MRSA Infection

MRSA Reinfection Common Among Sexually Active

Aidsmap | High rate of MRSA recurrence in patients with HIV.

The study involved patients with culture-proven skin and soft tissue MRSA infection who received care at the clinic between 2002 and 2006. A total of 62 patients were included in the investigators’ analysis. These patients had a median age of 39 years, 80% were men and 63% were gay men. Just under half were taking antiretroviral therapy and 25% had a CD4 cell count above 500 cells/mm3. The most common sites for initial MRSA infection were the buttocks/genital region (32%) and the head and neck (31%). Most of the patients (54, 87%) had a skin or soft tissue infection with the USA300 strain of MRSA. Forty-four (71%) patients experienced a recurrence of MRSA with a median of 136 days. In twelve of these patients (27%) the site of MRSA skin or soft tissue infection was the same as the site of the initial infection. The investigators were able to find no factors that were significantly associated with a risk of MRSA infection recurring.

MRSA: The issues for Gay Men

Link: MRSA: An Update on Virulent Staph Infection :: EDGE Boston.

What is known is that MRSA is a particularly virulent form of staph that has indeed made inroads in the gay world in recent years. While it has taken a toll generally--100,000 cases with a scary 25 percent of those cases resulting in death--gay me have been coming down with MRSA in large numbers. Experts attribute this a few factors. First of all, let’s face it: It’s true that many gay men have more sex than some other people. And MRSA can be transmitted through sexual contact, just as it can from any skin-on-skin contact. Also, MRSA is one of the many diseases that HIV-positive people are more likely to contract. Gay men also like to go to the gym and are known to frequent steam rooms and saunas--all excellent carriers of MRSA. Dr. Douglas Gurley, an Atlanta doctor with a mostly gay practice, points to shaving the groin, which exposes it to infection. And finally, gay men are more proactive in their health, so they notice and get treated for MRSA.

Doctors concern over USA 300 in European gay community

Link: Community-associated methicillin-resistant Staphylococcus aureus ST8 ("USA300") in an HIV-positive patient in Cologne, Germany, February 2008. The isolate exhibited the typical characteristics of CA-MRSA ST8 ("USA300", see above). It was resistant to oxacillin, erythromycin, ciprofloxacin, moxifloxacin and susceptible to gentamicin, oxytetracycline, clindamycin, rifampicin, cotrimoxazole, fusidic acid, linezolid, fosfomycin, tigecycline and daptomycin. As shown in the US, CA-MRSA ST8 ("USA300") may spread rapidly in MSM communities [3]. European doctors caring for HIV-positive patients and MSM with skin and soft tissue infections should be aware of the possibility of CA-MRSA in order to provide proper care and prevent further spread. Targeted measures include proper bacteriological diagnosis of skin and soft tissue infections in patients attending dermatological and surgical practises, as well as in HIV-positive patients. When MRSA is detected, it is likely that the infection is caused by a CA-MRSA strain. Early recognition of CA-MRSA ST8 ("USA300") is possible by PCR detection of the lukS-lukF and arcA genes [11]. Confirmation is obtained by additional typing such as spa-typing, MLST, and SCCmec [7]. Further spread can be prevented by personal, environmental and health care hygienic measures [12,13].

Gay and bi men’s health forum addresses MRSA

Link: Gay and bi men’s health forum addresses MRSA, HIV and increasing syphilis rates :: EDGE Boston.

A Feb. 13 health forum at Club Café sponsored by Fenway Community Health proved that there’s a fine line between keeping medical providers informed about issues in gay and bi men’s health and perpetuating anti-gay stereotypes. At the top of the forum’s agenda was Methicillin-resistant Staphylococcus aureus, more commonly known as MRSA. Last month international media reported on a study showing that gay and bi men in Boston and San Francisco were at higher than average risk for acquiring a multi-drug resistant form of MRSA, which causes abscesses and ulcerations and which if left untreated can be life-threatening, and that among those men it may have been sexually transmitted. Critics at the time argued that many of those stories sensationalized the study and played into the stereotype of gay men as spreaders of disease (see "MRSA media panic," Jan. 24, 2008). Panelists at the Club Café dialogue critiqued the media coverage and talked about the myths and realities of MRSA within the gay community. But the Fenway’s Dr. Ken Mayer, one of the researchers involved in the study and one of the evening’s panelists, said his colleagues at University of California-San Francisco had good intentions in publicizing the study. He said the publicity was aimed at clinicians to make them aware that their gay and bi male patients infected with MRSA may have the multi-drug resistant strain and that they should take that into account when determining how to treat the infection.

