Hepatitis B and Sex

Hepatitis B and Sex 

Living Together or Co Habiting Transmission 

Firstly in relationships and Co Habiting situations it is important to remember non sexual transmission routes are the most common. Most co habiting household HBV (65%) transmissions are from shared razors, domestic violence and general blood spill accidents.   The fact that 3 times as many siblings (our brothers and sisters when we are young) catch HBV as Partners reveals that non sexual transmission from a partner is the most common route. Many partners even after diagnosis are not advised of the main routes of transmission. Shared razors, lack of plasters, poor blood spill hygiene and lack of latex gloves are common calls on our helpline and reasons for infections.   Wearing condoms instead of getting vaccinated often leads to partners getting infected via these routes, many times on the helpline we have calls from infected partners who swear they also had safe sex without any idea blood and wounds cause 90% of HBV infections.

With HBV when and how is it sexually Infectious? 

Sex is a means of transmission with HBV as 15% of the infected will have high viral loads wherein the HBV is present in the sexual fluids as well as their blood. For instance approximately 4,000 young mums are diagnosed in the UK with HBV each year during routine NHS maternity testing and yet we find only 15% of partners have the HBV infection or signs of having had it too. This is true of HBV positive mums who have had many children and been with a partner for decades. 

The science behind this is that HBV can be infectious in sexual fluids as well as blood sometimes when the viral load goes above about 200,000IU/ml. This normally happens when acutely or just infected transmissions happen. Like many bugs including the common cold HBV is most infectious during the first 3 months. A recent caller was a St John first aider who caught HBV and by the time she went yellow she had a load of 30 million and had infected her partner sexually. So if a partner has HBV see if they know their individual risk level ask are they 

1. a low risk trace (HBV surface antigen viral load under 2000 IU/ml) known to be sexually un infectious? 
2. On HBV anti viral pills and un infectious, with undetectable results for HBV in their blood? 
3. A high load 250,000 IU/ml needing condoms and your accelerated vaccination? 
4. Having an e antigen and getting more infectious needing condoms and your accelerated vaccination? 

These facts can guide and help a lot here, becoming NO or LOW RISK are important medical events in patients lives and affect partners a lot also. Having run a national helpline for hepatitis for many years and taken thousands of calls we have noticed certain subjects come up again and again 

Sexual Helpline Call Themes

One Night Stands 
Many calls are from people after one night stands who have read HBV & HCV can take from 2 to 6 months to show up and then these callers worry themselves for months wondering if they are infected. We have never had a person who tested negative at 2 months test positive at 6 months since we started the helpline in 2004 is the point we make. So test at 2 months and then it is best to get HBV vaccinated

Oral Sex 
Many calls relate to oral sex, this seems common in Stag and Lap Dance venues, so the baffled virgin groom to be often calls, we even have call surges after TV shows and we have to say never recorded to have happened. Which is all we know about oral sex and HBV, neither the helpline or medical studies have noted infections via this route. 

Anal sex 
However is definitely more of a risk due to wounding and bleeding possibilities. With transfusion Hepatitis B  remember wound gateways are always hugely more risky than ear, vagina, and mouth etc gateways. Gay men are noted to be more infected with HBV due to this. 

Saliva Sex 
Saliva has not been documented to transmit HBV, however, blood from any wound will, so bleeding gums and lip cuts are times to not kiss. 

University Sex 
One Phenomenon of Helpline calls is Fresher’s 9first weeks at University), every year some huge numbers go to our universities and seemingly have a huge amount of extra sex, tattoos and co habitation while often intoxicated. In many campuses Hepatitis can be very present and we have still not tested enough to know what our students are dealing with. So every October end we notice a rash of students who have caught HBV calling with symptoms or diagnosis, none have accessed any HBV or Blood Hygiene information at all. With 1 in 20 humans having HBV and it being sexually and co habitingly available, surely the students needing warnings and vaccination options should have some? Again students are often in serious debt and unable to access expensive vaccinations. 

