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The Scenario:
The women's rugby team is a pretty rough bunch. Looking normal by night, their dates have no idea of the punishment inflicted on other women's bodies during the day. Probably a good thing.
Carla's team was playing well. It looked like the game was in hand. Then a freak thing happened. As she was sprinting down the field a defender approached, so she swung the ball to the side for a pass and managed to smack her hand into the mouth of one of her own players. The player was not wearing a tooth guard, and her teeth caused a cut in the back of Carla's hand. There was some bleeding but it stopped with a little pressure.
After the game, the team trainer told her to go to the emergency room for treatment of her hand. She didn't think that was necessary. The cut was not deep and did not look like it needed stitches. Her tetanus shot was up to date.
Questions:
Answer:
Well, live and learn. The answers were very interesting this week. To our great surprise, most people were concerned about the transmission of viruses such as HIV or hepatitis from the woman's mouth to Carla's hand. It's amazing how potential HIV transmission is on everyone's mind. As opposed to yours truly, who completely missed the boat.
My concern was the transmission of bacteria. That's because the human mouth is notorious for harboring tons of potentially nasty bacteria. A dog's bite is much cleaner, if you can believe it. And a bite in the hand is even more dangerous, because bacteria can slip down into deeper structures in the hand, that are hard for the immune system to get to. Such infections are hard to treat, and may require surgical drainage. A deep infection of the hand is therefore a real concern, even though the cut was small. Cleaning the cut thoroughly with copious amounts of water, and soap if you have it, is the best initial treatment. In the ER, she might well be given a prophylactic antibiotic. Some would even argue that she should be treated with a couple of days of intravenous antibiotics, before things get out of hand (so to speak). A bacterial infection is the most likely complication of such an injury.
But what about the transmission of other viruses? If we can assume that the other woman's mouth was not bleeding (therefore no direct blood-to-blood exposure) the chances of Carla picking up HIV, or some other virus, is very small, even though saliva does carry low amounts of HIV. But who wants to take a chance? Once again, careful cleaning is the most important thing to do first. AZT prophylaxis may be used in high risk exposures, but unless there is concern that the other woman was at high risk for carrying HIV, it is probable that no prophylaxis would be recommended. The efficacy of that prophylaxis is uncertain anyway. Similarly, hepatitis immunization or immune globulin injection would probably not be recommended unless Carla's teammate was known to be a carrier of hepatitis.
Some folks, having known a few rugby players themselves, cautioned against rabies transmission. Hmmm. I think they were referring more to rugby players' personalities than anything infectious.
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