How can I practice safe sexual intercourse with a partner who has Hepatitis B (HBV)?

Safe Sexual Intercourse with a Hepatitis B Positive Partner

If your partner has Hepatitis B, you should immediately get vaccinated with the hepatitis B vaccine series and use latex condoms during all sexual activity until you complete vaccination and confirm immunity with anti-HBs testing showing levels ≥10 mIU/mL. 1

Immediate Actions for the Uninfected Partner

Get Vaccinated Immediately

• Receive the first dose of hepatitis B vaccine as soon as possible, ideally at the same time blood is drawn for baseline testing 1
• Complete the full 3-dose series at 0,1-2, and 4-6 months 1
• The vaccine is highly effective: 50% protection after one dose, 85% after two doses, and >90% after three doses 1

Post-Exposure Prophylaxis (If Recently Exposed)

• If you had unprotected sexual contact within the past 14 days with a partner who has acute hepatitis B, you need both hepatitis B immune globulin (HBIG) AND the vaccine series 1
• HBIG prevents 75% of infections when given within 14 days of exposure 1
• For chronic HBV infection in your partner (not acute), vaccination alone without HBIG is highly effective 1

Barrier Protection During Sexual Activity

Condom Use is Essential

• Use latex condoms consistently during all sexual activity to protect against exposure to semen, vaginal secretions, and blood 1
• Continue condom use until you complete vaccination AND confirm immunity through testing 1
• While the exact efficacy of condoms in preventing HBV is unknown, proper use reduces transmission risk 1

When You Can Stop Using Condoms

• You may discontinue condoms only after completing the vaccine series AND confirming anti-HBs levels ≥10 mIU/mL through blood testing 1-2 months after the final dose 1, 2
• This testing is specifically recommended for sexual partners of HBsAg-positive persons 1

Testing and Monitoring Protocol

Initial Testing for the Uninfected Partner

• Get tested for total anti-HBc (hepatitis B core antibody) to determine if you're already immune or infected 1
• Also get tested for HIV, syphilis, gonorrhea, and chlamydia, as these infections commonly co-occur 1, 3

Post-Vaccination Testing

• Test anti-HBs levels 1-2 months after completing the 3-dose series 1, 2
• If anti-HBs is <10 mIU/mL, you need revaccination with another complete 3-dose series 2
• Most non-responders (44-100%) will develop protective antibodies after a second complete series 2

Additional Precautions Beyond Sexual Contact

Avoid Blood Exposure

• Do not share personal items that could have blood on them: toothbrushes, razors, nail clippers 1
• Your partner should cover any cuts or skin lesions to prevent blood exposure 1

Household Safety Measures

• HBV is NOT spread by hugging, coughing, food/water, sharing eating utensils, or casual contact 1
• No need for isolation or exclusion from normal activities 1

Management of the Infected Partner

Medical Evaluation Required

• Your partner should be evaluated by a specialist experienced in managing chronic hepatitis B 1
• They should be tested for HIV, syphilis, gonorrhea, and chlamydia 1, 3
• Chronic HBV infection requires monitoring and possible antiviral treatment 1

Liver Protection Measures

• Your partner should avoid or limit alcohol consumption 1
• Get vaccinated against hepatitis A, as coinfection increases mortality risk 5.6- to 29-fold 2
• Avoid starting new medications without checking with their healthcare provider 1

Common Pitfalls to Avoid

Do not assume you're protected just because you were vaccinated in childhood - antibody levels decline over time, and you need current testing to confirm immunity 2

Do not delay vaccination while waiting for test results - the first vaccine dose should be given immediately when blood is drawn for testing 1

Do not stop using condoms after starting vaccination - you need to complete the series AND confirm immunity through testing before discontinuing barrier protection 1

Do not assume your partner cannot transmit HBV if they're on antiviral treatment - while treatment reduces viral load, transmission risk persists, and barrier protection remains essential until you're confirmed immune 4, 5

Special Considerations

If You're Pregnant

• Pregnancy is NOT a contraindication to hepatitis B vaccination or HBIG 1
• All pregnant women should be tested for HBsAg at the first prenatal visit 1

If You're HIV-Positive

• You may have impaired vaccine response and need testing 1-2 months after the third dose 1
• Consider revaccination with three additional doses if you don't respond initially 1