[Question #5039] Risk of STD exposure?

26 months ago
Hello,  I am currently pregnant in my first trimester. I achieved this pregnancy via in vitro fertilization and was screened for all STDs as part of my pre-work up with my fertility doctor. At approximately 7 weeks pregnant, I suffered what I later learned was a subchorionic bleed while at work and I immediately visited  our inner-city emergency room for evaluation. As part of the ER evaluation, they performed a transvaginal ultrasound. The ultrasound technician had me insert the vaginal probe myself, and while I did,  I observed that she did not place a protective liner on the probe. I should have stopped and said something, but I didn't. I was in near hysterics as I believed I was having yet another miscarriage, and I just inserted it without the liner and she continued the exam. I later mentioned this encounter to my fertility doctor's nurse and their ultrasound tech.  They both were horrified, said this was "highly unusual" and likely a "breach of protocol." I asked if I was at risk of contracting an STD from this and they said it was unlikely as there are other disinfection measures that are likely in place.   I am still very concerned because if one protocol was broken, how am I to know if others were broken as well? So, my questions are this: 1) if the probe were not adequately cleaned prior to my exam, what is my risk of contracting an STD of any kind from this transvaginal exam? 2) More specifically, what is my risk of contracting the VIRAL STDs (Hepatitis, Herpes and HIV)? 3) In two weeks, I will transition from my fertility doctor to my regular OBGYN. Should I ask her to repeat my STD screening?  I'm very upset about this whole experience and concerned for my health and the health of my unborn babies. I appreciate your perspective on this matter and am grateful for this service. Thank you. 
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Welcome to our Forum.  Congratulations on your hard won pregnancy.  I will do my best to help.  I agree with your fertility doctor and his tech- this was a breach of protocol and most disconcerting.  It was also low risk-as they point out, there are other procedures in place for cleansing ultrasound probes and the protective sheaths are redundant.   

In answer to your specific questions:
1) if the probe were not adequately cleaned prior to my exam, what is my risk of contracting an STD of any kind from this transvaginal exam? 
I agree with your fertility specialist, your risk for any infection is very low.

2) More specifically, what is my risk of contracting the VIRAL STDs (Hepatitis, Herpes and HIV)? 
STIs are not typically transmitted on foreign bodies.  These viruses are very susceptible to drying, to room temperature, and to environmental exposure.  Your risk for herpes is effectively zero.  Your risk for viral hepatitis or HIV is theoretical.

3) In two weeks, I will transition from my fertility doctor to my regular OBGYN. Should I ask her to repeat my STD screening? 
Repeat STI screening is easy to do and I would encourage you to have it done for the peace of mind it will provide.  This should include testing for gonorrhea, chlamydia and trichomonas.  Blood tests for hepatitis, syphilis and HIV can be done but I would wait for 4-6 weeks after the event for these tests.  I believe that they will be negative and hope that they will provide you with peace of mind.  EWH
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26 months ago
Thank you, Dr. 

As a follow-up, can you clarify what you mean by theoretical risk? Does that mean possible but not documented? If I were your daughter in this situation, would you be worried for me?  I'm not trying to be ridiculous, I'm just scared. 

Also, my follow up appointment with my OBGYN doctor will be 25 days after the incident (3 days shy of 4 weeks). Would this an appropriate time to request the testing or should I try to delay by 3 days? 

My last question may or may not be something you can help me with. I feel so angry and upset that I have to be worrying about this rather than just being focused on my pregnancy (which is enough stress when you've lost as many pregnancies as I have). I feel like I should report this to someone.at the hospital, but I don't know who or how. Also, it's my word against hers, I suppose. There were only two of us in that ultrasound room. Do you have any advice? 

Thank you again. 
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
I am not aware of any infections transmitted in this way.  You want a 100% answer- they do not exist in science as something that did not exist or had not happened could be discovered tomorrow.  that is the nature of science.  I am not trying to be evasive, but to be clear.

Three days difference is not likely to make a difference in your test results.  

This is a matter of extreme concern to you.  You need some closure, if for no other reason, to make sure this does not happen again.  I would not call the ultrasonographer or her supervisor but the risk management department of the hospital.  At the very least, this will raise their awareness of this event.

I hope this helps.  EWH
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26 months ago
Thank you, Dr Hook.

I believe I am allowed one more reply. 

How long would you expect HIV to survive on a surface such as a probe? Minutes? Hours? Days?

I read somewhere that just because the HIV virus may be alive outside the body, doesn't mean that it still has the power to infect. Is this true? 

Thank you for your time. I'll be getting tested on Monday. Wish me luck! 
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
There are no scientific data on this.  Based on what is known, as well as the FACT that NO-ONE has ever been infected in the manner you describe, that HIV when exposed to the environment (air, room temperature etc.) would be non-infectious in minutes if not sooner. 

Your follow-up question suggests that you have been on Google looking for answers.  This is a bad idea- too much of what is found on the internet is out of date, taken out of context, misinterpreted, or just plain wrong.  I urge you to stay off the internet- it will not be helpful.

My sincere advice is to not overthink this.  Try to move forward.  Get tested as you plan and when you get a negative test, please put this behind you. 

As you point out, now, with this 3rd response, this thread will be closed without further responses. 

Take care, EWH
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