Hepatitis B


It is unfair to characterize the current status of our thinking as “completely disregarding” issues related to sexual health conditions as there are specific individuals and populations who are relatively more open towards this matter at hand than what most people would consider “normal” a few decades ago. However, this progress is still far from ideal, and this has led many people to be misinformed when it comes to sexually transmitted diseases and other conditions that may involve one’s sexual habits, one way or another. Sure, some of these false beliefs are harmless and are not necessarily that detrimental to the health and wellbeing of a person, but that only remains as it is because they have not encountered a situation wherein the false information that they know might cause their condition to worsen and progress indefinitely.

With all of these points considered and acknowledged, it is apparent that the best way to start the resolution of this stigma is by providing the necessary information to the public. This outline does not entirely provide everything that there is to know about a condition that they might have, but it does offer the essential details that they can use to get appropriately diagnosed and, more importantly, be treated properly. With the high prevalence of self-medication plaguing this field as well, it is just very apparent that educating the public will go a long way in bringing the number of cases down and preventing unfortunate circumstances that would have been preventable, to begin with.

After all, the provision of proper healthcare should always be the end goal when fixing the broken system, and perhaps, the healing can start with a simple discussion – one that could, at the very least, open an eye or two throughout the process.

Signs and Symptoms

Presentations

Some cases of HBV infections are asymptomatic, but in cases where the patient did show sure signs and symptoms, the following are observed:

  • Abdominal pain
  • Dark urine
  • Fever
  • Pain in the joints
  • Lack of appetite
  • Nausea and vomiting
  • Weakness
  • Fatigue
  • Jaundice (observed yellowing of the skin and eyes)
  • Clay-colored bowel movement

Incubation Period of the Disease

In most cases, the condition will remain asymptomatic for around one to four months following exposure as the virus replicates within your body. Following that, most patients can have symptomatic manifestations by this period.

Duration of Manifestations

Depending on the type of infection you contracted, your symptoms may last for a couple of weeks to around six months.

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Transmission

There are a number of ways that HBV is transmitted, though all have to do with being in contact with the bodily fluids of an infected person:

Perinatal Transmission

Children born with HBV are the most likely to have a chronic condition, so prompt treatment is necessary.

Through Contaminated Needles

It generally occurs when IV drug users share needles or medical employees accidentally stick themselves with used needles. Tattooing and acupuncture as likewise high-risk activities where the reuse of needles may unknowingly transmit hepatitis B infections from one person to another.

Exposure to Blood

Also known as horizontal transmission, another common method of transmission of hepatitis B is the exposure of a person to a blood sample infected with hepatitis B. Some of this may occur during childbirth (perinatal), but others may occur during needlestick injuries with used needles, or through unsafe blood transfusions.

Sexual Contact

  • Anal Sex
  • Oral Sex
  • Vaginal Sex
  • Shared sexual devices (if not cleaned properly)

Fleshing Out Hepatitis B Infections

Hepatitis is an infection caused by several viruses – all of which are distinct in their disease duration, diagnosis, and treatment of the condition. The three most common types of hepatitis infections are hepatitis A, hepatitis B, and hepatitis C. To cut everything short, the most distinct difference between the three is that hepatitis A is typically a short-term infection, while hepatitis B and C often begin as a short-term condition but may progress to cause chronic and lifelong illness in specific individuals. The main distinguishing factor between hepatitis B and C, on the one hand, is that hepatitis C does not have any available vaccine yet to prevent its transmission from an infected person to a vaccinated individual.

Defining Hepatitis B

To understand Hepatitis B infections a little better, we may first look at the distinctive points of a hepatitis B infection. Hepatitis B is caused by the microorganism known as Hepatitis B Virus or HBV, and the infection itself can be separated into two different types: acute infection and chronic infection. Essentially, the two types have distinctive characteristics in their names – an acute infection is more of a short-term infection where the patient is usually only sick for a few weeks, while a chronic infection is defined as a condition wherein the disease has progressed into a lifelong severe illness.

The signs and symptoms of a hepatitis B infection may wildly vary depending on how your body is responding to the attack of the virus, but the manifestations are primarily associated with a liver problem – causing symptoms such as jaundice, dark urine, fever, and fatigue.

The virus may be transmitted in several ways, but it is mainly transmitted through contact with the bodily fluids of an infected individual, such as their blood, semen, or any other fluid that has been sourced from the infected person. Due to this, hepatitis B infections are more common in instances where there is a chronic risk of being exposed to infected fluids, such as when you are sharing IV needles or if you are consistently exposed to human blood – some of which may be infected and may easily transmit the condition to you upon contact.

