FFinalistSouthampton · 2027
Sexual health
AKT · Sexual health/Viral STIslow yield

Hepatitis B (sexual/BBV)

Hepatitis B virus — blood-borne / sexually transmitted

Overview

A blood-borne virus transmitted sexually, parenterally and vertically — one of the blood-borne viruses GUM screens for alongside HIV, hepatitis C and syphilis. Causes acute hepatitis; a proportion (higher if acquired perinatally) become chronic carriers at risk of cirrhosis and hepatocellular carcinoma. Vaccine-preventable.

Recognise

  • Acute: malaise, anorexia, nausea, jaundice, RUQ pain (many subclinical)
  • Chronic carriage (esp. perinatal acquisition) → cirrhosis, hepatocellular carcinoma
  • Extrahepatic: polyarteritis nodosa, membranous nephropathy

Red flags

  • Fulminant hepatic failure (acute); cirrhosis/HCC (chronic); pregnancy (vertical transmission)

Differentials & how to tell them apart

Hepatitis A / Efaeco-oral, no chronic carriage; serology
Hepatitis Cblood-borne, often asymptomatic, high chronicity — anti-HCV/RNA
HIV seroconversiontest concurrently — co-infection common
EBV/CMV hepatitisglandular-fever picture

Investigations

Serology: HBsAg (current infection), anti-HBc (exposure; IgM = acute), HBeAg/HBV DNA (infectivity/viral load), anti-HBs (immunity/vaccination). LFTs. Screen for co-infection (HIV, HCV, HDV).

Management

Acute: supportive + notify; Chronic active: tenofovir/entecavir (specialist)

  1. 1Acute: supportive care; NOTIFIABLE — inform UKHSA; test/vaccinate contacts. Most acute adult infections clear spontaneously.
  2. 2Chronic (HBsAg >6 months): refer to hepatology; antiviral (tenofovir or entecavir) if active disease; HCC surveillance.Gate: In pregnancy with high viral load → maternal antiviral + neonatal vaccine AND HBIG at birth to prevent vertical transmission
  3. 3Prevention: HBV vaccination (at-risk groups, now universal in the UK infant schedule); post-exposure vaccine ± immunoglobulin.
HBV vaccine — prevention; post-exposure prophylaxis (± HBIG)
Tenofovir / entecavir — antiviral for chronic active disease (specialist)
Pegylated interferon — selected chronic cases

Key points

GUM screens the four BBV/STIs together: HIV, hepatitis B, hepatitis C and syphilis. Risk of chronicity is highest with perinatal acquisition. Hepatitis D only co-infects with B.

Monitor & prognosis

LFTs, HBV DNA, HBeAg seroconversion; HCC surveillance in cirrhosis.

Most acute adult cases resolve; chronic carriage risks cirrhosis/HCC.

Source: NICE CKS Hepatitis B; BASHH; QuackQuackMed cross-check