After linking new strain of staph to gay men, university scrambles to clarify

Link: After linking new strain of staph to gay men, university scrambles to clarify - International Herald Tribune.

I think we were looking at this from a scientific point of view and not projecting any political impact," he said. "We were focusing on the data. You want to make sure it's as right as possible and written up in a form that reviewers would understand what you're trying to say, and do it in a clear manner so it's not subject to misinterpretation. Which is what happened later, it appears." One of the major sore points for some critics was a quote attributed to the report's lead author, Bien Diep, a researcher who said he was concerned about "a potential spread of this strain into the general population." Diep, 29, said on Friday he regretted not being more thorough in communicating his research to reporters. He said that the term "general population" was part of medical jargon used in the report, which did not translate well.

New USA300 strain the New HIV

Link: BBC NEWS | Health | Deadly new form of MRSA emerges.

Professor Mark Enright, from Imperial College and St Mary's Hospital, London, Britain's leading authority on MRSA, said: "It's quite surprising that the figures are so high. "We do know that the USA300 strain is extremely good at spreading between people through skin-to-skin contact. "The main reservoir for this infection is gay men, drug users, and those involved in contact sports, like wrestling. Having lots of sexual partners and making skin contact with a large number of different people helps the infection to spread. "In the US it is already moving into the wider community." Roger Pebody, of the Terrence Higgins Trust, said: "This is not the new HIV. "What we are seeing is the emergence of an infection that can be passed on through close skin to skin contact, including sex. "It is worrying that one in ten of the American cases are resistant to antibiotics, but most cases are treatable."

2 cases of Extra Strength CA MRSA in UK

Link: 'Flesh-eating' MRSA strain threatens Britain - Telegraph.

Although only two cases of the lethal strain - which is a new form of a recently identified MRSA strain known as USA300 - have been recorded in the UK, experts fear it may only be a matter of time before it becomes established in Britain.

Super strength CA MRSA clustered in SF gay community

Link: Aidsmap | New multi-drug resistant MRSA strain disproportionately affecting gay, HIV-positive men.

Overall incidence of MRSA in San Francisco was estimated to be 275 cases per 100,000 people. However, overall the incidence of the newly-identified multidrug-resistant MRSA was much lower, at 26 cases per 100,000. When the investigators examined the incidence of multidrug-resistant MRSA based on the area of residence within San Francisco, they found that the highest incidence of multidrug-resistant MRSA (170 cases per 100,000) was in the zip code that included the Castro district, which has a higher proportion of gay men than any other part of San Francisco. They then examined the prevalence of multidrug-resistant MRSA in the 183 HIV-positive patients with MRSA at a San Francisco HIV clinic, and found that 30 (16%) were infected with multidrug-resistant MRSA. In multivariate analysis, sex between men was a highly statistically significant risk factor for having multidrug-resistant MRSA (relative risk, 13.2; p < 0.001).

New MRSA strain resisting more drugs

Link: Aidsmap | New multi-drug resistant MRSA strain disproportionately affecting gay, HIV-positive men.

A 2006 study tracking MRSA infections in patients admitted to an HIV hospital ward in San Francisco between 1996 to 2005, found that one community-acquired strain, USA300, first identified in 2002 made up 93% of MRSA by 2005. The current study has found a multidrug-resistant genotype of this MRSA strain that is resistant to treatment with pencillins, erythromycin, clindamycin, tetracycline, mupirocin, and Cipro-like antibiotics. However, it is still susceptible to older antibiotics, such as co-trimoxazole and may also resolve by simply draining the infected boil without the use of any antibiotics. Only in the most extreme – and rare – cases is the infection life-threatening.

