Hep B Blog

If Hepatitis B Is Sexually Transmitted, How Come My Partner Isn’t Infected?

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net.
Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net.

By Christine Kukka

I thought hepatitis B was sexually transmitted? I just tested positive, but my partner tested negative, we’ve been together for years, what gives?

This question is a common one. Hepatitis B is indeed easily transmitted sexually, so why do some people — who were not vaccinated — never get hepatitis B from their sexual partners?

It comes down to variables, such as the type of sexual activity you engage in, the viral load (HBV DNA) of the infected partner, and who is on the receiving end of infectious body fluids, especially blood that contains the most virus and semen.

Having one partner infected, and other not, can add more stress to an already traumatic hepatitis B diagnosis. “It was very confusing and made me question how was it possible I was the only one infected,” said a woman who tested positive while her husband tested negative.  “I thought it was possibly a mistake, maybe I was a biological anomaly, which of course I was not.”

Let’s look at the factors that affect who gets infected and who doesn’t when two people have sex.

Viral load: Semen, vaginal fluids and blood all contain the hepatitis B virus (HBV), and the higher the viral load, the more infectious one’s blood and body fluids are. However, having an undetectable viral load doesn’t mean you won’t infected someone during unsafe sex. Even if a man has an undetectable viral load, studies show his semen still contains some HBV and can spread infection, though the risk is lower.

So the rule here is if a man tests positive for the hepatitis B surface antigen (HBsAg), he must consider himself infectious.

The role of gender: In heterosexual relationships, uninfected women are at higher risk of getting infected by a male partner infected with hepatitis B, than the reverse. Women are on the receiving end of semen, which greatly increases their risk of becoming infected unless a condom is used.

Image courtesy of renjith krishnan at FreeDigitalPhotos.net.
Image courtesy of renjith krishnan at FreeDigitalPhotos.net.

When a woman is infected with hepatitis B, an uninfected man is at risk through direct contact with her vaginal secretions, but that contact is lower-risk than a woman’s direct exposure to infectious semen during intercourse.

However, an infected woman who is menstruating is more likely to spread hepatitis B because blood can contain higher levels of HBV than vaginal secretions. That is why gloves and dental dams are recommended to provide a barrier against exposure.

The type of sexual activity: Certain sexual activities are far more efficient at spreading hepatitis B than others. Oral sex appears to have a lower rate of hepatitis B transmission than vaginal sex. Anal sex carries a very high risk of transmission because of tears in the skin that can occur during penetration improves transmission of HBV.

Fingering carries a lesser risk, unless the infected woman is menstruating or a person has bruises or cuts on their hands that allow entry to hepatitis B in semen or vaginal fluids, then gloves are recommended.

The “uninfected” partner could already have been infected and cleared hepatitis B: When a person is first diagnosed with hepatitis B, doctors often test his or her partner for only the hepatitis B surface antigen (HBsAg), which indicates a current hepatitis B infection. If they are negative for HBsAg, they are immediately vaccinated.

If the partner isn’t also tested for the hepatitis B surface antibody (anti-HBs or HBsAb), then no one knows if  the individual was infected years ago (or earlier in the relationship) with hepatitis B and cleared the acute infection.

Hepatitis B is not called the “silent” infection for nothing — many people who get hepatitis B never have any symptoms and never realize they were infected. As a result, a wife, husband, partner or lover who tested negative for HBsAg, may actually have been infected in the past and cleared the infection and now has protective hepatitis B surface antibodies to forever safeguard them from infection. If they’re immediately vaccinated and retested after the three-dose vaccination, they will test positive for surface antibodies, without ever knowing that their antibodies resulted from a past infection, not immunization.

Bottom line, if one of you have been diagnosed and the other is not infected, it is unusual but not uncommon. Get tested and immediately vaccinated if the uninfected partner tests negative for the hepatitis B surface antibody.

Take a quiz to find out how much you know about hepatitis B transmission: click here.

Comments on this blog are closed. If you have questions about hepatitis B or this blog post, please email info@hepb.org or call 215-489-4900.

26 thoughts on “If Hepatitis B Is Sexually Transmitted, How Come My Partner Isn’t Infected?”

