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Body piercing - prevalence and risks

Prevalence of body piercing
Body piercing
Tattooing
Viral infections and body piercing
Comment

Bandolier leads a sheltered life. Other than seeing the occasional pierced ear and having a merchant seaman uncle with a few tattoos, the concept of body piercing or tattooing as 'body art' is alien. A visit to Oxford's Pitt-Rivers museum reminds one that other cultures at other times have used body art extensively. Readers obviously are not so sheltered, and have asked for the evidence about body art and health.

Prevalence of body piercing

Literature searches found a single study [1], examining body piercing and tattooing in undergraduates at an American university. A single-page questionnaire was refined through a pilot study, and then offered on a voluntary and anonymous basis to students over four months early in 2001. It asked about age and sex, and about body piercing and tattooing at various body sites, as well as about any complications associated with them. Women were specifically asked not to include pierced earlobes.

There were 454 completed questionnaires (218 men, 236 women), about 15% of the total undergraduate population. Their average age was 21 years.

Body piercing

This was present in 42% of men and 60% of women undergraduates, with 315 piercings in 229 students, with a maximum of five piercings.

In men 31% had pierced ears, with tongue, eyebrow, nipple, genitals and navel in 2% or fewer for each. Additionally 7% had had ear piercings removed, and tongue, nipple and navel piercings had been removed in 2% or fewer.

In women 29% had pierced navels, 27% had pierced ears (excluding pierced earlobes), 12% pierced tongue, and 5% pierced nipple, with genitals, nose or lip in 2% or fewer. Additionally 4% had had tongue piercings removed, 3% had navel piercings removed, and ear, eyebrow, nose, lip, nipple and genital piercings had been removed in 2% or fewer.

Complications were reported in 17% of piercings, the most common being bacterial infections, bleeding and local trauma (Figure 1). No cases of viral infection were reported. Tongue piercing was associated with subsequent oral or dental injury in 10%.

Figure 1: Body piercing problems



Tattooing

Tattoos were present in 22% of men and 26% of women undergraduates with one to three sites per individual. Common sites for men were hand or arm, backs and shoulders, and for women back. No complications were noted.

Viral infections and body piercing

One descriptive review [2] has looked at this. It may be a systematic review, but it does not give a search strategy. It included 12 studies published up to 1997 mostly conducted to identify risk factors for viral hepatitis. Three studies were in the USA, four in Italy (by the same investigator) and the remainder in Taiwan, Korea, Thailand and Africa. The size varied from about 110 to over 13,000 subjects.

Nine of the studies, including all the US and Italian studies, and all the largest studies, found body piercing to be a risk factor. The three that did not were all small (fewer than 323 subjects) studies from Taiwan or Korea.

A more recent study has examined risk factors for acquisition of hepatitis C virus infection in the United States [3]. Consecutive chronically infected HCV patients eligible for a clinical trial were recruited, with HBV and HIV as specific exclusions, as was advanced liver disease. A detailed questionnaire about risk factors was completed during an interview with a single investigator.

There were 148 patients (88 men, 60 women) aged 18 to 72 years (mean 45 years). Only 5% had no known risk factor, and the most common known risk factors were injected drug use, sharing razors and toothbrushes, body piercing, being a recipient of blood products, sexual exposure and occupational exposure to blood in 48% to 32% of cases. Tattooing was associated with 17% of cases. Exposure to risk factors differed greatly between men and women, with 92% of women having body piercing (Figure 2). Most cases had more than one risk factor, but in 3 of 23 cases with a single risk factor it was body piercing.

Figure 2: Associations between hepatitis C infection and known risk behaviours



Comment

Body piercing is common, and while the only solid evidence we have is that half the undergraduates at a single US university have body piercings, a few hours watching popular television programmes tells us that this is unlikely to be atypical. Adverse happenings with body piercing are also common, affecting about one in five of them. One in ten led to a bacterial infection.

We do not know how many will contract a serious viral infection from body piercing or tattooing. We know that there will be an increased risk. In the meantime, people considering body piercing should be aware that it is more than just a bit of fun. The industry should be careful regulated, single use sterile devices should be mandatory, and HBV vaccination for operators would be a very good idea. In the meantime, a significant public health problem may be silently building up.

References:

  1. LB Mayers et al. Prevalence of body art (body piercing and tattooing) in university undergraduates and incidence of medical complications. Mayo Clinic Proceedings 2002 77: 29-34.
  2. MO Hayes, GA Harkness. Body piercing as a risk factor for viral hepatitis: an integrative research review. American Journal of Infection Control 2001 29: 271-274.
  3. LJ Yee et al. Risk factors for acquisition of hepatitis C virus infection: a case series and potential implication for disease surveillance. BMC Infectious Diseases 2001 1: 8 ( www.biomedcentral.com/1471-2334/1/8 ).
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