Commonly mistaken by patients and doctors as a spider bite, a strain of staph continues to puzzle health experts who aren’t sure how prevalent the drug-resistant bacterial skin disease is, or exactly what contributes to its spread.

“There’s still no clear reason why this particular strain of staph is spreading,” said Dennis Melton, a physician with the Infectious Disease Group of Atlanta. “But the incidence seems to continue to increase.”

The infection, known medically as methicillin-resistant Staphylococcus aureus, or MRSA, surfaced more than two decades ago, but was commonly found only in the elderly or individuals who had been hospitalized.

But medical experts are observing the emergence of a relatively new strain, known as community-acquired MRSA, among gay and bisexual men, athletes, prisoners and Native Americans.

Since a staph outbreak among gay men in Los Angeles in early 2003, the Centers for Disease Control & Prevention identified five major factors that facilitate the transmission of the infection: close contact, crowding, cleanliness, contaminated items and surfaces, and compromised skin integrity, said Nicole Coffin, a CDC spokesperson.

The compromised skin integrity category includes tiny abrasions that may occur during “manscaping” — the cosmetic shaving of body parts popular with some gay men.

A recent study of a college football team in Connecticut found that 10 of the team’s 100 players acquired MRSA during an eight-week period, and those who shaved body parts other than the face were six times more likely to be infected.

“Body shaving is likely to produce microabrasions,” wrote study author Elizabeth Begier, a researcher with the Connecticut Department of Public Health. “This emerging cosmetic behavior among young men may contribute to the risk of infection in populations of athletes, especially in areas covered by clothing.”

The study appeared in the Nov. 15 issue of Clinical Infectious Diseases and noted “turf burns” and whirlpools as factors that also may help spread staph.

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. But the infection may also progress into a life-threatening blood stream infection if antibiotics fail to control it, said Coffin from the CDC.

Staph is the most common cause of skin or soft tissue infection in the U.S., and 90 percent of infections continue to occur in a hospital setting, Coffin said. But no national reporting system to track the prevalence of staph exists, mainly because of how varied its severity is, she said.

Four states — Connecticut, Minnesota, Georgia and Maryland — are collecting data on MRSA to help the CDC better understand the illness, according to the CDC.

According to a study published in the June 2004 issue of the Georgia Epidemiology Report, a publication of the state Department of Public Health, community-acquired MRSA infections accounted for 8 percent of all MRSA cases in Georgia in 2002, up from 4 percent in 2001.

The average community-acquired MRSA patient in the study, which reviewed data from eight counties surrounding Atlanta, was 38 years old, whereas patients who acquired MRSA in a hospital setting were an average age of 67.

The public health researchers wrote that they wish to continue to study the impact of MRSA in Georgia “by adding these infections to the list of notifiable diseases.”

Ryan Lee can be reached at rlee@sovo.com.