  1. My uncle is suffering from chronic HBV.his pcr DNA for hcv is negative but his HBS antigen is positive for the last 7 years.His Anti HBS is negative.HBE antigen is negative & anti HBE is positive.He was doing Pcr test every 6 months & the result was slways negative.for 6 yeard.7 months ago he did quantative PCR for HBv & the resilt came positive. 200 copies per ml.He was left with out treatment & last month he did quantative PCR for HBV & the result came 20 copies / ml.
    He was again left with out trement.Is it possible that his body will clear HBV with out anti HBS anti bodies.why HBV became positive after 6 years.Some laboratories give negative report for 100^copies/ ml.while other gives positive report for 20 copies/ml.
    Please answer me in detail.Does he need any treatment for 20 copies/ml.U/s & fibroscan for liver is normal. SGPT Is 17 & patient is asymptomatic.What is the prognosis & he watch for which things in future. He is checking SGPT after every three months & Quantative PCR DNA for HBV after every six months.How his HBV will be clear while he has no HBV antibodies.Does ge need any anti viral therapy ?

    1. Hello: Your uncle is very fortunate, he has inactive hepatitis B, which is causing no liver damage. His immune system is working well to keep the virus at undetectable levels. He requires no treatment at all, he should just simply get monitored regularly.
      Because his infection has been “inactive” for so long, he may eventually clear the infection and test negative for the hepatitis B surface antigen (HBsAg) one day.
      He is fortunate. Good luck.

  2. Please….if someone has been cleared from hepatitis B infection, is it possible for him or her to transmit the virus that has been cleared already in his or her system? Pls I need an immediate response.

    1. Hello: If you have cleared the infection (and lost the hepatitis B surface antigen (HBsAg) and test positive for the surface antibody (HBsAb)), you no longer have the virus in your body and cannot infect anyone. I hope this helps.
      Good luck.

  3. Hello; what want is clear answer, am positive to HbsAg since 2013 now i want marry this year, how can prevent my wife not to be infected with virus?

    1. Please be sure your future wife is tested for HBV. Remember that you are not alone and there are 257 million people living with chronic HBV. If she does not have a current infection or has not recovered from a past infection, then she should start the 3 shot vaccine series. She will be fully protected in 6 months. Until that time please practice safe sex and avoid direct contact with blood. If she wishes to confirm immunity, she should have her anti-HBs titers checked to confirm they are adequate.

  4. pls am tested hbsAg+ , hbsAb- , hbeAg- , hbeAb+ , hbcAb- and my infectivity is low. my wife was tested hbsAg-. pls what should I do to get out of this thanks

      1. Hello: In case your initial question was lost, could you please repost your question? Thank you.

    1. Hello: Your wife, by testing negative for the hepatitis B surface antigen (HBsAg), is not currently with hepatitis B. When your wife was tested, did they also test her for the hepatitis B surface antibody (anti-HBs)? If she is positive for surface antibodies, then she has already been exposed to the infection and has immunity against hepatitis B.
      If she has not been tested, please immediately get your wife vaccinated against hepatitis B. Make sure she gets all three doses, then one to two months after her last dose, get her tested for surface antibodies. If she has at least 10 mIU/mL of surface antibodies, then that shows she is protected and has immunity.
      Good luck.

  5. My husband just tested positive with hepatitisB I fear its a must I am infected too.is it possible that I have got the virus

    1. Hello: The hepatitis B virus is found in blood and body fluids, including semen, and is transmitted through unprotected sex. Please go to your doctor or clinic and explain your situation and ask to be immediately tested for hepatitis B. If you do not know if you were vaccinated during childhood, please ask to be vaccinated. If, as a healthy adult, you were infected by your husband at some point, in 90 percent of cases, your immune system will clear the infection. The problem occurs when newborns or young children are exposed and their immature immune systems can’t fight the infection and it becomes chronic. Good luck.

  6. hello my husband has hepatitis c I had blood test several times and it was negative how is possible we had unprotected sex

    1. Hello: Hepatitis B is easier to transmit sexually than hepatitis C. There are usually more hepatitis B virus in the blood and body fluids with that infection than with hepatitis C. You are very luck. Good luck and practice safe sex going forward until your husband is treated and has cleared hepatitis C.

