[Question #11695] Oral with condom + vaccine syringe reuse
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12 months ago
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Hey doc ,
Day 1 - received oral sex with condom on and got on PEP (TLD) within 48 hours
Day 10- got a tiny accidental bite from a friends dog , it was a tiny red dot of blood and i visited the same hiv clinic to get the rabies vaccine. I was asked to take 5 shots on day 0,3,7,14,28 .
However on day 0 of the first vaccine shot i bought my own rabies vaccine box that comes with a syringe but forgot to get a tetanus shot along with it. So my doctor asked his assistant who is very unprofessional to get the tetanus vaccine. I don’t remember her getting a syringe with the Tetanus ampule (in my country the Tetanus ampule and syringe are bought separately)
I got the rabies vaccine on my left deltoid and the tetanus vaccine on my right deltoid. I remember the patient before me was hiv+ve (he dropped his prescription on his way out and I saw HIV+ written in red bold letters) , and Ive been thinking what if he reused the tetanus vaccine syringe from the patient before me accidentally. Because i saw him put my vaccine syringe on his desk for a while before he discarded it.
The next day I asked the doctor if he couldve reused the syringe and he said it’s “unlikely” . On the 28th day of my PEP i asked him to please let me extend my PEP (TLD) for 10 more days as i was injected with the Tetanus shot 10 days after i started pep and i took PEP for 40 days total.
How likely is it for Hiv , Hepb/c to transmit through a Tetanus shot with an IM syringe on the deltoid.
Please be patient with me , im going crazy.
Thanks alot doc.
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12 months ago
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Id like to add
How likely is it for Hiv , Hepb/c to transmit through a Tetanus shot with an IM syringe that was potentially reused from a hiv patient on the deltoid.
Also , the next day I checked the billing history of the pharmacy it included both the syringe and the Tetanus ampule. But i don’t remember the doctor opening the new syringe and asked the doctor if he could’ve accidentally reused the syringe from the previous patient and he said it’s unlikely. But the doctors desk was a mess when i visited and i saw him put the syringe on his desk for some time before he discarded it. I haven’t slept properly for a few days
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H. Hunter Handsfield, MD
12 months ago
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Welcome to the forum. Thanks for your question.
First and perhaps most important, you should not be on PEP after such an exposure. There has never been a proved case of HIV transmission mouth to penis, even without a condom. I'm amazed any doctor or clinic was willing to prescribe PEP after such an event.
My only comment or advice about the risks of re-used syringe or other injection equipment in the situation you describe is that probably it didn't happen; and even if it did, the risk of HIV or any other blood borne infection was zero or close to it. I wouldn't worry about it and certainly would not have extended PEP on account of this event. (With an HIV exposure while taking anti-HIV treatment, there was no need to add extra time to PEP.)
I see zero risk for all the blood borne infections you mention. If somehow I were in your situation, I would stop PEP, not be tested for anything, and would be continuing unprotected sex with my wife without worry of infecting her.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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12 months ago
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1. Why do you think this is a zero risk situation if the IM vaccine syringe was reused from a hiv+ patient (maybe)
2. Is TLD a good PEP regimen ?
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12 months ago
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Dolutegravir,Lamivudine, Tenofovir disoproxil 50/300/300.
4. Are IM syringes less likely to spread the virus compared to IV ?
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12 months ago
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Im really sorry i forgot to add, does TLD also act as prep if started taken 10 days before the potential syringe exposure thanks alot doc , i wont ask further questions
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H. Hunter Handsfield, MD
12 months ago
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1. Because there is no chance the syringe was re-used, or that the previous person on which you fear it was used almost certainly does not have HIV.
2. TLD works fine as PTP.
4. I don't see why there would be a difference.
Yes PEP drugs act as PEP if being taken when exposed to PEP.
The main effect of you taking PEP is to delay the time until you can have valid testing for HIV several weeks, until 6 weeks after your last dose of PEP. It''s really inappropriate and unnecessary.
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12 months ago
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Im sorry i think you misread the question. The previous person on which the vaccine syringe was used was hiv+. And im afraid the same syringe was reused to give me a tetanus shot.
I did not pay attention when the doctor was injecting me with the syringe and didn’t see him open a new one. Does him refilling the old used syringe with a new tetanus vaccine ampule reduce any risk of transmission? And how effective is PEP if i started the course just 1 hour after the IM injection
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H. Hunter Handsfield, MD
12 months ago
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Sorry I misunderstood the other person is known HIV positive. (How do you know?) Still, that you didn't observe your doctor opening a new syringe does not suggest he instead used the previous one. Nobody does that these days. If he did, I would assume PEP started within an hour would effectively prevent HIV. But I still believe PEP is not warranted. Have you asked the doctor? I'm confident he would confirm he did not use the previous syringe. Why would he have done something that dumb?
That concludes this thread. I hope the discussion has been helpful.
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