Hepatitis B Symptoms Singapore | Shim Clinic

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Hepatitis B may be asymptomatic, but it may also be symptomatic.





Incubation period. 40-160 days


  • Virtually all infants and children have asymptomatic acute infection
  • Asymptomatic infection is also found in 10-50% of adults in the acute phase and is especially likely in those with HIV coinfection
  • Chronic carriers are usually asymptomatic but may have fatigue or loss of appetite
  • The prodromal and icteric phases are very similar to hepatitis A, but may be more severe and prolonged


  • As for Hepatitis A in the acute phase
  • If chronic infection occurs there are often no physical signs. After many years of infection, depending on the severity and duration, there may be signs of chronic liver disease


  • Fulminant hepatitis occurs in <1% of symptomatic cases but carries a worse prognosis than that caused by hepatitis A
  • Chronic infection (>6 months) occurs in 5-10% of symptomatic cases but the rate is higher in immunocompromised patients with HIV infection, chronic renal failure or those receiving immunosuppressive drugs. Immunosuppressive treatment can also reactivate hepatitis B. Almost all (>90%) of infants born to infectious (HBeAg +ve) mothers will become chronic carriers unless immunised
  • There are 4 phases of chronic carriage:
    1. Immune Tolerant (HBe Ag +ve, normal ALT levels, little or no necroinflammation on liver biopsy)
    2. Immune Active, HBe Ag +ve phase (HBe Ag +ve, raised ALT, progressive necroinflammation and fibrosis)
    3. Inactive hepatitis B carrier (HBsAg+ve, HBeAg -ve, low levels of HBV DNA and normal ALT)
    4. HBeAg –ve chronic active hepatitis (Precore, Corepromotor mutations, HBeAg –ve, detectable HBV DNA, progressive inflammation and fibrosis). Types 2 and 4 may progress to cirrhosis and liver cancer, with type 4 generally progressing fastest
  • Concurrent hepatitis C infection can lead to fulminant hepatitis, more aggressive chronic hepatitis and increased risk of liver cancer. Concurrent HIV infection increases the risk of progression to cirrhosis and death. Hepatitis A coinfection can be severe acutely, but may lead to the reduction of longterm HBV replication
  • Concurrent Delta virus infection, or delta virus superinfection may lead to progressive fibrosis, cirrhosis and endstage liver disease
  • Mortality is <1% for acute cases. Between 10 – 50 % of chronic carriers will develop cirrhosis leading to premature death in approximately 50%. Ten percent or more of cirrhotic patients will progress to liver cancer
  • There is an increased rate of miscarriage/premature labour in acute infection. There is a risk of vertical transmission

Sexual risk (of HIV/STD/pregnancy), and what you can do before and after exposure.
Timeline HIV STD Pregnancy
Before exposure
Abstain from sex, Be faithful, or Condom use
Circumcision (males only)
Contraception (females only)
HIV PrEP (pre-exposure prophylaxis) - Stop HIV infection before exposure STD vaccine: - Hepatitis vaccine - HPV vaccine
STD / HIV exposure
Unsafe sex / unprotected sex: No condom / Condom broke / Condom slip
0-72 hours HIV PEP (post-exposure prophylaxis) - Stop HIV infection after exposure STD testing * - Screening test - to look for asymptomatic infections - from previous exposures Emergency contraception with the morning-after pill (females only)
2 weeks HIV DNA Test
1 month HIV 4th Generation Test - SD Bioline HIV Ag/Ab Combo - Fingerprick blood sampling. - 20 minutes to results
3 months HIV 3rd Generation Test - OraQuick® HIV-1/2 Antibody - Oral fluid or - Fingerprick blood sampling. - 20 minutes to results STD testing * - Full & comprehensive - diagnostic test - to look for current infections
Watch for HIV Symptoms STD Symptoms
If infected HIV Treatment STD Treatment Abortion
* Males: Do not urinate for at least 4 hours before arriving. * Females: testing is more accurate when you are not menstruating.


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