The Hepatitis B virus (HBV) causes inflammation and damage to the liver. The infection exists in two phases—acute and chronic—and presents similarly in adults regardless of sex. Understanding HBV is important for women concerning routine screening, potential complications, and reproductive health considerations.
Acute and Chronic Symptoms
The initial acute phase typically manifests with generalized, flu-like symptoms 60 to 150 days after exposure. Many individuals experience no symptoms at all during this stage, making diagnosis difficult without blood testing. Common symptoms include fatigue, a low-grade fever, and general muscle aches.
Digestive indicators include loss of appetite, nausea, and vomiting. Some people report discomfort or mild pain in the upper right quadrant of the abdomen, corresponding to the liver’s location. The distinguishing symptoms of the acute phase are jaundice (yellowing of the skin and eyes) and the noticeable darkening of urine.
The chronic phase is defined as a persistent infection lasting six months or longer, characterized by the continued presence of the virus in the blood. Most women who transition into this chronic state remain asymptomatic for many years. This lack of symptoms often means chronic cases go undiagnosed until significant liver damage has occurred.
Symptoms in the chronic phase appear late, once the liver has sustained substantial injury. These late-stage signs can include swelling in the legs, ankles, or abdomen, and further episodes of jaundice. Untreated chronic HBV can lead to severe outcomes like cirrhosis (liver scarring) or hepatocellular carcinoma (a form of liver cancer).
Transmission Routes and Diagnostic Testing
Hepatitis B is transmitted when infected blood or other bodily fluids, such as semen or vaginal fluids, enter the body. Common routes include unprotected sexual contact and the sharing of contaminated needles. Transmission can also occur from mother to child during childbirth, which is a major reproductive health concern.
HBV is not spread through casual contact, such as hugging, sneezing, or sharing eating utensils. The virus is highly concentrated in blood, and transmission requires a direct entry point into the bloodstream or mucous membranes.
The status of an HBV infection is confirmed through blood tests that look for three main markers. The presence of Hepatitis B surface antigen (HBsAg) indicates a current infection, whether acute or chronic. If HBsAg is detected, the individual is contagious and can transmit the virus.
The Hepatitis B surface antibody (Anti-HBs) signifies immunity, meaning the person has recovered from a past infection or is protected through vaccination. The Hepatitis B core antibody (Anti-HBc) indicates past or current exposure to the virus. Interpreting these markers determines if the infection is new, chronic, resolved, or if the person is protected.
Hepatitis B and Pregnancy Risks
Screening for Hepatitis B is standard for all pregnant women, typically performed during initial prenatal blood work. This universal screening ensures early identification, allowing for interventions that protect the infant. Identifying an HBV-positive mother is necessary because the primary risk of transmission occurs during delivery.
This process is known as vertical transmission. Without intervention, the risk of the baby acquiring the infection ranges from 10% to 90%, depending on the mother’s viral load. If a newborn acquires HBV at birth, the infection is highly likely to become chronic, as the infant’s immune system is less likely to clear the virus compared to an adult’s.
Specific medical interventions immediately after birth drastically reduce transmission risk. The newborn of an HBV-positive mother must receive two protective treatments within 12 hours of delivery. This protocol involves administering Hepatitis B Immune Globulin (HBIG), which provides immediate, short-term antibodies.
The infant also receives the first dose of the Hepatitis B vaccine series simultaneously, stimulating the baby’s immune system for long-term protection. When both HBIG and the vaccine are administered promptly, the chance of the baby developing a chronic infection is reduced by over 90%.
Treatment, Monitoring, and Vaccination
Treatment focuses on managing the chronic phase and is generally not required for the acute phase. The goals of therapy are to suppress viral replication and reduce the overall viral load in the blood. Viral suppression helps prevent the progression of liver damage, including cirrhosis and liver cancer.
Antiviral medications, such as tenofovir or entecavir, are used for long-term management of chronic HBV. These drugs slow the virus’s ability to multiply but do not cure the infection. Treatment is reserved for individuals with evidence of active liver inflammation or high viral loads.
Individuals with chronic HBV require regular medical monitoring to assess liver health and track infection activity. Monitoring involves periodic blood tests to check liver enzyme levels and viral load counts. Imaging tests, such as ultrasound, are also used to screen the liver for scarring or tumor development.
The most effective way to prevent Hepatitis B is through the reliable HBV vaccine. The vaccine is recommended for all infants shortly after birth, and for all children and adolescents not previously vaccinated. It is also recommended for adults at increased risk of exposure, including healthcare workers and people with multiple sexual partners.