Health providers unsure if infections indicate a crisis or limited incidences
New York City gay men are apparently in the grip of an outbreak of antibiotic resistant bacteria of the kind that affected dozens of gay men on the West Coast in late 2002 and early 2003.
Dr. William Shay, who is one of four internists in a Manhattan practice, estimated that he and his colleagues had seen roughly 50 cases of methicillin-resistant staphylococcus aureus (MRSA) skin infections since the summer of 2003. “You can have two or three a day and then none for a while and then several per week,” Shay said. Roughly half of the infections were “very minor” requiring treatment with antibiotics while others were more serious and required a more aggressive intervention. None of the clients with MRSA had to be hospitalized.
Other doctors who see large numbers of gay men in their practices reported seeing MRSA cases beginning last summer.
“I have seen a slow, steady number since last year,” said Dr. Howard Grossman. “There doesn’t seem to have ever been a huge outbreak.”
Grossman estimated that he was seeing one case “every couple of months” and some of the infections may have been acquired during travels outside New York City.
Dr. Frank Spinelli, a physician in private practice, told Gay City News he saw a cluster of cases in the summer of 2003, but only two recently. One of those two recent cases came in 2004.
Dr. Joseph G. Olivieri, medical director for primary care at the Ambulatory Surgery Center of Brooklyn, reported seeing two cases since last July. Both men required treatment with antibiotics and outpatient surgery.
“They were very serious,” Olivieri said. Dr. John Montana reported just one recent case.
Usually, MRSA infections occur in medical settings, but beginning in the 1990s MRSA started to appear outside of hospitals in so-called community outbreaks.
“It seems to be that the overall case numbers are going up,” said Dr. Barry Kreiswirth, director of the Tuberculosis Center at the Public Health Research Institute. “We don’t understand why.”
There have been MRSA outbreaks among school children, prisoners and athletes. Part of the reason for the increase may be that doctors, who may not want their practice associated with the bug, are more comfortable reporting cases.
“Even with that said I still think the overall numbers are going up and definitely in many, many different settings,” Kreiswirth said. “The number of these cases is definitely rising.”
Unlike the resistant bacteria found in hospitals, MRSA in community outbreaks is usually resistant to just one type of antibiotic.
“These particular strains that are causing these community acquired clusters are easy to treat,” Kreiswirth said.
Following the West Coast outbreak the city health department investigated the possibility of an MRSA outbreak in New York, but by March of 2003 it appeared that the city had seen no more than three cases among gay men.
Two of those three cases were reported by the Callen-Lorde Community Health Center in Chelsea. Dr. Dawn Harbatkin, the center’s medical director, did not respond to calls asking if the center had seen any additional MRSA cases since early 2003.
The MRSA problem among gay men is not limited to New York City and Los Angeles.
In February of 2003, the Centers for Disease Control and Prevention held a conference call to discuss MRSA with seven health clinics across the country that serve predominantly queer populations. The federal agency learned during that call that clinics in Houston and Boston were also seeing MRSA cases, according to Nicole Coffin, a CDC spokesperson.
Since then the CDC has become “aware of clusters of men who have sex with men” across the country who were contending with MRSA infections, according to Coffin.
Government health officials are hampered to an extent in their efforts to track MRSA because doctors are not required to report it like other infections such as syphilis or HIV.
MRSA usually appears on intact skin as a pimple, but it will quickly grow larger, more inflamed and more painful. The infection can occur anywhere on the body. While MRSA can be easily cured, it must be treated immediately. If left untreated, MRSA can cause serious health problems including death. People who think they may have an MRSA infection should contact their doctor, Callen-Lorde at (212)271-7200, or go to a hospital emergency room.