Sharing or reusing needles, syringes, and other injection equipment can put people at risk for getting or transmitting serious infectious diseases, like HIV and hepatitis. This is because blood from an infected person may get directly into the bloodstream of another person through reused or shared needles, syringes, or other injection equipment. Here are some quick facts about the risks of reusing needles:
- Reusing needles is very dangerous – it spreads bloodborne diseases like HIV and hepatitis.
- Even tiny amounts of blood left in a used needle or syringe can transmit infection.
- HIV, hepatitis B and hepatitis C can all be spread by reusing needles and syringes.
- These diseases can have serious, lifelong consequences.
Reusing needles is an unsafe injection practice that too many people engage in, often because they lack access to or can’t afford new, sterile needles and syringes. However, the costs of reusing needles far outweigh any small savings – it can lead to potentially fatal infections that require expensive treatment down the road. There are safe options available, like syringe service programs and pharmacies selling inexpensive needles and syringes without a prescription. But first, understanding the risks associated with different diseases that can be transmitted by needles can encourage people to make safer choices.
HIV
HIV stands for human immunodeficiency virus. It is spread through contact with infected bodily fluids, including blood. HIV attacks the immune system by destroying CD4 cells, a type of white blood cell.
Transmission
HIV can be spread by reusing needles and syringes because infected blood can get directly into the bloodstream of another person. Even tiny amounts of blood left in a used needle or syringe can transmit HIV.
Sharing any injection equipment used by someone with HIV can spread the virus, including:
- Needles
- Syringes
- Cookers (spoons or containers used to dissolve or prepare drugs)
- Cotton filters
- Rinse water
- Tourniquets
HIV is easily transmitted through needle sharing. There is about a 1 in 150 chance of getting HIV from sharing a needle one time with someone who has HIV. The more often needles are shared, the greater the risk.
Symptoms
Many people with HIV experience flu-like symptoms 2-4 weeks after infection. This is called acute retroviral syndrome and may include:
- Fever
- Chills
- Rash
- Night sweats
- Sore throat
- Swollen lymph nodes
- Mouth ulcers
- Muscle aches
- Fatigue
After this stage, HIV enters a long asymptomatic period which can last years. Over time, the virus destroys CD4 cells and weakens the immune system. Without treatment, this leads to acquired immunodeficiency syndrome (AIDS). People with AIDS may develop opportunistic infections and cancers.
Testing
The only way to know if you have HIV is to get tested. Most tests look for HIV antibodies in the blood, urine, or oral fluid. Some tests directly detect viral RNA in the blood. It can take 23 to 90 days for the body to produce enough antibodies to be detected on a test. This is called the window period.
It’s recommended that people get tested for HIV at least once as part of their routine health care. People at high risk, like those who share needles, should get tested more frequently. Early diagnosis means earlier treatment.
Treatment
There is no cure for HIV, but treatment has advanced significantly. Antiretroviral therapy (ART) involves taking a combination of HIV medicines daily. ART prevents the virus from multiplying, reducing the viral load to undetectable levels in the body. People on effective ART have very low risk of transmitting HIV to partners.
Starting treatment early improves outcomes. With proper adherence to daily ART, people with HIV can live long and healthy lives. Lifespan is now approaching that of HIV-negative people.
Prevention
The most effective ways to avoid HIV from needle sharing include:
- Only using new, sterile needles and syringes
- Not reusing or sharing any injection equipment
- Using sterile injection equipment from syringe service programs
- Purchasing needles/syringes from pharmacies without a prescription
Treatment as prevention (TasP) also prevents spread of HIV from sharing needles. People with HIV who take ART and maintain an undetectable viral load have negligible risk of transmitting through needles.
Hepatitis B
Hepatitis B is a viral infection of the liver caused by the hepatitis B virus (HBV). It causes inflammation that damages liver cells.
Transmission
Hepatitis B is transmitted through contact with infected blood and body fluids. Sharing needles is one way HBV spreads from person to person. Even microscopic amounts of blood left on used needles or injection equipment can transmit HBV.
HBV is estimated to be over 100 times more infectious than HIV through needle sharing. Just 1 in 1000 needle-sharing incidents with someone infected can spread HBV. It can survive outside the body for up to 7 days.
