Neg HBSAG, Neg Anti HBS

Hello Experts,

I hope this message finds you well. My name is Hanna, a 29-year-old Asian female, and I am writing on my friend’s account. Thank you so much for allowing me to seek advice on this Hepatitis B forum.

During the ages of 18 to 26, I engaged in behaviors such as drinking, experiencing hangovers, and having multiple relationships since college. Although I did not use drugs, I am aware that my actions put me at risk for STDs. I have undergone all STD tests, and fortunately, everything came back negative, except for Hepatitis B. I did not take the test earlier because I mistakenly believed that Hepatitis B is not an STD.

Three weeks ago Nov 2023, my best friend, Jennica, passed away at the age of 35. It has left me profoundly saddened and confused, as the doctor revealed she had chronic Hepatitis B. The seriousness of HBV and the circumstances surrounding my friend’s passing have left me with mixed feelings and shaky hands.

Upon discussing my concerns with the doctor, I requested a blood test. The results are as follows:


The doctor assured me that considering my last sexual encounter in 2021 and the current year being 2023, with a two-year gap, I am not at risk for HBV.

Upon returning home, I conducted my own research at Viral Hepatitis Surveillance and Case Management - Hepatitis B | CDC and came across the term “Isolated hep B core: Occult HBV infection. HBV DNA is positive, typically at low levels. Anti-HBs might or might not be positive,” which I have not taken a test for.

I understand that taking the anti-HBC core test is crucial to determine occult HBV, but I would greatly appreciate receiving some information or guidance before proceeding with the test

Here are my questions:

  1. Can I develop occult HBV after resolving acute HBV, assuming I contracted HBV in my last sexual encounter in 2021, and it’s now 2023? prove by hbsag - ,anti hbs - in 2023,
  2. Many articles state that occult HBV is rare. How rare is it? Can you provide a percentage?
  3. If I might have occult HBV, what is the way to transmit it? I have read that it only transmits via blood transfusion and organ transplant. Can it spread during sex?
  4. If I have occult HBV, can it be treated with a vaccine?

Thank you so much for your assistance.

Best regards, Hanna

1 Like

Hi Hanna,
Welcome to the platform. Bansah1

Hello Bansah,

I hope this message finds you well. I am new here and currently using my friend’s account. I would greatly appreciate your help with my question.

Thank you kindly.

Warm regards,

to @Bansah1

Hi Hanna,

Thanks for sharing your story and sorry to hear about what a tough time you’re having.

Regarding your test results that you present here, there is no indication that you have ever been exposed to Hep B. When you say you were positive for Hep B in the first section, do you know what test was done? As you say, an anti-HBc Ab test is needed, but it also might be worthwhile to get a hep B vaccination so that you know you are protected.

Regarding your questions:

  1. It is possible (but unlikely) that occult HBV occurs after resolving an acute infection.
  2. It is unclear how common occult HBV infection is because it is rarely tested for. It’s difficult to give numbers on this, but it is not likely to be common.
  3. Occult HBV is very very unlikely to be spread by sex due to the very low viral levels in the blood.
  4. I believe that the science is still unclear about treatment with a vaccine.


Dear Dr. Thomas, @ThomasTu

I sincerely appreciate your assistance and guidance. I have consistently received negative results for both the HBSAG and anti-HBS tests. However, I must admit that after reviewing information on the CDC website regarding occult HBV, I find myself experiencing some anxiety. Nevertheless, I am grateful for your thorough explanation.

Thank you once again for your support.

Best regards,


Dear Hanna,

If your anti-HBs Ab levels are consistently negative, then it is usually recommended to get the vaccine to get these to protective levels. This would serve to protect you against any future exposure.

If you are still anxious about occult Hep B, then it might be worth asking for a HBV DNA PCR test as this would be the only to confirm it one way or another.

Hope this helps,