What is the appropriate management for a bite from a common house gecko (Hemidactylus species)?

Management of Common House Gecko Bites

Common house gecko (Hemidactylus species) bites require only basic wound care with thorough irrigation and do not necessitate antibiotics, rabies prophylaxis, or specialized treatment, as these reptiles are non-venomous and pose minimal infection risk to humans.

Immediate Wound Care

• Irrigate the bite wound immediately with copious amounts of running tap water or sterile saline until all visible debris is removed 1, 2.
• Use gentle irrigation technique with a 20-mL or larger syringe, avoiding high-pressure irrigation as it may force bacteria deeper into tissue planes 2.
• Clean the wound with soap and water or sterile normal saline 2.
• Remove any superficial debris carefully 1.

Infection Risk Assessment

• House geckos are non-venomous and their bites rarely cause serious health problems 3.
• The bacterial flora in gecko fecal material includes enteric organisms (E. coli, Citrobacter, Klebsiella, Salmonella species), but bite-related transmission to humans causing clinical infection is not documented in the medical literature 4.
• Unlike dog, cat, or human bites which have well-established polymicrobial infection patterns, gecko bites lack evidence of significant infection risk requiring prophylactic antibiotics 1, 2.

Antibiotic Considerations

• Prophylactic antibiotics are NOT indicated for routine gecko bites as there is no evidence supporting their use for reptile bites in the available guidelines 1, 2.
• The standard animal bite guidelines focus exclusively on mammalian bites (dogs, cats, humans) where specific oral flora create infection risk 1, 2.
• Consider antibiotics only if signs of infection develop (increasing redness, swelling, purulent drainage, fever, lymphangitis) after the initial 24-48 hours 1.

Tetanus Prophylaxis

• Administer tetanus toxoid (0.5 mL intramuscularly) if the patient has not been vaccinated within the past 5-10 years or if vaccination status is unknown 1, 2.
• Tdap is preferred over Td if the patient has not previously received pertussis vaccination 2.

Rabies Risk

• Rabies prophylaxis is NOT indicated for gecko bites as reptiles are not rabies vectors 1.
• Rabies guidelines specifically address only mammalian bites (dogs, cats, ferrets, wild mammals) as potential rabies exposures 1.

Wound Closure

• Do not close gecko bite wounds primarily; allow healing by secondary intention 1, 2.
• Approximation with Steri-Strips is acceptable for small wounds if there is no sign of infection 1, 2.

Follow-Up Care

• Monitor the wound for signs of infection over the next 24-72 hours 1, 2.
• Instruct the patient to return immediately if redness, swelling, increased pain, purulent drainage, or fever develops 1.
• Elevate the affected extremity if swelling occurs 1, 2.

Critical Pitfalls to Avoid

• Do not treat gecko bites with the same aggressive antibiotic protocols used for dog, cat, or human bites, as the infection risk profile is entirely different 1, 2.
• Do not administer rabies prophylaxis, as reptiles cannot transmit rabies 1.
• Do not overlook tetanus status, which remains important for any penetrating wound 1, 2.
• Do not dismiss the rare possibility of an autonomic response in children, though this has only been reported once in the literature and may have been coincidental 3.