Doctor,

We recently found out that my fiancé is suffering from Hepatitis B. Thankfully, we had already made a decision not to get sexually intimate until marriage. However we have kissed on a few occasions. Does this put me at risk of contracting the disease?

Anne U, Kicukiro

Dear Anne, 

You made a wise decision to not be sexually intimate before marriage. Premarital sex carries its own set of social and health related risks.

Hepatitis B is a viral infection, which causes chronic inflammation of the liver. This leads to complications like cirrhosis of the liver and even malignancy.  It is spread by transfusion of contaminated blood and blood products containing the virus. Injections by a contaminated syringe and needles, other pricks and interventions by contaminated tools are yet another source of infection. This includes all injections taken for medical purposes, haircuts, manicure, pedicure, and tattoos.

It also spreads though unprotected sex. Since sexual activity is the one done most frequently, the risk is multiplied. Once somebody has acquired the infection, they may not have any sickness for some days even up to 3 months, so the person may not feel the need to seek medical intervention but is capable of transmitting the virus to others. 

At times there may be an acute sickness manifesting as loss of appetite, nausea, vomiting, low grade fever, body and joints pain. This may subside by itself within 2 weeks giving a sense of well being to the affected person. But the virus still persists within the body and is transmitted to others through unprotected intercourse. 

A person harbouring Hepatitis B is at a much greater risk of acquiring and also transmitting HIV/AIDS, because modes of transmission and acquisition for the two are the same. A person infected with HIV may not have any illness physically but is at risk of infecting others. He also becomes more prone to develop other infections as the body’s resistance to fight infections is lowered.

As the person gets infected, virus causes swelling of the liver cells. As it persists, gradually liver cells start getting damaged and liver function gets progressively impaired. As it is a very vital organ of the body, its damage leads to multiple problems in the body.

But in your case you have nothing to worry about. There is no risk of spread Hepatitis B through kissing. The remote possibility is only if there is an open wound or blister on mouth or tongue which comes in direct contact with saliva of the person kissing.

Diagnosis of Hepatitis B is confirmed by serological tests. Treatment by means of antiretroviral drugs is available in Kigali. If your boyfriend does not have a long-standing infection, where liver damage has already occurred, he can benefit from these drugs. Untill then he has to refrain from unprotected sex and substances likely to damage the liver like alcohol and analgesic (pain killers).

Dr. Rachna Pande is a Specialist - Internal Medicine Ruhengeri Hospital.