Chronic hepatitis B is often described as a silent condition. The virus can quietly cause damage to the liver for years without producing any symptoms at all1. That is exactly why it is easy to miss.
In Singapore, estimates suggest that around 3.6% of the population may have hepatitis B2 3, and some may not know they have the infection. Many people only discover they are carriers by chance — when donating blood, going for a health screening, or being tested before a vaccination1.
For those with chronic hepatitis B, the news is more encouraging than it may sound. The condition is manageable, and regular monitoring with your GP is what keeps it that way.
What is Chronic Hepatitis B?
Hepatitis B is a virus that infects the liver. A new infection is described as acute and covers roughly the first six months, during which most healthy adults clear the virus and recover with lasting immunity. When the virus remains in the body beyond six months, it is considered chronic4.
In a chronic infection, the virus causes ongoing inflammation of the liver. Over many years, that inflammation can lead to scarring of the liver tissue, known as cirrhosis, and in some cases, progress to liver failure or liver cancer4. These changes develop gradually and usually without symptoms, which is why they can progress unnoticed.
However, not everyone with chronic hepatitis B develops serious liver disease. But carriers do face a substantially higher risk of liver cancer than people without the virus3, and that risk is the reason regular hepatitis B screening and monitoring are important for detecting changes early.
How Hepatitis B Spreads
Hepatitis B is carried in blood and certain body fluids. It can be passed on through2:
- Transmission from mother to baby at or around the time of birth
- Contact with infected blood, including through shared needles
- Unprotected sex with someone who has the virus
- Sharing personal items such as razors or toothbrushes that may have traces of infected blood on them
It is just as important to know how hepatitis B is not spread. You cannot catch it from hugging someone, shaking hands, coughing, sneezing, or sharing food and utensils3. Carriers can share meals with their families, work alongside colleagues and live ordinary lives without putting others at risk through everyday contact.
What Are the Symptoms of Chronic Hepatitis B?
Many people with chronic hepatitis B have no symptoms. When symptoms develop, particularly if the liver has become inflamed or damaged, they may include:
- Persistent tiredness
- Loss of appetite
- Nausea or vomiting
- Discomfort or pain in the upper-right side of the abdomen
- Tea-coloured urine
- Pale-coloured stools
- Yellowing of the skin or whites of the eyes, known as jaundice
These symptoms can also be caused by other conditions and do not necessarily mean that you have hepatitis B. See a doctor if you notice yellowing of the skin or eyes (jaundice), experience severe abdominal pain, persistent vomiting or abdominal swelling.
Hepatitis B Screening and Diagnosis
Because chronic hepatitis B so often causes no symptoms, screening is the only reliable way to know your status. A simple blood test can tell you whether you currently have the virus, have recovered from a past infection, level of immunity and how you can benefit from a hepatitis B vaccination.
The results usually rest on three markers, and it's the combination that tells the full story rather than any single one.
- HBsAg (hepatitis B surface antigen) — indicates a current infection. If it stays detectable for at least six months, the infection is considered chronic.
- Anti-HBs (surface antibody) — indicates immunity, whether from a past infection or from vaccination.
- Anti-HBc (core antibody) — indicates past or present exposure to the virus. It does not appear from vaccination, which helps distinguish someone who has encountered the virus from someone who is protected by their jab.
If your result shows a current infection (HBsAg positive), your GP will interpret it alongside your history and may repeat the test after six months to confirm whether the infection is chronic. Further blood tests can show how active the virus is and how well your liver is working. This will guide whether you need treatment or monitoring.
Who Should Consider Hepatitis B Screening?
You may be more likely to be a carrier and should consider speaking to a GP about hepatitis B screening if you:
- Were born before Singapore introduced universal newborn hepatitis B vaccination on 1 September 19872
- Were born in a country where hepatitis B is common
- Have a mother who is a hepatitis B carrier, as most infections here are acquired at birth or in early childhood1
- Live with, or have a sexual partner who is, a carrier of hepatitis B
- Have previously shared needles or equipment that may have been exposed to blood
- Have had a needlestick injury or another possible exposure to infected blood
If any of these apply to you and you've never been tested, speak to a GP about whether hepatitis B screening is right for you. The same goes if you're unsure whether you've been vaccinated or are already protected — your GP can advise on the right next step.
Talk to a Healthway Medical GPManaging Chronic Hepatitis B
Current treatments do not usually eliminate hepatitis B completely, but the condition can often be managed effectively5. The goals are to protect your liver, identify changes early, and prevent the virus from being passed on.
Protecting Your Liver
Regular Monitoring
Regular follow-up is a central part of chronic hepatitis B care. Your doctor will recommend a monitoring schedule based on factors such as your liver health, viral activity, age, family history and whether you are receiving treatment.
These reviews repeat the liver-function and viral-activity blood tests used at diagnosis, tracking any change over time. Some people also need regular liver ultrasound scans to check for liver damage and screen for liver cancer.
Chronic Hepatitis B Treatment
Not everyone with chronic hepatitis B needs medication. Whether you do need treatment depends on how active the virus is and whether your liver shows signs of inflammation or damage. Your age, family history, other health conditions and risk of complications may also be considered.
