Hep B Blog

The Fifty Shades of “Gray” of Hepatitis B Transmission – Part 2

1716136dfa105e7f9bdf96de16e31742You can’t neatly package and control everything, but you can use good judgment and not over react when thinking about hepatitis B transmission. HBV is not casually transmitted, but you know yourself, and both infected and uninfected individuals can take simple precautions. If you don’t have hepatitis B and you are sexually active, make sure you are vaccinated. If you have HBV, encourage your partners to get vaccinated.

(Click here if you’re looking for Part 1)

Back to the questions I hear often about “adult” hepatitis B transmission:

Can I have sex with my partner(s) and not transmit HBV?
Your partner is at risk if he or she is not vaccinated. At a minimum, you should be practicing safe sex by using a condom. There is a double whammy of both infected sexual fluids, along with direct contact with mucous membranes of either male or female genitalia. Anal sex presents a higher risk than vaginal sex, but both are risky.

Is oral sex safe for my partner if I have HBV?
There are no studies or confirmed reports of transmission as a result of oral sex. However, you should consider the following: how high is your viral load? Are you or your partner having oral problems – bleeding gums, mouth sores, or anything that might increase the likelihood of infection through direct contact with blood? This sexual activity would be of limited risk, but use good judgment before engaging.

What about French kissing?
Once again, there are no data or confirmed reports of HBV transmission through French kissing. Just use good judgment and consider the viral load and the oral health of you and your partner.

What is the risk if someone’s “hand” comes in contact with “sexual fluids”?
It is not uncommon to get questions about a hand that has come in contact with sexual fluids. As you can imagine, the venues vary from strip clubs to secluded work- place areas and everything in between. Transmission certainly seems unlikely, but if there is direct contact with infected blood, there is risk. Use common sense. Take simple prevention measures and thoroughly wash your hands.

If you have participated in a high or low risk sexual activity, and you’re concerned about infection with hepatitis B – either giving it or getting it, testing is the only way to know for sure. Remember there is up to a 9 week window where a person may not test positive, even if infected with HBV. Be sure to test or re-test outside the window. If the person does not have a current or previously resolved HBV infection, then they should be vaccinated. Both partners still need to consider the risk of transmission of other sexually transmitted diseases, but the “shades of gray” of hepatitis B are hopefully a little clearer.




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27 thoughts on “The Fifty Shades of “Gray” of Hepatitis B Transmission – Part 2”

    1. antivirals like lamivudine and others control and manage hepatitis B, but they do “cure” chronic HBV. Your viral load should go to a low or undetectable level, but you will not lose surface antigen and gain the antibody as a result of being on treatment with lamivudine. However, now that you are on antivirals, I encourage you to stay on them because abruptly stopping antivirals may result in a flare and damage to your liver. Please talk to your liver specialist before making any decisions. And remember, when on antivirals, the goal is to control the virus.

  1. I am a pregnant woman and this is my result HBs Ag positive HBs Ab positive HBe Ag Negative HBe Ab positive HBc Ab positive. My question now is that can i be treated with pregnant and for how long? Can my baby be vaccinated immidiately after birth and what type of vaccinate? Thanks

    1. Sorry to hear of your hepatitis B diagnosis based on screening during your pregnancy. It is very fortunate you learned of this now, when you have the time to prevent transmission to your baby. Birth prophylaxis, including a birth dose of the HBV vaccine and a shot of HBIG (if available) within 12-24 hours of birth, followed by the remaining shots of the HBV vaccine series according to schedule is effective greater than 90% of the time in preventing HBV transmission from mother to baby. Babies and children are much more vulnerable to hepatitis B than healthy adults. Greater than 90% of babies infected with HBV will remain chronically infected. That said, I cannot say if you would benefit from treatment for your HBV at this time. I am assuming it is a chronic infection, but you will want to discuss and confirm with your doctor. You are HBeAg negative so likely in a less active phase, but you want to confirm by getting a thorough evaluation by a liver specialist. He can help to ensure that the hospital where you deliver will have both the HBV vaccine and preferably a shot of HBIG available.

  2. I am a chronic carrier and my HBV DNA load is 302 iu/ml = 815 copies/ml . Is this considered as low and that the virus is inactive ?

    If my partner is vaccinated and has full immunity , is it safe to have unprotected sex and deep kissing ?