HIV Patients
are immuno compromised and for this group HBV present a huge problem both viruses seem sexually infectious to this group. It is worrying how little they know about viral Hepatitis too 

A list of 65 calls relating to Hepatitis B and Sex
Google can seriously confuse people with Hepatitis B Information often very poorly explained with a splash of HIV facts added in by the less well trained in both the NHS and the UK Charity sites, none of them explain that HBV is mainly caught by children for instance.
Without good information people who have run sexual risks, especially if the partner turns out to be HBV infected can just die inside as they google. The term 100 times more infectious than HIV and in saliva could have been written to send any nervous people raving mad quickly. It is crucial to remember that HBV is 3 times less sexually infectious than HIV, a several thousand to one risk from a one night stand. Assumption of transmission is the mother of all chaos, many have anxiety symptoms and they think are HBV symptoms when they ring.

1. University Outbreak sharing razors and unprotected sex with first partner, the boy was 19 and pretty depressed, with globally 1 in 30 sexually active humans having HBV, we need to tell our students the risks from sharing razors and being unvaccinated.
2. Young Nigerian man rang stunned by HBV cleared diagnosis, he had lived in Nigeria unvaccinated until 8 years old and was convinced HBV is a sex disease. He took a “which bitch” approach, first he blamed his UK girlfriend for cheating and infecting him, when she tested clear, he the accused his Nigerian wife even more convinced she was being unfaithful to him, she was clear also. He lost both girlfriend and wife but finally understood many young Nigerians catch HBV and clear it as children. 
3. Greek Diagnosed in 2008, remembered going yellow jaundice 2003 Poor chap has wife whose vaccination don’t work so he thought no wife and kids for 3 years and had a breakdown. He did not understand with a viral load of just 1000 IU/ml he is zero sexual risk. We reassured he will live long and vaccination will work if repeated. Now getting engaged and Bosnian fiancée re - vaccinated. 
4. Nigerian Husband tested HBV positive at work and was told he had a low risk infection common with Africans. He mentioned to the wife at breakfast. After googling and reading online all day she hit him with a frying pan when he got home. Explained to wife he is innocent further HBV testing showed his brothers and sisters had all had HBV.
5. Husband white British with Chinese wife HBV positive rang, family in uproar and doctor refusing to vaccinate his parents who live with them. No one understood she is very low risk, no one explained she is fine health wise either. Arranged HBV vaccinations for all. 
6. Ghanaian lady rang, diagnosed in Ghana and thought not true as often tested for things here, she had been to a sex clinic many times, yet 15 years of unprotected sex later she has not infected the 3 men she has been with after warning them. Sent her patient pack and trained her up. She was very receptive and really got the hang of being positive about managing her HBV diet and understanding her low risk and vaccinating future partners. Ghanaian's so far are all like that. 
7. Ivory Coast lady rang. Has never been tested for HBV, she has 20 years of unprotected sex with HBV on her conscience now we all have to up our game on this and recommend every single adult for testing and HBV vaccination if we are to control the spread of HBV.
8. Gambian Nurse rang sad she could not have children. Advised her her HBV positive husband is now low risk his viral load being just 40,000 IU/ml she asked if she could stop using condoms? I was amazed she is a nurse and well HBV vaccinated, I mean if a nurse doesn’t understand HBV vaccinations to the point of missing out on having children for 10 years? Explained her vaccination means she is immune to infection and just forget the condoms and start getting pregnant.
9. Chinese wife diagnosed recently and her family not yet vaccinated, sent info and arranged vaccination schedule, I wonder if doctors fail to recommend the vaccination rather than say they do not actually stock it or offer the service?. Husband not infected. 
10. Older woman rang her partner has gone yellow and is in an Intensive Care Unit with acute Hepatitis B and going fulminant and full of tubes. She was offered a leaflet saying 100 times more infectious than HIV, and she had had sex with her partner the day before she rang. She was in a panic thinking he is dying and she will be full of tubes next. She was wondering if the the entire hospital had gone mad or just did not care about her being next. Explained he will recover and that her being infected was highly unlikely as only one sexual connection recently. Partner eventually cleared, he had visited a dentist the week he was infected. 