There are instances wherein an infected patient may not notice or realize that they have the infection due to minimal manifestations, but do note that even asymptomatic individuals may still transmit the disease to others if they come into contact with the infected patients’ bodily fluids.

The Prevalence and Spread of Hepatitis B

As previously mentioned, hepatitis B is transmitted from one person to another through contact with the bodily fluids of an infected individual, such as their blood or semen. The transmission of the virus itself may be done in several pathways, and this may include:

  • A pregnant woman with an HBV infection giving birth to her baby
  • Having sex with someone who has an active infection
  • Sharing needles, syringes, and other IV equipment
  • Sharing personal items such as razors, toothbrushes, and even medical devices like glucometers.
  • Direct contact with the blood of an infected individual
  • Accidental needlestick injury when the patient being handled is positive for an HBV infection

Contrary to some misconceptions, though, it is not possible to transmit hepatitis B through food and water, and it is, therefore, safe to dine with someone who has an active HBV infection, unlike in the case of a hepatitis A infection where the virus is even more contagious that it can be transmitted through sharing food and water.

Considering such infection pathways, this easy transmission has led to the steady rise of hepatitis B infections over the years, amounting to an estimated 257 million people living with hepatitis B worldwide. According to the Centers for Disease Control and Prevention, there were a total of 3,322 new acute cases in 2018 that have been reported to the CDC, but this still did not account for the massive underreporting or underdiagnosis of many cases around the world due to the lack of symptoms in some patients, and the lack of incentive for having themselves checked in the other. Based on this consideration, the CDC has estimated that there were approximately 21,600 new acute cases in 2018, while there were around 862,000 who were assumed to be living with a chronic infection around the world during that year.

Hepatitis B: A Sexually Transmitted Condition?

The misconception about what construes a sexually transmitted condition or disease starts to blur the line a little bit when we start to wonder whether hepatitis B is, in fact, an STD, despite the condition not causing any significant manifestations within the genitalia where most STDs are being observed and noticed.

To answer this question, yes, hepatitis B may be considered a sexually transmitted disease or STD as the virus itself may be transferred to another individual through sexual fluids such as semen. When the semen of an infected person comes into contact with another individual, either when they are having intercourse or if the person somehow ingests the fluid, it is easy for the virus to take root and cause an infection in the patient’s partner.

Sure, many people start to question the validity of its classification under the category of STDs as its manifestations are commonly systemic, to begin with, but this is where the stigma becomes more apparent when it comes to a sexual health issue – we think sexual health, we almost immediately think of the genitalia and how it is going to be present in the genitalia along with some rash or lesion that would cover the genitals and other parts of the body that came into contact with the infected tissue or fluid.

Do remember once again that there are STDs that are typically isolated within the genitalia when it causes asymptomatic condition as the virus that can be transmitted through sex may travel through your systemic circulation and cause manifestations in other parts of your body – which, in the case of hepatitis B, is the liver.

Risk Factors for Hepatitis B Infections

Like many other conditions, several things, habits, and populations make a particular individual or group more susceptible to contracting the disease. As such, perhaps it is more efficient to identify these risk factors as this will significantly help in ensuring that you will be able to determine whether you are at risk of contracting the condition and whether you require a more frequent routine monitoring for the disease to avoid any complications that might be rooted from a delayed diagnosis and treatment.

Unprotected Sex

Considering that we have previously mentioned that hepatitis B infections are sexually transmitted, it is crucial that when you're having sex, you use condoms, mainly when you are not aware of the sexual health status of your partner. Do note as well that this is not necessarily restricted to the case of HBV infections, where the condition can be transmitted when an infected patient’s bodily fluids come into contact with a healthy person’s genitalia as the barrier that a condom provides will also avoid the transmission of condition that relies on direct contact, particularly when it comes to the mucosal membranes of the genitalia.

Needle Sharing

Hepatitis B can be transferred through contact with an infected person’s blood, and this transmission process is even hastened when the serum has been directly exposed to your systemic circulation, such as in the case of needle sharing. While it is minuscule and hard to see, microscopic particles may be left in the needle upon use, including the hepatitis B virus. Once you share that needle with someone else, the virus that has been left inside the needle will then be deposited into the bloodstream of another individual – allowing it to easily infect another host and increase within their body until it is time for them to carry out their full symptomatic manifestations.

