What is the management for a human bite?

Investigations for Human Bite Wounds

For a 24-year-old male with up-to-date immunizations and a human bite, the essential investigations include wound assessment for depth and structures involved, tetanus status verification (already current), bloodborne pathogen testing of the bite victim (bitee) for hepatitis C and HIV, and consideration of testing the biter for hepatitis B, hepatitis C, and HIV if there was visible blood in the saliva or if this was a bloody bite. 1, 2

Immediate Wound Assessment

• Evaluate wound depth and anatomical structures involved, particularly checking for penetration into tendons, joint capsules, synovium, or bone—especially critical for clenched-fist injuries which carry high risk of septic arthritis and osteomyelitis 1
• Document the location, size, and characteristics of the bite (indentation marks, lacerations, abrasions, or contusions) 3
• Assess for signs of infection including erythema, warmth, swelling, purulent drainage, or systemic symptoms 4, 5

Tetanus Prophylaxis Verification

• Confirm tetanus immunization status is current (which you've already established as up-to-date in this patient) 1, 6
• No additional tetanus toxoid needed if immunizations are current 1

Bloodborne Pathogen Testing

The testing algorithm depends on exposure characteristics:

For the Bite Victim (Your Patient - the Bitee):

• Test the bitee for hepatitis C virus and HIV because the biter's oral mucosa was exposed to the bitee's blood during the bite (reverse exposure risk) 2
• Hepatitis B testing and follow-up required since HBV can be transmitted through mucosal exposure to blood 2

For the Biter (if identifiable):

• Test the biter for hepatitis B, hepatitis C, and HIV only if there was visible blood in the saliva or if this was a particularly bloody bite 2
• If the bite involved blood-free saliva, HCV and HIV transmission risk from biter to bitee is negligible, making biter testing for these pathogens unnecessary 2
• Hepatitis B testing of the biter is warranted regardless, as HBV can rarely transmit through blood-free saliva to nonintact skin 2

Rabies Risk Assessment

• Rabies transmission from human bites is extraordinarily rare and typically not a concern in the United States 7
• Consider rabies prophylaxis only in exceptional circumstances where the biting person has suspected rabies exposure or compatible clinical signs 7
• If rabies exposure is genuinely suspected, previously unvaccinated persons require both rabies immune globulin (HRIG) and vaccine series (5 doses on days 0,3,7,14, and 28) 1

Microbiological Cultures

• Obtain wound cultures if the bite appears infected (not routinely needed for fresh, uninfected wounds) 4, 5
• Human bite infections are polymicrobial, typically yielding an average of five microorganisms including alpha-hemolytic streptococci, Staphylococcus aureus, Eikenella corrodens, Haemophilus species, and anaerobes in over 50% of cases 5

Imaging Studies

• Order plain radiographs for clenched-fist injuries or bites over joints to evaluate for foreign bodies, fractures, or joint involvement 1
• Consider imaging for deep wounds where bone or joint penetration is suspected 1

Common Pitfalls to Avoid

• Do not skip bloodborne pathogen testing of the bitee (your patient)—the reverse exposure risk (biter's mucosa to bitee's blood) always warrants HCV/HIV testing of the bite victim 2
• Do not routinely test biters for HCV/HIV unless visible blood was present in the saliva, as this prevents unnecessary testing and venipuncture harm 2
• Do not underestimate clenched-fist injuries—these require expert hand evaluation and have significantly higher complication rates including septic arthritis and osteomyelitis 1

Human bite transmission of bloodborne pathogens is rare in practice, with literature reviews showing no documented bite-related bloodborne pathogen transmission in some large institutional settings over 18-year periods 2. However, appropriate selective testing based on exposure characteristics remains important for OSHA compliance and patient safety 2.