HIv, okay.... But what's the real deal with Hepatitis B?

[hepcurious]

Hey Dr. HHH and Dr. Hook,
First off thanks for offering up your great advice and experienced opinions. I have done all of the HIV research and realize the theoretical risks involved with that, but accurate and reliable information of Hepatitis seems to be VERY slim in comparison.  I know there are no published risks as with HIV, but I heard that in general Hep B is easier than HIV to transmit (although way less people have it). All info seems to vary so much, and unlike HIV, I have found it tough to get reliable advice.
I performed unprotected fellatio and (rec. cunnilingus) on a guy (no ejaculation, no known blood) I met at a bar 5 months ago (I'm female), and only had oral both ways with him (aside from fingering and rimming- I know both no risk). We talked about std history etc., and he told me that he was bisexual and that he had an std checkup last year and currently has no known stds or any reason to suspect any. The only thing is, people don't really ask/get tested for/talk about Hep B. I am worried about Hep B as I have to do a test for entrance into school and testing positive would certainly suck. This is my only potential exposure. I had clay colored stools (I think) for about a day, but no other typical hep B symptoms (I know not everyone gets them). I was immunized as a baby (I'm 24), but I think I may have missed my junior high immunization due to sickness. So what's the real deal with risk here? I know it's ONLY a theoretical risk, and Indeed DR. HHH stated that he doesn't know of any happenings of it being trans. via oral sex, but I'm still a little concerned. I'm assuming that even though my partner was bisexual and told me he had unprot sex earlier on in life, but has a rule of using condoms now, that more than likely he was immunized (he was older... 35 ish) or didn't have it. Would that, coupled with the zero to low risk of transmission via oral sex make t insane rare for me to have caught it?

[Edward W Hook, MD]

There is no reason (other than the usual, common snese reasons) for you not to drink.  As you imply, we both hope you'll do so responisibly.  Take care.  EWH

[hepcurious]

Thanks Dr. Hook!,
I have a week of some school "rookie-ing" so to speak starting in a few days. I don't plan on drinking a huge amount, but I think a few drink will be inevitable. I know my risk is immeasurably low (the only thing is that after talking to my dept. of public health, they stated that I "should have been immunized" and I do not know for sure yet... waiting for tests to be done), but would it be safe for me to consume a moderate amount of alcohol? If I beat all odds and did contract Hep B with no symptoms, would having some alcohol make me more likely to become a chronic carrier, or would I likely have resolved the Hep B (If I was going to) by 5 months and a week?

[Edward W Hook, MD]

You've done a superb job of answering your own question so I guess my role here is to offer confirmation and perhaps a little perspective as well/.  You are right, there is far less known about hepatitis B transmission risk than there is for HIV.  There are several reasons for this including that hepatitis is actually a rarer infection than HIV today.  This is because the widespread use of hepatitis B vaccine, at least in developed nations, has dramatically reduced it, as has screening of blood products.  In addition, funding for scientific research does follow popular interest and there is far more public interest in HIV than hepatitis B, therefore less research at present.

Having said that, when we say that hepatitis B is more infectious than HIV, this is entirely based on data from needle stick injuries to health care workers in which the contaminated needle was from patients with both diseases.  Much less is known about sexual transmission.

In your case, immunization for hepatitis B is known to be very long standing and in many persons, life long.  When you combine that with the improbability that your bisexual partner had hepatitis B (he may well have been vaccinated, whether he knows it or not) and the very, very low "efficiency" of oral hepatitis B transmission, your risk of having gotten hepatitis B through the exposures you describe is immeasurably low.  I affirm Dr. Handsfield’s advice.  You have nothing to worry about.  EWH

[hepcurious]

Well, I guess I just answered my own question... I couldn't find any recent threads on it until AFTER I posted (then I found this:http://www.medhelp.org/posts/show/494064) where Dr. HHH says "Oral sex is not a risk for Hepatitis of any kind" (although I guess rimming is the exception for A). The post was recent, but I'm assuming the advice hasn't changed?