IV Drug Use

Similar to how sharing needles can increase the risk of someone getting an HBV infection, using intravenous drugs may also make you more susceptible to contracting the condition as habits such as using these prohibited substances are often performed in groups where people use the same syringe to administer the same medication into their system. It will then follow the exact mechanism where the virus will be retained within the syringe's needle, enter your system as you pierce your skin, and increase within your body until its number is sufficient to produce a noticeable manifestation.

Living with Someone who has an HBV Infection

Although we have previously mentioned that it is not possible to contract an HBV infection from an infected individual through food, water, or by simply being in close quarters with them, living with someone who has an active infection may increase your risk of contracting the disease as there is generally a greater risk of you getting into contact with their bodily fluids if you are around them more often. There is no direct causality between the two events, but one seems to potentiate the other – resulting in it being a risk factor despite there being no close relationship between the two occurrences.

Being Born from Someone with HBV

Among many other ways through which HBV infections can be transmitted, one that is relatively rare in the sense that its transmission is somewhat unique is called a vertical transmission – or the transfer of the virus from an infected mother to their baby during delivery. While this is commonly prevented with the help of treatment plans and monitoring throughout the prenatal period, there are instances wherein the mother is still infectious during labor and will inevitably expose the baby to the virus – making them at risk of developing an infection later on.

Occupational Exposure to Human Blood

Much like how living with someone who has an HBV infection makes you more susceptible to being exposed to an infected body fluid, working and being constantly exposed to human blood such as being a nurse, a doctor, or a medical technologist who handles serum samples in the lab makes you more at risk of accidental needle prick injuries or exposure to any contaminated samples - subsequently translating to an increased risk of being infection by the hepatitis B virus.

Traveling to Places with High HBV Infection Rates

Although there are several things that you can do to avoid being infected by the hepatitis B virus if you are aware of where you can be exposed or who you can be exposed to, simply being in a country where the rates of an HBV infection is significantly higher already puts you at a higher risk as your environment is even more efficient in transmitting the virus and you may catch the condition easier as compared to locales where the prevalence of the infection is less. The direct causality is not necessarily there, but this is more of a matter of exposure incidence than of direct transmission.

Infection Prevention

To ensure that you will not be exposed to the virus or, at the very least, you are protected from a full-blown infection if you are accidentally exposed to the causative microorganism, the following methods are considered efficient in minimizing your risk and ensuring that your safety is considered as much as possible.

Hepatitis B Vaccination

Unlike hepatitis C, vaccines are available for hepatitis B to help build a more solid defense against the virus if you are ever exposed to the causative microorganism. The vaccine is given in three or four divided doses in six months, and it is mainly recommended for the following populations:

  • Newborn infants
  • Children and adolescents that have not been vaccinated before
  • Those working or living in a center for the developmentally disabled
  • Living with someone who has an HBV infection
  • Healthcare workers
  • Anyone with an STI
  • Anyone with multiple sexual partners
  • Anyone who had sex with someone infected with HBV
  • People who use IV drugs
  • People with chronic liver diseases
  • People with end-stage kidney disease
  • Those who are planning to travel to a country with high HBV infection rates

Knowing the HBV Status of your Partner

Understandably, the topic of sexual health status might be a bit difficult for some people to broach with their partners as some might risk offending them if they ever did ask the question, but it is also crucial for you to know that awareness of your sexual health status is one of the best ways to be able to address the problem in the first place. Knowing whether you and your partner are safe is just one way of saying, “I want you to be safe.” Perhaps that is something you might want to consider in your relationship.

Using New Condoms for Each Intercourse

While condoms do not necessarily eliminate the risk as there might still be contact with bodily fluids even with the use of a barrier, using condoms will go a long way in, at the very least, minimizing the risk as much as possible, mainly if you are not aware of your partner’s sexual health status.

Avoiding IV Drug Use

Considering that IV drug use puts you at risk of being exposed to someone unaware that they have an active HBV infection, avoiding IV drugs and sharing needles will ultimately be more efficient in minimizing the risk of contracting the risk entirely.

Being Cautious About Piercings and Tattoos

Similar to how sharing needles may transmit the virus from an infected person to another, being exposed to the needles used when getting pierced or tattooed may also put you at risk of contracting the disease. Check out the shop where you are planning to get pierced or tattooed to ensure that they have a proper hygiene protocol to ensure that no two customers will be exposed to the same dirty needle.