    If a person with full immunity comes into contact with me through unprotected intercourse or kissing and my bodily fluids comes into contact with their body, can that person still carry the virus and transfer it to someone else?

    What is the most effective way of washing away any contaminated body fluids or blood ?

    Is it also safe to breastfeed after my baby is born or will the breastmilk be more of a risk for the baby to get the virus ? Can breastfeeding transfer the virus ?

    1. Hello: Your viral load (HBV DNA) is low, have you had your liver enzymes (ALT or SGPT) tested recently? If the infection is harming you liver your ALT levels would increase (healthy for women is 19 or less.) In addition to viral load, that test shows if the infection is active or inactive.
      Assuming your ALT levels are normal and your are negative for the hepatitis B “e” antigen (HBeAg), then your infection may be considered inactive, though only your doctor can tell that for sure.
      If your partner is vaccinated, and has at least 10 mIU/mL in antibodies, then he is considered protected and you may have unprotected sex. Deep kissing has not been shown to transmit hepatitis B unless you have mouth sores.
      A person who has immunity cannot transmit the infection to anyone else after they have had sexual contact with someone who is infected. To become infected, someone needs infectious body fluids (blood, semen etc.) to enter their body sexually or through a cut or other opening.
      A mixture of one-part bleach and nine parts water will disinfect any blood spills or body fluid spills and destroy the virus.
      If/when you become pregnant, it is very important that within 12 hours of birth that your baby receives the first hepatitis B vaccine shot and if it is available, HBIG (hepatitis B antibodies) to prevent infection. A baby is at high risk of infection because of his contact with blood and body fluids during delivery.
      It is safe for mothers with hepatitis B to breastfeed their babies, so do not worry!
      If you have other questions about pregnancy and hepatitis B, please read: http://www.hepb.org/pdf/pregnancy.pdf

  3. Please help me with some info. The man I am seeing found out he has hep b from his ex.They split over a year ago, but it only all came to light recently. I want to be with him, he has lots of other health problems including kidney disease. We will use a condom during sex and no oral or rimming even though before his diagnosis we wanted to. He wants to cum on my arm pits and pee on them. Now I have not shaved there for weeks, is it too risky to have him pee and cum on my arm pits? How safe is it him fingering me and me giving him a hand job? I am not vaccinated, I know the risks of not letting bodily fluids get on open sores,cuts etc. He has a high viral load. Can we do deep kissing? I have no sores or cuts on or in my mouth. He is possibly dying, he has so much wrong with him he doesn’t see the point in even trying dialysis. I want to be intimate with him but safe as I can be too.

    1. HBV is a vaccine preventable disease. I would begin the vaccine series as soon as possible to lower your risk. There is up to 50% protection following the first vaccine, and up to 80% following the second. You can have up to 80% protection after one month. That should be a priority.

      HBV is spread through direct contact with blood and infected body fluids. You say he has a high viral load so that makes him more infectious. The more you can do prevent direct contact by ensuring there are few or no microscopic breaks in the skin, the better. The concentration of the virus would be less in urine than semen. Deep kissing risks increase if there are issues with bleeding gums or mouth sores.

  4. I have a question on Hepatitis B, I had oral sex and the semen got on the bed and other places in the house. I keep cleaning everywhere with bleach..I dont want to have any on me and then spread it to others..also how do I clean myself up? I have using bleach in the shower. Any insight would be helpful.

    1. Hello: As you have been told by the foundation before, cleaning up potentially infectious liquids with a bleach solution is what is required to prevent possible exposure on household surfaces. Soap and water is adequate for cleaning yourself. If you have concerns about this, please contact your doctor and a mental health specialist. Good luck.

      1. what masturbation can spread the virus ? Should I have to clean my tub or my bed whenever I masturbate or change clothes ? when ever I hold handle or anything my viral load BTW is 640 and HbeAG negative.

        1. Hello: Your blood and body fluids, including semen, contain the virus. If any of these liquids are accessible on sheets, hard surfaces etc., you need to clean them up using a disinfectant or bleach and water (1:10 ratio) so no one else has contact with them and is at risk of infection.
          So clean up after yourself, and if you are using cloth/sheets as a barrier, make sure you bleach those materials. Good luck.

  5. My partner have chronic hepa B and she gives me a blowjob and Im not vaccinated is there possible that she transmitted hepa b to me? is there possible that she can transmitted hepa b to me if her saliva goes into my penis head?