For those who need it, antiviral treatment can suppress the virus and reduce the risk of liver damage and its complications5. Your doctor will advise whether treatment is appropriate for you.
Importantly, starting treatment does not replace the need for regular monitoring. Treatment and follow-up work together to protect your long-term liver health.
Everyday Habits
Alongside medical care, a few habits can help protect your liver:
- Avoid alcohol, or keep intake to a minimum as advised by your doctor
- Maintain a healthy weight, as fatty liver can cause additional liver damage
- Check with your doctor or pharmacist before taking new medications, supplements or traditional remedies, as some can affect the liver
- Attend your scheduled reviews even when you feel well
Protecting the People Around You
The best way to protect those close to you is to make sure they are screened and, where needed, vaccinated. Household members and sexual partners can have a blood test to check whether they are already infected, already immune, or neither. Anyone who is neither infected nor immune can be protected with the hepatitis B vaccine2.
If you are pregnant or planning a pregnancy, tell your doctor you are a carrier. Transmission from mother to baby can be prevented in most cases when the right steps are taken during pregnancy and shortly after birth2.
Chronic Hepatitis B Care at Your GP
A GP is a suitable first point of contact, whether you want to check your status, have just been diagnosed, or have lived with chronic hepatitis B for years.
Your GP can support you by:
- Screening and Testing — check whether you have hepatitis B or are already immune, either on its own or as part of a health screening
- Monitoring your liver — arrange follow-up blood tests and liver imaging based on your risk and clinical needs
- Advising on treatment and referrals — assess whether antiviral treatment is appropriate and refer you to a specialist when needed
- Protecting your household — Screen and vaccinate family members and close contacts
- Coordinating your care — manage hepatitis B alongside any other long-term conditions
- Advising on daily habits — guidance on alcohol, weight, and medicines or supplements that can affect the liver
Using MediSave for Chronic Hepatitis B Care
Chronic hepatitis B is covered under Singapore’s Chronic Disease Management Programme, also known as CDMP, having been added to the programme on 1 July 20226. Eligible Singapore Citizens and Permanent Residents may use MediSave to offset eligible outpatient hepatitis B treatment costs at accredited GP clinics, subject to prevailing scheme limits and eligibility criteria.
From 1 February 2024, patients receiving treatment for a CDMP condition from their enrolled Healthier SG primary care physician may use MediSave to fully pay their bill, up to prevailing withdrawal limits, without the 15% cash co-payment7.
All our GP clinics at Healthway Medical are accredited CDMP providers. If you are a hepatitis B carrier and not yet enrolled in Healthier SG, speak to your Healthway Medical GP at your next visit.
Find a Healthway Medical Clinic Near YouFrequently Asked Questions About Chronic Hepatitis B
Current treatments do not usually eliminate chronic hepatitis B completely, but they can suppress the virus and reduce the risk of liver damage. Regular monitoring also helps identify changes early. With appropriate care, many people continue to live well with the condition.
No. Hepatitis B is not spread by hugging, casual contact, coughing, sneezing, or sharing meals and utensils. ² It spreads through blood and certain body fluids. Your household can still be screened and vaccinated for reassurance and protection.
Not necessarily. Many carriers do not need medication. But feeling fine does not mean you can skip monitoring. The liver can be affected without causing symptoms, so regular reviews are recommended even when you feel completely well.
Yes. Household members and sexual partners should be tested to see whether they are already infected or immune. Anyone who is neither can be protected with the hepatitis B vaccine.
Tell your doctor you are a carrier if you are pregnant or planning a pregnancy. With the right precautions at birth, transmission from mother to baby can be prevented in most cases.
Both affect the liver, but hepatitis A spreads through contaminated food and water and does not become chronic, while hepatitis B spreads through blood and body fluids and can become a long-term infection. You can read more in our guide to hepatitis A and B. Vaccines are available for both hepatitis A and B viruses.
References
- SingHealth. Hepatitis B. https://www.singhealth.com.sg/symptoms-treatments/hepatitis-b
- Communicable Diseases Agency, Singapore. Hepatitis B. https://www.cda.gov.sg/professionals/diseases/hepatitis-b/
- HealthXchange, Singapore General Hospital. Hepatitis B: Symptoms, Treatment and Prevention Tips. https://www.healthxchange.sg/how-to-prevent/hepatitis-b/hepatitis-b-need-know
- National University Hospital. Hepatitis B. https://www.nuh.com.sg/health-resources/diseases-and-conditions/hepatitis-b
- World Health Organization. Hepatitis B (fact sheet). https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
- Ministry of Health Singapore. Chronic Disease Management Programme (CDMP). https://www.moh.gov.sg/others/resources-and-statistics/chronic-disease-management-programme-cdmp/
- Ministry of Health Singapore. MediSave — Outpatient Care. https://www.moh.gov.sg/managing-expenses/schemes-and-subsidies/medisave/outpatient-care/
This article is for general information and is not a substitute for personalised medical advice. Please consult a doctor for guidance specific to your health.
