MRSA in men who have sex with men

MRSA is a common cause of skin infections throughout the United States. These infections occur in men, women, adults, children, and persons of all races and sexual orientations, and are known to be transmitted by close skin-to-skin contact.

In this issue of the Annals of Internal Medicine, Diep et al looked at isolates of MRSA - USA300 strains containing a particular plasmid associated with additional drug resistance. The paper shows that multidrug-resistant USA300 has emerged as an important source of disease among men with have sex with men in 2 geographically distinct communities.

The strains of MRSA described in the recent Annals of Internal Medicine have mostly been identified in certain groups of men who have sex with men (MSM), but have also been found in some persons who are not MSM. It is important to note that the groups of MSM in which these isolates have been described are not representative of all MSM, so conclusions can not be drawn about the prevalence of these strains among all MSM. The groups studied in this report may share other characteristics or behaviours that facilitate spread of MRSA, such as frequent skin-to-skin contact.

CDC's extensive and continuing study of invasive MRSA in 9 US states indicates that these strains are rare. CDC continues to monitor resistance patterns and strain characteristics in MRSA isolates submitted to CDC for a variety of investigations. Bacteria are able to acquire resistance to antibiotics. It is concerning that these bacteria are becoming resistant to more antibiotics than the typical community associated-MRSA strains because this limits the available treatment options. Fortunately, there are still effective choices available to treat infections when antibiotics are required, including those antibiotics given by mouth. It remains important to do what we can to prevent transmission of these strains and of MRSA in general.

MRSA is typically transmitted through skin-to-skin contact, which occurs during a variety of activities, including sex. There is no evidence at this time to suggest that MRSA is a sexually-transmitted infection in the classical sense.

Therefore, CDC believes that their recommended prevention measures for CA-MRSA in general are also the most appropriate response to the strains described among MSM.

You can prevent spreading staph or MRSA skin infections to others by following these steps:

Cover your wound. Keep wounds that are draining or have pus covered with clean, dry bandages. Follow your healthcare provider's instructions on proper care of the wound. Pus from infected wounds can contain staph and MRSA, so keeping wounds covered will help prevent the spread to others. Bandages or tape can be discarded with the regular trash.
Clean your hands. You, your family, and others in close contact should wash their hands frequently with soap and warm water or use an alcohol-based hand sanitizer, especially after changing the bandage or touching the infected wounds.
Do not share personal items. Avoid sharing personal items such as towels, washcloths, razors, clothing, or uniforms that may have had contact with infected wounds or bandages. Wash sheets, towels, and clothes that become soiled with water and laundry detergent. Drying clothes in a hot dryer, rather than air-drying, also helps kill bacteria in clothes.
Talk to your doctor. Tell any healthcare providers who treat you that you have or had a staph or MRSA skin infection.

(Source: Annals of Internal Medicine: Center for Disease Control and Prevention: February 2008)