Body piercing—the use of needles, steel posts, rings, or other adornments—has become increasingly popular in recent years for both sexual and aesthetic reasons. An important element of history to obtain from patients is where the piercing was done (i.e., piercing parlor, doctor's office, store, by a friend, or by one's self), to assess whether aseptic technique was followed and needles were single use and sterilely packaged. If the piercing is performed by a novice, often it is too shallow, increasing injury and the chance that the body will reject the jewelry. Also, emergency physicians should attempt to ascertain the composition of the jewelry material, since contact metal-allergic dermatitis may occur with exposure to nickel or even surgical steel and gold. Ihe resultant inflammation may in cases be so extreme as to envelop the jewelry. Lymphadenopathy and granulomatous tissue formation have occurred as a result of piercing, as has keloid formation over the long term. Genital piercing is also subject to trauma and may rupture the urethra. Irauma to the genitalia secondary to genital piercing may require urologic consultation and further evaluation if anything other than superficial injury is involved.
Infectious complications of genital piercing tend to occur at certain times:
1. When the piercing is performed, possibly with nonsterile technique and/or instruments. Ihe instruments may include improperly sterilized spring-loaded finger-stick devices or piercing guns.
2. In the immediate postpiercing period, if the wound is not kept clean or is handled by the patient.
Embarrassment may cause patients with genital piercing to delay seeking medical attention for potential infection. Staphylococcus aureus is the organism most often responsible for piercing infections. However, group A b-hemolytic streptococci (GABHS) and Pseudomonas aeruginosa have also been isolated from infected piercing. Body piercing may be responsible for transmission of hepatitis B, hepatitis C, human papillomavirus (leading to recurrent condyloma accuminatum) and, although no cases in the literature currently exist, even HIV. Patients with relatively recent body piercing who present with unexplained hepatitis, endocarditis, or otherwise unexplained evidence of systemic infection should have a closer history of piercing obtained. Ietanus prophylaxis status should be determined for all recently pierced patients. In cases involving bacterial infection, culture specimens should obtained from the piercing site to identify the organism involved and direct appropriate antibiotic therapy. Removal of the jewelry may also be necessary in some cases.11
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