[Question #7044] Needle prick concerns
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61 months ago
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Hi doctors, writing in today with a concern about outside needles.
The other week, I happened to get pricked by what I believe to have been a needle (I didn't actually see it) while on the job. The work was outside - a long, private road away from the nearest signs of civilization - and the weather that day had already fluctuated between bright sun and torrential downpours. I believe the event was very low risk, but I still have some questions.
1. About 3 weeks have passed since then, with no signs of ARS other than what I think is a single lymph node directly behind my ear. My allergies have been acting up a bunch recently (both my sinuses and ears), so I feel inclined to believe that allergies are the root cause of my node. Could you consider it ARS if a person is suffering from a single lymph node with no other obvious symptoms (no fever, aches, rash, etc)?
2. I went into Quest Diagnostics this afternoon for an RNA test, following a 4th generation test at 2 weeks and a day - which I now realize was probably not conclusive. Can I count on the RNA test being accurate at this point?
3. All across the web (including this site), sources seem to be saying that over the last 40 years, not one reported case of HIV has come from being pricked by a needle outdoors. If my exposure was for a tiny fraction of a second, with a puncture mark (but no bleeding afterwards) visible on my finger, can I safely count this as a no-risk event?
Thank you so much for your advice.
The other week, I happened to get pricked by what I believe to have been a needle (I didn't actually see it) while on the job. The work was outside - a long, private road away from the nearest signs of civilization - and the weather that day had already fluctuated between bright sun and torrential downpours. I believe the event was very low risk, but I still have some questions.
1. About 3 weeks have passed since then, with no signs of ARS other than what I think is a single lymph node directly behind my ear. My allergies have been acting up a bunch recently (both my sinuses and ears), so I feel inclined to believe that allergies are the root cause of my node. Could you consider it ARS if a person is suffering from a single lymph node with no other obvious symptoms (no fever, aches, rash, etc)?
2. I went into Quest Diagnostics this afternoon for an RNA test, following a 4th generation test at 2 weeks and a day - which I now realize was probably not conclusive. Can I count on the RNA test being accurate at this point?
3. All across the web (including this site), sources seem to be saying that over the last 40 years, not one reported case of HIV has come from being pricked by a needle outdoors. If my exposure was for a tiny fraction of a second, with a puncture mark (but no bleeding afterwards) visible on my finger, can I safely count this as a no-risk event?
Thank you so much for your advice.
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Edward W. Hook M.D.
61 months ago
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Welcome to our forum. Thanks For your question. I’ll do my best to help and hopefully, relieve your concerns. The event you describe was, as you know, extraordinarily low risk. Because I read your post, it appears that you are not even sure that what stuck you was a needle. There are so many other sharp objects to be found in environments of the sort you describe. I know of no HIV infections ever acquired from being stuck with a needle found in the outside environment. Let’s work through your questions.
1. When persons have swollen lymph nodes due to HIV they are widespread, not solitary. The lymph node you describe certainly sounds as though it could result from allergies, a dental problem, or a respiratory tract infection. Most people do not routinely look for swollen lymph notes however when we start to look, we invariably find some at one place or another. What you describe is of no concern.
2. In RNA test at two weeks is generally considered conclusive although out of an abundance of caution, many experts recommend following the RNA test with a combination HIV antigen – antibody test at six weeks. I have never seen someone with a negative HIVRNA test at 14 days or beyond go on to have a positive antigen-antibody test.
3. I would certainly count the event that you describe is no risk.
I hope my comments have been helpful. If there are additional questions or anything is unclear please feel free to use your up to two follow-up questions for clarification. Take care. EWH
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61 months ago
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Doctor Hook, thank you so much for the reply. That does help ease my concerns a whole lot.
1. Going back and looking at my work gloves again, it does appear that there was a little patch of bleeding - I can still see some of the dried blood on the inside. However, this doesn't change the fact that the prick (needle or not) lasted for probably 1/10 of a second. Does the presence of blood change anything?
