What is the treatment for an infected navel (belly button) piercing with the ring still in place?

Treatment of Infected Belly Button Ring with Ring In Place

For an infected navel piercing with the ring still in place, the recommended treatment is to apply a topical antibiotic such as mupirocin ointment three times daily to the affected area, keep the piercing clean, and leave the jewelry in place unless severe infection requires removal. 1

Initial Assessment and Management

Evaluation

• Check for signs of localized infection: redness, swelling, warmth, pain, and purulent discharge
• Assess severity: mild (localized redness/swelling) vs. severe (extensive cellulitis, abscess formation, systemic symptoms)
• Determine if the infection is superficial or involves deeper tissues

Treatment Algorithm

Step 1: For Mild to Moderate Infection

• Leave the jewelry in place to maintain the piercing tract while treating the infection
• Clean the area with saline solution or mild soap and water 2-3 times daily
• Apply topical antibiotic after cleaning:
  • Mupirocin ointment: Apply a small amount three times daily 1
  • Alternative: Bacitracin ointment 1-3 times daily 2
• Avoid alcohol-based products as they can irritate the tissue
• Avoid rotating or moving the jewelry excessively during healing

Step 2: For Moderate to Severe Infection

• If signs of spreading infection (increasing redness, warmth, pain) or systemic symptoms:
  • Oral antibiotics are indicated:
    • First-line: Cephalexin 500 mg orally 3-4 times daily for 5-6 days 3
    • For penicillin allergy: Clindamycin 300-450 mg orally three times daily for 5-6 days 3
• Continue local care as described above
• Monitor for improvement within 48-72 hours of starting antibiotics 3

Step 3: For Abscess Formation

• If an abscess has formed, incision and drainage is the primary treatment 3
• After drainage, consider temporary removal of jewelry and replacement with a non-metallic spacer to maintain the tract 4
• Continue antibiotics as in Step 2

Special Considerations

When to Remove the Jewelry

• Severe infection not responding to antibiotics within 72 hours
• Abscess formation requiring extensive drainage
• Signs of tissue necrosis or systemic infection

Temporary Jewelry Removal Technique

If temporary removal is necessary:

1. Disinfect the area with 70% isopropyl alcohol
2. Remove the bead from the barbell
3. Place the tip of a sterile IV catheter (14 or 16 gauge, without needle) over the threaded tip
4. Advance the catheter to push the jewelry out while maintaining the tract
5. Leave the catheter as a spacer until reinsertion is possible 4

When to Seek Further Medical Care

• Failure to improve after 72 hours of appropriate treatment 3
• Development of systemic symptoms (fever, chills)
• Spreading cellulitis or abscess formation
• Severe pain or discharge

Prevention of Future Infections

• Regular cleaning with saline solution
• Avoid touching the piercing with unwashed hands
• Avoid swimming in pools, hot tubs, or natural bodies of water until fully healed
• Avoid tight clothing that may irritate the piercing

Remember that most mild to moderate infections can be successfully treated while leaving the jewelry in place. Removing the jewelry prematurely may lead to closure of the piercing tract and potentially trap infection, making it more difficult to treat.