11. Asian man had hepatitis b for 1 year and has failed to clear, talked him out of leaving family and into vaccinating them all, explained he will live long and normal life as load is small and he has good health insurance if ever in 20 years he needs treatment. 
12. African lady Thought she would die young and couldn’t have a partner or kids, a common confusion. Explained what a great 40 years I’ve had and how my partner cried with joy when I explained my hep infection, as she thought I was gay. 
13. White British Lady Had sex during menses didn’t tell partner previously had not infected partner of 7 years, was told low risk by specialist no info on blood hygiene common problem explained honesty and vaccination. as ever given the facts people can learn and change very quickly. 
14. Above’s partner rang calmed him as she is low risk, he tested clear sent info for both about liver health and diet.
15. Man ran a sexual risk and went crazy internet googling. we explained HBV is less sexually transmitted than HIV and sent Info and arranged vaccination booking he is now immune to HBV. 
16. Mum in law rang. Denied free NHS UK HBV vaccination, yet her live in son in law has HBV, greater families even siblings are almost always ignored for HBV vaccinations here, told her to tell walk-in clinic she’s in real need. She was vaccinated. She is a real character. 
17. Man Dating new girl who knows nothing about her HBV. Sent info. There are 2 million from very HBV infected areas in the UK without a front line doctor or any HBV test information. 
18. 30 year old lady muslim married to an HBV positive Ugandan Imam. He was diagnosed at birth his mum was positive too. He thought his HBV went away she now has herself and 3 kids to test 
19. Mum and daughter have signs of developing liver disease, planned test and vaccination for husband and other kids explained her low viral load state and sent info about attendant ailments, she had fibromyalgia pains and arthritis which is common. 
20. White British Man rang HBV Positive and his condom broke he is in utter terror thinking 100 times more infectious than HIV and really loves the girl crying on the phone, got her vaccinated. 
21. Lady rang in tears, her Pakistani finance tested HBV positive doctor said is probably because of sex or heroin problems. We told her 45% of Pakistanis catch HBV usually when young and to test his extended family for the other infections found a mum and sister also with HBV, sent info arranged her vaccination and saved her long arranged marriage. 
22. Health care worker called. Diagnosed in June yet 5 months later has no idea if she going to die, has lost partner feels could never have a partner. Sent info built hope told her employer not to vaccinate her as has HBV.   
23. Man doing oral, vaginal and anal sex while HBV positive had no understanding of his HBV at all, advised blood hygiene & condoms & referral to Liver doctor sent info. Got uninfected partner vaccinated. Sad people are diagnosed but given so little information. 
24. Greek man rang, scared. He had a blow job, we advised no risk and HBV vaccination 
25. Mother in law rang.  Her HBV infected son in law confessed to adultery, he was Nigerian so probably infected from childhood as other daughter tested negative. advised partner and child vaccinations sent info 
26. Man Obsessive Compulsive Disorder Ran sexual risk in Thailand unreassurable many calls. HBV information actually creates Obsessive Compulsive Disorder patients. 
27. Man Really suffered poor info “the 100 times more infectious a kiss kills granny type” GP variables in explanation again. Reckons we saved his life sent info 
28. Man Diagnosed HBV & HCV via phone no advice health visitor then told neighbours his HCV was mis diagnosis GP assumed IDU no referral wife left due to no vac and he tried suicide Support and Info 
29. Gay man Ran risk never heard of HBV or the vaccine advised vaccination and tests 
30. Somali Man Ran oral sex risk and had a set of tests afterwards and spent 3 years thinking he had HBV told him his results meant he has HbcAb an old cleared infection of HBV. Far too common confusion. 
31. Gay man has partner with acute HBV with bad liver tests especially 1000 plus ALTs needed more info. He is vaccinated, reassured need not be that his partner was unfaithful but more likely his recent tattoo, timed exactly to his symptoms at 2 months earlier.
32. White Mother Son HBV infected at university he is suicidal and feeling so alone and isolated, he thought a kiss could kill and didn’t know of vaccination schedule, sent info. 
33. Zimbabwe man jaundiced and yellow eyes, ran sex risks with prostitutes for 3 weeks back in Zimbabwe during holiday, got tested, HBV infected and now cleared. 
