BY DUNCAN OSBORNE | A strain of methicillin-resistant staphylococcus aureus (MRSA) which has spread among gay men in San Francisco and Boston, and was described in a January study, has not been seen in New York City, but a city health department epidemiologist said it will likely be found here.
“I would expect to see some of those cases in New York City,” said Dr. Melissa A. Marx, director of the department's Antibiotic Resistance Unit, at a February 5 forum on MRSA held at the Gay Men's Health Crisis (GMHC).
“We are still looking at our data to determine if we've got that here.”
Health officials say simple hygiene could prevent outbreak affecting gay men elsewhere.
A study by the University of California at San Francisco (UCSF) that was published online identified a “multi-drug-resistant, community-associated” strain of MRSA that was found only in men who have sex with men in those two cities.
MRSA began to emerge in healthcare settings in the 1960s and, beginning in the 1990s, was found among athletes, school children, prisoners, and other people who had not been in hospitals or nursing homes. These staph occurrences outside of healthcare facilities are known as community outbreaks.
A 2007 study found that more than eight out of ten MRSA infections are in healthcare settings, but one strain, USA 300, has emerged as the dominant strain in community outbreaks. The USA 300 strain described in the UCSF study has additional drug resistance and had not been identified previously.
Responding to queries from the gay press, the city health department began assessing the spread of MRSA here in 2005, Marx said. To date, the city has looked at 574 cases collected from a single private testing lab.
While the data is preliminary and not representative of the city as a whole, Marx said MRSA infections among gay men in the sample were associated with being HIV-positive, using crystal meth or Viagra, attending private sex parties, and waiting more than 30 minutes to wash after sex.
“It might be more about hygiene,” Marx said. “It might be about how quickly you wash up.”
Marx suggested that men who have sex at private parties should BYOT, or “bring your own towel,” wash after sex, and not share that towel with other men. She also advised that men not share needles, straws, or other equipment used to shoot or snort meth or other drugs. MRSA is most likely spread from skin to skin.
“Skin to skin contact we think is the best way to transmit MRSA,” Marx said.
Starting on February 27, all private labs will be required to report MRSA cases to the health department and the city will be better able to assess the spread of the bug.
While many media reports represented the strain in the UCSF study as a deadly “super bug,” Dr. Duane M. Smith, an infectious disease expert at New York-Presbyterian, a hospital affiliated with Columbia and Cornell Universities, said it is susceptible to some antibiotics and that in some cases those drugs may not be needed at all. The infection can be treated by opening the boil and draining the pus.
“I'd have to say I've done more draining in the past year than I've done in the 15 years before,” Smith said at the forum. “These are all treatable problems.”
It is when MRSA is misdiagnosed and treated with the wrong antibiotics or left untreated that it can become a dangerous and sometimes lethal infection.
Smith said that MRSA is “not a disease of just gay men” and he reiterated Marx's comments about hygiene and how the bug is spread.
“The common thing is that these are people who are in close contact where hygiene may be an issue,” Smith said of people who have contracted the infection.
GMHC held the forum, which drew roughly 30 people, after media reports on the UCSF study prompted more calls about MRSA to the AIDS agency.
“During this period, our GMHC hotline has had about three to five calls a day about this topic,” said Dr. Bill Stackhouse, director of GMHC's Institute for Gay Men's Health.
