Once, twice, three times a bite victim: recidivism in snake envenomation.

Introduction: We believe there are certain behaviors that may predispose people to being bitten by a snake. The purpose of this study was to describe cases reported to the North American Snakebite Registry in which the snakebite victim acknowledged multiple lifetime snakebites and to test the hypothesis that male sex, intentional handling of the snake, alcohol consumption, and maintaining snakes in captivity are associated with sustaining multiple snakebites in a lifetime.

Methods: This was a retrospective review of de-identified patient information reported to the snakebite registry between January 1, 2013 and December 31, 2023. Data regarding the circumstances of the snake encounter, patient demographics, previous snakebites, antivenom administration, and clinical outcomes were reviewed.

Results: Of the 2,140 snakebites reported during the study period, 94 (4.4%) involved patients with a history of one or more previous snakebites. Males accounted for 80 (85.1%) victims. Sixty-one (64.9%) bites followed intentional interaction with the snake. Alcohol use was reported in 15 (24.6%) of these cases. Captive snakes were responsible for 18 (29.5%) bites. Of the bites that resulted from unintentional snake interaction, alcohol was implicated in three (9.1%) cases. One (3%) bite was from a captive snake. Acute hypersensitivity reactions were observed in six (7.5%) patients who received antivenom.

Discussion: Most patients with multiple lifetime snakebites were intentionally interacting with the snake just prior to being bitten. Maintaining snakes in captivity was reported more frequently in patients with previous bites than among the general snakebite population. Although alcohol use was more common among patients who intentionally interacted with snakes, most patients with multiple lifetime snakebites did not report preceding alcohol use.

Conclusions: Male sex, intentionally handling snakes, and maintaining snakes in captivity are more common in patients with multiple lifetime snakebites than those who have experienced only one bite.