Walking on the beach

[Tgreeneyes]

Dear DR,

My husband and I were walking barefoot on a beach in Thailand where they have drug full moon parties at night.  My husband felt a prick while we were walking on the beach in the day and walked away.  A few minutes we looked and saw a small puncture under his foot by the toe area, we are afraid that this might of been a needle.  We are extremely worried.  Please advise what are the chances of an HIV transmission.

[H. Hunter Handsfield, M.D.]

I would guess that water motion would flush the needle clean, and also that the salt concentration in seawater would kill HIV or other viruses.  But this is just an educated guess.  But if the injury occurred in the water, not dry sand, I would completely disregard the event.

That will wind up my advice.  Try not to worry about this.

[Tgreeneyes]

Thank you doctor I will try to calm him down.

My final question is, is stepping on a syringe in the ocean is a no risk because the syringe is submerged?

Sorry about these questions we ran into more than we bargained for in Thailand.


Thank you once again

[H. Hunter Handsfield, M.D.]

I suppose there could have been some risk "if it was used recently".  But that's highly speculative, and within hours HIV probably is not transmissible.  I don't know the potential duration of viable hepatitis B or C viruses.  (You don't mention hep B, but perhaps you have been immunized against it, in which case no worry.)  And you don't know that the sharp object was from drug injection equipment.

In summary, these are "what if" questions that are impossible to answer definitively.  All I can tell you is that there are few if any known cases of any bloodborne viruses being acquired in this fashion, despite the theoretical possibility that it could occur -- and as I said above, it is highly improbable your husband is going to be the world's first known case, at least of HIV.

[Tgreeneyes]

Thank you for your response.
I just want to make sure that your aware that it was a particularly scary situation for him, because we saw a lot of backpackers and lots of heavy traffic on that narrow beach and we were told by our tour guide of the many crazy parties happen at night on that beach. Which really scared us.  
Can you please confirm that if indeed it was a syringe that:
A. Transmission of HIV or Hep C is not possible even if it was used recently?
B. If he was clipped by something else and walked around with wet sandy slippers with the open wound is any transmition possible?  Because the streets where un-paved and littered.

Thank you in advance

[H. Hunter Handsfield, M.D.]

Welcome to the forum and thanks for your question.

Being stuck by a contaminated needle in the environment has been a concern by many since the earliest days of the recognized HIV/AIDS epidemic, certainly since it was understood that injection drug users were at high risk.  However, in the 3 decades since those early days, there has never been a single case of HIV that could be attributed to such exposure. Your husband is not likely to be the first in history!

First, the chance the injury to his foot was from an injection needle is low; a thorn, a small piece of glass, or a sharp pebble are far more likely.  Second, if a needle, it is not statistically likely it was contaminated with blood.  Third, even if blood was involved, HIV would have not survived the drying and exposure to air that would have been necessary for there to be any danger.

So my advice is to simply put this event out of your minds.  The chance of being infected with HIV in this scenario is infintessimal -- zero for all practical purposes.  I see no cause for worry, do not recommend testing, and I am certain it is safe for you and he to continue unprotected sex with each other.

I hope this has helped.  Best wishes-- HHH, MD