Not sure where to start here...so the beginning

On about 6-30-21 had last of several encounters with a gay bottom.  He is married and said he is tested...after some time moved to me topping without condom.  Probably 6 times.  Also did oral on many occasions.

Had my regular partner (female) had abdominal pains on about 7-20-21.  went to er where they said her ALT and AST levels were elevated.  She followed up with her regular Dr (8/5/21)) and they performed a blood test.  Elevated liver enzymes still.  They then performed the Hepatitis tests A,B,C.  All came back negative.  Normal ultrasound and normal CT Scan.

I am freaked as I cant help but think that I could have caused this from my indiscretions.  I got tested for hep ABC on 7-26-21 as well   all negative as well as HIV and the standard 10 panel test performed by Quest labs.

Again Got tested for HIV 4th generation on 8-20-21.      All  negative

Tested for Hep B Surface antigens on 8-20-21                    Non Reactive

Tested for Hep B surface antibodies QL  on 8-20-21                Non Reactive

Tested for Hepatitis B core AB total on 8-20-21               Non Reactive

So my first tests were about 4 weeks post exposure and my last tests were about 6-7 weeks post exposure.

1. Can I rely on these tests?

2.  Could my female friend have elevated Liver tests and abdominal pain and still test negative if she in fact had become infected?

I understand your concerns. However, you can be completely certain that you do not have either a hepatitis B virus (HBV) infection or HIV, and that your regular partner doesn't have hepatitis B. Something else is responsible for her abnormal liver function tests, which probably have nothing at all to do with your the sexual exposures you have described. First, the tests for HBV and other kinds of viral hepatitis are extremely accurate:  they prove that neither you nor your regular partner has it. Second, there are many causes of abnormal liver enzymes -- your partner needs evaluation for causes other than hepatitis A, B or C.

In addition, the antigen-antibody (4th generation) HIV tests are among the most accurate diagnostic tests ever developed, for any medical condition. Your negative result 2 months after the sexual exposures you mention proves you didn't catch HIV.

Those comments answer both your numbered questions. You definitely can rely on all the test results you mention; and no, your partner's abnormal liver tests are not possibility due to viral hepatitis. If the problem persists, she needs to keep working with her doctor about other explanations. 

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

HHH, MD

Thank you so much for your reply.  I am actually stunned at how soon you got back to me given all the questions I am sure you are answering each day.

My follow question to your reply :

Would a viral hepatitis  test be positive when liver enzymes are elevated?

I am guessing the Hep B surface antigen and the Hep B core are the tests you would look at for current (acute) infection?  What is the time frame for testing for these two tests? 

Also I had 2 of 3 twinrix vaccine back in 2008.  I never got my third dose.  Would any of the hepatitis B tests I had indicate I had a vaccine or did I not get the correct test?  I did test positive for the hep A immunity.

Thank you again so much. 

The proper tests for HBV infection are surface antigen and antibody. They would have been positive by the time you were tested, if you were infected during the exposure described. If these are negative, there is no need or recommendation for core antibody testing.

Two vaccine doses are pretty good, and you may be immune despite your negative surface antibody test. However, confirmed immunity requires a positive resulton test. You should discuss re-vaccination with your physician. 

Thank you for your answers to my questions.  The Hiv test I had was by alere and it was not yet two months, the timing was more like 6 weeks. 

Thanks again.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.