[Question #7191] Hepatitis B Assessment

7 months ago
I recently began seeing a new woman. 19 days ago we had sex (vaginal sex, protected by a condom every time). I did, however, finger her with no protection.

My concern is: I got tested the following day, everything came back negative. We met that weekend, I showed her my results, and she showed me her STD panel results from the beginning of June. All was negative, except for Hep B (not sure, but I think it might have been the Ag test). On the test, it stated that this was likely a positive result due to recent vaccination. 

She explained to me (and showed me) that she got Hep B vaccination in January and the second shot in February (it's the new two-dose version). Later she showed me that had a follow up Hbs AB Quant test two months later in April which was reactive, stating immunity. 

She told me she went over her June results with her doctor and he assured her all was well, even though there was a positive result. How could this be? 

Well, about 10 days after we had sex, I had intermittent body aches and joint pain for about two days. Nothing major, but I noticed it. Then on the 13th day I had a random back spasm which locked up my back. On the 17th day I started feeling bloated/pressure on my stomach, and my kidney/spleen area was slightly aching. Now on the 19th day I can definitely feel an ache where my spleen (maybe kidney?) is. This is starting to really worry me. Could I have contracted Hep B? 

My immunization record ends when I'm 5 years old (I'm 30), and there was no Hep B vaccine on it. I'm not sure if I got it in school. I did get a Hep A and B shot in 2015 before I traveled out of the country, but never returned for my follow up shots. Can you give me some insight on my situation? How I should proceed? Also, speaking with the girl I was seeing was helpful in that she explained her situation, but refuses to retest since she feels there is no need since her last test in June

Thank you! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
7 months ago
Welcome back to the forum. Thanks for your continued confidence in our services.

You needn't be worried at all about hepatitis B virus (HBV) infection. First, heterosexually transmitted HBV is rare, a lot less frequent than you might assume from most health education advice. Second, your partner's positive HBV antibody result indeed shows she was successfully vaccinated and is immune. Therefore, there is no chance you could have acquired HBV from her, regardless of your own immunization status. Also, the symptoms you describe are not suggestive of hepaitis B or any other STD. I agree with your partner's refusal to be tested again; there is no need and you should not keep asking her to do so.

Finally, it's a good bet you're immune anyway, having had the hep A/B shot several years ago. But if you want to be certain, you can have a blood test to confirm the expected result, i.e. positve for HBsAb and negative for the other HBV blood test components (HBsAg, HBcAb).

"How to proceed?" If your symptoms continue and you remain concerned, see a doctor. No further hepatitis testing is needed, unless you decide to be tested to check your vaccination status. If there is any reason to suspect you or your partner might be at risk for other STDs, consider testing for gonorrhea, chlamydia, syphilis and HIV. But there is nothing in your story or your symptoms that suggests a need for it.

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

HHH, MD
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