  7. Hello… I tested negative for hbsag after a hepatitis b patient forced sex on me.. I’m at risk for getting it later. I’m worried

    1. Hello: I am so sorry to hear that you were sexually assault.
      According to medical guidelines, if you were exposed to hepatitis B sexually:
      -If you have never been vaccinated, please get the hepatitis B vaccine series and also receive a dose of HBIG (hepatitis B antibodies).
      -If you have been vaccinated in the past, immediately get a hepatitis B vaccine dose (called a booster dose.)
      -Also, get tested for other sexually-transmitted diseases to make sure you were not infected.
      For more information on sexual assault and hepatitis B transmission, please read: https://www.hepb.org/blog/facing-threat-hepatitis-b-following-sexual-coercion-assault/
      I know it’s hard to do, but I hope you reported the assault to the proper authorities, and if there were inadequate safeguards at your facility, please consult with a lawyer to consider damages, and requiring safeguards so this does not happen to anyone else.
      I am so sorry, my thoughts are with you. Good luck.

  8. hello ,i was taking metronidazole tablets , i tested for hepatitis b and found positive ,could this treatment for metronidazole not affected my results

    1. Hello: It appears metronidazole is an antibiotic, which does not affect or cause hepatitis B.
      If this is the first time you’ve ever tested positive for hepatitis B (and the hepatitis B surface antigen) You must get tested again in six months to find out if this is a new or acute infection, or if you were infected during early childhood and have a chronic or long-term infection. If you continue to test positive for HBsAg, you should also get a test to see if you have experienced any liver damage. Good luck.

  9. Pls doctor am hepatitis B positive but my wife has taken the 3 dose of the vaccine and she is breast feeding can she get the virus? because we keep having oral sex

    1. Hello: If your wife has received all three vaccine doses, she should be immune to hepatitis B. Breastfeeding will not make her more susceptible to infection.
      Good luck.

  10. Please, I would like to know if people with chronic hepatitis B stand any chance of clearing the virus from their system with or without treatment. Also, what is the fate of a foetus whose father is HB+ and mother HB- or immunized against the virus?:

    1. Hello: A small percentage of people with chronic hepatitis B infection do manage to clear the infection over time, but of course eating healthy foods and avoiding alcohol and cigarettes is important.
      A baby, whose mother is not infected with hepatitis B, has nothing to fear from a father who has chronic hepatitis B. Make sure that the newborn is immediately vaccinated with the first dose of the hepatitis B vaccine, and that the baby receives all three doses. Then, you have nothing to worry about!
      Good luck.

  11. Hello: I just found my wife blood test shaw Hepatitis B + in last stage of her pregnancy.During her maternity, child is vaccinated with Hepatitis and Immunoglobulin within 2/3 hours of birth. I have checked my self and my elder son and found both of negative. My wife pathology report shows, HBeAg(ECI method)=0.49, Anti HBe(ECI method)=9.01, HBV VIRAL DNA LOAD=559 IU/mL and HBsAg(ECI method)=8250. Please, let me know, how in risk are we(me, my younger and eldor son)? I have taken first dose of vaccine and will take all. How much risk while having sex with condoms? Is chances of transmitting while in tongue kisses? Doctors told, she is infected from childhood.So, why is not transmitted to me till nine years of relationships while I had not been vaccinated?
    Please, tell me in details as you can with my queries.
    Thank You!

    1. Hello: It is not unusual for a man not to catch hepatitis B from an infected woman. Please read: https://www.hepb.org/blog/hepatitis-b-sexually-transmitted-come-partner-isnt-infected/
      Men do not come into direct contact with infectious body fluids during sex as women do. For example, semen contains the virus and women are directly exposed during unprotected sex.
      Hepatitis B is not spread through casual contact, such as hugging or kissing. As long as you are all vaccinated, you will be protected!
      Good luck.

  12. Doctor May God continue to give u more knowledge and understanding Pls I ve just been tested hbv+ and my wife is breastfeeding but she took the three shots of the vaccine before she gave birth and we ve been having an unprotected sex Pls I want to know if my wife and my baby can be infected.Thank u sir

    1. Hello: As long as your wife and baby were vaccinated, they are not at risk of infection. And breastfeeding is perfectly safe, especially if both have been vaccinated. Congratulations on your new baby and good luck.

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