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3rd times a charm-you do amazing work
Mar 27, 2009

Hello, Doctor Four weeks back I snorted cocaine several lines with a woman of unknown status(I was negative prior to this).I don't know if there was any blood nor was I looking,exactly 14 days later I woke up to 4 red bumps in my pubic region,dermatologist said could be bites,could be viral,16 days after incident I came down with a stomach ache and cold type feeling minus sneezing/sniffling that lasted 4-5 days,one week after that a fairly consistent stiff neck.Does this sound like ARS,can you tell me about my risk.Want to donate,your work is amazing!!

Response from Dr. Frascino

Hi,

Apparently the second time was the charm. See below.

Dr. Bob

DR.please help Mar 25, 2009

Three weeks back I snorted several lines of cocaine with a woman of unknown status(not something I normally do,too much alcohol at a party).I did not notice any blood nor was I looking.My nose was bloody for days afterward when blowing it.Exactly 14 days later I awoke to four red bumps in my groin area,dermatologist said could be bites or could be viral,two days after that I came down with a stomach ache that has lasted six days now,severe first three days now mild.Additionally had a headache and feeling of a cold minus the stuffines and sneezing.One week after stomach ache got a fairly consistent stiff neck.My concern is HIV risk,I have no explanation for the rash and timing.I did not have sex that night and my status was negative prior to that.Please advise regarding risk and testing.Could this be ARS

Response from Dr. Frascino

Hi,

Snorting coke is never a good idea. There is a theoretical risk for transmission of bloodborne diseases such as HIV and hepatitis C (see below). The risk is slight, but if you remain worried, you should be screened for these diseases at the three-month mark. I strongly doubt your symptoms are HIV ARS-related.

Good luck.

Dr. Bob

Shared Cocaine Snorting Straw With Someone, and Worried (HEPATITIS C and SNORTING COCAINE, 2008) Oct 27, 2008

About two weeks ago I shared a straw to snort cocaine with a friend twice in one night. Now I am feeling extremely worried that I could have contracted HIV, Hep C, or Hep B. How much of a risk did I put myself at? I don't recall noticing any blood on the dollar bill we used if that's at all important. Thanks for your time.

Response from Dr. Frascino

Hi,

The risk is theoretical. I'll post below the summary of a very recently published article that supports the theoretical risk that hepatitis C could be transmitted via a rolled Ben Franklin.

Your risk from snorting only twice and not noticing any blood on the dollar bill would be extremely low at best. However, even you have not contracted a bloodborne pathogen, such as HIV or hepatitis, I'm still concerned about your health, because you are using cocaine. Cocaine can rob you of your health and happiness in many ways. I urge you not to use it.

Finally, if you remain concerned about HIV and hepatitis, get tested. Remember to wait for the three-month mark for the HIV test so that the answer will be conclusive.

Good luck.

Dr. Bob

Evidence to support belief in transmission of hepatitis C by sharing drug sniffing equipment printer friendly version send to friend glossary comment

Roger Pebody, Thursday, September 11, 2008

Hepatitis C can be detected in the nasal passage, and in straws which are inserted in the nose, report researchers in the October 1st edition of Clinical Infectious Diseases. Their findings support the hypothesis that hepatitis C can be transmitted by sharing straws or banknotes which are used to snort drugs.

The theory of hepatitis C transmission through this route is that frequent or long-term sniffing or snorting of drugs such as cocaine can cause damage and bleeding in the nasal passage. Straws or banknotes that are inserted in the nose could come into contact with hepatitis C infected blood or mucus, which may then be transmitted to someone else sharing the same straw.

In recent years there have been numerous outbreaks of hepatitis C among HIV-positive gay men in Europe. Whilst there is a growing body of evidence that infection is associated with sexual practices including fisting, use of sex toys and group sex, some studies have also suggested that sniffing drugs may contribute to transmission.

At the same time, in many countries up to a quarter of hepatitis C infections remain unexplained, with individuals reporting no risky practices such as use of shared drug injection equipment.

And a number of epidemiological studies in largely HIV-negative populations (typically, blood donors or street drug users who do not inject) have found an association between snorting drugs and hepatitis C infection. Nonetheless not all studies have reported this finding, and there have been some criticisms of the methodological quality of these studies.

However, until now no study has examined the virological plausibility of the belief that sharing equipment to sniff drugs may contribute to hepatitis transmission. Investigators in New York therefore recruited 38 adults who snort drugs and have hepatitis C at a neighbourhood health clinic.

Tests conducted included:

Nasal swabs to test for the presence of hepatitis C and blood in the nasal passage

Each subject was asked to inhale air through plastic straws, which were then tested for hepatitis C and blood

An examination of the nasal cavity to check for disease.

In these tests, hepatitis C RNA was detected using the same sort of technology as a viral load test.

A third of the sample was coinfected with HIV, and 45% with hepatitis B. Hepatitis C viral load varied widely in the sample, with a mean of 5000 copies/ml. Liver function tests for ALT (alanine aminotransferase) indicated some damage, with a mean of 47 u/l.

The researchers were able to detect hepatitis C on 13% of the nasal swabs, and on 5% of the sniffing straws.

Blood was detected in the samples more frequently than hepatitis C. However whether blood was present or not did not predict whether hepatitis could be found. For example, of the five nasal swabs that were positive for hepatitis, there were no traces of blood on two of them.

Pathologies and damage to the nasal passage could increase the risk of hepatitis transmission. Among other problems, more than four out of ten subjects reported having a runny or stuffy nose at least once a week. Rates of inflammation of the nasal membrane were high at 71%, while rates of inflammation of the sinuses were normal.

It is known that hepatitis C can remain infectious outside the body for up to 16 hours. However the authors acknowledge that little is known about the quantity of virus needed for transmission. They suggest that when drugs are being snorted, there is greater discharge of nasal fluids and blood, and the quantity of virus is likely to be larger.

The authors believe that their most significant finding is that hepatitis C can be transferred onto sniffing implements. Nonetheless they recommend further studies to confirm this mode of transmission and its contribution to the spread of hepatitis C.

Reference Aaron S et al. Intranasal transmission of hepatitis C virus: virological and clinical evidence. Clinical Infectious Diseases 47: 931-934, 2008.



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