Artfully dodging an unforgettable holiday memento

By Tonia Buzzolini*

After decades of safe-sex campaigns, we’re all aware of the potential risk of blood-borne infections like HIV and hepatitis from unprotected sex.
It’s sensible to use a condom with a new partner – whether travelling overseas or at home.
But, many travellers don’t associate these diseases with having a holiday tattoo and body piercing, while the risk of infection from a pedicure or manicure seems even more remote.
After all, it’s so common to see young Australians lining up for a new ‘tatt’ or piercing in places like Bali and Thailand.
Even older women who may not be into body art regard a manicure or pedicure as an essential part of their Asian holiday experience.
The good news is there are steps travellers can take to reduce the risk of infection.

Avoiding infection ‘sheer luck’

As much as it looks like harmless holiday fun, market stalls like those at Kuta Beach or Phuket are the worst places to get a tattoo, piercing, manicure, or pedicure. Even a shop front is no guarantee that you won’t come home with more than you bargained for.
Keeping equipment sterile between clients is simply impossible for a lone operator offering cut-price services. Avoiding infection is sheer luck.
Diseases like HIV, and hepatitis B or C are slow, silent, and potentially fatal. You may not find out for years – even decades – that you’re infected and by then the damage may be severe and irreversible.
That said, I have a confession to make: While a tattoo is not my idea of a must-have holiday memento, I do enjoy a manicure and pedicure.
However, being a former intensive care nurse, I’m always mindful of the potential for infection. It’s ingrained in me.

My BYO solution

So, what do I do when travelling to a developing country? I bring along my own nail equipment comprising nail clippers, emery boards, buffers, cuticle sticks, foot files, and sponges.
After the holiday, it’s simple to clean and sterilise the metal tools – either by scrubbing them clean then boiling them in rolling water for 3 minutes, or immersing them in sodium hypochlorite (bleach) for 10 minutes – ready for next time I travel.
I also go through a mental checklist before the procedure begins, ensuring that:
- The nail technician washes her hands and puts on gloves.
- A blade isn’t used on skin calluses. (A deep soak followed by scrubbing is the safest way to remove thick calluses.)
- I don’t get my cuticles clipped, just gently pushed down. (Cuticles are what separate feet and hands from lurking bacteria, fungi, or viruses and clipping them can allow germs in. For the same reasons I put off the manicure or pedicure if I have any infections on my hands or feet, or any open wounds, insect bites, scratches, cuts, or scabs. And, shaving your legs can leave tiny nicks that make you susceptible to infections. Leave leg shaving for afterwards.)

High rates of blood-borne diseases

All this might seem a little overly cautious – even over the top.
But, you need to remember that many Asian countries have high rates of HIV-AIDS and hepatitis. Indonesian authorities estimated that in 2012, 1-in-4 of Bali’s prostitutes was HIV-positive and there’d been a worrying rise in new HIV infections among the population.
However, it’s the hepatitis B and C viruses that are causing the greatest concern in Indonesia and its South and Southeast Asian neighbours. Viral hepatitis is a bigger killer in Asia than malaria, dengue and HIV/AIDS combined, according to the WHO.
Thirty times more prevalent than HIV, these blood-borne viruses are among the leading causes of preventable deaths in 11 Asian countries – Indonesia, Bangladesh, Bhutan, Burma, East Timor, India, Maldives, Nepal, North Korea, Sri Lanka, and Thailand. Between them, they have an estimated 130 million sufferers – a quarter of the global burden.
And, while there are effective vaccines for hepatitis A and B, there is none for hepatitis C and treatment is costly and problematic.

Tattoo tips for avoiding infection

Any time a needle pierces your skin, microorganisms can enter via the puncture wound. Some blood-borne viruses can live on objects and surfaces for up to three weeks, to be spread if surfaces are not disinfected effectively or if equipment that comes into contact with them is not cleaned and sterilised between clients.
Even if they’re done safely, a tattoo is for life (well, at least until you have it removed! Ouch!).
Frankly, I’d advise against a holiday tattoo – it’s not worth the risk. But, if you’ve decided on having one there are a few essential precautions to take to avoid an infection that could be even harder to get rid of, including:
- Make sure you are vaccinated against hepatitis B.
- It’s worth paying a bit more to get your tattoo from a shop-front parlour that has a working autoclave machine for sterilising reusable tools and equipment.
- The work surfaces should be disinfected regularly and look and smell clean.
- Most importantly, ensure (in fact, insist) that only new needles are used. (Watch that they come from a single-use sealed packet or container.)
- Sharps (such as needles) should not be recapped, but instead disposed of safely in a sharps container.
- Single-use and disposable tattoo supplies should be used, including ink containers, gels and soaps, and stencils.
- Clean gloves should be used for every new client and the tattooist’s hands should be washed frequently. (Gloves aren’t a substitute for hand washing.)
Inks used should be those specifically manufactured for tattooing and must not be mixed with tap water or substances that might not be sterile or safe. If ink is diluted, only sterile water should be used. 
- Avoid getting a tattoo if you have a wound or infection on the section of skin to be inked.
Be prepared for moderate pain and redness at the site: they are common after a tattoo. Some people have an allergic reaction, while a small number develop scarring.
The CDC has more advice on cross-contamination and the do’s and don’ts of getting a tattoo.
Finally, while on the subject of safe travel, your travel first aid kit should contain basic sterile medical equipment in case you ever need a minor medical procedure requiring a stitch or a shot in a developing country. Dental kits are also available for travel. 
If the procedure has to be carried out in an under-resourced clinic somewhere off the beaten track, it will be a huge relief to have your own items on hand.

* Tonia Buzzolini is a registered nurse with internationally recognised qualifications and extensive experience in travel medicine. She is also the National Operations Manager of Travelvax Australia.

Call us for more information on all of the health risks for your overseas journey or to book a pre-departure medical consultation. Contact Travelvax Australia’s travel health advisory service on 1300 360 164 (toll-free from landlines).