The Domino Effect

3.31.2008

By Steve Weinstein

Ray, a Los Angeles-area resident now 35 years old, once discovered what looked like a pimple at the bottom of his butt cheek. He tried to ignore it and dabbed the pus with toilet tissue, but it kept getting redder and larger, the pain more and more intense. When he finally went to a doctor, he was told he had a routine staph infection.

By the next day he couldn't move, let alone get out of bed, despite being on the potent painkiller Vicodin. The antibiotics his regular doctor had prescribed weren't working. Finally, a friend drove him to the hospital emergency room, where the ER doctor told him he'd received the wrong treatment and the dabbing was making it worse. The infection was now nearly three inches in diameter and deep enough for the doctor to use his bare hands to dig out the pus, 'like on a battlefield,' Ray says.

'Two years later, I still remember it as the most intense pain of my life,' Ray recalled. The ER doctor had diagnosed Ray's condition correctly; Ray had contracted MRSA ('MUR-sah'), a particularly virulent skin infection.

Actually, even MRSA's formal name, methicillin-resistant Staphylococcus aureus, is misleading, since methicillin is not the only penicillin synthetic to which this fast-moving bug has developed a resistance. Contrary to news reports, however, which hinted at an unstoppable scourge plaguing gay men, MRSA is treatable, through a variety of options in various combinations. Even multidrug-resistant MRSA, which can't be cured by some antibiotics outside the penicillin-synthetic drug family, is treatable.

These are only some of the gross inaccuracies surrounding this ailment since a team of researchers released a report in January. At first glance, a peer-reviewed analysis of data from hospitals and clinics in San Francisco and Boston, which was published under the aegis of the University of California, San Francisco, appeared to reveal that multidrug-resistant MRSA was becoming particularly prevalent among gay men. A report on National Public Radio and an article in The New York Times by Lawrence Altman, the highly respected medical journalist, set off a right-wing tidal wave of finger-pointing.

Rather than informing the public, the mainstream media inflamed the situation. A British tabloid said there was a 'new HIV,' while the respected international news agency Reuters headlined an article 'Drug-resistant Staph Passed in Gay Sex.'

The only problem with such reporting was that it simply wasn't true. The authors of the study quickly backpedaled, partly shifting the blame to a young epidemiologist who was the report's lead author for his misstatements. Meanwhile, other scientists and doctors came forward to assert that MRSA is not a new disease or even a 'gay disease' -- and sexual contact is only one of many ways of contracting it.

'We've been hearing about MRSA for decades in all people -- men, women, young, old, gay, straight,' explained Melissa Marx, an epidemiologist in New York City's health department who spoke at a city public forum in late February, one of several held at LGBT centers around the country to counter the hysterical claims.

In 2005, Marx went through MRSA test results (which is legal to do under the New York City health code) at a commercial lab used by private physicians. As is done with similar outbreaks that could affect the public at large, she then contacted those who tested positive, asking a series of questions about their lifestyle. Her results were similar to those of the recent controversial study: Men who had gay sex contracted MRSA at higher rates than normal. But, Marx hastened to add, that may well have been the result of many factors concerning hygiene, seconded by others who have studied the disease.

Douglas Gurley, an Atlanta doctor with a largely gay practice, points to shaving the groin, which increases MRSA risk. Also, gay men go to the gym more often; we frequent saunas, Jacuzzis, and steam rooms; and we wear more revealing clothing in these places. All of these are risk factors. In addition, gay men tend to be more proactive in their health care, added Mary Beth Minyard, a microbiologist at the Southern Research Institute in Birmingham, Ala., who has studied MRSA for several years. We probably notice aberrations on our skin more readily...and yes, we are more likely to seek treatment and insist on having a culture analyzed, a point made by Marx and others.

If it's true that MRSA is more common in HIV-positive men, as the UCSF study concluded, that could also be the result of other factors. Kenneth Mayer, MD, a Brown University professor and medical research director at Boston's Fenway Community Health who was a coauthor of the controversial study, acknowledges a 'modest immunologic dysfunction' among HIV-positive men that makes them more susceptible to staph infections. But Gurley and others believe that these men and gay men in general have been unfairly targeted.

Despite the dire warnings from groups like Concerned Women for America that gay men are inflicting another pandemic on the population at large, all doctors and researchers agree that gay sex is no more of a risk than any other skin-to-skin contact, since the fundamental source of MRSA is faulty hygiene -- not sex.