New MRSA Superbug More Prevalent Among Sexually Active Gay Men

Link: New MRSA Superbug More Prevalent Among Sexually Active Gay Men.

The study was in two parts: a population-based survey of 9 San Francisco hospitals and a cross-sectional study in 2 outpatient clinics in San Francisco and Boston. The data reviewed related to culture proven cases of MRSA infections spanning 2004 to 2006. The researchers looked for: risk factors, annual incidence and spatial clustering for infection by multidrug-resistant USA300. The strain of MRSA in the samples were identified using a range of methods such as: DNA sequencing (establishing the pattern of nucleotides in the DNA), polymerase chain reaction assays (amplifying DNA to help identify it), and pulse field gel electrophoresis (looking at very large DNA molecules). The results for San Francisco showed that:     * The overall incidence of USA300 infection in San Francisco was 26 cases per 100,000 of the population (ranging from 16 to 36).     * The incidence was higher in 8 adjacent neighbourhoods (identified by ZIP codes) that had a higher proportion of male same-sex couples.     * Men who have sex with men were 13 times more likely to be infected with USA300.     * This risk was independent of previous history of MRSA infection or use of clindamycin (an antibiotic used to treat MRSA).     * The risk also appeared to be independent of HIV infection.     * USA300 infection mostly occurred in the buttocks, genitals, or perineum (the area between the anus and the penis). The results for Boston showed that multi-drug resistant USA300 strains were recovered only from men who have sex with men.

HIV males - 1 in 3 with MRSA suffer chronic infection

Link: Arch Intern Med -- High Recurrence Rate of CA-MRSA Skin and Soft Tissue Infections, Dec 10/24, 2007, Skiest and Cooper 167 (22): 2527.

We read with interest the study by Shastry et al1 describing community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) in men who have sex with men. Their study included 100 men with SSTIs due to MRSA; the majority of their cohort was seropositive for human immunodeficiency virus (HIV) (mean CD4 cell count, 497 cells/�L). Shastry et al1 report a high rate of recurrent MRSA SSTIs; 27 of 87 patients (31%) had a recurrence, of which 18 had a recurrence at a new site. Thus, 21% had a recurrence of MRSA SSTI at a new site.

Sexually active are MRSA spreaders

Link: HighWire Press -- Medline Abstract.

The rising incidence of methicillin resistant Staph. aureus (MRSA) infections is a concern for emergency practitioners. While studies have examined MRSA in inpatients, few have focused on emergency department populations. We sought to describe predictors of MRSA skin infections in an emergency department population. METHODS: This was a prospective observational cohort study conducted over three months in 2005. A convenience sample of patients with culturable skin infections presenting to a busy, urban emergency department was enrolled. Demographic and risk factor information was collected by structured interview. The predictive value of each risk factor for MRSA, as identified by culture, was tested using univariable logistic regression, and a multivariable predictive model was developed. RESULTS: Patients were 43% black, 40% female and mean age was 39 years (SD 14 years). Of the 182 patients with cultures, prevalence of MRSA was 58% (95%CI 50% to 65%). Significant predictors of MRSA were youth, lower body mass index, sexual contact in the past month, presence of an abscess cavity, spontaneous infection, and incarceration. The multivariable model had a C-statistic of 0.73 (95%CI 0.67 to 0.79) with four significant variables: age, group living, abscess cavity, and sexual contact within one month. CONCLUSION: In this population of emergency department patients, MRSA skin infection was related to youth, recent sexual contact, presence of abscess, low body mass index, spontaneity of infection, incarceration or contact with an inmate, and group home living.

Lap Dancer’s MRSA (Staph) Epidemic Fear

MRSA, the staph infection resistant to many drugs, is becoming a threat to Phillidelphia lap dancers who are said to have come to regard it as an occupational hazard. With many different customers in any given week the dancers could become ‘superspreaders’ of the infection which has migrated into the community from our hospitals. The infection which can lay dormant for long periods can severely debilitate or kill once it enters the bloodstream via a cut or even a shaving ‘nick’ 

With a recent Chicago survey suggesting that MRSA has risen sevenfold in a 5 year period, the role of the sexually active as ‘superspreaders’ is coming under increasing scrutiny. In an uncanny echo of AIDS many will suffer not because of their own activity but because of the actions of someone else in their friendship network. 

