New here but very very grateful to have found this space! I am very confused and could use some guidance from people who seem to have much more knowledge about all of this than me. Apologies because this will be long.
So I am a mid 20’s male, adopted from Asia as a baby, raised in the US. I was diagnosed about 4 years ago, found out by almost completely accident. I’m gay and was deciding to go on Truvada once a day for PrEP (which coincidentally contains tenofovir, for those unfamiliar, thus treating my Hep B). I had never been tested for hep b before in my life, just vaccinated when I started going to school here and my PCP told me that she thought I should get checked for it because my liver enzymes were elevated and there was no record of me ever being tested. Nasty shock for me and my adoptive parents to find out. The doctors said based on my lab work, it was most likely that I contracted hep b as a baby, given high transmission rates in Asia and a lack of testing I received in Alabama when I was brought to the US.
The good news though is that every lab test I’ve ever had for hep b has been exceedingly normal. My viral load is undetectable and has been since the first set of labs I got 4 years ago (<10 IU/mL). I feel like I’ve had a lot of time to make peace with the diagnosis in terms of having Hep B and that being a part of my healthcare.
My question/confusion though, pertains to the dating and sex part of the equation. I feel like I have received some mixed and confusing messaging around what to tell prospective partners and even what the varying risk levels are of different activities. And I always get so nervous and embarrassed asking these questions face to face with a doctor so I’m hoping that in typing it all out (even if it’s cringey), somebody in this community will be able to help me figure this out.
Basically my understanding is that while it’s really good that my viral load is undetectable and will certainly make transmission unlikely, there isn’t enough research to know for absolute sure if u=u for hep b as it does for HIV. And so generally, the recommendation is to use a barrier (ie, condom, dental dam, etc) if you don’t know the other partners vaccination/immunity status? But I had also previously been under the impression that if the other partner either had been vaccinated as a baby and confirms immunity/antibody titer, or was boosted/vaccinated recently, then it was possible to safely forego the condom, as I wouldn’t be able to transmit the virus at that point. That was what I thought I had been told at least.
What I usually tell guys on apps or in person is a long text that essentially contains 5 pieces of info:
- I have Hep B, which I got as a child, but I’m on medication for it so viral load is undetectable
- But they don’t have enough research to know for sure if that means untransmittable
- Good news is many people have been vaccinated for it for school, or work or what have you at this point, which makes them immune
- They’re also supposed to check you for immunity before you go on PrEP
- But they recommend using condoms unless you confirm the partners immunity status, just for complete safety
Some guys are overwhelmed and have never even heard of it before. Some guys are familiar with it and don’t wanna fuck w it. Some guys are fine with using condoms. And of course there are other dudes who know they’ve been vaccinated and want to have unprotected sex. For anyone who is not a part of specifically the gay male community, with the prevalence of PrEP in the community over the last 5 years or so, unprotected sex has become MUCH more common. And I would be lying if I said I had not been partaking (not sure if this is too much information, but I have exclusively been the receptive partner or “bottom”) with guys who had been vaccinated, been boosted and/or tested for immunity, because I was under the impression and was telling them that was safe….
Cut to two days ago, I’m having an appointment with a different infectious disease doctor and they are saying that the vaccine is incredibly effective and lowers risk to very close to or basically 0… but it’s not actually 0 as I’d thought. I later emailed them to clarify this exact question (ie, can the condom be safely foregone if the other partner has been vaccinated). They said the vaccine was very effective and though they still recommend condoms to protect from other STIs, “the risk of HBV transmission to a vaccinated partner is extremely low”. Which still isn’t saying that it’s a zero chance or that it’s safe. So it seems that they are advocating for an approach of using barriers for everything all the time? Which I know is technically public health sexual guidance anyway but in practice, I know few people who regularly use protection for oral sex. And having done oral with protection before, it’s a hard sell for most guys.
But I also don’t know if this is just sorta doctor/science/public health speak for “functionally zero chance” of transmission or what, as I know many professionals like to err on the side of caution unless they can say with absolute confidence. And this leaves me at a hard place for what I tell guys. If the best answer medicine and science can give is “it’s an extremely low chance” or “very unlikely” but not zero… then does every guy I potentially have some form of unprotected sexual contact with (even just oral) need to have a hep b panel after we hookup? Even if someone was comfortable with the “low chance” and wanted to proceed with unprotected contact, I feel like they’d still wanna have some way of making sure they’re all good after the fact. Which maybe is why the doctor is recommending the condoms for everything then?
Now I’m just sorta a confused and anxious mess. The TLDR is basically:
- Given my undetectable status, if I’m with a partner who is vaccinated for hep b, is any amount of sexual contact safe without barriers or should there always be a condom involved?
- What should I be telling prospective partners?
- If unprotected sex turns out to in fact not be safe, as it’s seeming like it is, do I need to attempt to track down all former unprotected partners? What do I even tell them to do? Just get tested for hep b? And “sorry I told you we’d be fine but turns out I misunderstood information”?
Ultimately, if the answer is yes, I must use a condom for everything and if eventually I have a long term partner who is comfortable risking it, then we can see, then that is fine. I just sorta want a more firm answer lol.
Definitely struggling with some low morale at the moment, and just general frustration at the situation. Hope everyone else is doing okay
Any help is MUCH appreciated! (Please don’t hesitate if you need more of my lab work info to get more context, didn’t really know what was needed for this).