Inquiring for HepB Vaccination Before Travel

Considering that Hepatitis B vaccines are given over six months before your travel, it might be wise to inquire about the HBV infection rates in your destination to have yourself prepared and immunized for any possible exposures while you are on your vacation or trip.

Hepatitis B Complications

Like other conditions, hepatitis B also progresses to certain more severe conditions once the disease is not resolved and diagnosed immediately.

Liver Cirrhosis

This is essentially the scarring of the liver that then results in inflammation – impairing the liver’s ability to function correctly and process the necessary biomolecules for your metabolism.

Liver Cancer

Due to the extensive damage caused by chronic hepatitis B infections, it is also possible for liver cells to mutate and form cancerous cells.

Liver Failure

With the damages inflicted by a hepatitis B infection on the liver, the organ can shut down and undergo acute liver failure. The organ's vital functions stop, requiring affected patients to request a transplant.

Other Conditions

Other conditions that might arise from an untreated hepatitis B infection include kidney disease or even the inflammation of blood vessels.

Hepatitis B Infections: How it Affects the Body

The Mechanism

Hepatitis may be caused by several factors such as alcohol use, toxins, medications, and even certain concurrent medical conditions. However, what these causative agents have in common is that they result in the inflammation of the liver due to the extensive damage that it has caused within its structure. The same thing is considered the mechanism in hepatitis B infections where the Hepatitis B Virus or HBV causes the condition. When this happens, the affected person may spread the virus to other individuals through their bodily fluids, such as blood and semen, but it cannot be spread through their saliva – making it relatively safe for healthy individuals to be around other people with an active HBV infection.

Acute vs. Chronic Hepatitis B Infections

An acute hepatitis B infection is mainly characterized as a disease that lasts for approximately less than six months. In most cases, the immune system is strong enough to fight off such a case, but proper treatment and management are still necessary to ensure that you will be able to recover from the condition entirely after a few months. Acute hepatitis B infections are commonly seen in people who got an HBV infection as an adult.

Chronic hepatitis B infections, on the one hand, would usually last for at least six months or longer, and this is mainly associated with a failing immune system where the body cannot handle an acute attack from the virus. Such infections could last for a lifetime, and this would often result in the development of certain complications such as liver cirrhosis and cancer.

Hepatitis B Infections: Diagnosis and Testing Procedures

To correctly confirm and identify whether or not the hepatitis B virus has infected you, you must be able to seek the correct diagnostic procedures or be consulted by an appropriate physician that will prescribe the tests appropriate for your case.

Several tests can be availed in the market, some of which can be performed both in the laboratory or with the help of at-home specimen collection kits, and their purpose would vary but would mainly comprise the following end-goal:

  • Determine whether you have acute or chronic hepatitis B infection
  • Determine whether you are immune to hepatitis B following your vaccination
  • Determine whether you have been infected by the virus previously, if the virus has already been cleared from your system and if you are already immune to subsequent infection by the same virus

The general tests that can be performed to determine your hepatitis B status are the following:

  • Blood tests: this will entail the collection of a blood sample that will mainly determine whether you have an active hepatitis B infection, if you have a chronic or acute case, and if you are already immune to the condition either due to past infection or a prior vaccination.
  • Liver ultrasound: a liver ultrasound will essentially show the doctor the structure of your liver. It utilizes a procedure known as transient elastography to show the amount and extent of your liver’s damage.
  • Liver biopsy: in this procedure, a small sample from your liver will be collected and examined under a microscope to determine whether the damage to your liver has permeated even at a cellular level. This could sometimes decide whether or not you are at risk for developing or are already suffering from liver cancer.

Hepatitis B Infections: Common Treatment Plan

The treatment process for hepatitis B infections would vary depending on several factors, including when the condition was diagnosed and managed, what type of hepatitis B the patient has, and their tolerance to the medications administered.

When you are aware that you have been exposed to an infected serum or bodily fluid, you can immediately treat the condition (post-exposure prophylaxis) by using an injection of hepatitis B immunoglobulin (similar to the vaccine) within 12 hours from the initial exposure to the virus. The immunoglobulin is only similar to the vaccine but only offers short-term protection, so it might be wise to get vaccinated following that.

Meanwhile, if you have been diagnosed with an acute infection, no treatment is encouraged since the disease is expected to go away on its own. Contrary to this, chronic conditions which are more prone to complications may be treated using antiviral medications, interferons, or even a liver transplant if the damage to the organ has been too extensive already.

