Is Staph Strain a 'Gay Disease'?

The headlines this week about a new "gay" infection were dramatic. FLESH-EATING BUG SPREADS AMONG GAYS, said one Australian newspaper, referring to a study about an antibiotic-resistant bacterial infection affecting homosexual men in San Francisco and other American cities. EPIDEMIC FEARED--GAYS MAY SPREAD DEADLY STAPH INFECTION TO GENERAL POPULATION, shouted a press release from the Concerned Women for America, a conservative public-policy group.

But is there a new HIV-like public health epidemic on the horizon? Not likely, says Dr. Henry (Chip) Chambers, coauthor of the study, which was published this week in the online edition of the Annals of Internal Medicine. "This is definitely not the new AIDS," says Chambers, a professor of medicine at the University of California, San Francisco (UCSF). "HIV is a life-threatening disease that is incurable and necessitates lifelong treatment," adds Bill Stackhouse, director of the Institute for Gay Men's Health at the Gay Men's Health Crisis in New York.

That's not to say that drug-resistant staph infections aren't a serious health problem. As these so-called superbugs become more resistant to common first-line drugs, doctors have been forced to turn to alternative antibiotics, explains Chambers. Once restricted to hospitals, these virulent forms of staph have increasingly afflicted day-care centers, schools, gyms and other public areas in the last decade. These community forms of MRSA (methicillin-resistant Staphylococcus aureus) typically cause boils or abscesses to develop on the skin, and in serious cases, they can produce necrotizing fasciitis, which destroys tissue (hence the "flesh-eating" label). Infections that aren't controlled by medication or are left untreated can also damage the heart and infect the blood.

In the UCSF study, researchers found that men in a clinic for HIV-positive patients who had a history of having sex with men were 13 times more likely than other HIV-positive patients to get a particular form of community-associated staph infection called MRSA USA300. But this does not mean that there is a new "gay" form of MRSA, the study's authors say. USA300 has been around since 2002 and has appeared in at least 38 American states among heterosexual and homosexual patients. What is new is the rapid rate the bacteria spread among this particular population of gay men, studied between 2004-2006. Why these men are more vulnerable than the heterosexuals studied is still a question. Researchers stopped short of labeling USA300 a sexually transmitted disease, but they did note that the infections in the men they studied were commonly found on parts of the body where skin-to-skin contact occurs during sexual activity.

Gay men's health advocates point out that MRSA can be spread through any kind of skin-to-skin contact, either sexual or nonsexual, without regard for sexual orientation. And they have been very critical of the media for its focus on the sexual aspects of the story. "It's very unfortunate," says GMHC's Stackhouse. "It's very stigmatizing, it's alarmist, it's homophobic and it's just unnecessary."

Stackhouse believes that no one benefits if USA300 gets labeled as a "gay disease." When that happens, he says, "people who aren't gay don't see themselves at risk, and there is a risk out there," he adds. "This kind of stigma presents a challenge. 'I'm not gay, so I'm not at risk,' whether it's about HIV, whether it's about MRSA. That's the big downside to this kind of reporting."

Awareness of the symptoms of a potentially serious bacterial infection can help contain the spread. Experts note that this, and other community-associated forms of MRSA, generally begin as a pimplelike sore that looks like a spider bite and starts to get bigger. "Someone says, 'I think I've got a spider bite'," says Dr. Gary Noskin, an infectious disease specialist at Northwestern University's Feinberg School of Medicine. Typically, it's "localized" and remains in a specific area of the body. Noskin has seen some infections the size of a dime and some that are five to six inches. Doctors typically give patients antibiotics and lance their boil.

Infections are more likely to occur if there is some opening in the skin, such as from a shaving nick or a needle puncture, that breaks the body's "protective barrier," says Noskin. "Direct contact with an open wound would increase the likelihood."

As with other forms of staph, doctors recommend hand washing and showers as ways of preventing infection. This regime could be particularly important for those that were identified by the study as vulnerable to USA300. "We want gay men to be aware of the risk, we want them to know this can easily be prevented through good hygiene and cleanliness," says GMHC's Stackhouse. "It's cold and flu season. We should all be washing our hands."

Those who do get infected with USA300 are commonly treated with the antibiotic Bactrim (trimethoprim-sulfamethoxazole), which is still effective against the infection. But if that doesn't work, or a patient is allergic, doctors may have to resort to other antibiotics, many of them intravenous and expensive. Typically, patients need five or six days of treatment.

The current challenge with any kind of MRSA is to get more information about the way the infection behaves in the community. "We don't really understand the dynamics of acquisition or resistance or the dynamics of spread," says Chambers. For the immediate future, Chambers believes most community-associated MRSA infections will be treatable with medication. (Community and hospital-acquired MRSA were responsible for 94,000 life-threatening infections and 18,650 deaths in 2005, according to the Centers for Disease Control).

The bottom line is that Americans don't need to worry that every kid in their school, or every gay man they know, will come down with the infection. "It's not like it's a scourge, like measles," says Chambers. A viral disease, measles infects basically everyone who hasn't had it or been vaccinated against it. Even in San Francisco's Castro district, only one in 588 people is carrying this variant of MRSA, the study estimates. That compares with 1 in 3,800 people in the overall city of San Francisco.

Like other community forms of MRSA, this variant is "more virulent than the hospital strain," says Chambers. "It needs to be because it's taking on healthier people." That's cause for concern and increased vigilance, he says, but not panicky headlines.