    1. Hello: To become infected, you need infectious blood or body fluids, such as semen, to enter your body. Saliva is not infectious, unless she has a mouth sore or wound that bleeds. Generally, oral sex is not effective at transmitting hepatitis B. However, I encourage you to get vaccinated so you do not have to worry about becoming infected in your lifetime.
      Good luck.

  6. I have had Hep B for 2 years now. Myou Liver enzymes have been normal. HBeAb and HBeAg has been negative. Viral load is low. I have been generally asymptomatic. But I have had a few mouth sore that were not bleeding. I am also HIV negative. What are the chances of infecting another person if I kiss them? Or give oral sex during this period.

    1. Hello: It is safe to kiss someone. Saliva does not transmit hepatitis B, however if you have bleeding gums or mouth sores, as you mentioned, then you need to be careful.
      Oral sex can still transmit all types of sexually transmitted infections. We recommend that a condom is used so there is a barrier between you. Good luck.

  7. My husband has chronic Hep B. Can he transmit it me by sucking my breast? I am in process of getting my vaccination.

    1. Hello: No, saliva does not transmit hepatitis B. Only blood, semen and other body fluids contain the virus and can transmit hepatitis B. I am glad you are getting vaccinated. Good luck.

  8. Hi.
    I read on your site that there is a 4-6 weeks window period. Do you mean that a aghbs test at ex. 8 weeks is conclusive (100%)?
    Receiving oral sex (i’m a male) and french kissing with an unknow hep.b status woman, is a low risk for hep. B? I found on the internet that there’s only a risk if the girl is in the acute phase of hep. b (the first 6 months???) to transmit hep. b with oral sex or french kissing. After the acute phase that is no risk anymore that she transmit hep b on French kissing and oral sex. Is this True?

    1. Hello: You are at relatively low risk for hepatitis B. Kissing does not transmit hepatitis B, and receiving oral sex, the woman is actually on the receiving end of potential infectious body fluids (semen) unless a condom was used.
      And yes, a test result at eight weeks should provide accurate results.
      Please get vaccinated against hepatitis B so you do not have to worry about this in the future. Good luck.

  9. Hi.

    1)When someone has a fatigue from hepatitis b, are the SGTP and SGOT high? Or can they be normal? I’ve read that the reason of fatigue during hepatitis, is because the liver is suffering, can i conclude that the liver test must be eleved when someone has a fatigue from hbv?

    2)Almost 3 months ago i got a tiny(+- 6cm) white colored stool. The other stool was normal of color. When someone has white colored stool from hbv, is it possible that he got only a tiny white colored stool or are all the stool colored white?

    3)when someone has acute hbv, and he did the SGTP and SGOT test after the white colored stool and during the fatigue, what do do you think, is he recovering (disappearing of aghbs)? 2 months ago i got that tiny white stool. I’m fatigue since 4 weeks, (still now) and i did a SGTP (19) and SGOT (18) test, douleurs you think that the SGTP and SGOT must be elevated?

    4)someone who is recovering of hbv (no aghbs anymore), can he have still a fatigue for weeks? Or not?

    A lot of questions but i’ll appreciate if you taken the time to answer them.


    1. Hello: The only way to find out if you are experiencing an acute vs. a chronic infection is to be tested for the hepatitis B surface antigen (HBsAg) over a six-month period. If you continue to test positive for HBsAg after six months, it means you are chronically infected.
      Please continue to be monitored to determine if your infection is chronic or acute. Good luck.

  10. Hi.

    What do you think? True, pls.
    If someone has white stool from hbv, can it only veel a littekens stool?(see what me happen?)

    1. Hello: It is impossible to say what caused the white stool, please see your doctor and ask if you should be tested for hepatitis B. Good luck.

  11. Hello….. I got tested for hepatitis b nd it was positive a long time ago …….. My partner got tested recently nd we have had a lot of unprotected physical contact together nd he was negative does it mean the virus has cleared frm my system………..

    1. Hello: It’s impossible to say, perhaps he was vaccinated during childhood, or your viral load (HBV DNA) is low. You should be monitored at least once a year, and have your liver enzymes (ALT or SGPT) tested to make sure the infection is not harming your liver.
      Lastly, did your partner test positive for the hepatitis B surface antibody (HBsAb)? If not, he should be vaccinated. Good luck.

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