[Question #2564] Stepped on a discarded syringe

42 months ago
I was walking on a trail passing a road.  I didn't think much about the potential for coming across something hazardous.  While walking, I stepped on a discarded syringe.  I was wearing athletic shows and didn't feel a puncture but I have nerve issues in my feet since childhood (congenital birth defect affecting both feet).  When we returned we noticed around five more syringes on the path I walked.  I alerted law enforcement.  It turns out that drug users are throwing the syringes out of their car windows after using on nearby park walking trail.  I went to the ER after it happened and they didn't feel I needed a PEP.  I returned yesterday because I couldn't believe that PEP isn't warranted, but they still didn't believe I needed a PEP and that there was no risk.  I am not sure if they're just brushing this off and I need to go get PEP immediately.  I am on vacation right now and have no other resources but the emergency department.  Should I rush back to the Emergency Department and beg for PEP?  I am a mess right now I would never of imagined this to happen.  Not in a billion years.  I had a workplace incident not long ago and just the bad luck is overwhelming.  BTW, I can post or send pictures of the discarded syringes.  So far the majority look like insulin syringes. Thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
Welcome to our Forum.  Your tale is a sad commentary on the extent of our nation's ongoing epidemic of drug use.  I will provide you with some comments which I hope you will find useful but ultimately how hard you press for PEP is a judgement call.  If you approached me at my office I would provide you with the following information, then leave the decision up to you.  Were it me, while I probably would not take PEP, I would get tested, not only for HIV but also for hepatitis C and, if not vaccinated, hepatitis B about 6 weeks after the event.  Here are the data:

PEP is highly effective in reducing HIV preventing most such infections, reducing the risk for infection by 80-90%.  The studies of PEP were performed in persons with known exposures to HIV by needle stick, usually in hospital settings.  The effectiveness of PEP was higher the sooner it was started and there was no benefit of PEP more than 72 hours after the exposure.  In hospital settings, the risk of a needle stick from a person with HIV is about 1 infection in 400 exposures.  Many people do not finish taking PEP, both because they forget to take it and sometimes because of drug side effects - about a quarter of persons on PEP experience side effects, most often GI upset.   (there is less data about the likelihood of infection with hepatitis viruses).

In the event you describe, you do not know that the persons who had used the needle you stepped on had HIV.  Most drug users do not (about 10% on average, rates vary).  Further, you do not know how long the needle had been there and this is an issue because the longer the interval since use, even if the user had HIV, the less likely any virus present would be infectious.  Thus your statistical risk for infection is in the neighborhood of 0.025% -less than 3 out of 10,000).  Considering this, I would consider your risk for infection as low but certainly think testing for HIB and hepatitis viruses about 6 weeks form now would be prudent. 

I hope these comments are helpful.  If any of this is unclear, please let me know.

Also, I was wondering, if you did not feel the needle stick, how did you know you had sustained a puncture?  Did you see the needle in the sole of your shoe?  Just wondering. EWH




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42 months ago
Thanks for the response.  When I stepped on the syringe I felt awkward in the sense that I knew something was under my shoe.  I looked down and the syringe was there. Thankfully, I didn't have to pull it out of my shoe.  I was moving pretty fast and the turf was rocky with intermittent grass and weeds.  If I got stuck by the syringe then it would of had to of removed after a step or two because it wasn't connected to my shoe when I looked, meaning it wasn't sticking in my shoe. The doctor looked for puncture marks on my feet and couldn't find any, but it should be noted that I often I have sores and blisters on my feet because of their unique structure.

Also, the syringes that i noticed looked kind of weathered.   I tried to attach a picture of one of syringes.  It's hard to see the needle because of the turf over top in the one phone but it is in place.  The picture quality is bad.  Hopefully, the picture attached.  It doesn't mean they weren't just used in desperation but I am guessing diseases might die after sometime in a syringe.  I read something like after a day the hiv is no longer able to infect in a syringe.  I am probably totally wrong, I don't really know much about this subject.  

I am nearing 48 hours since the incident and will be back home in roughly 12 hours.  So I could try another ER for PEP if needed.  If not, I guess I could take one of those rna pcr tests for early results.  Crazy times. Thanks for all your input.


42 months ago
I couldn't post the pictures in the previous post but here they are...

Thx again 




Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
Sorry, as a matter of policy, we do not look at pictures on our site.  there are two reasons for this- first, it gets close to practicing medicine which is not our goal or intent.  Second, the quality of the pictures typically are not helpful to allow analysis. 

From what you tell me (no visible puncture wound, the needle dislodged itself from your shoe), my assessment  of your risk is even lower than before.   That does not change that the choice about pursuit of PEP is an individual one but, were i you, personally, I would not do it. 

 A negative PCR test at two weeks after the event would rule out HIV.  EWH
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