa, for example, women’s inability to control their lives sexually is fueling the HIV epidemic. One study that followed 1,500 pregnant women who were in married or stable relationships found an astonishing HIV infection rate of 38 percent. Many reported having been abused physically and sexually in the recent past, which helps explain why AIDS is now the biggest killer of young women in southern Africa.

Image courtesy of Sira Anamwong at FreeDigitalPhotos.net
Image courtesy of Sira Anamwong at FreeDigitalPhotos.net

Sexual assault is not always accompanied by physical violence. A woman may not have the power to require her partner to use a condom without risking physical or verbal abuse, or a person may not tell his or her sexual partner that they have hepatitis B. Coercion can be silent, and fueled by ignorance and low self-esteem.

Here is an email that the Hepatitis B Foundation recently received that illustrates this: “My boyfriend is hepatitis B and C positive, as he was a drug addict. We had unprotected sex often over two to three months. I want to ask, is there any chance of myself being infected?”

Sadly, this woman is at very high risk of infection, especially from hepatitis B. What stopped her from insisting he wear a condom or walking away from a relationship with a man who had little concern for her health and welfare?

Poverty, a lack of choices, resources and education, and a host of other factors stop victims from walking away from their abusers every day around the world.

To protect the health of people around the world, we need to fight in any way we can to stop sexual violence, protect women’s reproductive health, and enable everyone to control their lives.

In southern Africa, researchers have come up with a vaginal ring that contains anti-HIV drugs and discreetly protects a woman from HIV infection, without requiring her to negotiate condom use with an abuser inside or outside her marriage.

But this treats a symptom, not the disease of sexual violence that spreads trauma, fear and diseases such as hepatitis B. However we can, whenever we can, we must work to make a difference.

Hepatitis B Prevention, Living with Hepatitis B

How Much Do You Really Know About Sex and Hepatitis B? Take This Quiz and Find Out

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Image courtesy of Vichaya Kiatying-Angsulee at FreeDigitalPhotos.net.
Image courtesy of Vichaya Kiatying-Angsulee at FreeDigitalPhotos.net.

By Christine Kukka

It’s Sexual Health Awareness month and a great time to test your knowledge about how hepatitis B is — and isn’t — spread sexually.

We know hepatitis B is easily transmitted through sex. It’s a resilient virus, can live for up to a week on a dry surface and it’s 50- to 100-times more infectious than HIV.  In fact, sexual contact is the most common way hepatitis B is spread in the United States. So let’s see how much you know:

I’m in my 20s and can safely assume everyone has been vaccinated against hepatitis B, so I don’t have to disclose my infection.   True or False?

False. New hepatitis B cases have indeed been steadily declining since the vaccine was introduced in the 1980s, but not everyone has been vaccinated. Here’s proof. As a result of the heroin epidemic sweeping through rural America, new hepatitis B infections have risen for the first time in decades among 20- and 30-year-olds who were not lucky enough to be immunized during childhood.

Oral sex doesn’t transmit hepatitis B.   True or False?

It’s complicated. There are no confirmed reports of hepatitis B infection resulting from oral sex, but there’s still a risk for infection. If you have a high viral load (HBV DNA), you may still be putting partners at risk of infection if they have bleeding gums, mouth sores, or anything that increases the likelihood of infectious fluids entering their bodies. Bottom line, oral sex has a lower risk of spreading hepatitis B than other sexual practices, but some risk remains. And don’t forget, other sexually-transmitted infections such as  chlamydia, gonorrhea and syphilis are spread through oral sex. Using a condom or dental dam reduces infection risk.

Image courtesy of photostock at FreeDigitalPhotos.net.
Image courtesy of photostock at FreeDigitalPhotos.net.

An uninfected woman is at higher risk of catching hepatitis B from an infected male partner, than an uninfected man who has sex with an infected woman.   True or False?

True.  It’s not gender but sexual activity that usually defines the infection risk, but in this case an  uninfected woman is at very high risk of infection if she has unprotected sex and is on the receiving end of hepatitis B-infected semen.

