[Question #178] Hepatitis B,C fear

37 months ago
Dear Doctors,

Just few days ago I got some answers from Dr Hook on STD risks and tests from an oral exposure. My questions dealt mostly with HIV and syphilis.
A recap of my situation: 46 days ago I received oral sex from a south east Asian CSW (endemic area for hepatitis). I was wearing a condom (although i am not sure the condom was intact as the CSW put in on me in a 'rough manner' by stretching the bottom elastic instead of gently rolling it down). After oral sex, the CSW removed the condom and finished with the hand. 
I was starting to feel relief from the answers from Dr Hook but the fear of hepatitis (B,C) came on me as I have been recommended by the hospital to test for it after 3 months. The hospital personnel stated that Hep B can be spread through saliva, hence my fears and questions below:
1) I vaccinated for Hep B in 1993. Am i still protected? 
2) do you agree that exposure to saliva is a risk?
3) when the CSW removed the condom it is likely that her hand touched her own saliva. Can she have infected me by touching my bare penis?
4) do you agree with the recommendation for testing for hepatitis? I was really hoping to move on when I heard this.

I am feeling very stressed and I am afraid of spreading the infection to my child.

Looking forward to hearing from you. Thanks again for your service
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
I'm sorry you feel the need to return to our site to ask these questions.  Your questions about hepatitis B were asked and answered in your earlier post.  Your unwarranted anxiety is being exacerbated by mis-information from whomever you were asking besides us.  There are no instances in which hepatitis B has ever been documented to be transmitted through receipt of oral sex (particularly condom protected oral sex).  There is likewise no known risk for infection from contact with the saliva of an infected person.  Thus there is no need for concern about hepatitis B, as I told you before.  This is all the more true since you have been vaccinated.  The protection provided by the vaccine is long lasting.  You need to stop worrying about ANY testing for hepatitis B related to your no risk exposure.

As for hepatitis C, this is an area of active research.  In the past it was said that there was no sexual transmission of hepatitis C but this statement is incorrect and we have learned that it is RARELY transmitted through receptive rectal intercourse.  The mechanism is thought to be the trauma associated with rectal sex.  As for hepatitis B however, there is no good evidence that hepatitis C is transmitted through receipt of oral sex or contact (directly or indirectly) with saliva.

STIs are not trans titled by transfer of infectious material from person to person on a person's hands.

To summarize.  Your fears of having acquired hepatitis of any sort from the exposure you have described are unwarranted.  I urge you to work to put what I presume is guild-fueled paranoia related to your misstep and resulting low risk exposure aside and stop worrying.  If you cannot, instead of wasting more money on unnecessary posts and testing, use it to seek the help of a mental health professional to address your fears and guilt.  I say this only out of concern for you.  EWH
---
37 months ago
Dear Doctor,
Many sites (including CDC) are quoting oral sex as a risk for hepatitis B transmission and mention that saliva is infectious. Anyhow, I will trust your practical experience on the field. One question related to this: do you know how long does the vaccine last?

Few days ago (day 42 after exposure) i developed a couple of red spots on the top of the penis. They present a small tip (like a pimple or very very tiny blister). The first time they disappeared in half a day. Today they reappeared in the very same spot. They are not painful, nor itchy. Can it be herpes? seems a too fast recovery from the first episode. What could it be?

Thanks for your patience.

Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
Sigh.  You can't help yourself, can you.  Vaccine protection by the hepatitis vaccine is considered lifelong.

The lesions you describe do not suggest herpes.  They suggest too much self examination on your part.  Please get a grip on yourself.  EWH
---
37 months ago
You are right. I have been really troubled by this event and I need to get a grip on it; and probably the start is to stay away from Internet.
I will test for Hep B just for peace of mind and to verify that my antibodies are at the right level; I am travelling frequently to areas where hep is endemic.
I will try to work on the psychological aspects of this misstep. 

Once again, thanks for your frank advice 

Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
I hope I was of assistance to you.  This thread will be closed in a few hours.  EWH
---