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Medical Treatment Accident
Apr 11, 2002

I work in a cancer center and I was assisting a therapist, who was administering palliative treatment to a patient with Kaposi's sarcoma and, seemingly, the whole gamut of STDs. Perhaps, I was a bit more tense around this patient than I typically am around patients who aren't quite so ill, but in an attempt to avoid touching some of the open wounds on the patient's skin, I inadvertently jerked into the needle that the therapist had just used on the patient. Since his viral load was so high, I'm very concerned with my chances for seroconversion, not to mention the potential for contracting whatever else he had. I've been tested for HIV and had been vaccinated for Hepatitis B, and so far everything is negative, but given the situation, I'm still pretty paranoid. From what I understand, the patient also had tertiary syphilis and HSV-2. Is it possible to transmit these via a needle-prick accident?

I hope you can allay my fears somewhat. Thank you in advance for your help.

Response from Dr. Frascino

Hello,

Did you sustain a significant needle stick when you jerked into the needle? If so, yes, the exposure is significant, as I assume the needle was hollow-bore. I would recommend you review the CDC's guidelines for evaluation and management of occupational exposures to blood-born pathogens.

Your overall risk for HIV is 0.03% (that's a 1 in 300-400 chance). You should also be screened for hepatitis C. Fill out an incident report form to document the exposure. You should also consider post-exposure prophylaxis, depending on when this incident occurred. The choice of antiretroviral agents would depend on what the source patient was taking and his resistance profile. An HIV specialist can help you make the proper selection of medications and discuss the pros and cons of taking or not taking PEP, as well as details about the individual drugs. Because of your significant exposure risk, I'd recommend you follow the CDC guidelines for testing up to the full 6 months. Try not to be paranoid. Most exposures do not result in seroconversion, but I would follow the guidelines nonetheless. The CDC/MMWR website with the revised guidelines is: www.cdc.gov/mmwr/preview/mmwrhtml/rr5011al.htm.

Good luck.

Dr. Bob


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