34. Somali woman rang, her friend had HBV yellow eyes as a child and came to the UK thinking it’s over however her doctor just mentioned she is high risk, too many Africans think it goes away with onset symptoms and ignore the problem, just like I did from 1979 until 2004. Told her take friend back to doctor and demand referral to hospital and liver function tests and liver scan Husband refuses test as he thinks he’s infected now. For 5 years her local doctor has seen her diagnosis and not advised her. 
35. Woman her partner developed HBV 4 months ago during her unprotected sexual relationship with him. Bleeding anal sex involved. People planning rough anal sex need HBV vaccinating. She should be lucky this time she is getting final test in December sent info. She was clear, his infection was around the time of a fight in which he was wounded.
36. Wife rang her HBV husband and her keen to learn sent info. Sad she thought he must be cheating but he is a school caretaker and has mopped bloodspills unvaccinated for 25 years.
37. Nigerian 6 years of UK sex no protection GP mentioned condoms not vaccinations for sex, this is just too common why not vaccination and ask if married. Arranged vacc for wife. 
38. NHS Doctor rang with HBV positive wife sex clinic told him after 3 shots HBV vaccinations shots failed to do 1 in a year. Arranged 3 shots privately as risk is high, he admitted drinking wine a lot during the 3 week vaccination course which makes them fail often. I mean our doctors are calling a helpline to HBV vaccinate their own selves now! 
39. Ivory Coast man had gone mad with worry after a sexual risk and had 18 HBV blood tests 3 Cognitive Behavioural courses 6 months of terror. He had run no HBV risk as obly oral sex, solved in 5 minutes chat. The NHS spent the equal of a year’s funding for our helpline on him. 
40. Cameroon Lady HBV positive needed all the usual advice, she was such a good learner and eventually so positive about things Just love empowering patients and the I am going to be fine at the end, so few patients understand their infections.She was low load and cried when she understood how to get married and have kids.
41. Egyptian Lady HBV Positive but poor vaccination info thought kissing was infectious for many years. Sent accelerated schedule Just an accelerated schedule so helps imagine asking a date to wait 9 months for a kiss 
42. Gay man Recent infection, so many are not vaccinated Sent acute advice and fingers crossed 
43. Mum Son dating a Romanian HBV positive girl he has trouble getting vaccinated. Arranged quick course, they felt all they could do was condoms. It is best to get partners to study up HBV together and use that info to increase love, then vaccinations get easier and understood. 
44. Ethiopian man Just diagnosed sent pack and vaccination schedule he was not told to vaccinate for HBV girlfriend but use condoms, unless we give vaccination schedules to patients how do they know what to do? 
45. Nurse Wife asked Is your HBV positive Turkish husband faithful by London doctor! Then told to forget having kids, calmed wife and him, his uncle and cousin are also infected so common among Turks, who catch HBV young just like Africans. 
46. Bulgarian lady Emotionally isolated and depressed no understanding every visit to her liver unit just upsets her her we trained her up with HBV positive information she is just stunningly pretty and has now started dating. Teenage and young people with HBV and HCV really need confidence boosting. She was so upset about everyone telling her she has a sexual infection, she was a 19 teen year old virgin after all. Her mother also has it so explained how it gets from brother to sister and mother to child and in Bulgaria mainly from healthcare. Explained care path and HBV positive she felt much better so many people have such preconceptions HBV is HIV
47. Teenage girl diagnosed at 15 had never touched anyone and is now 19, counseled her and educated her about transmission and vaccination, now in a relationship 
48. Gay Man rang and asked Is the HBV vaccination safe for in this order 
having blow job 
giving anal sex  
giving blow job 
taking anal sex
said yes his score will make him safe, a voice said I told you so, laughter frolicking noises man said ”I really have to go.” 
49. Asian man went to lap dance club and a ladies naked "down there" touched his willy for a second during a dance - Definitely no risk! Explained he is not at risk from this brief down there touch recommended vaccination lap dance clubs bewilder many patrons 
50. Man Woke up next to African girl after office party, he is married and shocked as he did not remember if he did or how he got there recommended super low risk and HBV vaccination. Explained HBV is not 100 times the risk of HBV sexually as he thought. 
