What does it mean if the hepatitis B surface antigen test is negative?

Sep 02, 2025 Source: Cainiu Health

Dr. Gao Jun

Introduction

In general, a negative hepatitis B surface antigen result usually indicates that an individual does not have an active hepatitis B virus infection, which is normal and requires no action. If an individual has never received the hepatitis B vaccine or has low levels of hepatitis B surface antibodies, it is recommended to consult a physician regarding the need for vaccination to enhance protection against the hepatitis B virus, even if the test result is negative.

Generally, a negative hepatitis B surface antigen (HBsAg) result usually indicates that an individual does not have an active hepatitis B virus infection, which is considered normal and requires no intervention. Detailed analysis is as follows:

A negative hepatitis B surface antigen result typically means the individual has no active hepatitis B virus infection and is considered a normal test outcome, requiring no special treatment. This indicator is one of the key markers used to determine whether an individual has been infected with the hepatitis B virus. A negative result indicates that hepatitis B surface antigen is not detected in the body at present, suggesting a low likelihood of infection and no active viral damage to the liver.

If an individual has never received the hepatitis B vaccine or has low levels of hepatitis B surface antibodies, it is recommended to consult a physician regarding vaccination to enhance resistance against the hepatitis B virus. Even with a negative test result, maintaining healthy lifestyle habits is important, including avoiding the sharing of personal items such as toothbrushes and razors that may come into contact with blood, to reduce the risk of infection. Regular health checkups and monitoring of hepatitis B-related indicators can help detect abnormalities promptly and better protect liver health.

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What should you eat if you have mild hepatitis B (small three positives)?

In general, patients with "small three positives" (chronic hepatitis B with positive HBsAg, anti-HBe, and HBV DNA) should support liver health through diet while using medication to control the condition. Recommended foods typically include eggs, broccoli, sea bass, spinach, and oats. Commonly used medications include entecavir dispersible tablets, tenofovir disoproxil fumarate tablets, silybin capsules, compound glycyrrhizin tablets, and hepatoprotective tablets.

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How to determine normal results for the five hepatitis B tests

Under normal circumstances, the main results of the five hepatitis B tests include all negative, only hepatitis B surface antibody positive, and hepatitis B surface antigen negative with hepatitis B surface antibody positive. Additionally, determining whether the five hepatitis B test results are normal requires a comprehensive analysis of all indicators; a single result should not be viewed in isolation. If there are doubts about the test results or if the hepatitis B surface antigen is positive, further evaluation may be necessary.

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What is the difference between "big three positive" and "small three positive" in hepatitis B?

Under normal circumstances, the main differences between hepatitis B "big three positives" and "small three positives" include different viral markers, varying levels of viral replication activity, differing degrees of infectivity, different risks of liver damage, and distinct treatment strategies. In addition, patients with either hepatitis B "big three positives" or "small three positives" should undergo regular liver function tests and hepatitis B virus DNA testing.

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Can hepatitis B 'small three positives' be transmitted between spouses?

HBV small three positives refers to a situation in the five-serum marker test for hepatitis B where the hepatitis B surface antigen (HBsAg), hepatitis B e antibody (HBeAb), and hepatitis B core antibody (HBcAb) are positive, while the other two markers are negative. Generally, transmission between spouses may occur in such cases. The uninfected partner should regularly monitor their hepatitis B antibody levels and receive hepatitis B vaccination or booster shots if the antibody titer is insufficient. Protective measures can also be taken during sexual activity, according to a physician's recommendation.