Trying to understand how I was infected with HBV

[s0w0rried]

Hi, first of all thank you for having this forum to discuss Hep B.

I was recently diagnosed with hepatitis B, recent infection. I am trying to understand how I might have contracted the virus. This was the first time I had sex in over a year. It was a one night stand- I met a young woman while out with friends during vacation. We deeply kissed, she performed unprotected fellatio on me, and we had protected vaginal sex (no anal). This lasted ~10 minutes. The condom did not break at any point and was confirmed in- tact after we finished.

The next day through friends I found out that she is also a sex worker, which terrified me and why I got tested as soon as I found out. Normally I would not consider my activities mentioned about as risk (since I used a condom and it did not break).

I am just trying to understand how the virus may have been transmitted. I am just perplexed as to which transmission routes could have been possible? One thing I think is worth mentioning is that before going out that night I shaved all of my pubic hair. Would this have left me more vulnerable to infection? Perhaps if her vaginal fluid secretions contacted my pubic area skin? Is this a possible mode of transmission?

Please advise. I know you may wonder why am I speculating about something that has already happened, but it is important to me to understand how it may have happened so that I can warn others of risk.

What is really unlucky is I was vaccinated for Hepatitis B as a baby but the vaccination did not work. Apparently, some of the versions of the vaccination is not 100% full proof so for others on this forum, please don't depend on your hepatitis B vaccination. Make sure you have all the boosters or that you have the hepatitis B surface antibody before assuming you're immune to the virus.

Please help... much appreciated!

[Lynn K]

Hi so worried,

I deleted your duplicate post.

It is entirely possible and even likely you will never know how you became infected with hep b. You may have been infected for a period of time before this incident.

Did you complete the hepatitis b vaccine series? It takes more than one vaccination to develop full immunity to the hep B virus

https://www.cdc.gov/hepatitis/hbv/bfaq.htm#bFAQc01

How is hepatitis B spread?

The hepatitis B virus is spread when blood, semen, or other body fluid infected with the hepatitis B virus enters the body of a person who is not infected. People can become infected with the virus from:

Birth (spread from an infected mother to her baby during birth)
Sex with an infected partner
Sharing needles, syringes, or drug preparation equipment
Sharing items such as toothbrushes, razors or medical equipment such as a glucose monitor with an infected person
Direct contact with the blood or open sores of an infected person
Exposure to blood from needlesticks or other sharp instruments of an infected person
Hepatitis B virus is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, or sneezing.


Can a person spread the hepatitis B virus and not know it?

Yes. Many people with a hepatitis B virus infection do not know they are infected since they do not feel or look sick. However, they can still spread the virus to others.


Can the hepatitis B virus be spread through sex?

Yes. The hepatitis B virus can be in the blood, semen, and other body fluids of an infected person. A person who has sex with an infected partner can become infected with the virus.


Can hepatitis B be spread through food?

Unlike hepatitis A, hepatitis B is not spread routinely through food or water.


Who is at risk for hepatitis B?
Although anyone can get hepatitis B, some people are at greater risk:

Infants born to infected mothers
People who inject drugs or share needles, syringes, or other drug equipment
Sex partners of people with hepatitis B
Men who have sexual contact with men
People who live with a person who has hepatitis B
Health care and public safety workers exposed to blood on the job
Hemodialysis patients

Can hepatitis B be prevented?

Yes. The best way to prevent hepatitis B is by getting vaccinated. The hepatitis B vaccine is safe and effective. Completing the series of shots is needed for full protection.

How does the hepatitis B vaccine work?

The hepatitis B vaccine stimulates your natural immune system to protect against the hepatitis B virus. After the vaccine is given, your body makes antibodies that protect you against the virus. An antibody is a substance found in the blood that is produced in response to a virus invading the body. These antibodies will fight off the infection if a person is exposed to the hepatitis B virus in the future.

[Lynn K]

Here is an interesting article I found about hep b and sexual transmission.

http://www.hepb.org/blog/hepatitis-b-sexually-transmitted-come-partner-isnt-infected/

[s0w0rried]

Hi Lynn,
Thanks for deleting my duplicate post (that was done in error).

