[Question #560] Hepatitis B

93 months ago
Dear Doctors, I'm sorry to be back on the forum.
I'm not back about the questions I already did happenly, but I would like to have your oppionon on an other STD question.

Yesterday when my boss asked me to check for vaccination for Hepatitis B. (as I will go more frequently to Asia from now on) I checked for an appointment and vaccination myself and therefore had to go on the internet to see about the procedures etc.  There I stumbled across Hepatitis B on our equivalent for the CDC (to find the local vaccination location), where it was stated that it's mainly a STD, could be 100x more infectious than HIV and in the middle they have a map with world wide prevelances and saw Mongolia to be very very high. So at that moment I was pretty shocked as I (maybe naive/stupid) always thought it was only a blood diseas, which ofcourse can be transmitted with sex, but only when blood is involved.

I would like to ask you:
1)Do I need to worry about hepatitis B for this one time unprotected encounter  (unprotected vaginal sex with a mongolian lady)?(what is the chance?)
2) If Hepatitis B is so infectious as STD, why don't don't we hear much about this?

Thank you very much again for your information in this matter.

Ps I have my appointment for vaccination/blood test in 4 weeks from now.

With regards.

Edward W. Hook M.D.
93 months ago

Welcome back to the Forum. As you probably are aware, Dr. Handsfield and I share this Forum and answer questions interchangeably.  Today I happened to pick up your question.  I did review your earlier interaction with Dr. Handsfield and agree with all that he has said. You now ask another good question and I will be happy to answer it.  Before I do, a word or two of background information.  The ways in which hepatitis B is transmitted varies greatly with geography.  Here in North America, the infection is most often spread through sexual contact as other routes of infection such as through transfused blood have been eliminated through routine testing of the blood supply and congenital transmission is also lower in North America as the result of widespread vaccination and screening during pregnancy. In other parts of the world, while sexual transmission remains common, congenitally acquired infection is more common (particularly in parts of Asia).

Also, similar to what Dr. Handsfield has already told you, many people who acquire hepatitis B do so without symptoms and then their immune systems eliminate the infection.  When you are tested for hepatitis B prior to possible vaccination, the test will tell you not only whether you have already been vaccinated or not but also may tell you whether you have been infected in the past or not.  Now on to your questions.

1)Do I need to worry about hepatitis B for this one time unprotected encounter  (unprotected vaginal sex with a mongolian lady)?(what is the chance?)

There are no formal studies of how easily hepatitis B is transmitted, In general however, most single exposures do not lead to infection.  IF your partner was infected and infectious (and you do not know that she was), I suspect your risk for infection from a single exposure is les than 1%.  As I mentioned above, your test results will tell you your infection status.  The doctor who does the tests should be able to help you interpret them.  If he/she does not, feel free to follow-up here and we can try to help.

2) If Hepatitis B is so infectious as STD, why don't don't we hear much about this?

Another good question without a good answer.  Hepatitis B is now a relatively rare infection in North America, particularly in comparison to diseases like chlamydia or gonorrhea, so other STIs get prioritized above it.  this is sad since it is a vaccine preventable diseases.  Even in campaigns to promote hepatitis B vaccination, many choose not to say much about sexual transmission because of prudish misperceptions.

I hope these comments are helpful.  EWH

93 months ago
Dear Dr. Hook,

Thank you very very much for your quick and clear reply. I already noticed on this forum you both randomly answer questions.
I pretty much like both your styles of answering eventhough the style is slightly different, but still very clear in imo.

I only think you mistaken my earlier conversation with Dr. Handsfield as we haven't spoken about Hepatitis B. See my earlier question: #549.
This doesn't matter because you explain everything pretty clearly and almost very reassuring :-)

From what read in your reply I presume that eventhough it's as an STD, most transmissions have been through blood-blood transmissions and congenitally.
So I'm a bit reassured as the chance for a single exposure is very small (not completely zero as I understand now) and I hope that: Or I'm not been infected or that if I've been infected I cleared the virus and I'm protected for life.

As to be completely sure I have to wait a few weeks.

Can I ask you one last thing before closing this item?

