Three hundred thirty-seven community-based spouses were tested for the presence of hepatitis B virus (HBV) markers to assess the direction of HBV transmission between couples. The prevalence rate of HBV infection among husbands whose wives were hepatitis B surface antigen (HBsAg)-positive was higher compared with those whose wives were HBsAg-negative. Moreover, the frequency of HBV seropositivity among husbands was 100% if their wives carried HBeAg and showed a trend correlation (P = .009). The prevalence difference was 13.8%, and the 95% confidence interval (95% Cl) was 7.9-19.7% after adjusting for spouses' age. In contrast, HBV infection rate of wives did not show an association with the husbands' HBsAg or HBeAg carrier status. The prevalence difference was 7.1%, but 95% Cl was -2.5-16.8% after adjusting for spouses' age. Female to male transmission of HBV between spouses appears to be more efficient.