confused

[joe710]

I screwed up and now I've been tested positive for HBV.  I'll try to make this short and to the point.  I first noticed malaise, joint stiffness, jaundice eyes, pressure around the eyes and headaches early Sept.  Before I confessed to the doctor that I had unprotected sex with another guy I was given a CT scan on my brain, MRI on the brain, a spinal tap and blood tests.  Never were they looking for HBV, so, they didn't find it.  However, the scans on my brain showed a 10mm growth that my primary and then a neurologist said not to worry about and it probably wasn't causing the headaches.  I'm not sure if the spinal tap will show a STD if they're not looking for it.  Will it?  My last blood tests for HBV indicated that my liver function was normal and that antibodies were found.  My primary told me explicitly that I cleared the virus and that I will not die.  My next blood test is scheduled for next week, and he said he is hoping to see an increase in antibodies.  Also, he told me two months ago that I was not contageous and my headaches and pains around the liver will go away.  Well, so far, the jaundice eyes remain, the pain around the liver remains, lately I'm feeling tired again, and lost my appetite again.  I'm confused and scared.  Do you think I'm contageous?  What does that mean?  Do I have to have protected sex from now on?  Have I experienced a flare up and I actually have not cleared the HBV?  Could the headaches be caused by syphillis?  Perhaps I was exposed to it, even though I never had symptoms for it.   I know this was a lot of information and without details from the blood tests there is not much more to go on.  I plan on asking my primary for all the details on the types of tests and the results.   Thanks for listening and I'll be looking for your response.

[H. Hunter Handsfield, M.D.]

HBV is diagnosed by testing the blood both for antibodies to the virus, and by tests for the virus itself.  Apparently you have antibodies, and you can never catch a new HBV infection again.  The thing you need to ask the doctor -- which the nurse didn't understand, or you didn't know to ask -- is whether markers of the virus itself can still be detected.  The most common such marker is called "hepatitis B surface antigen", or HBsAg.  Undoubtedly it was positive during your acute infection.  If it has become negative, it means you are cured, will have no problem with chronic hepatits, and that you are not a carrier.

Many (most?) doctors treating people for hepatitis would make all this very clear at the time of diagnosis.  Are you sure it was not explained?  Often doctors give their patients written brochures.  You can also find such information on line.  Have you tried the hepatitis B foundation (www.hepb.org)?  I'm not highly familiar with the organizations and do not vouch for them.  But it is large, well known, and has a website that looks pretty good.  They should be able to answer any further questions you may have.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  I can address your STD related questions, but not those about monitoring your HBV infection, treatment, etc.  We are experts on HBV transmission, but not on diagnosis or treatment of hepatitis B.  It sounds like the infection is clearing up (yellow eyes often take a while to return to normal), and most people don't become chronic carriers.  But that's all I can say about it.

Also, I have no comments about the "growth" that was found in your brain.  HIV and syphilis can cause various abnormalities of the central nervous system.  Almost certainly you have been tested for them -- but if not, talk to your doctor and make sure the tests are done soon.

If your cerebrospinal fluid (i.e., the spinal tap) was normal, then almost certainly you have no STD involving your nervous system or brain.  CSF is often tested automatically for syphilis; you can ask your doc if that was done.  But if your blood test is negative for syphilis, the CSF test really doesn't matter.  There are no other routine STD tests on CSF.  

As far as contagiousness of HBV in the future, this will depend on whether or not you become a carrier, which in turn depends on what your blood tests show in the future.  If you indeed continue to carry infectious HBV, the main prevention strategies should be first to make sure your partner(s) have been vaccinated; and for unvaccinated partners, make sure they know about your carrier state and always use condoms for anal sex.  (You should always have protected sex anyway, except for longstanding, mutually monogamous relationships.)

Please ask all these questions of the doctor who is caring for your HBV infection, and trust what s/he tells you.  Chances are s/he knows more about all this than I do.  However, feel free to return heare with a comment to report the results of syphilis tests on your blood and/or CSF, HIV blood test result, and more details about your HBV test results now or in the future.  Until then, there isn't much more to say.  However, based on all the information you provide, it seems things are going well.

Happy new year--  HHH, MD

[joe710]

Hi.  I know you wrote that you're not an expert on diagnosis and treatment of HBV but I'm hoping you can shed some light on this.  My doctor's nurse called today and told me that the last blood test I took two days ago showed that my imunity to HBV was positive and that I'm totally imune to the virus.  I asked her what exactly that meant and she refused to expound.  My doctor will call me soon to explain things.  As you can probably tell, I'm anxious for an explanation.  In your opinion, what does this latest result mean?  

[joe710]

Thanks for the quick and informed response.  I'll be sure to ask my primary the questions that you suggested.  I just wish the headaches would go away and I pray that I'm not going to be a carrier.