Before you scold me i want to say that i am sorry to come again in a month only. I will make sure to not come again for next 6 months.

Now i will continue with my query. Last month when i came to you i told you that i had Hbsag negative test. After that test i have multiple encounters. 3 protected oral and handjob, 1 protected oral and protected vaginal. I dont think during these encounters i exposed myself to hep b as even handjob was protected. 

Yesterday i went to a cheap escort for massage. First she started protected oral. I made sure that her lips remain on the condom. Then suddenly she started sucking my Lips. It continued max for a minute. I kept my mouth closed but some saliva of her might have come in contact with those pin sized wounds due to bite that i made on my lips by my self I dont know if they were bleeding at that time but after an hour when i came home one of them was white and others were red. I tasted  something weird at that time so i stopped. After 20 hours i took hep b vaccine. I want to know a few things:

1) What are the chances of getting Hep B from the anove mentioned encounter 

2) Do i need to take HBIG also because of yesterdays encounter or vaccine series is enough?

3) I have not tested for HBsag before vaccine. Did i made a mistake? I thought that i was not exposed after the test so i didnt take that test.

I don't understand your HBV vaccine status. Have you been immunized? What dose(s) have you had and when?

To your specific questions:

1) These all were zero risk events for HBV infection, even if your commercial sex partner has active, transmissible hepatitis B -- which she probably does not.

2) You do not need HBIG on account of yesterday's event or any of the others you have mentioned.

3) There is no need for HBsAg testing before vaccination. However, it would have been smart to be tested for HBsAb (i.e. antibody to HBs). If that is positive, it would mean you already are immune, either from past infection or past vaccination, and you would not need vaccination at this time. (On the other hand, there is no harm in vaccinating even if you're already immune.)

I may have further comments if you'd like to provide the information about your recent or planned HBV vaccination.

HHH, MD

I am from India Sir. And the exposure of yesterday is from a place where HIV and HepB rates are high as this is a red light area.

I am not immunised for hep b as it was launched in india when i was 16 years old. I am getting yearly check up for hnsag because of my sexual relations. Never get positive test (Hbsag).

This time i have started vaccination series as a part of PeP because of yesterday's exposure where my ulcers and tiny wounds are exposed to saliva of a CSW. Dont know if there was blood or not. On medhelp i was told that microscopic blood in saliva can also lead to hep b that is why i opted to ask you about this.

Please let me know if i can add any more details and if your views change regarding HBIG need after these additional information.

Also pls let me know that does starting vaccination before 24 hours really act as PeP in case of Hep B (this is what i was told and read on internet).

The vaccine i used is rDNA vaccine 1ml.

Thanks for clarifying your situation. I cannot advise about HIV or HBV prevalence in your setting. However, it remains the case that the exposures you describe were free of risk for both HIV and HBV even with infected partners. But given the setting, including the high frequency of hepatitis B in some if not all of your country, I still think it would be worthwhile for you to be tested for HBsAb (anti-HBs) before completing your HBV vaccine series. However, your doctor or clinic there is more reliable about the situation in India than I am, so I would suggest you follow their advice.  The same is true for HBIG in this situation -- but given the nature of the exposures you have described, I doubt they would recommend it. In case you're not aware, in much of India, the medical expertise on HIV, hepatitis B, and other STDs is very sophisticated, especially in major urban areas. Probably you can rely on local expertise and advice on all these issues.

I'm not familiar with that particular HBV vaccine, but I'm sure it is very effective. Here too, you can rely on India's biological and medical industries.

Persons infected with HBV typically have little if any virus in saliva or the oral cavity. I don't know if saliva inhibits HBV as it does HIV. Sorry.

My few last questions to you Sir:

1) if i would have came to your clinic with this case and the status of source assumed to be positive and some ulcers and cut in my mouth would you prescribed me HBIG along with vaccine?

2) If i decide to take HBIG then how soon after the exposure i can take it like before 7 days..14 days.. keeping in mind that i have taken the vaccine dose after 20 hours.

3)This question remains unanswered sir. Will vaccine alone plays the role of PeP and after how many days i will become immune.

4)Can HIV and other STIs peneterate through intact condoms and pinholes?

5)Sir i have read many times that you have suggested people that with protection HIV is not a worry bug on the other hand for people with multiple partners and protected sex ypu suggested hiv test once a year. May i know why? If condom protected sex is safe then why number of partners matter?

2) Because HBV is rarely an STD in my setting, I have limited personal experience managing or recommending HBV prevention. I do not know the answer to this question. Sorry.

3) HBV vaccination after exposure has no effect on risk of catching the virus from that event. It is given not for that actual exposure, but because so many persons at such risk are likely to be at risk again in the future. I would guess that some protection (against new exposures) begins after about 10-14 days.

4) No. The notion of microscopic pores or holes in condoms is an urban myth. Even natural skin condoms do not permit enough sexual fluids or infectious agents to pass through.

5) There is a difference between what is called biological effectiveness of condoms (i.e. zero risk when properly used, no breakage, etc, etc). However, in the real world mistakes are made (whether remembered or not), condoms break, and other unrecognized failures may occur. Whether for contraception STI prevention, consistent condom users have roughly 90% protection over time, not 100%. Hence all experts world wide would recommend occasional testing for HIV and other STIs even in consistent condom users.

Final question:  Vaccination and HBIG do not cause positive HBsAg, only HBsAb. A negative HBsAg test will be evidence you were not infected within the preceding 5-6 weeks. After vaccine, it probably takes at least a couple of weeks for HBsAb to be detectable by blood test. I do not know whether the test would detect the antibody soon after HGIB.

That completes the two follow-up exchanges included with each question and so ends this thread. Please note the forum policy against repeated question on the same topic. This being your second, it will have to be your last about these issues; excess ones are subject to deletion without reply and without refund of the posting fee. Thank you for your understanding. I hope the discussions have been helpful. Best wishes and stay safe.