'There's no similarity to HIV,' Mayer says. Ironically, until recently many cases of MRSA have been traced back to medical personnel. Hospitals, clinics, and nursing homes are great incubators of MRSA, especially when health professionals don't wash their hands after touching patients or equipment.

MRSA outbreaks have occurred among professional athletes, such as a rash of cases among NFL players (notably, the St. Louis Rams, subjects of a 2005 study), and in prisons, schools, and gyms. Some worry that MRSA may be carried up the food chain by farm animals that have been pumped full of antibiotics.

So why were gay men singled out in the San Francisco-Boston study? One reason is that these cities were where these particular researchers had collected their data. The study contained 'no radical new information,' Mayer says. 'What created the misperception was how the data were introduced.'

The authors issued a press release -- unusual for such a study, and as they later tacitly acknowledged, a bad idea in retrospect. That brought media attention, and as Mayer notes, 'the media tend to feed on themselves.' Thus, through miscommunication, a treatable infection was covered by the media as though it were incurable and threatened to run rampant through the general population. In the ensuing public-health panic, those with their own agendas ran with the story, creating even more headlines.

As a result of the misinformation, activists in San Francisco formed a group similar to ACT UP to counter the hysteria. Founded by Richard A. Loftus, MD, an out HIV specialist and respected academic researcher, the group called attention to the San Francisco Chronicle, which headlined its story on the research findings 'S.F. Gay Community an Epicenter for New Strain of Virulent Staph.'

An analysis of the fiasco by the highly respected Columbia Journalism Review pointed a finger at medical reporting in general, with its 'tendency to glaze over important scientific details and to mischaracterize the science in order to emphasize its (in this case literally) sexier aspects.' The New York Times, whose original coverage was headlined 'New Bacteria Strain Is Striking Gay Men,' covered its tracks with a follow-up only five days later that essentially retracted the original article's headline.

That's not to say that MRSA hasn't become a serious health issue. If left untreated, MRSA can spread to internal organs. In 2005, nearly 100,000 people contracted MRSA in the United States, and 16,000 died from complications. Everyone needs to be vigilant to prevent contracting MRSA [see sidebar] and to make sure that their doctor sends a culture of any skin infection to a lab for analysis.

James Millner, 35, first contracted MRSA when he was living in Washington, D.C. His primary care physician asked a few questions and concluded he had MRSA. A few years later, when he was living in New York City, he went to what he calls 'one of those doc-in-the-box places,' where he was mistreated concerning another skin infection.

'In retrospect, I should have been more aggressive,' says Millner, who has since moved back to D.C. 'I'd had it before. I even asked the doctor later, and he said, 'We see 70 of these a month.'' Both times, once he was put on the proper treatment regimen the infection cleared up within 24 hours.

Gurley recommends seeing a medical provider accustomed to treating gays; chances are, they will be more knowledgeable about MRSA. Besides, even though MRSA is not a sexually transmitted disease, it's possible to have an experience like the man who spoke up at a public forum in Boston. While visiting his mother in Fort Lauderdale, he says, he contracted MRSA from a hospital visit. But once he told the ER doctors he was gay, they assumed it was a 'community-acquired' case transmitted through sexual contact.

'People don't need to feel badly about getting this,' Millner says. 'They shouldn't be afraid of getting tagged as having had sex with a lot of people. It shouldn't be a stigma.'

HOW TO PREVENT MRSA

A few easy precautions can prevent getting MRSA:

IN THE GYM
Disinfect with bleach before using.
Wear gloves -- and wash them.
Don't wear sweaty clothes.
Don't share razors or towels.
Bring your own yoga mat.
Put a towel on a sauna or steam room bench.

HAVING SEX
If you notice a spider bite on your partner, ask him if he knows what it is.
Shower immediately after sex.
Wipe off any fluids from your body; MRSA thrives in warm, moist climates.

DOING DRUGS
Don't share bumpers, spoons, or straws.
Crystal meth leads to marathon sex and skin abrasion. Snorting meth also wears down nasal membranes, a prime source of staph. (But by now, do you really have to be told not to do tina?)

EVERYWHERE
Wash your hands frequently.
Carry a pocket-size hand sanitizer.

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