I’m positive for the hepatitis B surface antigen (HBsAg), but my viral load is undetectable. I don’t have to worry about disclosing or spreading hepatitis B.    True or False?

False.  As long as you test positive for the surface antigen, you still have the hepatitis B virus in your blood and body fluids. Yes, the risk is lower because you’re HBV DNA-undetectable, but you still need to practice safe sex and disclose your hepatitis B to your prospective sexual partners.

Anal sex is more effective at transmitting hepatitis B than vaginal sex.   True or False?

True.  Any sexual activity that might cause abrasions, cuts, or other trauma is especially risky. To minimize risk, experts recommend use of a condom.

Kissing can transmit hepatitis B.    True or False?

False. Spreading hepatitis B through kissing is highly unlikely, however, deep kissing that involves the exchange of large amounts of saliva might result in infection if there are cuts or abrasions in the mouth of the infected person, especially if they have a high viral load.

Blood has more hepatitis B virus in it than semen or vaginal fluids.  True or False?

True.  Blood has the highest volume of virus. Semen and vaginal fluids have intermediate levels, and urine and feces have the lowest level.

 

Hepatitis B Diagnosis & Monitoring, Living with Hepatitis B

Newly Diagnosed with Hepatitis B? Acute or Chronic? Learning the Hep B Basics

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Image courtesy of dream designs at FreeDigitalPhotos.net
Image courtesy of dream designs at FreeDigitalPhotos.net

If you’ve just been diagnosed with hepatitis B after a routine blood test or following a blood donation, you may be feeling overwhelmed with information about this complicated infection and references to acute or chronic hepatitis B.

Here is an explanation of these two terms and what happens when you’re first infected with the hepatitis B virus (HBV). Hepatitis B is transmitted through blood and sexual fluids. It can be spread during unprotected sex, unsafe medical procedures, exposure to blood that enters your body through a cut,  or by sharing personal items such as razors, body jewelry or toothbrushes. Most commonly it is spread during childbirth when the mother is infected.

What is a chronic infection? When we’re infected as newborns or young children, our immature immune systems don’t notice or fight the virus and it travels to our liver and begins reproducing. With no opposition from our immune systems, a hepatitis B infection can continue for years. When a hepatitis B infection lasts longer than six months, it is considered a chronic or long-term infection. Most people with chronic hepatitis B were infected at birth or during early childhood. Immunization with the hepatitis B vaccine and hepatitis B immune globulin (HBIG), if available, within 12 to 24 hours of birth can break this mother-to-child infection cycle, but sometimes the birth dose of the hep B vaccine,  and more often HBIG, is not always available around the world. The birth dose must be followed with the remaining doses of the vaccine, often given as part of a combination vaccine according to schedule. Here are the U.S. and International hep B vaccine schedules. 

What is an acute infection? When we’re infected with HBV as healthy adults, about 90 percent of us are able to get rid of the infection within six months. It can take up to six months for our immune systems to generate antibodies and get rid of the infection in our liver. This short-term infection is called acute hepatitis B.

To determine if you have an acute or chronic infection, you must be tested for hepatitis B over a six-month period. The specific test that indicates if you are infected is the hepatitis B surface antigen (HBsAg) test. This antigen covers the surface of the virus and there are usually lots of HBsAg in your blood when you’re infected. If you test positive for HBsAg for longer than six months, it means you have a chronic hepatitis B infection.

But, if you no longer test positive (or “reactive”) for HBsAg after six months and you develop hepatitis B surface antibodies (HBsAb), then you have cleared hepatitis B after an “acute” infection. There are some additional blood tests that your doctor may order to get a better understanding of your infection, but not everyone has access to these tests. Some tests are rather expensive and they may still need to be repeated over time in order to confirm the diagnosis. Please be patient. The good news is that hepatitis B is not typically an emergency.

