[Question #2127] Hepatitis B.

45 months ago
Dear Doctors, this a follow up to question 1984 " I have all the symptoms of HIV". Dr Handsfield answered my questions for the above and if Doctor Hook responds to this I would appreciate it if he viewed my interactions with Dr Handsfield.

I'm concerned about Hep B, because for the last week or so, I've had unexplained joint pain, particulary in my knees and also in the rest of my legs. Pain is quite severe.

I'm not sure whether I was vaccinated for Hep B as a child, I am born and raised in the Republic of Ireland.I'm 23 years old.

Dr Handsfield told me my testing at 30 days post exposure was conclusive for all STD's including Hep B.

But I read that testing isn't conclusive until 7 weeks.

Q.1 What is the  offical recommended time post exposure for Hep B testing?

Q.2 Is receiving oral sex a known way of getting Hep B?

Q.3 Would a bite be a good way to acquire Hep B. I don't if I was bitten, but it's possible. I didn't see any blood.

Q.4 Would testing at 7 weeks post exposure be conclusive, or are they just as conclusive at 4 weeks? (I got tested again at 7, awaiting results).

Q.5Dr handsfield told me I was in the clear, but I would like to know why. Was it because of the low risk form of sexual activity or was it because of the testing at four weeks.

I'm sorry to be back here and I understand you don't approve of continous interactions with people, but I need to know if joint pain is linked to Hep B or not.

Thank you for your time.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
As you apparently know, users do not select which experts answers their questions. In this case, it is my turn so I will be answering this question. I can assure you that Dr. Hook's and my knowledge and expertise are identical and his replies would be no dfferent than mine, either in your previous thread or this one.

Your previous thread started with HIV concerns and ended questions about viral hepatitis. This expands on that theme, with emphasis on hepatitis B virus (HBV), where I reassured you the risk was low and it was very unlikely you were infected, especailly given the test result you already had. That basic advice remains the same. To your specific questions:

Q1) There are no "official recommenations" on this. You are overly focused on HBV as an STD. In fact, even the busiest STD clinics rarely see new HBV infections and rarely serve patients with concerns like yours. We would never recommend testing at all, unless someone had a true high risk exposure with a known infected person. That means unprotected vaginal or anal sex, not oral, with a partner who for sure is infected. Since this rarely comes up, no STD programs have developed standard recommendations. However, 4 weeks probably detects the vast majority of new infection, probably 90-95%. Part of the problem is that standard testing includes 3 separate tests:  HBsAg, HBsAb, and HBcAb, and these become positive at different intervals. Six or 7 weeks probably reaches 100%.

Q2. No. Oral sex rarely if ever transmits HBV.

Q3. Biting might do it, but it's not a "good way" for transmission. In other words, even an overt bite with signficant injury, by a known HBV infected person, probably would rarely transmit the infection. And certainly a minor nip or bite without obvious injury cannot do so. It is not feasible you were bitten (with enough injury to transmit any infection) without being aware of it. Nonsense.

Q4. I don't see that this matters, since you've gone ahead with a 7 week test. I'm sure it will also be negative.

Q5. My judgment in your previous thread was based on both:  the exposure was low enough risk that most experts would not have recommended testing for HBV. The 4 week negative result gave a very high degree of additional confidence.

A small proportion of people with new HBV infections get a kind of arthritis, with multiple painful joints body wide. These people also have fever and usually a skinr ash, and within 1-2 weeks most develop jaundice, abdominal pain, nausea, and other symptoms of acute hepatitis. Joint pain alone is very unlikely to be a symptom of HBV infection.

I'll leave this thread open in case you want to post the resuit of your new HBV test results. But since there is little point in speculating when a conclusive answer is at hadn, I will have no further comments until then. But stay mellow as you await the results, which almost certainly will remain negative.

HHH, MD
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45 months ago
Hello again Doctor.

As you assumed my STD test results including, Hep B came back negative.

I didn't mention that immediatley after my blood and urine were taken, I was give my first Hep Vaccine. The Dr tested my blood and knew that I wasn't immune from the Hep virus.

