I am Male, from England and aged 30. My question relates to Hep B and I am seeking a second opinion from yourselves.

As part of my overseas employment, I am tested every 2-years for my lungs, HIV and Hep B. I am therefore extremely worked up with my visa renewal in August and hope you can provide reassurance.

157 days ago I had unprotected vagina intercourse with my ex-girlfriend when visiting home. We ended up having a further two instances of unprotected intercourse after this. The last exposure was 153 days ago.

These were moments of madness that I really regret. I was not vaccinated for Hep B as a baby and neither was my ex (only Hep A and other things like Typhoid, Cholera etc).

She assured me beforehand that she had been tested and was clear, however she had slept with a guy in April 2024 more than once (and given we had unprotected, I think she would also not have been fussed about protection with him). Her last STI test was also in March 2024 (although she could not remember if this included Hep B). Personally, I do not believe she has been honest with me and my fear is there could be other partners.

According to the NHS website, the odds of getting Hep B in the UK is extremely low. I have also read posts on this forum where you state that although an STI, it is barely (if at all) sexually transmitted between men and women.

I consulted a Doctor in January 2025 who advised against Hep B testing. I have now had 2 doses of the vaccine since. 

I have had no sexual encounters with anyone since these events.

Do you also agree not testing for Hep B and think there is no reason at all for my stress?

Thank you

Thanks for reviewing the forum for other discussions of your concerns; you have correctly interpreted our comments about the current rarity of heterosexual transmission of hepatitis B virus (HBV) in the US, Western Europe, and industrialized countries in general. I don't recall seeing or even hearing about any case of heterosexually transmitted HBV in the past 40 years. Of course it has happened in much of the world, but even there is increasingly uncommon. Further, it sounds like zero chance your ex-GF acquired HBV during her sexual exposure prior to yours and I don't see these as "moments of madness" nor any reason for regret in regard to HPV infection. Why didn't you find the NHS data for the UK reassuring enough to drop all your concerns? I agree with the doctor you saw in January. I hope HBV isn't the reason you have been avoiding sexual encounters recently. To the extent you were at risk at all, you were completely immune within 2 weeks of your second dose of vaccine. 

"Do you also agree not testing for Hep B?" Certainly there is no need. But of course you're free to be tested if you like; if so, the result will be negative. "...and think there is no reason at all for my stress?" Correct.

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

I really wish that I had come across this forum sooner. Thank you for taking the time to comment.

I admit I do overthink things (both medically and in general life).

Apologies for any confusion - my two doses of the Hep B vaccine were given in February  (3 months after the final exposure with my ex). My final and third dose will be given in June.

I should add that following these exposures, it has now been 5 months and I have experienced zero symptoms like urination discomfort, body rash, extreme sore throat etc.

For peace of mind (given my visa medical), I had blood taken by a nurse at my apartment for an HIV RNA Qualitative PCR test exactly 21 days after the final exposure (the clinic recommended this timeframe). This was only because positive HIV tests lead to visa cancellation and I could not bare waiting 8 months to test and living with the unknown.

Having looked at previous comments regarding HIV RNA PCR tests on this forum, it seems my result is 100% accurate and this is another matter I can ignore.

My follow up questions are:

1. Does it matter if blood was drawn remotely and not in a clinic? 

(will it impact on the result - i.e lead to a false negative , or am I overthinking again?).

2. I absolutely don’t have HIV and can move on without any worry whatsoever?

3. I absolutely don’t have Hepatitis B and can move on without any worry whatsoever?

4. I have just started seeing someone in the last month. Can I begin sexual practices with her without any worry whatsoever? 

Thank you for your assistance once again.

1. Where the blood was drawn makes no difference.

Thank you for your reassurance. I must also apologise for the delay in responding.

I am aware that this is my final follow up and the thread will be closed afterwards.

Of course I understand that the easiest way to ease anxiety is simply by testing, however I am sure you will understand my hesitancy about doing so here in MENA (where I work) and I am not back in the UK for a few months.

Therefore, my final follow up questions are below and I will 100% be treating your responses as concrete given you are a worldwide expert in the field.

1. Does the fact that I had THREE instances of unprotected vaginal intercourse and oral sex with my ex-gf change your assessment at all? (i.e still no risk for HIV and Hepatitis B?)

2. Regarding the nurse taking a blood sample in my apartment for my HIV RNA PCR, would temperature impact upon the result at all (i.e placing the sample tube in a bag / plastic tupperware afterwards, leading to a false negative for HIV) or am I overthinking?

3. When I have my employment visa medical, I will be negative for both HIV and Hepatitis B?

4. Given it is now 164 days since the last unprotected exposure with my ex and I have still had zero symptoms like body rash, painful urination etc. does this mean I do not need to be tested for anything at all? 

(if you say no testing is needed, I will follow your advice).

I greatly appreciate your help.

1. No, this doesn't change my assessment or advice. Let's say the risk of HIV or other STI from single episodes of such exposures is, say, one in a million (perhaps a good guess for both HIV and HBV), then with 3 episodes it's one in 330,000 -- still zero for all practical purposes.

2. Overthinking. PCR RNA tests are very robust, including little known interference with over-heating of the specimen.

3. Same question in different words. I've already repeatedly addressed the low chance of a positive test result.

4. Lack of symptoms means nothing. Most people with new HBV or HIV have no symptoms. But of course this doesn't mean there's a high risk you are infected.

You really shouldn't be worried at all. But question 2 implies you have tested or are planning to be tested, regardless of your MENA location. That would be the smart thing to do; there is nothing other than negative test results that is likely to convince you there is nothing to worry about. Just do it.

That concludes this thread. I hope the discussion has been helpful.