Hepatits B and Oral sex Question: am I immune or not ?

[boken]

Hi Dr.

3 years ago I had intercourse after that I tested all STDs which are negative within 3 months. My Doctor told me at that time my liver enzymes are high.

Then, 7 weeks ago, I had protected oral sex and tested at 4 weeks for all stds.

All results are good(negative) except following cause I didn't understand following lab reports.

Hep B results for 4 weeks after having oral sex. The Doctor which at clinic told me I am immune and don't have to worry.

-Hepatitis B Surface Antigen W/REFL CONFIRM
-Hepatitis B Core AB Total Reactive
-Hepatitis B Surface Antigen Non-Rective

Then I went to my doctor and he ordered Viral load test at 5 weeks after having oral sex for HepB and got following results. He said I have virus and its acute HepB and I can transfer the virus. I am really confused with the early result and with viral result.

HBV Real-time PCR, Quant  
HBV as IU/ml^4 < 29^5  (This is 29x29x29x29x29)
HBV as Copies/mL <168^5  (This is 168x168x168x168x168)

AST/SGOT: 92 H
ALT/SGPT: 220 H


My questions :

-Can I transfer the virus to my sex partner ? am I immune ?
-what are the possiblities of transmitting Hep B via oral sex(receiving )
-If I have hep B, can i estimate when I got the virus ? I mean from 3 years ago or 7 weeks ago. Remember I used condom with oral in 7 weeks.

Thank you.

[H. Hunter Handsfield, M.D.]

Low risk, but perhaps not zero.  You should not be having any kind of sex, oral or otherwise, for the time being, until all this is sorted out.

This thread is over.  No more comments, please.

[boken]

Thanks Doc.

One last question, oral sex has low risk of HepB ? right ?

[H. Hunter Handsfield, M.D.]

Sorry, I have no comment.  These are issues and questions for a hematologist (liver disease specialist) or gastrenterologist, not an STD specialist.  Equally important, I suggest you stop screwing around trying to find answers online.  These issues require professional care in person.  Your future health and even your life might be at stake.  

That's all I'll have to say.  This forum can't help you further.

[boken]

Hi Doc,

I have found AST/ALT levels and Hep B results from 2-3 years ago as I mentioned above. Can you please comment on these results combining above results ?

As i understand at that time I was infected Hep  B, and as I know I can be infected only once in my life time if my body responds successfully to Hep B.

1. Liver enzyem level : AST/ALT Level

(2008.5.16 AST/ALT : 61/162(normal range 15-40/10-40), r-GTP : 60(normal range 2-30)

2007.5.14 AST/ALT : 24/23)



2.Hepatitis B test results (2008.5.16 HBs Ag : nagative, HBs Ab : positive(titer: 64.46)

2007.5.12 HBs Ag : nagative, HBs Ab : positive(titer: 59.93))

[boken]

Thanks Doctor for your prompt answer.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.

I also do not entirely understand your HBV test results.  I believe "Hepatitis B Surface Antigen W/REFL CONFIRM" is simply the name of the tests done.  The next two lines are the results:  positive ("reactive") for Hepatitis B Core antibody (AB) and negative for hepatitis B surface antigen (HBsAg).  That combination usually means a past HBV infection that is no longer active, i.e. no risk of ongoing hepatitis and no possibility of transmission.

Jumping to the AST/SGOT and ALT/SGPT results, these are tests for certain liver enzymes.  The results are abnormal, suggesting some sort of liver disease.  However, enzyme results say nothing about the cause.  Hepatitis, alcoholic liver disease, and a large number other conditions cause the same results.

Since the initial HBV tests were negative, I do not know why your doctor ordered a viral load test.  Perhaps he was concerned the abnormal enzyme results indicated hepatitis despite the negative HBsAg result.  I am not familiar with the details of that test and cannot coment on the numerical results you state, but apparently the PCR results are positive for HBV in your blood.

I am unable to explain why you have the discrepant results, nor can I tell whether you have acute hepatitis B or a chronic infection, or whether you might have more than one abnormal liver condition that explains all this.  STD experts do not typically provide care for hepatitis -- we sometimes diagnose it, but then refer patients to internists or gastroenterologists (or liver exprts) for ongoing care.

Can your transfer HBV to your partner(s)?  Probably yes.  HBV probably is rarely transmitted by oral sex, but it might be possible.  Since your liver function tests were abnormal 3 years ago, it seems most likely that you have had your HBV infection at least that long.  For sure you didn't catch HBV through a condom, so it is pretty much impossible you were infected 7 weeks ago.

Although I am not a hepatitis expert, I believe your health may be in serious danger.  Ask all these same questions of the doctor who ordered the PCR test results then follow his or her advice about further diagnostic tests, perhaps including a liver biopsy; possible need for treatment; and how to protect your sex partner(s).  If that doctor is not a gastroenterologist or hepatitis expert, consider asking for referral to such an expert for an additional opinion.  For the time being, until you have an expert's opinion, you should avoid all sex with anybody else.

Good luck--  HHH, MD