2. I really appreciate the info either way, but my test at 2 weeks + 1 day was a antibody-antigen 4th generation test, not an RNA test, which I took this morning. I know two weeks and a day is on the early side, but the site I used (stdcheck.com) says that the window period for 4th generation testing is 2-3 weeks after the event. Did that first 4th gen test (which was negative) count for anything? I'm 20 years old with a healthy immune system, so I feel like I might on the earlier side of possible immune responses.
Thanks again for your help!
1. Going back and looking at my work gloves again, it does appear that there was a little patch of bleeding - I can still see some of the dried blood on the inside. However, this doesn't change the fact that the prick (needle or not) lasted for probably 1/10 of a second. Does the presence of blood change anything?
2. I really appreciate the info either way, but my test at 2 weeks + 1 day was a antibody-antigen 4th generation test, not an RNA test, which I took this morning. I know two weeks and a day is on the early side, but the site I used (stdcheck.com) says that the window period for 4th generation testing is 2-3 weeks after the event. Did that first 4th gen test (which was negative) count for anything? I'm 20 years old with a healthy immune system, so I feel like I might on the earlier side of possible immune responses.
Thanks again for your help!
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Edward W. Hook M.D.
61 months ago
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Thanks for the additional information. Sorry if I misunderstood the timing of your RNA test. My assessment of your risk is unchanged. In answer to your questions:
1. The presence of blood indicates that a puncture occurred and, theoretically indicates a risk. The realistic risk however remains less than minuscule. No change in my assessment.
2. Your 2 week result offers modest comfort. At 2 weeks an HIV antigen/antibody test would detect more than half of recent infections. At 4 weeks, these tests would detect over 99% of recent infections. Your RNA test will provide the assurance you are looking for.
Please don’t worry. EWH
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61 months ago
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Thank you so much for the advice, Dr. Hook. I feel a lot better about things than I did a couple days ago. Just to wrap things up, I have a couple questions left.
1. Is 3 to 3.5 weeks too late for ARS symptoms to begin? I've been reading some of the other questions on here, and Dr. HHH says that even 2 weeks would be late for ARS symptoms to start.
2. If my lymph nodes were indeed inflamed, would they be large enough for me to notice? The only one that obviously sticks out is behind my ear, with none other on my body - as far as I can tell.
3. Could you classify just lymph nodes as an ARS symptom? Or is it the specific combination of lymph nodes, fever, muscle/joint aches, and a sore throat? If that's the case, would they all happen at the same time?
Thank you so much for your advice, I really appreciate it!
1. Is 3 to 3.5 weeks too late for ARS symptoms to begin? I've been reading some of the other questions on here, and Dr. HHH says that even 2 weeks would be late for ARS symptoms to start.
2. If my lymph nodes were indeed inflamed, would they be large enough for me to notice? The only one that obviously sticks out is behind my ear, with none other on my body - as far as I can tell.
3. Could you classify just lymph nodes as an ARS symptom? Or is it the specific combination of lymph nodes, fever, muscle/joint aches, and a sore throat? If that's the case, would they all happen at the same time?
Thank you so much for your advice, I really appreciate it!
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Edward W. Hook M.D.
61 months ago
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Final responses:
1. Typically The ARS begins at 10 to 14 days following exposure with increasing time beyond that it becomes less and less common and less and less likely. 3 to 3.5 weeks will be quite late for the ARS to begin experts believe that it may occasionally a curb up to four weeks following exposure.
2. As I said above, a trained clinician can find lymph nodes on just about anyone. I would I repeat, I would not worry about lymph node you have noted behind your ear.
3. Swollen lymph nodes are not a necessary part of the ARS. When the ARS occurs persons have high fevers, a severe sore throat, and muscle or joint aches all of which occur at about the same time.
As you know, we provide up to three responses to each clients questions. This is my third reply. Thus, this thread will be closed shortly without further responses. My sense is that you are worrying about this needle stick more than you need to. The event you describe was no meaningful risk for HIV. Your RNA test will be negative, your subsequent tests will be negative. I hope that between your test results and my comments you will be able to move forward without continued worry. Take care. EWH
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