Hello Doc,

Firstly, thank you for all you do and your expertise.          

I messed up again.  My wife was just told that she tested positive for Hep B.  She went for a yearly routine blood test and the Hep B Surface Antigen was reactive. I believe I may have infected her and will be tested today.

The reason for my suspicion is because I had a recent exposure.  On Jan 25, I was on business trip in Kenya and made a very fatal mistake.  I had unprotected oral and protected vaginal sex. with CSW.  However, the condoms slipped off on me twice during the episodes.  I am not sure how long I was inside her after the slippage both times.  I freaked out and asked her about her HIV status.  She assured me she was HIV negative. Well, she did take an HIV test the next day and tested negative.  When I returned to US, I had HIV, syphilis and gonorrhea tests done – all negative.  I thought I was in the clear and did not even think about getting a Hep B test.  BTW – I don’t believe I have been fully vaccinated for Hep B.  I vaguely remember receiving only 1 shot when I was a teenager but never returned for the last 2.  I now feel sick to my stomach knowing that I may have infected my wife.  She is very scared and confused as to how she could have contracted the virus.  I will need to come clean with her at some point.

Here’s the timeline:

Jan 25 – date of exposure

Feb 3 – first time having normal sex with wife after returning from Kenya

Feb 21 – wife tested for routine blood work

Feb 25 – wife is notified to come back as something came out abnormal and needs retest

Mar 11 – wife received results of reactive to Hep B.  More blood work drawn.

Mar 12 – I will be going for Hep B testing

My question is –

1.       If I was indeed infected on the Jan 25 exposure, how soon would I have been contagious to infect others?

2.       Is there a possibility that my wife’s test is false positive?  If so, what would cause it and how common/uncommon does this happen?

Welcome back to the forum. Sorry for you that this situation has come up.---
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Thanks for your response Dr. Handsfield,

You need more than surface antigen testing (HBs Ag). You should also have both surface and core antibody tests (HBsAb and HBcAb, sometimes called anti-HBs and -HBc). These plus HBsAg will determine if you have active infection, past infection (which might have reactivated recently), or may show evidence of immunity due to your partial immunization. That would be the conclusion if you were positive for HBsAb and neither of the others. On top of these tests, if there is any indication of current or recent active infection, you'll need tests of liver function. It would be OK to have the additional HBsAb and HBcAb tests on your own -- your might be able to contact the lab and request them without another blood draw. But if any hint of current or recently active infection, you'll need to see a doctor for proper evalution.---

I just received my HBs Ag results (non-reative).  Should I  proceed and ask for the HBsAb and HBcAb?  Would a positive on any of those could have infected my wife?  

Also - should my wife and I use protection until this is sorted out?

Do you mean your wife was not positive for HBsAg after all? That she has had a positive test only for hepatitis A virus? If so, I'm guessing she was positive by IgG antibody testing and negative by IgM. If so, she has had hepatitis A in the past, or was vaccinated. One of these seems most likely, since her liver function tests are entirely normal. Although hepatitis A can be asymptomatic, it almost always causes elevated liver enzymes (alk phos, AST, ALT). In the unlikely event your wife indeed has acute or recent hep A, it's from a food or water source, not manicure or other exposures in a salon.---
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She has not spoken to doctor yet.  Just received the positive Hep A result and the Hep B positive still stands.  Is there any remote chance that I could  technically have infected her with both infections - although I did receive the Hep A vaccine and non reactive to HBs Ag?  Otherwise, I will follow up with my doctor for the entire Hep B panel and ask her to do same with her doctor for more clarity.

There's no chance you infected her with hepatitis A. Hepatitis B remains an uncertainty. I recommend you go ahead with the additional HBV testing discussed above (HBsAb and HBcAb) and that your wife both see a specialist who understands viral hepatitis. If you do it ahead of time, it likely will save time and perhaps save a second visit to the specialist. ---
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Update - my wife HBV VL BY RT PCR:

Forgot to ask on previous post - can this mean she has Chronic Hep B?  Looks like it's a high viral load?  Was googling the test results and all I see is something about Chronic Hep B.

Your own research has been good:  your wife has an active HBV infection with high viral load. With her normal liver function tests, I agree it's most likely chronic and longstanding, probably not causing serious liver disease at this time. But that could change, and she definitely needs to follow up with the specialist as planned. You need to see your doctor as well, but you might skip that and accompany your wife when she sees the specialist.  Your own doctor might refer you anyway, and the specialist's advice about testing you need might be more expert than your doctor's.---
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