* I have a son of 4 from a previous relationship. He lives with me for a week every month approx.(depands on my traveling) He is vaccinated for Hepatitis B with regular infant vaccinations(from 2011 it's routine here it seems :-)). But he is not tested if the vaccination is really working.  Will this vaccination be 100% protect him if he is vaccinated as an infant?(he got three shots from what I can see in the paperwork within his first 12 month) This question, because I don't want to unintentionally put him in danger in any way possible. My new girlfriend is vaccinated because of her work and she is tested if the level is ok to be immuun against it.
This fear because I read on our CDC equivalent site even sharing a toothbrush could be a problem! Please reprove me if the thought is very irrational.

Anyway, thank you also for the very clear, honest answers up to now. I really appreciate both of your and Dr. Handsfield way of answering and the chance for me to ask these kind of questions.

Edward W. Hook M.D.
93 months ago

Sorry if I wasn't clear.  I knew that you had not addressed the question of hepatitis be in your earlier exchange. 

The proportion of hepatitis B transmitted by sex in Asia is a minority of cases and yes, your risk of infection from this encounter is quite low. 

As for your other question-  it is not standard practice (or recommended) that persons who receive hepatitis B vaccination be checked to be sure that they have responded.  the vaccine is highly efficacious and testing of this sort is not needed.  Thus, since your son and your new girlfriend have ben vaccinated, they (and you) should presume that they are protected and you need not be worried.  the CDC statement about sharing toothbrushes is a bit alarmist and overstated.  So much of the information on the CDC sites tends to be overly conservative, perhaps because as a politicized federal agency, they feel they cannot "afford" to be wrong....ever.  As a result, some of the information at their sites tends to be overly worrisome. 

Hope this is helpful.  EWH

93 months ago
Dear Dr. Hook. Thank you again for answering.
I happenly understood your reply correctly :-) and think it's reassuring that overall the risk is really small and if I catched I would probably have resolved it with my immuun system :-)  Would there be any factors which could make a risk for getting chronic Hep-B bigger? (I only drink a 2 to 3 beers on Saturdays and eat pretty healthy, overall I'm pretty healthy and I'm hardly really sick, but maybe this all doesn't really matter for this )

I'm a bit dissapointed in our govnerments not warning people about Hepatitis B as they are doing with Chlamydia and HIV (in my country they are more and less only focussing on these two STD's in their TV campaigns) because with a vaccination available it's a needless diseas in my opinion!
The only thing I'm happy about is that without really asking opinions of the people in my country, they have just are doing standard vaccination for Hep-B for infants. This means that in the near future this diseas will me even more rare then it was.

Also thank you for explaining that govnerment sites like CDC are very conservative, which I can understand from their point of view. But it's also pretty scary, they also had this with HIV with in my country as they noticed that a false negative is possible after 3 month as the testings are not 100%. But I understand now that with 4th Gen this is only theoratically possible in only a few scenarios.(which they didn't mentioned)

Anyway. Thank you all on this forum to give me reassurance and also knowledge about these cases. Thanks to this, as I mentioned to Dr. Handsfield, this whole encounter has been an eye opener for me and I've learned my lesson for being careless previously!
Edward W. Hook M.D.
93 months ago

As you know, Forum rules permit only three interactions per question.  This will be my final reply.

The moderate alcohol intake you describe would not change your risk for getting hepatitis B.  Children infected during pregnancy (before delivery) are more likely to develop chronic infection than adults.

I agree with and appreciate your sentiments about the lack of knowledge about STIs.  Hopefully you will share the information you have learned, here and elsewhere with others in a non-judgment way and help our efforts to promote sexual health.  Take care.  EWH

93 months ago
I know and respect the rules.(otherwise it can keep going)
Than as to close it I repeat myself: I want to thank you also for everything, it's really good to know there is such a forum with down to earth(if this is correct english way to say this) explaining and advise.

As this encounter etc opened my own eyes, I've in within my friends and family informed about how important awereness is.
As you mentioned correctly this should not be in a judgement way as an STI/STD is not judging and it can happen to everyone!

I wish you well.