Body Fluid Exposures Clinical Presentation

Updated: Jun 19, 2019
  • Author: Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Patients present with a history of exposure. Typically, this is a splash-type exposure to mucosal or non-intact skin, or it is an exposure resulting from a needlestick injury to intact skin. Patients often report exposures to intact keratinized skin out of uninformed concern, or they may be aware of some preexisting injury that predisposes them to infection. Reassurance through awareness of the risks for viral transmission in various scenarios is of significant importance to the health care provider and the patient.

In addition, the history should include any illnesses that may increase susceptibility to infection and/or to adverse reactions to the medications usually used for prophylaxis. The history should also include any medications the patient is taking that may interact with the PEP medications and any allergies.

A history of immunizations for tetanus and HBV should be obtained.


Physical Examination

During the physical examination, be sure to assess the body area of exposure and the depth of any wounds. The neurovascular status in the setting of extremity wounds is an important and often omitted element. The clinician should remain suspicious of occult injury, such as paper cuts or abrasions, which may threaten the integrity of the skin. For mucosal exposures, especially on the face, keep in mind that the exposure may not be limited to only one area and may occur simultaneously in nasal, oral, and conjunctival mucosal surfaces.