[Question #10818] Potential NeedleStick HIV Risk Evaluation

19 months ago

Dear Dr's.

I have been doing great for last few years, but today had an incidence that prompted bit of my anxiety and wanted to run my risk related to HIV transmission. I have contractor working in my house, he is originally from Mexico, married with kids, though he recently found his wife cheating so is taking divorce (sorry need to give this background). While working in my house today he asked to remove a tool from the pocket of his jacket that was hanging on a door. When I reached into his pocket I removed few objects and one of them to my horror was used insulin diabetic pen needle (very fine), it was capped on end that goes into skin but open on the other end (needle that goes into the pen, with needle exposed but not outside the rear cap. I asked him when he had last used his pen he said in the morning so it was 3 hrs before I pulled it out of his pocket.

I immediately dropped it and checked my hands for any puncture wounds. I did not find any puncture wound or blood on my hands. now my questions are below
1. What are my risk for HIV assuming I got hi by the rear end of this diabetic pen needle?

2. Should I go to ER and ask for PEP? Would you recommend your patients in this scenario for PeP?

3. Do I need to test at 6 week for HIV and Hep etc?

4. Should I continue unprotected sex with my wife of 20 years of marriage? Dont want to put her at any risk.

Thank you Dr's

H. Hunter Handsfield, MD

19 months ago

Welcome back, but sorry you again found it necessary. That's especially the case since I reviewed your previous threads, especially the two most recent ones (18 and 30 months ago). The answers to these questions are obvious from your prior discussions. Among other statements was this one

If you do not have sex with an infected person and do not have HIV infected blood injected directly into you, you will never get HIV. There is almost never a need to ask about any other possible exposure.

and this one, which you wrote yourself (and I certified as accurate)...

...so to summarize if I don't have unprotected sex with random/unknown person and do not share drug injection needles and do not get massive amount of blood on me like in car accident THEN I NEVER HAVE TO WORRY ABOUT HIV. Any other event or thoughts should be ignored.

1. From your description, obviously there was no needle stick. And in any case, you say nothing to suggest the contractor has HIV. But even if he does this was zero risk.

2,3. No I do not recommend testing for HIV or other blood borne infections and of course would not advice PEP. Probably no knowledgeable health care provider would agree to prescribe it.

4. You should continue your normal sex life at home.

I hope this doesn't come across as too direct or in some way unfeeling about your fears. Clearly they are real. But abnormal fears like this -- it's a form of germophobia -- rarely respond to detailed explanations or verbal hand holding. Even though your forum questions have been infrequent, they suggest your fears play a pretty important role in your life. Perhaps we have advised professional counseling before. It really should be a consideration for you. I hope you take the suggestion seriously and that it helps.

Best wishes-- HHH, MD

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19 months ago

Dear Dr, Yes for 2 years I have the anxiety under control, and I did take counseling as well, maybe take few more to completely eradicate this issue. Its a monster that suddenly come back when there is an incidence like this one that happened today.

To answer your questions, NO I don't know the HIV status of the contractor,. So to confirm one more time this was a NO Risk event after potential needlestick from diabetic pen needle, considering I don't know the HIV status of contractor? No Risk No Testing Enjoy happy life with wife. Just curious have you even seen or heard of HIV infection via diabetic pen needle with years of your experience in this field?

I have coped up with my anxiety with logic and that has helped me a lot. IN this case My logic was, Diabetic Needles are not like needles used to draw blood, they are very fine, holding less that drop of fluid in it. These needles are used to inject not draw blood, they are usually administered subcutaneously so no exposure typically to large quantity of blood, there is no backwash as is the case with drug syringes and blood if any is exposed to air and NO one has every been infected with needlestick in environment? Is my logic and thinking process all correct?

Thank you again, I promise to stay calm, composed and logical.

H. Hunter Handsfield, MD

19 months ago

No, I have never seen anyone who acquired HIV by contact with a diabetic's needles or lancets. To the best of my knowledge, no such case ever has been known, anywhere in the world.

This is not a psychological support service. But I suggest you listen to and rely on your own logical analysis, both for this particular event and for other obsessive worries about HIV when they arise again. And get back with your counselor: it seems there has been a relapse in your psychological health issues. Good luck with it.

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19 months ago

I will surely go back my counselor. I know I get only 3 follow up questions to ask before the thread is closed so below are my last few clarifications I need.

1. You said you have not seen any case of HIV on “contact “ with diabetic pen needle when you say contact do you mean actual prick with diabetic needle pen?

2. Your assessment is no risk because you feel Needlestick did not happen and you are probably right I did not feel any prick. But will your assessment still be no risk and no testing if I was sure I had Needlestick with diabetic needle (rear end) that goes in the pen

after 3-4 hrs of use by my contractor whose HIV history is unknown. .

Thanks again

H. Hunter Handsfield, MD

19 months ago

1. This is serious hair-splitting! There have never been any reported cases of HIV acquired by either injury or other contact with diabetic lancets, pens, needles, etc.

2. I would still consider this zero or near zero risk. All needle sticks known to have transmitted HIV have been with hollow needles that contained HIV infected blood. Solid needles are minimal risk. In any case, if you didn't have a visible injury that drew blood, there would be no chance of HIV transmission -- at least no such cases ever have been reported.

Please note the forum does not permit repeated questions on the same topic or exposure. This being your sixth with versions of the exact same questions -- and with the same answers each time -- it will have to be your last one; future new questions along these lines will receive no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. (In the event of future concerns like this, I suggest you go back and re-read your previous threads and the replies. The answers were there even if the details are somewhat different. Thanks for your understanding.

Best wishes and stay safe.

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