[Question #1953] Risk?

46 months ago
I am the one with the OCD of health issues.  I also am the one with the previous but now gone diagnosis of CIN1 (gone via 2 pap & colposcopies).  I went to Dermatologist (rated high is a professor at a major medical school here).  I had a spot on the labia minora and I wanted to find out what it was since I fear vulval hpv.  He looked said he thought it was a sebaceous gland  but took a biopsy.  Without me realizing as I was quite nervous, he circled the tiny area  with a pen then took a shave biopsy.   I am not sure if that was a clean pen and am scared I could have been contaminated with HIV or something.  How realistic is my fear.?   The area circled was smaller than a dime.
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
Welcome back to the Forum.  Today I happened to be on when your question "popped up" and will be answering this one.  Health-related OCD is a challenge- I hope my comments will be helpful to you.  Before we get into the specific of your questions, let's put HPV in context.  In a recently published study of the prevalence of HPV about 40% of American women ages 18-59 who were sampled once had HPV of which about half were infections with so called "high risk" types (I really have trouble with the term "high risk" when nearly everyone with so-called "high risk" HPV will have those infections resolve spontaneously.  Even the term higher is an overstatement.  These terms really only fuel concerns such as yours.)  Your concerns both about HPV (in past exchanges) and HIV are excessive.  I hope and trust that you are working with a professional to manage your OCD. 

As for your specific question, transmission of HIV or other infections with a shave biopsy is unheard of.  When a shave biopsy is taken only the upper layers of the epidermis are removed, not the lower layers of skin cells or underlying tissue.  As such, what is take are dead or dying skin cells, and to take them a new, sterile, disposable scalpel is used.  In this way there is no realistic chance of transferring infection from the procedure.  I would not be concerned at all about this and hope that my comments to this effect will be helpful to you.  EWH
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46 months ago
Ok, I am wrong it was a regular biopsy.  What I am concerned about is the use of the pen on the labia minora.  That can't be clean he used it prior to the biopsy to outline the area.  Could the pen have transmitted HIV to me?
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
No, I would have no fear of a pen or it's ink transferring infection of any sort to you.  EWH
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46 months ago
I believe the dr who again I say is a well respected dermatologist  used on the labia minora not a disposable scalpel but a metal one.  I looked recently at the area and it's probably the size of a grain of rice that he took for biopsy and not deep enough for a stitch.  Do drs offices get checked by an agency such as OSHA for how they sterilize their equipment?   I understand marking me with a unsanitized pen (tiny area) probably didn't give me AIDS (hopefully not hepatitis b either) but worried about if he wasn't worried about the pen issue does he really sterilize the scalpel and would cutting me that  tiny area (I was probably the first patient in the morning )would I be at risk.   This is hard with OCD.  I do see a therapist (actually saw him yesterday) . 
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
I can assure you that scalpels are not re-used in North America or Western Europe.  Sometimes the blades are replaced, other times the entire device is disposable but I promise you that your doctor would not use a scalpel on you that had been used on another patient.  Further, as I mentioned above, the superficial layers of skin remove with shave biopsies do not represent a manner win which HIV, hepatitis or any other infection could be introduced into you to cause infection.

I cannot comment on what sort of inspection process/credentialing is performed for private offices- just not something I deal with, sorry. 

I am quite confident that having  shave biopsy represents a no risk event for you in terms of HIV, hepatitis or other blood borne infection risk.  Congratulations on your choice to work with a therapist- Health-related OCD is a challenging problem. Please feel free to share this and my prior interactions with your therapist. 

EWH
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46 months ago
I don't think it was a shave biopsy seems a little deep but not enough I guess for a stitch since he didn't use one.  I understand he may not have used the scalpel on another person but what if he didn't sterilize it enough? Also, if he used the pen to outline someone else and hours or days later used the same pen on me then cut  the area is it still too small of a risk to cause issues?
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
This will be my 4th answer to your comments, one more than is called for by our guidelines.  This thread will be closed later today.

This comment is a bit redundant and may be reflecting your OCD.  You called it a shave biopsy, then called it a "regular" biopsy.  A "regular biopsy would have most likely be performed with a punch biopsy tool (again, disposable, used only on a single patient) whereas shave biopsies are taken using a scalpel.  Apparently there was no bleeding.  As I mentioned above, there is no indication, nor any scientific basis for believing that reuse of a marking pen or a scalpel used for obtaining a shave biopsy would put you at risk for HIV, hepatitis or any other blood borne infection.  Rather that worrying about such things (I realize it is difficult for you to do so), my advice would be to ask your dermatologist about your concerns.  I am confident that you will find that the scalpel used was not one that was re-used.  This being the case, you should also be confident that it was sterile when manufactured and brought to your doctor's office since such manufacturing processes are carefully regulated to insure sterility. 

I wish you the best.  I hope my comments have been helpful.  Take care.  EWH
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