All pun and a little fun is intended with this title, but the “adult” version of hepatitis B transmission is a serious concern. There are “shades of gray” when it comes to hepatitis B transmission and the degree of risk with sexual activity.
Lets get something straight before we delve into the details. Hepatitis B is a vaccine preventable disease. You should be vaccinated to protect against hepatitis B unless you are allergic to the vaccine, have a health condition that prevents you from being vaccinated, or if you have a current or previously resolved HBV infection (Talk to your doctor if you have questions.)
If you have an HBV infection, make sure your sexual partners and close household contacts are protected through vaccination. You can also consider confirming immunity with a blood test called an anti-HBs titer, run 1-2 months after the last shot of the HBV vaccine series. If your partners are not vaccinated, it is essential you practice safe sex using a latex or polyurethane condom to help prevent transmission.
Hepatitis B is transmitted through direct contact with blood and infected body fluids. Direct contact means blood-to-blood, or infected body fluid to an opening in the skin or mucous membrane. This includes anything from direct contact with an open, gaping wound to something as subtle as trace amounts of blood making direct contact with tiny, open breaks in the skin, or contact with mucous membranes. Hepatitis B is a tenacious virus that can live outside the body for a good week. It is 50-100 times more infectious than HIV and more infectious than hepatitis C. Fortunately hepatitis B is vaccine preventable.
Blood and serum in particular are the most infectious, and the concentration of the virus or viral titers will be highest in these body fluids. HBV is present in other body fluids, but in much lower concentrations. These fluids include semen, vaginal fluid, saliva, sweat, tears, urine, and breast milk. Add even trace amounts of blood to these other fluids and the risk of transmission may increase significantly.
Everyone is clear about the gaping wounds and blood-to-blood contact, right? The problems are with the less obvious – the tiny, barely observable breaks in our skin, contact with a mucous membrane, or contact with other body fluids that may make a person vulnerable to HBV infection This is where logic and common sense are important because there are no hard data out there. There are a few things to keep in mind with all hepatitis B transmission:
- What is the viral load of the person infected with hepatitis B? Remember it may change over time, so the infected person needs to be regularly monitored to get a clear idea of the HBV status.
- What is the health and age of the person who comes in contact with HBV infected body fluids? Babies and young children with underdeveloped immune systems are particularly vulnerable. Those with immune system disorders and the elderly may also be more at risk. Then there are apparently unknown reasons for some that may make them vulnerable, and that’s impossible to predict.
- How much of these data can you confirm? When was the last time an HBV viral load was run? And how much do we really, or can we really know about the current state of our immune system?
Tune in for Part 2 of the 50 Shades of Gray of Hepatitis B Transmission and learn about the risk associated with sexual activity.