Symptoms
Hepatitis B infection can be either acute or chronic:
- Acute HBV: Short-term illness occurring within the first 6 months. Many adults experience no symptoms, while some may have:
- Jaundice
- Fatigue
- Abdominal pain
- Loss of appetite
- Nausea
- Vomiting
- Joint pain
- Chronic HBV: Lifelong infection. Most children infected will develop chronic HBV. Approximately 5% of adults progress to chronic infection. Over time, this can lead to serious complications like cirrhosis or liver cancer.
Testing
Blood tests are used to diagnose both acute and chronic hepatitis B. Tests look for:
- HBV surface antigen – indicates active infection
- HBV core antibody – indicates past or current infection
- HBV surface antibody – indicates previous infection and immunity
The Centers for Disease Control and Prevention (CDC) recommends screening high-risk adults and pregnant women for hepatitis B. People who share injection equipment should be regularly tested.
Treatment
For acute HBV, treatment focuses on supportive care to manage symptoms as the infection resolves. Avoiding alcohol and acetaminophen is important, as these can cause further liver damage.
Chronic hepatitis B is treated with antiviral medications like entecavir or tenofovir. These suppress viral replication and reduce liver inflammation, but are not a cure. Treatment is generally lifelong. Close monitoring for liver problems is necessary.
For end-stage liver disease from hepatitis B, a liver transplant may be necessary. Hepatitis B immunoglobulin therapy prevents reinfection after transplant.
Prevention
The hepatitis B vaccine provides the best protection – it is 95-100% effective at preventing infection from needle-sharing. The vaccine is given as a 2-3 dose series. It is recommended for all infants and high-risk groups, including people sharing injection equipment.
For those already infected, precautions to avoid transmitting HBV through needles include:
- Not sharing any injection supplies
- Not donating blood, plasma, tissue, or semen
- Using condoms during sex
- Disinfecting any blood spills
- Having others get vaccinated
Newborns of infected mothers receive hepatitis B immune globulin and vaccination to protect them from infection during birth.
Hepatitis C
Hepatitis C is a contagious liver disease caused by the hepatitis C virus (HCV). Infection causes inflammation that damages liver cells.
Transmission
Hepatitis C is primarily spread through contact with infected blood. Sharing needles and injection equipment is very high risk for HCV transmission. Even trace amounts of blood on needles or syringes can spread infection.
The estimated risk of getting hepatitis C from sharing needles one time ranges from 1-7%. This risk increases with more frequent sharing.
Symptoms
Many people with acute hepatitis C experience mild or no symptoms. When symptoms do appear, they may include:
- Fever
- Fatigue
- Loss of appetite
- Nausea
- Vomiting
- Abdominal pain
- Joint pain
- Jaundice
Chronic hepatitis C typically has no symptoms until significant liver damage occurs. This can take 20-30 years. Ongoing inflammation slowly scars the liver, called fibrosis. Eventually cirrhosis (severe scarring) and liver failure can occur.
Testing
A blood test called an HCV antibody test detects antibodies made in response to the virus. It can confirm previous or current infection.
An HCV RNA test looks for genetic material of the virus in the blood and confirms current infection. RNA levels (viral load) can be monitored to measure treatment response.
The CDC recommends a one-time hepatitis C screening test for all adults 18-79 years old. Annual testing is recommended for those who share injection equipment.
Treatment
Treatment for hepatitis C involves taking daily antiviral medications for 8-12 weeks. The currently recommended regimens have cure rates of 90-95%. Stopping the virus early prevents progression to cirrhosis, liver failure, and liver cancer.
Treating hepatitis C requires regular medical visits for lab testing during therapy to confirm HCV clearance from the body. Supportive care is also important for managing symptoms and side effects. For those with serious liver damage, a liver transplant may be necessary.
Prevention
There is no vaccine for hepatitis C. The only way to fully prevent infection is to avoid exposure to infected blood through injection equipment sharing. Steps to prevent HCV transmission include:
- Using new, sterile needles and injection supplies every time
- Avoiding sharing any equipment involved in preparing or injecting drugs
- Using proper disinfection of any blood spills
- Not donating blood if infected
- Using condoms or abstaining from sex if infected
Programs providing new, sterile needles and injection supplies reduce the rate of HCV infection. Widespread treatment also lowers transmission rates.