Several different avenues of infection are becoming apparent. A recent New York study identifies that sexual activity was an infection cause in 3 of the 114 cases investigated. The practice among some women of shaving the pubic area had created the minor cuts that allowed the infection to enter the bloodstream in 2 of the cases. 

Another study identified 500 MRSA sufferers in the New York area and suggested that as many as 45% were men who have sex with men. Sexual practices that damage the anal membrane and lifestyle choices (gay and straight) that involve multiple sexual partners will make people more liable to be exposed to the bacterial baggage sloughing from the skin of their partners and for that bacteria to find it’s way into cuts and abrasions. 

High risk behaviours and drug use is more of an indicator for MRSA carriage then being HIV positive. Outbreaks have also been found to sometimes centre on specific activities such as bath house sex. 

Sometimes the impact of sexual activity on infection is more subtle. A growing body of evidence suggests that drug resistance is fuelled by the need for sex industry workers to consume large amounts of antibiotics to fight the infections caught from their customers.

Sources

http://www.usatoday.com/news/health/2007-01-10-mrsa-usat_x.htm

http://www.gaycitynews.com/site/news.cfm?newsid=17855835&BRD=2729&PAG=461&dept_id=568864&rfi=6

http://www.aidsmap.com/en/news/1E09B5BC-4AEB-4774-B911-EB508B679E64.asp

Sex spreads MRSA infection

Link: Sex spreads MRSA infection - USATODAY.com.

In the new study, researchers looked at 114 households in Manhattan where MRSA infections had been identified and found three in which the bacteria was spread by sexual activity. In two cases, the women said they regularly shaved their pubic area, and their sexual partners had "pimples" in the groin area, researchers say. In a third, the woman had MRSA-positive abscesses on her buttock, and her husband later developed a rash and MRSA-positive boils on his body. One of the women also had herpes. The spread of MRSA through sexual activity has been seen by emergency room doctors, says James Roberts of Mercy Hospital of Philadelphia. In a letter published in the Annals of Emergency Medicine in January, he reported treating a lap dancer for MRSA infections on her buttocks. "She relayed that other lap dancers at her club had similar problems, considered a known occupational hazard by the women," he wrote.

Sexually active men are MRSA superspreaders

Link: GayCityNews - Resistant Staph Spreads Among NYC Gay Men.

The New York City gay health clinic first noted an increase in cases in early 2004, Mayer said. Among gay men nationally, the bug's spread was first observed in an outbreak affecting dozens of gay men in Los Angeles in late 2002. By early 2004, private physicians across the country who treat large numbers of gay men were seeing cases. Other gay clinics are also seeing cases. Dr. Kenneth Mayer, medical research director at Boston's Fenway Community Health, said that clinic saw less than 10 MRSA cases a year until 2003, when there were 20. The clinic saw just under 100 in 2004 and between 120 and 130 cases in 2005. "At this point we're seeing cases at least once a week," Fenway's Mayer said. "The number has definitely dramatically gone up." While doctors are not required to report MRSA cases to the health authorities, the New York City health department launched an investigation roughly 18 months ago and has interviewed about 500 people who were infected with the bug. About 65 percent of the 500 cases are among men and 65 percent of those are men who have sex with men. The city has looked at only some of its MRSA cases and received a number of referrals from Callen-Lorde. "We're really only seeing a portion of the patients that are being diagnosed with MRSA in the city," said Dr. Melissa Marx, director of science in the health department's Bureau of Communicable Disease. "Our main goal at the end of the investigation is to figure out what the exposures are, what the risk factors are, then we can develop prevention materials and get them out to the public."

Heterosexual transmission of community-acquired MRSA

Link: Aidsmap | Heterosexual transmission of community-acquired MRSA.