Do note, however, that this does not encourage self-medication, and it is crucial that you first get examined and tested to ensure that you will be choosing the right and appropriate management approach for your case.

Hepatitis B Infections: Prevention

Get vaccinated

The hepatitis B vaccine is affordable and easily available. For most countries, this has been a long part of local health programs, especially for children.

Maintain a clean environment wherever you stay

Viruses only thrive in a condition that is suitable for them. Maintaining a well-sanitized and hygienic surrounding will effectively prevent the spread and transmission of the virus.

Avoid using common tools that have been exposed to fluids and blood

For tools that have been used by other people, particularly those whose health status you are not wary about, make sure to request a new set of unused tools (e.g. needles for injection) to minimize the risk of HepB transmission.

Frequently Asked Questions (FAQs)

Where can I get the hepatitis B vaccine?

Hepatitis vaccines are usually available for free or at a lower cost in your local clinics, but you may consult your local health department for a more detailed guide to how you can avail of one.

Is it okay to take the hepatitis B vaccine if I already have the hepatitis A vaccine?

Yes. There is no interaction whatsoever between the two vaccines.

If a dose of the vaccine was missed, what should be done to make up for this gap?

If the dosing schedule was unfortunately interrupted, the next dose should be given to the patient as soon as possible. Repeating the series from the first dose is not advisable.

If I have been infected by HBV before, can I get the infection again?

No. If you have been infected by HBV before, you are already immune to the condition.

How long can HBV survive outside of the human body?

It can survive for up to 7 days – making it essential to not be in contact with human bodily fluids no matter what due to the risk of transmission even after a few days.

Can I get Hepatitis B by holding hands, coughing or sneezing?

No. The virus can only be transmitted through blood, saliva, vaginal fluids or infected semen.

Is breastfeeding considered a risk for perinatal transmission?

No. You cannot transmit hepatitis B with breastfeeding.

Additional Readings

Centers for Disease Control and Prevention

  • Read more on how hepatitis A works and produces its effects on the human body through the CDC’s comprehensive information hub on viral hepatitis.

World Health Organization

  • Learn more key facts about hepatitis C and the several nuances in this condition that are distinct and different from those observed in a hepatitis B infection.

Cleveland Clinic

  • Discover liver cirrhosis and how it is managed and diagnosed in patients with or without a hepatitis infection.

References

  • Centers for Disease Control and Prevention. (n.d.). Hepatitis B Questions and Answers for the Public. https://www.cdc.gov/hepatitis/hbv/bfaq.htm#overview
  • Centers for Disease Control and Prevention. (n.d.). Hepatitis B. https://www.cdc.gov/hepatitis/hbv/index.htm
  • Cleveland Clinic. (n.d.). Hepatitis B. https://my.clevelandclinic.org/health/diseases/4246-hepatitis-b
  • Hepatitis B Foundation. (n.d.). What is Hepatitis B? https://www.hepb.org/what-is-hepatitis-b/what-is-hepb/
  • HHS. (n.d.). Hepatitis B Basic Information. https://www.hhs.gov/hepatitis/learn-about-viral-hepatitis/hepatitis-b-basics/index.html
  • Mayo Clinic. (n.d.). Hepatitis B. https://www.mayoclinic.org/diseases-conditions/hepatitis-b/diagnosis-treatment/drc-20366821
  • National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Hepatitis B. https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-b
  • Nazario, B. (2020). Hepatitis B. https://www.webmd.com/hepatitis/digestive-diseases-hepatitis-b
  • Pyrsopoulos, N. (2021). Hepatitis B. https://emedicine.medscape.com/article/177632-overview
  • World Health Organization. (2021). Hepatitis B. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b

Written by Mark Riegel, MD

Quick Snapshot

Can it be cured?

No. Acute HBV will resolve itself within six months; chronic HBV is generally a life-long condition.

Type of infection

Viral. The Hepatitis B virus infects the liver.

How is treated?

Antiviral Medicine. A single dose of Azithromycin or seven daily doses of Doxycycline.

Recovery time

Up to 6 Months. An acute case of HBV is usually over within six months.

Can I have sex?

No. It is recommended that sexual intercourse is avoided until you are free from the disease.

Can I get re-infected?

No. Once you have had an acute HBV infection, you cannot get it again, though you can still contract other types of hepatitis.

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