One Blood Test Could Reveal a Silent Infection: 6 Times Women Should Ask About Hepatitis Screening

A woman can feel completely healthy—no pain, no yellowing of the eyes and no unusual fatigue—while living with a hepatitis infection she does not know she has.

That is why the most important question is not always, “Do I feel sick?” It may be: “Has anything happened in my life that could have exposed me to hepatitis?”

Hepatitis B and C can remain undetected for years, particularly when the infection becomes chronic. Some women only learn they are infected during prenatal blood work, after an abnormal liver test or when a household member or partner is diagnosed.

Many people living with acute or chronic hepatitis B have no symptoms or experience only mild signs. Chronic hepatitis C is also frequently asymptomatic, although both infections can eventually lead to serious liver damage if they remain undiagnosed and untreated.

This does not mean that every woman needs every hepatitis test. In Canada, screening outside pregnancy is generally based on a person’s medical history, possible exposure and clinical findings.

However, the following six situations deserve a conversation with a health-care provider.

1. You Are Pregnant—even if You Were Tested Before

The Public Health Agency of Canada recommends hepatitis B screening during the first trimester of every pregnancy. Canadian immunization guidance also recommends testing for the hepatitis B surface antigen, known as HBsAg, during each pregnancy unless the person is already known to be immune to hepatitis B or known to carry the virus.

The reason is practical and urgent: hepatitis B can be passed to a baby during pregnancy or childbirth. When the infection is detected before delivery, the mother can receive appropriate medical care and the newborn can be given preventive treatment immediately after birth.

Hepatitis C should also be discussed at the first prenatal visit, particularly when any risk factor is present, because the virus can be transmitted to the baby during pregnancy or childbirth.

A negative result from an earlier pregnancy does not rule out a new infection if a possible exposure occurred afterward.

2. You Were Born or Lived in a Region Where Hepatitis Is More Common

Some hepatitis B infections occur during childbirth or early childhood and can remain unnoticed well into adulthood. Women who were born in or spent significant time in regions with higher rates of hepatitis B should discuss their history with a health-care provider.

Hepatitis C screening is also recommended for people who were born in, travelled to or lived in regions where the virus is more common. Canadian guidance identifies areas including North Africa, the Middle East, Central, East and South Asia, Eastern Europe and sub-Saharan Africa.

Coming from one of these regions does not mean that a woman has hepatitis. It simply represents one factor a clinician may consider when deciding whether testing is appropriate.

3. You Received Blood or Had a Medical Procedure Years Ago

Women who received blood, blood products or an organ transplant in Canada before 1992 should ask about hepatitis C testing.

Canada began screening its blood supply for hepatitis C in 1992, which has virtually eliminated transmission through blood transfusions in the country. Before that screening began, however, some recipients were unknowingly exposed to the virus.

Testing may also be appropriate after a medical, dental or surgical procedure in a country or setting where infection-control practices were not standardized or where equipment may not have been properly sterilized.

A procedure that happened only once—or many years ago—may still matter because chronic hepatitis can remain silent for a long time.

4. You Had a Tattoo, Piercing or Cosmetic Procedure With Questionable Sterilization

Tattoos, piercings and cosmetic procedures do not automatically cause hepatitis. The risk comes from equipment contaminated with infected blood.

A woman should mention the procedure to her doctor when it was performed in an unlicensed setting, when she did not see a new needle being opened or when she is unsure whether reusable equipment was sterilized correctly.

Canadian hepatitis C guidance includes tattooing and body piercing with non-sterile equipment among the exposures that justify screening.

Procedures involving needles or blades should not be dismissed simply because no redness, infection or immediate complication appeared afterward.

5. Someone in Your Household or Your Partner Has Hepatitis B

Hepatitis B can be transmitted through infected blood and certain body fluids.

Household members may also be exposed through personal items that can carry tiny traces of blood, including razors and toothbrushes. A woman whose partner or household member has hepatitis B should speak with a health-care provider about testing, immunity and vaccination.

The Public Health Agency of Canada advises that people who may have been exposed—including household members and sexual partners—should be offered testing. Those who are not infected may be offered the hepatitis B vaccine.

An occupational needlestick injury or contact between another person’s blood and an open wound also requires prompt medical assessment. A woman should not wait for symptoms to appear.

6. Your Liver Tests Are Abnormal—or You Have Unexplained Symptoms

Abnormal liver enzymes, signs of liver disease or unexplained changes in liver blood work may lead a doctor to order hepatitis testing.

Hepatitis C testing is recommended for people with symptoms or clinical indications of liver disease, abnormal liver biochemistry, hepatitis B or HIV. Occupational exposure to blood is another clinical indication for testing.

Women preparing to start immunosuppressive medication should also tell their doctor about any past hepatitis diagnosis or possible exposure. Canadian guidance recommends hepatitis B screening for people who are immunocompromised or about to receive certain immunosuppressive treatments.

Symptoms that deserve medical attention include:

• Yellowing of the skin or eyes
• Dark urine
• Pale or clay-coloured stools
• Persistent nausea or vomiting
• Loss of appetite
• Severe fatigue
• Abdominal pain

These symptoms do not prove that someone has hepatitis, but they require assessment. Their absence also does not rule out an infection when a known risk factor exists.

Do Not Ask for Only a “Liver Test”

A liver function test can show signs of inflammation or liver damage, but it cannot determine on its own whether hepatitis B or C is present.

For hepatitis B, a health-care provider may order a combination of blood tests. These can include:

• HBsAg, which may indicate a current hepatitis B infection
• Anti-HBs, which helps assess immunity
• Anti-HBc, which can provide evidence of previous or ongoing exposure
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The combination of results—not one number in isolation—helps the clinician distinguish between current infection, previous infection, vaccination-related immunity and susceptibility.

Hepatitis C diagnosis normally requires two stages.

The first is an anti-HCV antibody test. A positive result shows that the person has been exposed to the virus at some point, but it does not confirm that an active infection remains.

A second test, usually called HCV RNA, is needed to determine whether the virus is currently present in the blood. Canadian guidance states that diagnosing hepatitis C requires two tests.

This distinction matters. A woman may receive a positive antibody result and assume she has an active lifelong infection, while the RNA test may show that her body previously cleared the virus.

What Happens After a Positive Result?

A positive result is not a verdict that severe liver disease is inevitable.

Chronic hepatitis B can be monitored and treated when necessary to reduce liver damage and prevent the infection from worsening. An effective vaccine is available to prevent hepatitis B and may protect household members and others who are not infected.

Hepatitis C has no effective vaccine, but modern direct-acting antiviral medicines can cure more than 95% of people who receive treatment, according to the World Health Organization.

Before your next medical appointment, consider three questions:

Have I been screened for hepatitis B during my current pregnancy?

Have I experienced any of the exposures described above?

Do I know whether I completed the hepatitis B vaccine series?

The purpose is not to frighten women or encourage unnecessary testing. It is to prevent a detectable and often manageable infection from remaining hidden simply because it has not caused pain.