Following a human bite, it is usually worth seeing a doctor or health professional for advice.
How might I get a human bite?
Bites from humans are either intentional in a fight, or accidental, again most often during a fight - for example, when a clenched fist comes into contact with another person's teeth. Accidental contact with another person's teeth may also occur during some sports, or playground games. Bites can also be inflicted during sexual activity, either on purpose or as a result of getting accidentally carried away.
What should I do if I am bitten?
There are many germs (bacteria) in human mouths. Cleaning will reduce the chance of infection. If the wound is small, you can clean it yourself, using ordinary tap water. Wounds that are large, deep, or dirty are best cleaned by a nurse or doctor. Allow the wound to bleed. However, if the wound is bleeding heavily, a clean dressing or sterile pad should be used to apply pressure until you can get medical help. After cleaning, cover the wound with a sterile, non-sticky dressing.
Should I seek medical advice for a human bite?
It is usually wise to get bite wounds checked out, however small they seem. Always seek medical advice in the following situations:
- The bite does not stop bleeding.
- The bite was on the knuckles of your hand, your fingers, your face or your ears.
- The bite is deep and appears to involve other tissues other than your skin (such as tendons or bone).
- You do not know the person who bit you.
- The person who bit you has, or is at risk of having hepatitis B, hepatitis C or HIV.
- You think the bite wound has become infected. If the skin around the wound is becoming more red and hot and painful, this may be the case. Also if you develop a high temperature (fever), or sweats and/or chills.
- A small child or baby has a bite to the head.
- You have not completed a course of tetanus vaccinations with boosters. Or if you are not sure about your tetanus vaccinations.
- Your immune system is not as effective as it should be. This might be due to not having a spleen, or due to medication, or chemotherapy, or an illness such as AIDS. Diabetes also makes you more prone to infections.
Where should I attend if I have a human bite?
Usually the most appropriate place to attend will be A&E. This is particularly the case if an X-ray or stitches might be needed. A&E departments are also usually the best placed to advise on the need for testing and treatment for viral infections such as HIV or hepatitis. However, for small wounds, from low-risk people, your GP will be able to assess whether you need antibiotics or not, and treat you if necessary. Also if you think a bite is starting to become infected, your GP will normally be able to advise without you having to go to hospital.
What treatment might I need from a health professional for a human bite?
If part of the wound has dead or damaged skin then it may need to be trimmed or removed. This is because infection is more likely to develop in dead skin. Some wounds may need to be closed - they can be stitched, glued, or pulled together with sticky tape. However, often it is safest to let bite wounds heal naturally, as they may be less likely to get infected.
Wounds might be closed if you are seen within six hours of the bite happening or if the wound is on your face. Wounds will usually be left open if they are more likely to get infected - for example, bites to the hands. They will be left open if it has been more than 24 hours since the bite. Sometimes the wound will be closed a few days later, when the risk of infection is thought to have passed.
A short course of antibiotics may be prescribed to prevent infection developing in the bite wounds. The antibiotic usually used is called co-amoxiclav. Many doctors feel antibiotics should always be prescribed for human bites. Others feel antibiotics are not always necessary, but may be prescribed in certain situations. For example:
- Bite wounds which are large or deep.
- The bite wound is on the face, hand or foot. Bite wounds to the hand are the most likely to get infected.
- If your resistance to infection is low. For example, if you are on chemotherapy; have no working spleen; have diabetes; have an immune system problem such as AIDS, etc.
- If you have an artificial heart valve (and sometimes, if you have an artificial joint).
Antibiotics will be prescribed if it is thought the wound has already started to become infected.
Are you up to date with your tetanus immunisations? If not, you may need a booster dose.
HIV, hepatitis B, and hepatitis C
If you are bitten by a person who has one of these viral infections, there is a very small risk that the infection can pass on to you. There is a much smaller risk after a bite than from a contaminated needle. See your doctor immediately if this is a concern.
- To protect against HIV, you can be given medication which counters the HIV virus.
- To protect against hepatitis B, you can be given an injection to be immunised against hepatitis B.
