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Human Bites
Apr 29, 2005

Dear Doctor Conway,

I am a Police Officer in a Rural Upstate New York county. Recently I was bitten by homeless man, on the inside of my left ankle, while trying to subdue him during an arrest. The subject bit through my sock and broke the skin on my ankle causing some bruising and slight bleeding caused by a pinch of his front teeth. This happened in front of a Hospital Emergency Room where I quickly received prompt cleaning and treatment. I was given a tetanus shot and I also had a baseline blood test for HIV drawn that day. I was subsequently put on antibiotics to prevent any possible infections. The ER doctor told me that this was such an extremely low risk for an HIV infection, that he advised me against any taking the pills that are supposed to prevent HIV. He said these can cause unwarranted complications. The ER doctor said he was more worried about other possible infections from his mouth. The subject told me that he did not have hepatitis or HIV. The ER doctor that examined this subject, soon after this happened, determined that no blood or cuts were visibly present in his mouth. The doctor did note that the subject's teeth were very unclean and rotted. The subject did give his consent, that day, to take an HIV test and to give me the results, which I subsequently found out were negative for HIV and Hepatitis. The doctor told me that the chances of contracting HIV in this manner, from an actual HIV infected person, was extremely remote and told me not to worry about it especially since his HIV and hepatitis test came back negative. One of my concerns is the window period. When I asked the doctor about this he told me not to concern myself with it and assured me I had nothing to worry about. The subject, as far as I could research, is not an intravenous drug user, no drugs were found in his blood that would indicate this, but he may be, according to rumor, a homosexual. I have no other information regarding his life style other than he is an obnoxious town drunk that frequently gets arrested for disorderly conduct. After hearing my story, is the ER doctor correct in telling me not to worry about this? I heard of cases where infection has happened as a result of being bitten. However, these cases involved deep wounds with severe tissue damage to the person being bitten and a significant amount of blood that was in the mouth of the person doing the biting. Is this correct and how much is significant blood? Is the wound I described on my ankle an adequate access point for it? I wonder if this person had some blood or cuts or sores in his mouth that went undetected by the doctor. I plan on following up with another HIV test in 6 weeks and 3 months. Am I overreacting to this whole situation?

Paranoid in New York

Response from Dr. Conway

You are reacting to the situation in a very clear and reasoned manner. The risk of HIV transmission from a bite is extremely low to begin with. If you add to that the fact that the bite was relatively superficial, came from an HIV-negative person and was cleaned in a prompt manner, the remaining risk (if any) becomes vanishingly small. You raise the possibility that the person who bit you may have been in the window period for HIV infection (i.e. was infected quite recently and still had a negative test for HIV antibodies). Many such individuals have symptoms of a flu-like illness, which he did not. Also, it sounds as if he was very forthcoming with information and if he were at a significant risk of recent HIV infection, he would probably have shared this with the hospital staff, which he did not.

You should definitely go ahead with the tests for HIV antibodies over 3 months, for documentation purposes. Other than that, you should congratulate yourself on having dealt with a very difficult situation in a reasoned and rational manner.

Re: Subtype N
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