Health experts say bacterial infections, hepatitis B and C, and possibly even HIV are being transmitted by acupuncture needles.
In an editorial in the British Medical Journal, reported by the BBC, microbiologists at the University of Hong Kong say the number of reported acupuncture-related infections worldwide is the tip of an iceberg.
Professor Patrick Woo and colleagues argue that acupuncture may pose risks to patients because needles are inserted deep beneath the skin. The link with acupuncture often goes unrecognised, they say, because of the long incubation period of some of the transmitted infections.
Drawing on worldwide studies, they say there have been cases where bacterial infections were transmitted to patients who went on to develop serious problems like multi-organ failure, flesh-eating disease and paralysis.
Professor Woo says acupuncture has also been associated with hepatitis B.
Stricter regulation and greater vigilance sought
The authors call for clinicians to have a "high index of suspicion" for infections that might be transmitted by acupuncture and to "alert health authorities about clusters of cases".
They conclude that "to prevent infections transmitted by acupuncture, infection control measures should be implemented, such as use of disposable needles, skin disinfection procedures, and aseptic techniques".
Stricter regulation and accreditation requirements are also needed, they say.
British acupuncturists defend their standards
British acupuncturists say practitioners who belong to a professional body in the UK have very high standards.
Janet Stringer, a practitioner and spokesperson for the Acupuncture Council, says members undergo three and a half years of training and follow a strict code that includes the infection control measures suggested in the article.
The medical director of the British Association of Medical Acupuncturists, Dr Mike Cummings, says severe infections associated with acupuncture are "incredibly rare" - one in every 200,000 cases.