Evidence has emerged of heterosexual transmission of community-acquired MRSA (methicillin-resistant Staphylococcus aureus. In the February 1st edition of Clinical Infectious Diseases investigators from New York provide detailed information on three heterosexual couples where there was evidence of sexual transmission of MRSA and also provide details of a prospective, community-based study involving individuals who had been diagnosed with community-acquired MRSA that found that the pubic region was the site of infection in 3% of cases. There have been reports of community-acquired MRSA in sports team members, military recruits, and children using daycare centres. There is also evidence of sexual transmission among HIV-positive gay men, but there have previously been no reports of heterosexual transmission of the infection. Between 2004 and 2006, individuals with positive cultures for MRSA in New York were asked to participate in a study to determine the prevalence of community-acquired MRSA.

CA MRSA a grave threat to HIV community

Link: HighWire Press -- Medline Abstract.

     The prevalence of community-associated methicillin-resistant Staphylococus aureus (CA-MRSA) has increased alarmingly in both the general population and the HIV-infected community. We look at the background of MRSA including the mechanisms of resistance, genetics, and trends in the individual with HIV infection. Numerous studies have investigated the risk factors for CA-MRSA. Other studies have further characterized the incidence of and risk factors for MRSA infections in the HIV community. Although one might not readily associate advanced HIV infection with increased susceptibility to bacterial pathogens, a number of studies have explained the mechanisms of this B-cell-mediated susceptibility. Invasive MRSA infections have spread into communities, are increasingly prevalent, and pose a public health challenge for their containment, prevention, and treatment.

Recurrent neck infection in a person with HIV/AIDS.

Link: Recurrent neck infection in a person with HIV/AIDS.

      A case of recurrent methicillin-resistant Staphylococcus aureus (MRSA) neck infection in an HIV-infected patient is presented. HIV infection is a known risk factor for the development of MRSA infections; this report suggests that HIV infection may also increase the risk of recurrent disease. Among HIV-infected persons, risk factors for MRSA infection include injection drug use, low CD4  cell count, high HIV viral load, sex partners with skin infections, absence of trimethoprim/sulfamethoxazole prophylaxis, and recent receipt of a beta-lactam antibiotic. The diagnosis of MRSA infection should be entertained and the appropriate cultures obtained when HIV-infected persons present with soft tissue infections. Given the rising rates of MRSA infection among HIV-infected persons, empiric antibiotics may be recommended. Since inducible resistance to clindamycin is increasing in MRSA isolates, an erythromycin/clindamycin "D-zone" test should be performed before this antibiotic is used. Educating HIV-infected patients about the risk factors for MRSA infection and hygienic measures to potentially reduce infection is advocated; further studies of preventive strategies in this population are needed.

MRSA jumps sixfold among people with HIV

Link: Gay.com UK.

     Gay male patients were five times more likely to get MRSA than people who’d contracted HIV heterosexually or through drug use. This was a stronger association than having a low CD4 count: having a seriously low count (under 50) only increased your chances of getting MRSA 2.4 times. But having a HIV viral load over 10,000 also increased the chances of MRSA fivefold –- and sixfold if it was over 100,000. The annual incidence of MRSA increased 6.2 times over the three years of the study. One explanation may be that patients are less likely to be on Septrin: patients who’d taken over four months of Septrin were less likely to get MRSA infections than those who hadn’t. The strains of community-acquired MRSA identified were almost entirely resistant to the commonly-used antibiotics ciprofloxacin and erythromycin. One in six trains was resistant to tetracycline and nearly one in five to Septrin –- 9 times more resistant than strains acquired in hospital. However, the bug was still treatable with the antibiotic vancomycin and 97% were susceptible to the TB drug rifampicin.

Research center seeks gay men for MRSA study

Link: Advocate.com.

Researchers at the New York City-based Aaron Diamond AIDS Research Center are seeking HIV-negative gay men to participate in a study of methicillin resistant Staphylococcus aureus, commonly referred to as drug-resistant staph infections. MRSA is a common bacteria that can cause skin infections ranging from mild cases to deep-tissue, life-threatening infections. MRSA has been diagnosed among many gay men across the United states during the past two years, with many of the cases occurring in HIV-positive men. MRSA can be carried on the skin without causing any symptoms, and it is easily passed to other men through skin-to-skin contact, including sex. The researchers are seeking gay men for their study that will gauge whether any of them are unknowingly carrying the virus.