Based on extensive testing this was a new infection, approximately 3 weeks (no advanced antibodies had been converted yet).

Thanks for your articles. Yes, I got the three shot vaccination series (once on the date I was born, another one 30 days after and the last, 4 months from the first shot). From studies I have read, 5-10% of people do not respond to the vaccination.

Regarding your information on transmission; I still have questions. Is it possible/ are there documented cases of HBV in vaginal fluid secretions infecting someone by contact with shaved pubic region? You mention that body fluids infected with HBV can enter the person who is not infected but how fragile is HBV? Can it be in the open air? Again, is body fluid to shaved skin contact a legitimate transmission route or does it need to be direct impact with mucous membrane?

You included this statement: Yes. The hepatitis B virus can be in the blood, semen, and other body fluids of an infected person. A person who has sex with an infected partner can become infected with the virus.

The last sentence is very vague. Can you elaborate? Can HBV cross a latex condom barrier? Can it be transmitted by receiving oral sex (fellatio)?

if you can comment on the questions from my original post that would be very helpful.

[Lynn K]

I got that information from the CDC website with the link. I am only a lay person as is most everyone here so I can only point you to good references like the CDC.

I would believe it would not cross the latex barrier but as hep b can be found in vaginal secreations if there are open injuries (fresh cuts as opposed to scabbed over) I suppose in theory the virus could enter the blood stream in this manner. Hepatitis is a blood borne virus so it has to enter the blood stream.

In regards to oral sex as a route of transmission the second link I provided:
“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.”

 So per the Hepatitis b foundations web page it does appear that oral sex is not an efficient manner of transmission but not impossible.

I suppose if you want more information about the relative risks of different acts you could discuss without healthcare professional.

I doubt there is really any exacting information about the exact risk of various situations. Partly due to the nature of reporting that would be needed from patients and also to the variability of risk due to age, gender, overall health of the persons involved, nature of the acts, and the viral load of the infected person.

I’m not sure how knowing the unknowable would be meaningful at this point. The important thing is being diagnosed and treated.

[Lynn K]

How fragile is the hepatitis B virus
Here is some information I found

“Hepatitis B virus can survive outside the body at least 7 days. During that time, the virus can still cause infection if it enters the body of a person who is not infected.”

I also found
http://www.who.int/features/qa/11/en/

“HBV is spread by contact with blood or body fluids of an infected person – the same way as the human immunodeficiency virus (HIV). However, HBV is 50 to 100 times more infectious than HIV.

The main ways of getting infected with HBV are:

from mother to baby at the birth (perinatal)
from child-to-child
unsafe injections and transfusions
unprotected sexual contact.”

http://www.hepb.org/blog/tag/condom-use/

“Show the love by protecting yourself and your sexual partners by wearing a condom. They protect the mouth, vagina or rectum from infected semen if used consistently and correctly.  Keep in mind that the riskiest sexual activity is unprotected receptive anal intercourse. This is because the lining of the rectum is very thin and more likely to bleed leading to the possibility of infection with blood borne pathogens like HBV, HCV and HIV, along with other sexually transmitted diseases. Receptive vaginal intercourse is the next highest risk. Although the lining of the vagina is stronger than the rectum, inflammation, infection, or microscopic scrapes make the vagina vulnerable to unprotected intercourse. The likelihood of blood borne pathogen transmission with oral sex is least risky, but that is because the risk of blood contact is much lower. However, any kind of intimate sharing of bodily fluids presents some degree of risk of transmitting blood borne pathogens like HBV, HCV and HIV, and may effectively transmit other sexually transmitted diseases.

It’s important if you’re living with HBV, not living with HBV, or not quite sure of your infectious disease status. If you are living with HBV, properly wearing a condom keeps you safe from becoming co-infected with another infectious disease. No one wants a co-infection.  It complicated and dangerous for your health.  If you do not have HBV, then avoid getting an infection by you or your partner wearing a condom. HBV is vaccine preventable, but HCV, HIV and other STDs are not vaccine preventable. Considering the health and safety of yourself and your sexual partners is paramount. You may not know what they have, and they may not know what you have. Why take the risk? Love safely, get vaccinated against HBV, and wear a condom consistently and correctly. “Share affection, not infection”.