Human bites

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 during playground games. Bites can also be inflicted during sexual activity, either on purpose or as a result of loss of self-control.

What should I do if I am bitten?

There are many germs (bacteria) in human mouths, so it is important to wash the wound to reduce the chance of infection. If the wound is small, you can clean it yourself, using soap and 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 or your fingers, your face or ears, or your genital area.

• 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. Signs of infection include the skin around the wound becoming more red and hot and painful. Also if you develop a high temperature (fever), or sweats and/or chills this can indicate an infection.

• 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 for human bite treatment 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 may 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 may be able to advise without you having to go to hospital.

What treatment might I need from a health professional for a human bite?

Wound care

If part of the wound has dead or damaged skin then this 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.

Antibiotic medicines

Guidelines recommend that we do not offer antibiotics to people with human bites that have not broken the skin.

If the bite has broken the skin but not drawn blood, antibiotics will be offered if it involves a high-risk area such as the hands, feet, face, genitals, skin over joints or an area of poor circulation, or if you are at higher risk of a serious wound infection because of a medical condition such as:

• Diabetes.

• A poorly acting immune system.

• Not having a spleen.

• Significant liver disease.

Antibiotics will be prescribed if the bite has broken the skin and drawn blood, and if it is thought the wound has already started to become infected.

The first-choice antibiotic for an adult with a human bite is co-amoxiclav - also called Augmentin® . If you are allergic to penicillin you will be given doxycycline and metronidazole. If you already have an infection you will need to take the medicine for five days but if the medicine is being used to prevent infection, three days of treatment should be enough.

If a child has a bite there is an alternative first-choice antibiotic called co-trimoxazole, but the other antibiotics used are the same.

Tetanus

Are you up to date with your tetanus immunisations? If not, or if the bite is considered 'tetanus prone' (eg, the bone is broken under it, there is any soil or manure in it, it requires an operation that cannot be performed for several hours after the injury) you may need a booster dose, or occasionally a different type of tetanus treatment called immunoglobulins.

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.

Swabs

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.

X-rays

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.

Blood tests

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:

• Tetanus.

• Syphilis.

• Hepatitis B.

• Hepatitis C.

• HIV.

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. Early antibiotics help to reduce the chance of any deformity or loss of function.

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 red 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 (sepsis). Consult 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.