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VOLUME 3, ISSUE 306 | February 05 – 11, 2004

HEALTH

Doctors Report Staph Outbreaks

Nationwide, urban areas see clusters of infections in gay population

What was a local outbreak of antibiotic resistant bacterial infections that hit dozens of gay men on the West Coast in late 2002 and early 2003 appears to have quickly swelled into outbreaks in several cities affecting hundreds of gay men across America.

“It started about this time last year and we have seen a marked increase since last year,” said Dr. Timothy A. Price, a physician in private practice with one other doctor in Washington, D.C. “I would say 60 cases since September.”

Price, whose patients are mostly gay men, estimated he was seeing about three methicillin-resistant staphylococcus aureus (MRSA) skin infections per week. None of the men had to be hospitalized for treatment.

Dr. Bruce Rashbaum, another D.C. physician in private practice, said that he was seeing, on average, two to five cases per week with a number of those infections occurring in men who had previous infections of MRSA. That number has been consistent for some time.

“It comes in spurts, but probably for the last year,” Rashbaum said.

Across the nation in Seattle, Dr. Peter Shalit, who works in a two-doctor practice, said he and his colleague have seen, on average, two MRSA cases per week for the past six to eight months.

“It varies, some weeks several, some weeks none,” Shalit said. “It seems like it’s sort of established here.”

Like Price and Rashbaum, Shalit sees large numbers of gay men in his practice. Most of Shalit’s cases were easily treated though a small number, perhaps five, had to be hospitalized.

In Chicago, Dr. Ross A Slotten, a physician in a three-doctor practice, saw his first cases two years ago.

“Then there was a period of six to nine months where I didn’t see anything,” Slotten said. “Then about a year ago I started to see an upsurge… In January [of 2004] we saw five or six cases in our practice.”

Slotten estimated that 80 percent of the clients coming to his office are gay men.

“The incidence of MRSA is really shockingly high,” he said. “It does seem to be weekly or bi-weekly occurrence… It seems to be accelerating.”

The 2002 and 2003 West Coast outbreak was centered in Los Angeles and by March of 2003 reports in the gay press indicated just small numbers of cases in New York City, Atlanta, Boston, and Houston.

Recently, New York City saw a dramatic rise in MRSA among gay men. Dr. William Shay, who is one of four internists in a Manhattan practice, estimated that he and his colleagues had seen roughly 50 cases 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.

Other doctors in the city reported seeing smaller numbers of recent MRSA infections.

Gay City News either did not get phone calls returned from private physicians in Atlanta, Boston, or Houston or the newspaper could not identify doctors in those cities who see large numbers of gay men.

Denver has now joined the list of cities that are seeing MRSA among gay men. Responding to an e-mail query, Dr. David Cohn, a staffer in Denver’s health department, wrote: “Yes we are seeing cases of MRSA among gay men in our clinic, just as we are seeing increasing rates of MRSA infection in other patients. Believe these are local and not imported, and that this is an emerging problem in many parts of the country.”

Part of the problem with assessing the spread of MRSA across the country is that doctors and hospitals are not required to report the infection to health officials as they must with conditions such as syphilis or gonorrhea.

Dan Jernigan, a medical epidemiologist at the federal Centers for Disease Control and Prevention (CDC), estimated that there are 150,000 MRSA cases each year among all populations in the U.S.

While the CDC has anecdotal information about clusters of MRSA cases among gay men in Washington, D.C., Boston, Houston, and Florida, Jernigan could not say definitively where MRSA was affecting gay men or how many men were infected.

“That is not a figure that we have the ability to collect,” he said.

Similarly, local health officials across the country are hamstrung by the lack of a MRSA reporting requirement.

In February 2003, the CDC held a conference call on MRSA with seven health clinics across the country that serve queer populations in an effort to address the infection. It appears, however, that private physicians are seeing most of the MRSA cases.

A spokesperson for the Whitman Walker Clinic in Washington, D.C. said they saw three MRSA cases in 2003 and none this year.

Dr. Dawn Harbatkin, medical director at New York City’s Callen-Lorde Community Health Center, said, “We’ve had 21 cases in the past seven months. We have 15 more that are pending test results.”

Usually, MRSA infections occur in medical settings, but beginning in the 1990s MRSA started to appear outside of hospitals in so-called community outbreaks.

Gay men are merely the latest group to get hit by the bug. There have been MRSA outbreaks among school children, prisoners, and athletes.

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 treated, it must be treated immediately. If left untreated, MRSA can cause serious health problems including death.

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