51. Wife has husband HBV positive of Gambian origin, poor wife was told it is a sex disease by doctor. We pointed out in Gambia 50 to 80% of children catch HBV by 18 years old due especially vaccine guns used in the Eighties, wife tears of relief. All his other family siblings were infected and all remembered the vaccination days. We did HBV positive training and got a referral to a liver unit arranged 
52. Lady found out her Turkish husband has HBV, local doctor said it is like having flu!? This doctor googled for an answer in front of his patient and said he had only had 1 case in 13 years. There is real ignorance in some parts of the medical profession even in London. Sent her for vaccination and him to see a hepatitis professor.
53. Turkish girlfriend awful alts 500 and off food tired symptoms. poor info using condoms not vaccination. Checked if on paracetamol or alcohol and her diet. Found she was living on McDonalds as a manager at a shop, she changed food and symptoms gone and normal alts now. Food is very important.
54. Indian man Infection from back home knows infected but out of Tenofovir and out of care for 3 years. Panic tried to get into care taught what HBV is to him, explained HBV positive and got GP and referral he cried with relief. Too many migrants have no healthcare access 
55. Spanish lady Just diagnosed googled for an hour had bottle of wine and rang in terrible state explained she is inactive and low risk sent pack explained to her partner should be fine now, he was clear and will get vaccinated. 
56. Pakistani HBV positive with poor understanding, very depressed and no future wife attitude, explained HBV vaccination and dating to him. 2 weeks later he is getting married it’s amazing how Pakistani parents have wives up their sleeves for their sons at the drop of a hat! 
57. HBV positive Lithuanian man with load over 1000 million IU/ml, a super carrier of HBV he has infected his partner who is acute after 3 months together. She has 6 children and is very ill also with a high load and fulminant hepatitis symptoms, she is in an Intensive Care Unit in semi coma from blood toxins. Then a BBV Nurse shook her hand and with a clip board asked if she was into paid for sex or drugs and she was trying to leave the hospital when he called. Calmed her down,, arranged testing for the 6 children found one infected and that the school principal had caught HBV from him when he bled on her. Fortunately both have since cleared and the Lithuanian is now undetectable on Tenofovir. School Principal also cleared. 
58. Gambian Nurse Left in limbo for 5 months was clear in 2009 and diagnosed in 2011! Knew nothing about HBV or its transmission Hospital still vaccinating her! 
59. Woman wandered if handshakes infect said no and Sent info 
60. Woman asked if swimming is infectious after a HBV person swims in the pool, said no never and explained the difference between water borne viruses such as cholera and blood borne viruses such as HBV to her. 
61. Fresher’s female teenager wanked and anal fingered man 2 days previously recommended struck by lightning risk in the absence of any wound arranged vaccination and status awareness. (Testing yourself for all sexual infections and a potential partner BEFORE sex) 
62. Man had one saturday night with a Chinese girl and called 9.04 on Sunday morning wondering if he had HBV. Explained no race is more than 10% infected and a year of sex with someone with HBV is 1 in 3 only infectious, advised status awareness and HBV vaccination. He is very attracted to Chinese girls. 
63. Gay 21 year old HBV positive had anal sex with 16 year old and HBV infection resulted. Father rang gathering hate mob ready to kill, gay man had been to sex clinic before sex for full set of tests but they forgot HBV, which is all too common. Sex Clinic results confirmed things calmed dad as best I could and no one attacked elder gay partner Made everybody understand the 16 year old was only acute and after many calls he cleared HBV. . 
64. Gay man ran sexual risk told get tested and vaccinated sent info. Far too many gay men are unaware they are supposed to be HBV vaccinated if they are active sexually. 
65. Somali Mother rang her son infected in university fresher’s week left with bad info and pretty depressed, kids know nothing or too little about this vaccine, sent info and explained how we have wives, children, travel and health etc, tried to make him feel he has a future, explained he is like me infected at 19 and that is now 30 great years ago. Above’s mum rang and said he’s going back to university and is a different person he even got a part time job to make a donation, bless him. 

               Hep Africa Org part of the Hepatitis B Positive Trust  

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