Dr. T. Douglas Gurley of Atlanta speculated that behaviors besides sex that are common in gay men, such as shaving, could be responsible for MRSAs. (Photo courtesy Gurley)
Drug-resistant staph seen in Atlanta gay men Hype over recent San Fran study overblown, experts say MRSA misrepresented as ‘superbug’
Sources: “Emergence of Multidrug-Resistant, Community-Associated, Methicillin-Resistant Staphylococcus aureus Clone USA300 in Men Who Have Sex with Men” at www.annals.org, WebMD
Many media outlets misread, overstated or used a study examining antibiotic-resistant staph infections in San Francisco’s Castro District as ammunition for political agendas, according to health experts and the study’s authors.
A report published in next month’s issue of Annals of Internal Medicine identified a strain of Methicillin Resistant Staphylococcus Aureus, or MRSA, resistant to three antibiotics used to treat the skin infection. The report stated men who have sex with men are 13 times more likely to develop this infection than the general population.
Mainstream news outlets ran headlines like, “Gay men 13 times more likely to develop MRSA infections.” One London tabloid went so far as to call MRSA the “new HIV," and several news organizations deemed it a sexually transmitted disease. But few of the reports were accurate, according to one of the study’s authors, Dr. Henry Chambers, professor of medicine at the University of California - San Francisco.
“We put the information out there, and how one is going to interpret what we put out, we can never know,” Chambers said.
Most of the misreading can be attributed to a disconnect between the highly technical language of researchers and how those words are understood by the public, he said.
The claim men who have sex with men are 13 times more likely to acquire this strain of MRSA than the general population is true, Chambers said, but those words need to be put into the proper perspective. The study only looked at individuals in San Francisco with reported MRSA infections, so when the report says general population, it means those with an MRSA infection in San Francisco, not the population as a whole, Chambers said.
Dr. Rachel Gorwitz, a medical epidemiologist with the Centers for Disease Control & Prevention in Atlanta, said MRSA had been misrepresented as a “superbug.”
“I guess the implication when people use the word ‘superbug’ is that it can’t be treated, and that isn’t the case,” Gorwitz said.
In ideal circumstances, most people can be treated by lancing the boil caused by the infection and covering the wound.
RESEARCH FINDINGS
What Chambers and his colleagues found is a variation in the plasmid in the USA300 strain of MRSA, resistant to the antibiotics Tetracycline, Clindamycin and Mupirocin. But Gorwitz stressed there are still treatment options available.
“What these strains are, what actually defines these strains, is they contain this particular plasmid, and this plasmid contains some drug resistant elements,” Gorwitz said.
Plasmid is an extrachromosomal ring of DNA in bacteria that reproduces itself.
“There is no reason to expect that this plasmid containing form is any more virulent, or causes any worse disease than [normal],” Gorwitz said. “The concern is that these strains are more drug resistant.”
In an audio recap of their findings, Dr. Binh Diep and Chambers speculated the USA300 clone developed its drug resistance in HIV infected men.
“This may be a situation where the multi-drug resistant form of USA300 evolved among HIV-positive men who have sex with men and then spreads into the population of HIV negative men who have sex with men,” Diep told the Annals of Internal Medicine.
CDC's Gorwitz said that is a plausible explanation.
“That makes sense, because resistant bacteria tend to develop in places that have more exposure to antibiotics,” she said. “It would not be surprising that it developed in this population and then spread out into the general population.”
MRSA is not tracked by the CDC, so there are no firm numbers regarding the number of MRSA infections in Atlanta. Anecdotal evidence from medical practices with large numbers of gay male patients suggests a high concentration of MSRA in that population.
“I see it every day,” said Dr. T. Douglas Gurley, who has a practice at the King Plow Arts Center.
Dr. Joel Rosenstock of AbsoluteCare Medical Center on Briarcliff Road also reported that MRSA infections are seen several times a day at his practice.
“It’s not surprising that we don’t have as a big an outbreak as San Francisco or Boston, but guess what, we’re at the other end of that triangle,” said Rosenstock.
The study suggests MRSA is spread by gay men through sexual acts. Because the bacteria can survive around the anus, skin-abrading anal sex can open a wound that can be infected.
“It's not the sex, it’s the close contact you have with other people,” Rosenstock said.
Gurley speculated that other behavior common in gay men could be responsible for MRSA's spread.
“It‘s spread through skin to skin contact, or sex, or a contaminated surface, so it really gets transmitted at gyms, sauna or sex clubs,” Gurley said. “Interestingly it was found 30 percent in the groin area, and gay men shave that area, and shaving creates micro-abrasions which can make you more susceptible.”
Men who have sex with men were only one factor in the report, and Chambers said they found the same strain in other communities.
“There were other factors that no one wanted to talk about, such as receiving antibiotics as Clindamycin, or those who have had previous staph infections. There are two other pretty powerful factors, but the most powerful is men who have sex with men,” said study co-author Chambers.
ANTI-GAY UPROAR
While MRSA infections are being seen in gay men, "I think the bigger story is how the religious right and other conservatives, think tanks, policy groups, have turned this into a stigmatizing story about gay men,” Dr. Jason Schneider said.
Schneider is the associate medical director of the Primary Care Center for Atlanta's Grady Memorial Hospital and president of the national Gay & Lesbian Medical Association.
“I’ve been seeing these infections, not this particular strain, but this infection in people from all demographics for four or five years now," he said.
Peter LaBarbera, president of the socially conservative Americans for Truth, seized on the idea that the clone developed among gay men and coined a new term, “Second Hand Sodomy,” as he called for the government to close down sex clubs and bath houses.
In a podcast on the website of Concerned Women of America, Martha Peter, a policy analyst, implied that AIDS is a gay disease and blamed MRSA on behavior.
“This really points out a big difference between say the HIV/AIDS epidemic and MRSA — MRSA is not a gay disease, it is a serious Staph infection that anyone can get. … Yet here you have behavior throwing gasoline on the situation,” Peter said.
The study's author disagreed.
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