Skin infections
Reusing needles can introduce various bacteria into the skin that cause infections in the injection site. Common types include:
Abscesses
Abscesses are pockets of pus caused by bacterial infections under the skin. Symptoms include:
- Swollen, painful area on skin
- Redness and warmth around site
- Fever and chills
Abscesses require antibiotics to clear the infection. Drainage or surgical incision may be needed to remove pus.
Cellulitis
Cellulitis is a bacterial infection of the deeper layers of skin and tissue under the skin. Signs and symptoms include:
- Red, swollen skin that feels hot and tender
- Skin dimpling or blistering
- Swollen lymph nodes
- Fever and chills
Cellulitis is treated with oral antibiotics. It can spread to the bloodstream and become life-threatening without treatment.
Necrotizing fasciitis
Necrotizing fasciitis is a serious, rapidly spreading infection that destroys skin, muscle, and tissue. It requires emergency medical treatment. Symptoms include:
- Severe pain and swelling
- Fever
- Ulcers on the skin
- Skin discoloration
- Oozing from the infected area
Surgery is needed to remove dead and infected tissue. High doses of intravenous antibiotics are given to stop the infection. Even with aggressive treatment, necrotizing fasciitis can be fatal.
Tetanus
Tetanus is caused by bacterial spores (Clostridium tetani) found in soil, dust, and animal feces. The bacteria release a toxin that affects the nervous system, causing painful muscle spasms. Symptoms include:
- Stiffness in the jaw (lockjaw)
- Neck, back, and abdominal muscle spasms
- Difficulty swallowing and breathing
- Facial muscle twitching
Tetanus is prevented through vaccination. After injury, a tetanus immune booster is given if the last vaccine was over 5 years ago. Tetanus immune globulin provides immediate short-term protection. Antibiotics (metronidazole or penicillin) may be prescribed to fight the infection. Other treatment focuses on supportive care.
Heart infections
Reusing needles or syringes can introduce bacteria into the bloodstream that infect the inner lining of the heart (endocarditis). People with existing heart valve problems are especially at risk. Symptoms may include:
- Fever
- Fatigue
- Chest pain
- Shortness of breath
- Heart murmur
- Skin lesions or bumps
Bacterial endocarditis requires prompt antibiotic treatment often in the hospital for several weeks. Surgery to repair or replace damaged heart valves may be necessary.
Other viral infections
Sharing needles can also spread other viral infections like hepatitis A and hepatitis D.
Hepatitis A
Hepatitis A is an acute liver infection caused by the hepatitis A virus (HAV). It is usually spread through contaminated food or water but can spread through needle-sharing.
HAV does not cause chronic infection. Symptoms often resolve on their own after a few weeks or months. Severe infections may require hospitalization.
There is a vaccine available to prevent hepatitis A infection. Frequent handwashing and avoiding sharing needles or other items that might have come in contact with feces can also prevent spread.
Hepatitis D
Also known as delta hepatitis, hepatitis D can only infect people who are already infected with hepatitis B (HBV). The hepatitis D virus requires HBV to replicate.
Hepatitis D is rare in areas where hepatitis B vaccination is widespread. Symptoms are similar to acute hepatitis B.
There is no vaccine or treatment for hepatitis D. Preventing hepatitis B infection through vaccination provides protection against hepatitis D as well. Not sharing needles and avoiding contact with infected blood prevents spread.
Conclusion
Sharing needles and other injection equipment puts people at high risk for acquiring dangerous infections. Diseases that can be transmitted through this route include HIV, hepatitis B, hepatitis C, skin infections, heart infections, and other viral infections.
The greatest risks come from HIV and hepatitis B and C. These viruses can lead to chronic infections causing liver damage, cancer, and potentially death down the road. Even hepatitis A, which generally causes an acute, self-limited infection, can make people very ill.
Bacteria introduced into the bloodstream through unsterile injection practices can result in serious heart and skin infections requiring emergency treatment. Diseases like tetanus and MRSA can have devastating outcomes.
The safest option is to avoid needle re-use and sharing entirely. Resources like syringe service programs and non-prescription pharmacy sales of sterile needles allow affordable access to clean supplies. For people who continue higher risk injection drug use, screening and vaccination for HIV and hepatitis B/C can detect infections earlier and prevent complications. But ultimately, stopping needle and syringe sharing in the first place is key to avoiding these life-altering diseases.