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MRSA: Skip the Rumors, Learn the Facts

By Elizabeth Boskey, Ph.D. M.P.H. C.H.E.S.

The so-called "MRSA epidemic" has struck fear in the hearts and heads of many people. However, calling it an epidemic is premature. The recent research study that has gotten so much media attention has simply found that a bacteria previously thought to primarily be problematic in hospitalized patients has also managed to take hold in certain parts of the general population—more specifically in gay men.

This is not to say that the fact that MRSA infections may be sexually transmitted is not a serious problem. It is. Although a reasonable proportion of the population carries at least one strain of Staphylococcus aureus on their skin, and the presence of the bacteria isn't inherently a big deal, serious problems can come about when the bacteria gets into a cut or other open wound. Whereas a normal staph infection is unpleasant, but easily treatable, a MRSA infection can often only be treated with expensive intravenous antibiotics, because the bacteria have become resistant to treatment with ordinary drugs.

What is MRSA?
MRSA is the acronym for methicillin-resistant Staphylococcus aureus. In other words it is a description for a type of bacteria (Staphylococcus aureus) that has become resistant to a particular class of antibiotics. In practice, most MRSA strains are actually multi-drug resistant, which means that there are very few options for treatment. Not all Staphylococcus infections are MRSA infections. Staph infections are actually one of the most common form of skin infection in the United States, although most infections are minor—simply pimples or boils—and can be treated without antibiotics. Staph can, however, cause more serious infections such as surgical wound infections, blood infections, and pneumonia.

Understanding MRSA
MRSA is mostly a problem in hospitals. It is primarily transmitted between providers, staff, and patients, and until recently has only been seen rarely in the community. The Centers for Disease Control statistics state that only around 12 percent of MRSA infections occur outside of a healthcare setting. The people at greatest risk of a MRSA infection are those with a recent hospitalization and those who have impaired immune systems because of HIV, old age, or other health conditions.

Is it normal to have Staphylococcus on your skin?
Approximately 25 to 30 percent of people have Staphylococcus bacteria living in their noses, and it is thought that similar numbers have it present on their skin. However, only approximately 1 percent of people are colonized with MRSA. Colonization is different than infection. It is possible to carry the bacteria on your skin without it ever causing problems.

How can you reduce the likelihood of MRSA becoming a problem?

  1. Wash with soap and water after sex and other skin-to-skin contact (including sports games, etc.)
  2. Wash your hands frequently with soap and water, particularly after going to the bathroom, to avoid transferring bacteria from one part of your skin to another.
  3. Keep your cuts, scrapes, and scratches clean, dry and covered.
  4. Don't share personal items like towels, razors, or tweezers.
  5. Clean shared gym equipment, or cover it with towels, before using it.
What should you do if you think you have a skin infection?
If you have a scrape or cut that seems to be infected, or that's warm to the touch, red, swollen, draining pus, or streaky in appearance, you should bring it to the attention of a health care professional.

What do recent studies say about MRSA in gay men?
There is evidence that gay men are at a higher risk of contracting MRSA:
  1. In San Francisco, MRSA cases are more common in zip codes with higher proportions of male-male couples.
  2. In San Francisco, Boston, and New York, MRSA is more common in men who have sex with other men than in men who do not have sex with men.
  3. For men, being HIV positive and having sex with men are independentt risk factors for acquisition of MRSA.
  4. Spread of MRSA among men who have sex with men is associated with high-risk sexual behaviors including "use of methamphetamine and other illicit drugs, sex with multiple partners, participation in a group sex party, use of the internet for sexual contacts, skin-abrading sex, and history of sexually transmitted infections."
Conclusion: Don't Panic, Be Proactive
MRSA infection is a real problem for gay men, particularly in Boston, San Francisco, and New York, but it is by no means untreatable or a plague. It is also not only a problem for gay men. MRSA is still, and will probably continue to be, most common in health care settings, with only a relatively small number of community acquired infections. That having been said, the fact that MRSA appears to potentially be sexually transmitted is something that people need to be informed about. Remembering to shower with soap and water after sex, as well as after any form of skin-to-skin contact, is a good idea for everyone, as is practicing good hygiene with equipment at the gym.

MRSA is not a "gay disease." It is a disease of opportunity. Basic hygiene and some common sense are your main weapons against giving it one. Even in hospitals, scientists have found that one of the best ways to reduce the transmission of MRSA is simply to encourage everyone to wash their hands.

Sources
  1. Binh An Diep et al. "Emergence of Multidrug-Resistant, Community-Associated, Methicillin-Resistant Staphylococcus aureus Clone USA300 in Men Who Have Sex with Men" Annals of Internal Medicine 148(4) Epub Ahead of Print. (Accessed 1/22/08)
  2. CDC Community Associated MRSA Information Page (Accessed 1/22/08)