He also recommended that due to my limited sexual contact in the past that I should consider the HPV vaccine.

Q.1 Under what circumstances would a person receive a false negative for Hep B or HIV when tested?

And at what time would such a person post exposure test positive?

Q.2Would a Co-Infection of two or more STD's cause a false negative?

Q.3Would you recommend the HPV vaccine for someone like me, I'm 23?
My concern is that I may  have acquired HPV from my encounter as my penis is inflamed, it's inflammation has lessened from the use of E45 (over the counter soothing cream).

Q.4Can a person be tested for HPV? Or is diagnosis based on simply examining a persons genitals?

Should I wait a few months to see if warts present themselves?

Q.5 Does the Hepatitis vaccine protect from both Hep A and B? Or are they different vaccines?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Q1. I am not aware of anything that causes false neg tests for hep A or B. There are several components to the HAV and HBV tests, which become positive 2 weeks to 6 weeks after exposure. If you were tested at 6+ weeks, your results are conlclusive. And your doctor would not have started the vaccine if any part of your HBV test was positive.
Q2. No; multiple infections have no result on the tests for others.
Q3. Yes, you should be immunized against HPV. But your penile "inflammation" has nothing to do with HPV, which does not cause such symptoms. When HPV does cause symptoms (e.g. warts), it's usually not for at least 3 months or up to a year after exposure.
Q4. There are no approved or recommended HPV tests for males. HPV testing is usually done in women as part of the pap smear procedure.
Q5. Separate vaccines, although there is a commercial product that combines both vaccines. Ask your doctor which vaccine was started and whether HAV immunization is a good idea based on your lifestyle and risks.

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44 months ago
Hello again Doctor.

The vaccine, I received was Twinrex, which protects from Hep A and B, I've had two shots to date and receive my third five months from now.

As you may remember my Doctor wanted me to be tested 3 months post exposure.

This on your part and the opinion of the Doctor I visited at the STI clinic is not necessary as my results at 7 weeks were conclusive.

Unfortunatley I have other, potentially serious medical concerns that are unrelated to anything sexually transmitted.

So in order to satisfy my Doctor, I intend to be tested from Hep and HIV again, in order so that she can test me for other things (silly I know).

Q1. Will the fact that I have received two shots of Hep A and B vaccine alter the testing process, and give me a false negative?

The STI Doctor also examined my penis at my request as it was inflammed and itchy/sore.

She told me it was thrush.

Q.2 Is thrush sexually transmitted?

And do you believe I acquired it from my encounter, my symptoms came about right after I had receptive oral?

Are there any meds available to help get rid of the penile thrush?

Q.3 Will having thrush make me more at risk of acquiring STI's if I have future sexual partners.

Thanks for the help Doc, I promise I will not post a further thread on this forum in relation to this exposure. And will try my very best to protect myself in the future so that I don't need to avail of your services again.

Thank you.
44 months ago
Could you please reply Doctor, again I promise I will not be back here with more questions about this incident.

Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Apologies for initally missing this follow up question and the dleay in responding.

Q1:  As discussed above, vaccination can cause certain components ot the tests for HAV and HBV to be positive. However, that's easy to tell by the pattern of results. Your doctor will easily be able to advise you when the test results are available.

Q2: Localized fungal infections (sometimes called thrush) generally are not sexually transmitted. Sometimes men get penile rash from exposure to partners with vaginal yeast infections. It's usuallly a trivial problem, easily treated with anti-fungal ointment.

Q3: Genital fungal/yeast infections do not increase the risk of HIV. In any case, once this has been treated and cleared up, it definitely won't be an issue.

It seems you aware of the forum policy on repeat questions, but to assure no understanding, here is the standard statement:  Please note the forum does not permit repeated questions on the same topic or exposure. This being your second, it will have to be your last; future new questions about this exposure, testing, and your fears about HIV or other STDs will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, continued answers tend to prolong users' anxieties. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.

Best wishes and stay safe!

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