[Question #1945] indirect transmission

89 months ago

Dear doctor,

Five days ago I visited a dermatologist, who examined an old mole situated next to the urethra of my penis. In order to examine the mole, he placed the dermatoscope (without cleaning it first) on the penis and touche my penis glan, may be the urethra as well. It was Monday morning and I believe that I was his first customer for the day, therefore the dermatoscope could not have been used on another patient for several hours. Is there any risk for any std or other infection? What if he had placed the dermatoscope on other patients, in order to identify skin infections and there was blood on the dermatoscope? Could I have contracted hepatitis b or c if there was blood on the dermatoscope from the previous patient?

Further to the above, is there any risk for any std, including hepatitis b or c from using scuba gear (snorkel tube) of others? Everybody says that indirect transmission of hepatitis is possible, beacuse the virus survives well on the enviroment, but you reject this way of transmission. Can you elaborate?

Edward W. Hook M.D.

89 months ago

Welcome to our Forum. Of late we have had several questions about indirect transmission of HIV or hepatitis B or C viruses. While not entirely devoted to the topic you have asked about, please look at the answers to questions 1932 and 1941 as well as this response. The basic message here is that HIV and hepatitis is ONLY transmitted through direct sexual contact and through injection of infectious material deep into tissue with a hollow point needle or similar device. There are no instances that either of us is aware of in which HIV has been proven to be transmitted through medical devices such as a dermatoscope applied directly to the skin, by contact (or unbroken or broken skin) with surfaces (counters, toilet seats, gloves) which have been contaminated with infectious secretions and/or blood. Similarly, there are no instances in which HIV has been proven to be transmitted through contact with eating utensils, glasses, or food which has been contaminated by infectious material. Support for these statements not only comes from the fact that neither HIV nor hepatitis B or C has ever been proven to be transmitted by kissing, even open mouth, "deep" kissing. Thus I would not worry at all about the contact you mention with the dermatoscope or by using a snorkel that was previously used by a person with HIV.

I am not sure what you mean by the statement that "everybody" says that indirect transmission of hepatitis is possible. If you are discussing information gotten from the internet, I would urge you to ignore this- it is an incorrect statement. While HIV is a somewhat less fragile and more infectious virus than HIV, there are still no instances in which indirect transmission has been a concern and the virus clearly also becomes non-infectious upon exposure to the environment, to water, or to drying. . I see no reason for worry about your contact with the dermatoscope or shared scuba/snorkeling gear. similarly, there is no reason to test.

I hope these comments are helpful. EWH

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89 months ago

Dear doctor,

Your reply seems to refer to hiv while my main concern, as stated in my initial post, is hepatitis b and c. Does your reference to indirect contact apply to hepatitis b and c as well?

With regards to my note that “everybody states that indirect transmission of hepatitis is possible” I mostly refer to the fact that hepatitis virus seems to survive in air for days while hiv dies almost instantly. Assuming that hepatitis virus does indeed survive for days, indirect transmission seems possible. Is this assumption correct?

Lastly, my main concern from the fact thjat the dermatoscope was places on my penis, is that the dermatoscope could have been placed on open sores of others. Is it true that the dermatoscope is only used for identifying moles or other lesions as well?

Thank you in advance.

Edward W. Hook M.D.

89 months ago

Sorry for my focus on HIV, most of our clients are focused on HIV and seem to add hepatitis to their lists as they are other blood born illnesses. That said, what I stated about HIV also is true for hepatitis B and C. Transmission of these viruses is virtually entirely through parenteral (i.e. with needles) or sexual transmission. Despite the fact that hepatitis C virus (and perhaps hepatitis C) may remain viable longer than HIV following exposure to air and drying, there is no evidence that these viruses are transmitted by touching, either directly or indirectly (like through transfer on an inanimate object like a dermatoscope). For the same reason, there are no recommendations to avoid shaking hands or touching people who have these infections. I would have NO concerns about transmission through indirect contact and would encourage you to not worry either.

Magnification of skin lesions is a great help to diagnosis and recognition of what is present. On the other hand, there is little to be gained with magnification of open sores. While I do not use a dermatoscope, I cannot imagine that anyone would apply them to an open sore or use them in a way which would put you at risk for acquisition of infection through contamination and indirect transfer of any infection, including hepatitis viruses. EWH

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89 months ago

Dear doctor,

When I asked about the possibility that the dermatologist may had placed the dermatoscope on the open sore of another patient, I meant that the dermatoscope may had been placed on the skin of another patient with a skin infection that involved open lesion and esposure of blood (for example herpes or syphilis). In such a case, the blood of the other patient would be on the dermatoscope.

Is this usual or is the dermatoscope used only for melanomas, basal cell canrinomas, moles etc, that do not bleed.

Thank you in advance.

That will be my last post.

Edward W. Hook M.D.

89 months ago

This question is a bit redundant. When I said "Magnification of skin lesions is a great help to diagnosis and recognition of what is present. On the other hand, there is little to be gained with magnification of open sores. While I do not use a dermatoscope, I cannot imagine that anyone would apply them to an open sore or use them in a way which would put you at risk for acquisition of infection through contamination and indirect transfer of any infection, including hepatitis viruses." above, it was meant to indicate that I cannot conceive of why a dermatologist would use a dermatoscope on an open sore or lesion. This would include herpes and syphilis lesions.

I see no reason for you to be concerned about your dermatologist's use of a dermatoscope.

As you know, this is my third reply to your questions. As indicated in our Guidelines, this thread will be closed in a few hours.

Take care. EWH

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