Here is more good news. If you are a healthy adult and are newly or acutely infected, know that your chances are good that the hepatitis B infection will go away on its own. It is rare that you require medication to get rid of the virus, your immune system does that for you.  A person with a new hepatitis B infection may not have any symptoms, or they may not be very notable. For example, you might feel more tired. About 70 percent of people newly-infected with hepatitis B never experience symptoms.

But, some people experience severe symptoms like jaundice (yellowing skin or eyes), severe nausea or vomiting, or a bloated stomach (unrelated to your weight), and they need to see a doctor immediately. If you have a new or acute infection, even these drastic symptoms may not necessarily mean that you need any form of treatment, but you will need to be monitored with additional tests to make sure your liver is safe. (Tests like ALT/AST, platelets and bilirubin.)

If you can’t confirm you were infected as a child, you will need to wait the six months to find out if you cleared your infection. Please be patient and do not panic, but remember you need to take precautions during this time to make sure you do not spread the infection to others. Practice safe sex (use a condom), and don’t share personal hygiene items that may have trace amounts of blood on them.

We also  suggest that family members, close household contacts and sexual partners get tested for hepatitis B and vaccinated if needed. Have them get the triple hepatitis B panel: HBsAg, HBcAb total and HBsAb. This will tell them if they have a current infection, if they recovered from a past infection, or if they are vulnerable and need to be vaccinated. This helpful chart will help with understanding blood tests.  There can be up to a nine-week period right after infection when they may not test positive for HBsAg even if they have been infected.  Repeat testing if unsure.

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Liver Cancer

It’s Hepatitis Awareness Month: Five Reasons We Don’t Get Tested, and How to Overcome Them

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Members of Drexel University's Asian Pacific American Medical Student Association participate in a hepatitis B screening program at a Chinese Christian church in Philadelphia.
Members of Drexel University’s Asian Pacific American Medical Student Association participate in a hepatitis B screening program at a Chinese Christian church in Philadelphia.

May is Hepatitis Awareness month. Why do we need an annual reminder about hepatitis B? Because 65 percent of the estimated 2.2 million people in the U.S. living with hepatitis B don’t know they’re infected.

Studies show when people know their hepatitis B status, they’re more likely to get monitored regularly, get treatment, and take steps to avoid passing on the disease to partners and their children.

So why are so many Americans unaware of their hepatitis B infection? Here are five roadblocks that stop us from getting tested for hepatitis B, and what how we can do to overcome them.

We feel fine, so we assume we’re not infected. Hepatitis B rarely causes symptoms. There are very few sensory nerves around the liver, so when a viral hepatitis infection strikes, we rarely feel its effects. As a result, most of us – especially if we were infected as children or newborns – never experience any symptoms for decades. So remember, “feeling OK” is no excuse to avoid testing. Continue reading "It’s Hepatitis Awareness Month: Five Reasons We Don’t Get Tested, and How to Overcome Them" →

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Living with Hepatitis B

Romance in the Air? Take a Deep Breath and Disclose

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Image courtesy of tiverylucky, at FreeDigitalPhotos.net
Image courtesy of tiverylucky, at FreeDigitalPhotos.net

Valentine’s Day may be a time to celebrate romance, but first you need a relationship. When you have chronic hepatitis B, starting a relationship and initiating sex is fraught with stress, hard disclosures, and the potential for break-up before an intimate relationship can even begin.

Recently, the Hepatitis B Foundation received this heart-breaking post from a 33 year-old man who thought his “inactive” hepatitis B could not be transmitted sexually.

“I’ve lived my entire life with this, but always thought it was just a normal thing (my mother said many Asians have it) and thought it was nothing to be concerned about as I never showed symptoms,” he wrote. “My doctor never said anything either. I lived my life thinking being a carrier was nothing out of the ordinary, and that I … could transfer it via blood, but could not sexually. Continue reading "Romance in the Air? Take a Deep Breath and Disclose" →

Baruch S. Blumberg Institute