Chronic Hep B carrier?

Dear Alice,

Though I have read the answers on Hep B, I still do have some questions about it. I have a friend who discovered that she is a hepatitis B virus carrier when she went for a blood donation.

What are the risks subjected to my friend? Does it mean that she cannot enjoy a normal sexual life and cannot even kiss? Will her partner be 100 percent immune to Hep B if he gets a Hep B immunization?

Dear Reader, 

It’s great that your friend has someone who cares so much about her health as well as her partner’s. Hepatitis B virus (HBV) is a disease that causes liver infection. HBV can manifest as an acute illness which is often short-term, lasting up to six months or as a chronic illness which may cause the person to experience long-term symptoms that may lead to liver damage and other potentially life-threatening conditions. Because there’s no “cure”, people with chronic HBV often require treatment for the rest of their lives. That said, although it’s possible for someone with HBV to spread the disease to others, there are precautions they can take to help reduce the risk of transmission. Because HBV is spread through blood, semen, and other body fluids, your friend will likely need to be diligent about safer sex practices and behaviors that involve exchanging of fluids such as sharing needles. If she chooses to give birth to a child, it’s best that she also communicates her status to her health care provider so they can take measures to prevent the child from getting infected. 

In the United States (US), approximately 14,000 people are estimated to be diagnosed with Hep B each year and about 296 million people are affected worldwide. Of those infected, about five percent become chronic carriers. Those infected with HBV may have a range of symptoms. Some people may have no symptoms or have mild flu-like symptoms. Others may have severe symptoms such as fever, abdominal and joint pain, weakness or fatigue, loss of appetite, dark urine, and nausea or vomiting. The greatest health risk of chronic Hep B lies in developing long-term liver disease. About one-fourth of all people with chronic cases develop either cirrhosis of the liver or liver cancer. 

Now that your friend is aware of her HBV status, there are certain measures your friend and her partner can take to minimize the risk of transmission. First off, it will be important for your friend to inform her partner (and any future partners) that she carries Hepatitis B and encourage them to receive the vaccine. Practicing safer sex practices such as using barrier methods of contraception can be helpful. In regard to kissing, HBV can be transmitted through any mucous membrane (of an uninfected person) coming into contact with any infected bodily fluid, including saliva, semen, vaginal secretions, and blood. That being said, the highest concentrations of the virus are found in the blood. It should be up to your friend and her informed partner(s) to decide what risks they want to take. 

It's important to note that among chronic HBV carriers, there may be varying degrees of how infectious they are, so it’s possible that your friend isn’t very infectious at all. It depends on what antigens a person carries, and on whether they have developed certain antibodies. These antigens and antibodies can easily be detected by a specific blood test. If she hasn't already, your friend can have this test run so that her level of infectivity can be assessed by her health care provider. Those results may also inform the level of risk her and her partner want to take when it comes to engaging in different romantic or sexual activities. 

As for her partner, he may have already been exposed. In such a case, it’s usually recommended that the individual receive the Hepatitis B immune globulin (HBIG)—a shot different from the vaccine—within two weeks of their last exposure. Additionally, if he isn’t already vaccinated, it’s recommended that her partner get the Hepatitis B vaccine. It's important to receive the last shot, as that one packs the greatest protection punch! In general, the vaccine tends to provide immunity to about 90 percent of the adult population who complete the series, and to about 95 percent of vaccinated children. 

Last updated Jul 28, 2023
Originally published Sep 06, 1996

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