MRSA skin infections associated with sex, drug use and environmental exposure in HIV-positive gay men

Link: Aidsmap

Long article at link above - can be summed up in a sentence. Randy people spread CA MRSA (and will infect others who are not as promiscous as them). It's not just STD's we need to worry about

“We found that community-associated MRSA skin infections among HIV-positive men who have sex with men were associated with high-risk sex and drug-using behaviours but not with immune status,” write the investigators. “Our findings indicate that community acquired MRSA spreads by contact transmission – via direct skin-to-skin transmission, such as sexual contact with someone with a skin infection – or by indirect transmission, such as during hot tub or sauna use.”

HPA deny CA MRSA Gym Link

Link: Health Protection Agency

There has been recent media interest in community acquired MRSA (C-MRSA) but the Health Protection Agency are unaware of any link to gyms or healthclubs. Over the past three years, the Agency has identified approximately 100 cases of C-MRSA in the UK, and one patient has unfortunately died. These cases have been acquired within the community. So far, most of the UK cases identified have been seen in injecting drug users. Several other countries have encountered more serious problems with C-MRSA. Risk factors in these countries have included gay massage parlours and close-contact sports such as rugby or wrestling. In these situations, skin abrasions are common, so leaving the person more prone to contracting C-MRSA. Other risk groups in the US have included individuals who have stayed in jails and there have been infections described in children. In some countries these strains have also been seen in hospitals.

MRSA in HIV-positive patients often community acquired

Link: Aidsmap.

Infection with MRSA, or methicillin-resistant Staphylococcus aureus, is being observed with greater frequency among HIV-positive patients, according to an epidemiological study presented on Friday at the Twelfth Annual Retrovirus Conference in Boston. The study also suggests that the majority of MRSA infections in HIV-positive people are being acquired in the community, rather than in hospital, and that the risk of being diagnosed is increased by more advanced HIV disease.

Gay population face MRSA risk for HIV men

Link: AHF

Beginning in the spring of 2000, gay and bisexual men in L.A. County experienced a syphilis outbreak, and still bear more than 60% of the burden of early syphilis (in numbers of cases) in the County. In addition, a recent outbreak of methicillin-resistant Staphylococcus aureus (MRSA), a strain of hard-to-treat medication-resistant bacteria, occurred in Los Angeles among people without traditional risk factors, including gay and bisexual men (the population that is also known to be most at risk for HIV infection). These factors underscored the need for innovative new approaches to health care delivery in Los Angeles County that targets such at-risk populations.

The Voice and Choice

Link: PCP drug works against "flesh-eating" gay bug

One of a number of new sexually-acquired infections reported among gay men in the last year was an outbreak of community-acquired MRSA in the USA. (Others include the stomach bug Shigella, the "Chlamydia with claws" germ Lymphogranuloma, and new outbreaks of hepatitis A.) MRSA is methicillin-resistant Staphylococcus aureus, the "flesh-eating" bug more familiar in hospital settings, where it is a common post-operative complication. However last year a rash of infections was seen among gay men in the USA, associated with sex in bathhouses. Even if it doesn't have the horrific effects sometimes seen in hospitals, MRSA can cause nasty and painful abscesses in the groin area, especially when it causes cellulitis, which is an infection of the layer of fat underneath the skin.

MRSA & Gay Men

Link: Southern Voice Online.

Both body shaving and the whirlpools found at bathhouses are suspected of helping fuel the spread of staph among gay men, Melton said. “It’s been known for some time that shaving could promote skin infection,” said Melton, who noted many doctors now clip, instead of shave, a patient before surgery.  The towels and linens recycled among men at bathhouses and in locker rooms at gyms may also facilitate the spread of staph, Melton said. People with HIV may be more at risk for acquiring staph because of their “increased exposure to antibiotics and the healthcare setting,” according to the CDC.  They may also be more susceptible to severe illness if infected with MRSA, Melton said. Gay men who use anabolic steroids for bodybuilding may also increase their chances of contracting staph if they develop acne or other skin infections, Melton said.  Skin-to-skin contact is the most common mode of transmission for community-acquired MRSA, which usually appears in the form of a swollen, puss-filled skin boil