A few random questions about Hep B

Hi all,

i had a few random questions that have popped in my mind over the past few weeks I was curious about-

  1. For positive / negative couples (primarily when the man is positive and the woman negative) are they required to use protection during intercourse if the woman is fully vaccinated w/ proper titer counts? I know several people have had kids while having Hep B, but do they forego protection just when wanting to have kids but use it at all other times? Or is it fine to forego protection during every encounter as long as the woman is properly vaccinated w/ the appropriate titer counts?

  2. Where does most of the virus for people who have Hep B live? Is it primarily found in the blood? If so, does the vaccine protect against accidental blood exposure form a person that has Hep B? Or does it just protect against bodily fluids where the virus is not as readily found, such as semen?

  3. What does the mix of reactive and non-reactive results from the below Hep B readings indicate? Does it indicate anything important or noteworthy about one’s Hep B status?

Hepatitis B Core AG IgM: non-reactive
Hepatitis B Surface Antigen II: Reactive
Hepatitis B Core Total: Reactive

Hello @Anon2023

I can answer one of your questions.

I was married 18 years, to a vaccinated


We never used protection :blush:

And he remains HBV free.

Others will answer your questions soon.

Thanks for your questions.



Hi @Anon2023,

Caraline has answered the first question appropriately, so I’ll take on the others.

Both the liver and the blood will contain the highest levels of the virus, but it can also be found in menstrual fluids, semen, saliva (to a small extent) and other bodily fluids. To infect someone, the virus needs to first make its way to the blood then the liver. The antibodies generated by vaccination will prevent the virus from getting to the liver while it travels in the blood. If the virus gets through by chance, the immune system can also target and kill any cells that get infected.

The results you post are consistent with a hepatitis B infection that has lasted more than a few months.

Hope this helps,


What about breakthrough infection even if we are vaccinated and have adequate titers is it possible to have unprotected intercourse with our spouse who is hbsag positive anytime and not get infected

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@ThomasTu thanks for the insight! Regarding the use of protection, is it safe to forego protection if the male is the one whose a carrier but the female is negative (but she is vaccinated)? I’m assuming Caraline is a female and I read once that males are more likely to pass on the virus than females, simply due to the nature of intercourse.

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If she is vaccinated, unprotected sex is safe.
What did you do before you found out you were a carrier? Or is this a new relationship?

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Everything I have read indicates that anyone vaccinated for hepatitis B does not need to use sexual protection against hepatitis B specifically. Of course Hep B vaccination will not protect against other diseases.


Hi @Anon2023, the likelihood of transmission if protected by vaccination is very low to negligible.



Hi @Caraline this is a new relationship, so there are just some concerns!