[Question #12720] Hepatitis B worry

5 months ago

Hello Doctors - I am extremely stressed about exposures which happened 3 months ago.

I stupidly had unprotected penis-vagina intercourse on three separate occasions with my ex-wife over the space of 6 days. There was also kissing, I received oral sex; and fingered her vagina.

I was not vaccinated against Hepatitis B and my ex-wife is convinced she also has not been vaccinated (we are both in our 20’s and born and raised in the UK).

My ex-wife has just exited an 18-month relationship and she said they were sexually active weekly. However, her last STI test was in June 2024! This was a huge shock because she told me she was tested monthly, and I am sure you can understand now why I am so stressed!

In January I decided to get the Hepatitis B vaccine (after these encounters) and I have just had my second dose.

Would you be worried if you were in my shoes regarding Hepatitis B? (I am only stressed about this because it forms part of the medical for my work).

Any assurance you can offer will be very welcoming! Thank you

H. Hunter Handsfield, MD

5 months ago

Welcome to the forum. I'm happy to help.

In the US, Europe, and most industrialized countries (of course including the UK), the current frequency of heterosexually transmitted hepaitits B virus (HBV) is extremely low. I have not encountered or heard about a case in more than 30 years. Even if you and your wife have not been vaccinated, most people have. The chance your ex wife acquired HBV in the last 7-8 months (since last June) undoubtedly is near zero. Maybe a bit higher if some of her partners we men who mostly have sex with men, or if some are injection drug users. But even these groups currently have very low frequencies of HIB carriage. In addition, you were partly protected 2-3 weeks after your first vaccine dose, and will be highly protected a couple weeks after the second.

And of course for further reassurance, your ex wife could be tested now to see if she is infected. The odds are overwhelming she is not, but the negative test probably would be reassuring. And maybe other STIs as well? From what you say, the chance your ex wife has chlamydia, gonorrhea, herpes, HPV, syphilis, or even HIV probably are higher than for HBV.

To answer your single quesiton -- no: if somehow I were in your situation, I would not be worried in the least. (I don't know how to interpet increased concernn on account of medical issues in regard to your work life. Health care providers with HBV are of little or no risk to their patients, for example. Finally, you might consider contacting your local or regional health authorities (like Public Health England) to get an official assessment of the current situation for sexual transmission of HBV in your area.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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5 months ago

Apologies - to obtain my work visa overseas I must be clear of HIV and Hep B. I would be grateful for your guidance to my follow up questions:

1. I should (in my words), get a grip and stop overthinking about Hep B? I have nothing to stress about?

2. Even though I had two doses of the Hep B vaccine AFTER the encounters, will that still protect me? (first dose was 9 weeks after)

3. My HIV RNA PCR result is 100% accurate and will not change? It was negative for HIV 1/2 and taken 21 days after the last exposure.

4. Hep C is not a concern?

5. Can I resume unprotected sex with my current girlfriend?

5 months ago

Dr Handsfield - my apologies, the forum asked me to reduce the word count of my response so my tone may come across blunt in my follow up questions.

I wanted to thank you for your speedy response and for your assistance.

H. Hunter Handsfield, MD

5 months ago

1) "...get a grip and stop overthinking about Hep B? I have nothing to stress about?" Exactly right.

2) The is no protection at all for exposures prior to vaccination.

3) THE HIV RNA PCR test is conclusive at 11 days. Your result is conclusive.

4) Hep C has been oversold as an STI. It is NOT sexually transmitted by vaginal sex. The only proved high risk sexual activity for this is unprotected and potentially traumatic anal sex between men.

5) It wasn't clear you have another ongoing relationship other than your ex-wife. From HBV, HCV or HIV standpoints, no risk and no worries. You might consider testing for other STIs as suggested above, if not yet done.

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