[Question #1868] HIV via needle stick

43 months ago

Hello,

 

Thanks for taking my question. This question is part of a behavioral plan I’m participating in with a mental health professional for my GAD and OCD.

I experience significant and localized anxiety surrounding the possibility of being infected with HIV via a needle stick (or other percutaneous exposure) in public settings. As a result, I experience increased vigilance and participate in checking behavior, avoidance behavior, etc., usually operating under the “what if” question about mistaking an object for a needle, accidentally being poked by a needle, not realizing I’ve been poked, scraped, etc. by a needle. My behavioral plan includes minimizing my checking and avoidance behavior. This question (and your answer) is meant to facilitate that process – my provider emphasizing that I mention that any answer provided to me can only reduce, not eliminate, uncertainty.

The research my clinician and I completed indicates that the possibility of contracting HIV via a needle stick is approximately a 1 in 300 chance per exposure. Further, it appears that this chance is further reduced because 1) even were I to encounter a needle in public, it would be unlikely it would be contaminated with HIV infected blood and 2) even if it were, the HIV virus would not likely transmit the virus since it would have been exposed to room and//or external temperatures, air, etc. and therefore damaged and 3) typically a deep wound is required for transmission of HIV – a wound I would almost certainly notice.

Thus, my question is, if I were to be accidentally stuck//poked with a needle in a public setting, would this still be a negligible risk (e.g., one that does not warrant any PEP) whether I notice the needle poke//scrape or not?

Thanks for answering

Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
Welcome to the Forum.  I'll be happy to comment on your questions and add some perspective.  As an infectious disease expert, the needle stick events I worry about occur in clinical settings, not only for all the reasons that you mention but also because in a clinical setting:
1.  You are more likely to be stuck with a fresh needle which was used recently and therefore there has been less time for the viruses' infectivity to decay.
2.  Person in clinical settings are somewhat more likely to be infected than needles encountered outside of clinical settings.  This is because HIV infected persons are more likely to be encountered in such settings, as they attend for care or for follow-up.

On the other hand, in public settings, IF you were stuck with a wayward needle, odds are that he person who had used it do not have HIV- most IV drug users do not have HIV.  Further exposure of the needle and its contents to the environment, as you point out, would reduce/negate infectivity.  Finally, sticks in such setting, when they occur tend to be superficial and DO NOT involve injection of contents, further reducing the risk for infection.

For all of these reasons, as you point out, your risk for infection would be negligible.  I hope this perhaps overly long affirmation of your thoughts and process is useful and helpful.  O this Forum my colleagues and I spend much time trying to counter misperceptions and unwarranted fears about HIV acquisition from environmental exposure.  I congratulate you on talking your HOCD and anxieties' head on.  I wish you the best.  EWH

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43 months ago
Thanks Dr. Hook, I appreciate your reply. It was prompt and helpful.

One clarification: is the 1 in 300 risk of contracting HIV via needle stick based on data in which the needle doing the sticking was known to be used on a patient with HIV? Or is this a general 1 in 300 for all hospital//clinic setting needle sticks? Regardless of the all swer to this clarification question, I assume your advice (no need to test, no need for concern regarding environmental needle stick exposure I described in my original question) remains the same.

Thanks again!
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
The one in 300 figure is the figure that you used in your original question as well as the figure given by the CDC as the risk of HIV infection following being stuck with an HIV contaminated needle  in a healthcare setting. The risk of needlesticks outside of healthcare settings is almost certainly lower. 

 And yes you are correct, I see no need for testing related to the exposure you described in your original question. EWH
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43 months ago
Doctor,

I understand that I'm allowed one more follow up. I appreciate this.

Thanks so much for your advice thus far. It's significantly reduced the distress associated with my not participating in checking//avoidance behavior, which is very nice! So thank you so much for this. It means a lot to me to be able to confidently reduce my problematic checking and avoidance behavior.

 My final follow up question is similar. As part of my treatment plan, I'm also going to a local gym multiple times a week for exercise. I see men shaving in the locker room frequently. If I were I to be accidentally scraped by another man's razor, while they are shaving or as they are walking to and from the sink area, is it true that this would also be a negligible risk and not warrant testing? 

Perhaps the more abstract way of phrasing my question is this: As long as I don't have unprotected sex or share needles, can I assume that any pokes or scrapes with any object in an environmental setting (that's not a hospital) is not something I should be concerned about and not something that poses a risk or warrants testing?

Thanks again and I appreciate the chance to ask this final follow up.
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
I like your second version of this question better than the first. After all, I suspect you appreciate that the risk of sustaining a razor scrape from a HIV infected man in your locker room is incredibly low.  Far better to say that if you don't have unprotected sex or share needles, you can assume that any pokes or scrapes with any object in an environmental setting (that is not a hospital) is not something you should be concerned about and not something that poses a risk or warrants testing.  This is a statement that I can endorse and agree with.

With that this will complete this thread.  The thread will be closed in a few hours, as per forum policy.  I wish you the best.  Take care. EWH

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