I have Issues..please Help

[RamsRaiders]

I posted before..because I had dangerous encounters with prostitutes that do drugs. I've been clean for 6 months ..but last night..I messed up.  I sniffed cocaine and drank a lot...then I had a encounter with a prostitute and did crack cocaine.   I know I have drug issues..which I intend to get help.  I used to this about once a month for about a year. I only recieved unprotected  oral sex for a long period of time.....i've been tested for std/hiv and been negative everytime.  But last night..as I layed down on her bed...I layed on a needle.  It poked me..but didn't poke me to the point where I was bleeding.  The needle poke..left a little bruised mark.  She said the needle was unused..and i didn't see no blood.  She also said she was clean..but thats hard to believe.  Am I in risk of Std or Hiv? I am really worried.  If that needle was hiv positive..what are the chances that I caught the virus? ...

Please help...

[Edward W Hook, MD]

I do not recommend PEP if the needle did not penetate your skin.

The most obvious symptom of hepatitis is jaundice.

Let's not get into "so what if..." questions.  No further questions please.  EWH

[RamsRaiders]

K...thanks doctor.  What and when would the symptoms be if I was positive for Hep A or Hep B? ....I will go get HIV/STD test 3 months from now..I will not get a PEP test..because since the needle didn't cause no bleeding..but there is a lil bruised mark..so i will assume that it didn't penetrate hard enough ...Or if you recommend me getting PEP.then I will go today.  This will be my last post of this matter..thanks

[Edward W Hook, MD]

If the needle did not penetrate your skin, then there is no risk.  Even if HIV had been somewhere on the needle (i.e. "dirty"), if it did not break your skin, the virus could not have been introduced to where it can cause infection.  Intact skin is a highly effective barrier to HIV transmission.  No pentetration, no risk, therefore no need for PEP or for testing of any sort.  EWH

[RamsRaiders]

Hello doctor...

You said "assuming" i was really stuck by the needle..but I know I wasn't..the needle did hit me and I felt a sharp needle-like pain..this happend on my right lower abdomen, kindney area. Was no blood..and no mark..But the needle was definitely dirty...Do you still recomment me going in for PEP and Hep A test.  Will PEP prevent me from catching HIV.  What are my real risks as of now? Where should I get this done, ( I do not have medical Insurance) , and does Planned Parenthood do PEP and Hep A test?
Thanks for your time

[Edward W Hook, MD]

Assuming that you really were stuck with the needle and not just bruised by it, next steps depend on the situation.   Hepatitis (C and B) are the problems most likely to be spread through a needle stick exposure, if the needle was used and if your partner shares or has shared needles.  The best thing you can do is find a place where rapid tests (30 minutes) are done and see if she will go there for a test today.  If she is HIV negative, you still have concerns about hepatitis and getting those tests would be helpful as well.  If she has HIV or if you cannot find out, then you are a candidate for "post-exposure prophylaxis" (PEP) against HIV which should be started within 72 hours of exposure.

If she has hepatitis C, there is no proven preventative therapy so you would just have to wait and get a blood test at about 8-12 weeks.  Hepatitis A can be prevented with a combination of immune globulin injections and vaccine.

Thus the steps are for her to be tested for HIV if possible with a rapid test.  If she cannot on will not, you need to see a knowledgeable specialist ASAP.  Do not go to an emergency department if possible or, if you do, make sure that they can make arrangements for the follow-up that is needed in situations like this.

Hope these comments help.  The steps I have outlined above need to be taken as quickly as possible and certainly within 72 hours of exposure.  FYI, in terms of follow-up, I will be unavailable for further comment for the next 12-14 hours.  EWH