- Currently there is no treatment to prevent hepatitis C infection from developing. However, the risk of getting it from a bite is very small. If it is a possibility, your doctor will be able to do blood tests to make sure you are not developing it. In the unlikely event that you do, you can have treatment early.
Are there any tests I should have if I have a human bite?
For most bites, tests are not needed. In some circumstances, one or more of the following might be necessary.
If your bite wound has become infected, the doctor may wish to know which germ is causing the infection in order to treat it with the correct antibiotic. If this is the case they will take a swab. This looks rather like a cotton bud on a long stick. A sample of any pus in your wound is collected on this swab and sent to the laboratory.
An X-ray is often needed if you have a wound to your hand, particularly a bite on your clenched fist. This is to check there is no break (fracture) to the bone and there are no bits of tooth in the wound. Small children who have been bitten on the head may need an X-ray, as their skull bones are soft and more likely to have a fracture.
If there is a risk that the person who bit you might have hepatitis B, hepatitis C or HIV, you may be advised to have a blood test to check for these conditions. If you were the person who gave the bite, you may also be asked to have a blood test for these conditions.
The blood test would be done at the time of the injury and then repeated six weeks later and again after a further six weeks. This is because if you have become infected, it takes a while for the blood test to become positive.
What are the complications of a human bite?
Infection is the most common complication and it occurs in 9-50 out of every 100 human bites. The usual type of infection is with a type of germ called bacteria. This can be infection of the surrounding skin (cellulitis). It may also spread to tissues close to the skin - in particular, bones (osteomyelitis) or tendons (infectious tenosynovitis). Occasionally infection can spread further, causing infection around the brain (meningitis), of the heart (endocarditis) or throughout the body (sepsis or streptococcal toxic shock syndrome).
Other infections which may be transmitted through human bites include:
Hepatitis C and HIV are very unlikely to be spread from a bite. In order to get one of these infections from a bite, there usually has to be blood in the saliva of an infected person biting. Hepatitis B is more likely to spread via saliva but it is still much rarer than through needlestick injuries.
Other complications include disfigurement or deformity of the affected part. This may occur if there is a large scar, or if bones and tendons have become involved. Certain parts of the body do not heal very well if cut, such as the ear or nose, and may become deformed as they heal from a bite.
Who is particularly at risk of complications after a human bite?
Some people are more at risk of infection following a bite. For example:
- Those who have an immune system which does not work very well. This may be due to not having a spleen, from certain medication, from chemotherapy or from illness such as AIDS.
- Older people.
- People with diabetes.
Some specific wounds are more at risk of infection. For example:
- Bites to the hands or feet.
- Bites which have had stitches to close the wound.
- Deep bites.
- Bites on the head or face of a baby or infant.
- Bites over joints.
Can these complications be prevented?
Infection with germs (bacteria) can be prevented by using an antibiotic. Usually the one used is an antibiotic called co-amoxiclav. Many doctors treat all human bites with antibiotics to be on the safe side. Others only treat those which are at high risk of infection. Early antibiotics help to reduce the chance of any deformity or loss of function.
People who are at higher risk of infections such as hepatitis B or HIV include men who have sex with men, intravenous drug users, and sex workers. If you have been bitten by someone in one of these categories, you might be considered to be at high risk. If you are considered to be at high risk of developing hepatitis B, you may be given a vaccination to try to prevent this. If you are at high risk of catching HIV from the bite, you may be given some medication to try to prevent this.
What should I look out for after a human bite?
The most common complication following a bite is infection of the wound. See a doctor if the skin surrounding a wound becomes more tender, painful, swollen, or reddened over the few days following the bite.
Rarely, some germs (bacteria) can get into the bloodstream through a wound and cause a serious infection in the body. See a doctor if you become generally unwell with a high temperature (fever), shivers, or other worrying symptoms within a week or so after a bite.
Further reading and references
; NICE CKS, July 2015 (UK access only)
; A 4-year review of human bite injuries presenting to emergency medicine and Injury. 2009 Aug40(8):826-30. Epub 2009 Feb 1.
; EMI toolkit, Health Protection Surveillance Centre, September 2012
; Managing human bites. J Emerg Trauma Shock. 2009 Sep2(3):186-90. doi: 10.4103/0974-2700.55331.
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