[Question #8687] Hepatitis B query
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41 months ago
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Hello Doctors,
Sorry for a follow up to a resolved question but I had a query surrounding Hepatitis B testing. It's affecting my anxiety quite badly.
I had unprotected mutual oral sex with a girl on December 15th 2021 about 3 times. I have tested for the following:
HIV (I believe 4th gen), Hepatitis B, Syphilis, Gonorrhea, Chlamydia and Trichomoniasis.
I took the first round of tests at 3 weeks post potential exposure, then another at 8 weeks - everything was negative. I supplemented that with one more round at 90 days just for HIV, Hepatitis B, Syphilis. This was more to help quell my anxiety than anything else. Unfortunatley the lab have not received my sample for HIV and Hep B, only the syphilis one (which was an EIA test that came back negative). I'm now in a position where I have to wait for another test kit to be sent to my home so I can provide another blood sample from my finger to test for HIV and Hep B.
The girl I had oral sex with also tested at 75 days (28th February) after and everything was negative. Her tests did not include a Hepatitis B test though (just tested for HIV, Syphilis, Gonorrhea and Chlamydia). She said she thinks she was vaccinated for Hep B before going abroad about 10 years ago but wasn't sure how many injections she had.
My local health authority have advised that I'd need to wait for 90 days for a conclusive Hepatitis B test but even then there are some cases where it's not detectable for six months.
Would my Hep B test at 8 weeks be conclusive? Have you ever seen or heard of a case of someone testing negative at this time and then test positive at a later date? Would all my other results be conclusive based on the time they were taken?
The girl I hooked up with is not not partner and I'm terrified of passing something on to my gf. Are we ok to resume having sex?
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Edward W. Hook M.D.
41 months ago
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Welcome back to the forum although I’m sorry you felt the need. Your concerns and the related anxiety are unwarranted. Related to the exposure you described, first of all you cannot become infected from someone who is not infected themselves and your partners negative tests prove this to be the case. As far as sexual acquisition of hepatitis B is concerned this is simply not a concern. I am unaware of any evidence that hepatitis B is transmitted or acquired through oral sex. The possibility is not even mentioned in major textbooks and review articles on the subject. Further, the prevalence of hepatitis B is relatively low and it is quite likely that your partner has been vaccinated for hepatitis B making it most unlikely that she has infected.
I am not sure of the evidence with your local health authority is using to make his/her recommendation but it is overly conservative. My strong and unqualified advice is for you to believe your test results. I see no other reason, other than to address your on needed anxiety, for further testing. Your exposures were virtually no risk, even if your partner happened to have hepatitis B and the likelihood that she was in fact infected is very, very low.
Please don’t worry. I know I see no reason related to the encounter you have described to abstain from having unprotected sex with your regular partner.
I hope this reply is helpful. EWH
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41 months ago
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Thank you for your informative answer - it's really allayed my concerns.
Whilst I have your attention, for future reference could I please just ask you to clarify my understanding of test windows for conclusive test results?
HIV - 6 weeks with a 4th generation test
Syphilis - 6 weeks
Chlamydia - 2 weeks
Gonorrhea - 2 weeks
Trichomoniasis - 4 weeks
Hepatitis B - 8 weeks
Is my understanding of these windows accurate or do any of them need revising?
The level of ID knowledge that you and Dr Hansfield have is second to none and this clarification will help me avoid any potential anxiety caused by overly conservative health authority recommendations when testing in the future.
Thanks again
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Edward W. Hook M.D.
41 months ago
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I’m glad my response was helpful to you.
Regarding testing, the diagnosis of gonorrhea and chlamydia could be reliably tested for at sites of exposure at any time more than five days after exposure. Are they testing wonderful window for trichomoniasis is similar. One does not need to wait two weeks for a reliable answer regarding these three infections. Otherwise the time intervals you mention are certainly adequate and appropriate.
Again I hope the information I provided helpful to you. Take care. EWH
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41 months ago
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If you'll permit me one final question. On 24th Feb I participated in brief mutual masturbation with the same girl. After fingering her I masturbated myself to climax - there was definitely vaginal fluid on my hands while I was doing this.
This morning I noticed a red patch on the top of my penis shaft, not far from under the head. It looks like an abrasion possibly. It's smooth and painless, a dark red/brown colour with a couple of white parts around either side of it (almost looks like a break in the skin). Slightly above this is a smaller red patch. These were definitely not present a couple of days ago.
Whilst we have both recently tested negative, there is a chance that her partner may have cheated recently as well. Is there any risk of syphilis or any other STI from this type of exposure? I'm working with my councillor to deal with this kind of anxiety. My recent test results and your comments had put my mind at ease but noticing this today made me remember the encounter described.
Would I need to re-test 6 weeks after this exposure or am I ok?
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41 months ago
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My primary cncern here is passing something on to my girlfriend.
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Edward W. Hook M.D.
41 months ago
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final Response:
It is unanimous among experts that mutual masturbation is a no risk event in terms of acquisition or transmission of STIs. This is the case even though it is entirely typical for persons engaged in mutual masturbation to get each other's genital secretions on one another in the process. Part of this is that exposure to the environment virtually immediately renders the microorganisms non-infectious.
Further, the red patch you describe does not suggest an STI, including HIV. I really see no reason for concern, no reason for testing. The activity you describe did not put you or your partner at risk. EWH
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41 months ago
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Thank you so much for all your help, Dr Hook. It's greatly appreciated. Al the best.
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Edward W. Hook M.D.
41 months ago
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You're welcome. Take Care. EWH---