The Great MRSA Epidemic: Is It Time to Worry?

Jan. 23, 2008— -- Flesh-eating bacteria. A drug-resistant menace, spreading silently through hospital hallways.

If one were asked to come up with a recipe for a panic-inducing disease, it would be hard to come up with something more horrifying than methicillin-resistant Staphylococcus aureus -- or MRSA.

But even as new research suggests that the disease may be spreading though the homosexual community -- and could even be developing into a full-blown epidemic -- health experts studying MRSA say panic over the disease may be premature.

Just ask Dr. Daniel Pallin, director of clinical research in the department of emergency medicine at Brigham and Women's Hospital in Boston.

Pallin led a team of investigators to track the rise in the number of infections from drug-resistant staph germs between 1993 and 2005 using government-provided data. Their mission: to determine whether we have an epidemic on our hands.

"In simple terms, the answer is yes," Pallin says. "The number of emergency room visits for these skin infections increased by about triple."

Specifically, Pallin and his colleagues discovered that visits to emergency departments due to MRSA rose from 1.2 million in 1993 to 3.4 million in 2005. Community-acquired MRSA infections have become the No. 1 cause of abscesses in otherwise healthy emergency room patients.

But Pallin, whose study will appear in the upcoming issue of the journal Annals of Emergency Medicine, says that despite the confirmation that a MRSA epidemic is in full swing, the disease does not pose the level of disaster that the use of the term might suggest.

"This suggests to us that this actually is an epidemic, though it is an epidemic of a minor disease, and we don't want to create hysteria," he says. "I would say that people should be concerned but maybe not afraid or worried. But a certain level of concern is appropriate."

According to the study, the overall percentage of all emergency room patients who had MRSA skin infections rose from 1.35 percent in 1993 to 2.98 percent in 2005. And researchers found that of these cases, only 14 percent required admission to the hospital. Many cases did not even require treatment with antibiotics.

From Hospitals to Homosexuals, Worries Spread

But some say MRSA fears are spreading faster than the disease itself. Joel Ginsberg, executive director of the Gay and Lesbian Medical Association, says a different piece of research released last week may have been twisted to foster a wave of homophobia.

In a study released by the Annals of Internal Medicine Jan. 14, researchers at the University of California at San Francisco looked at populations of men in both hospitals and a clinic for HIV-positive patients. What they found was that men who had sex with men were 13 times more likely to get a certain form of MRSA.

Immediately, news organizations reported that the infection was passed through gay sex -- even though no hard evidence of such a route of transmission existed. One U.K. paper labeled the strain as "the new HIV."

"It seemed like there was some impulse to go straight to the most salacious way of talking about this issue," Ginsberg says. "We've seen that so much with issues affecting gay men's health. It strikes a nerve."

In particular, Ginsberg cites a comment last week by one of the study's lead researchers to Reuters reporters that may have been used by anti-gay groups in a barrage of what he characterizes as stereotypes and misinformation.

"Once this reaches the general population, it will be truly unstoppable," researcher Binh Diep was quoted as saying Jan. 14. He also suggested that the germ may be spread through sexual activity -- a statement that, as noted in the discussion section of the paper, was not directly supported by the study's findings.

Diep has since said that his statements were mischaracterized. But some groups have already pointed to this notion as proof that gay sex facilitates MRSA's spread. One of these groups is Concerned Women for America.

"The medical community has known for years that homosexual conduct, especially among males, creates a breeding ground for often deadly disease," said Matt Barber, policy director for cultural issues at the CWA, in a statement issued over the weekend. "When two men mimic the act of heterosexual intercourse with one another, they create an environment, a biological counterfeit, wherein disease can thrive."

But Ginsberg says messages like the one conveyed by the CWA may give the public the wrong idea about the disease.

"The stereotype about gay men is that they are very promiscuous and are vectors for disease," he says. "We know that there are hate groups eager for any confirmation of their prejudices, and that they will seize upon anything they can to make the point that gay people are fundamentally sick.

"It's unfortunate that good quality research out of a respectable institution could become fodder for these hate groups."

Ginsberg says the CWA episode is reminiscent of diseases that, in the past, have been labeled "gay diseases." In the 1980s, AIDS was largely thought to be a disease that was spread primarily through gay sex.

And in 1976, a group of proctologists in New York City coined the term "gay bowel syndrome" to describe an illness that comprised hemorrhoids, anal fissures and other conditions of the lower intestine. The "disease" was later criticized as a collection of unrelated maladies, none of which were exclusively experienced by homosexual male patients.

Possible Behavioral Causes

Still, the question remains: Why was this strain seemingly more prevalent in the gay communities the researchers studied? The authors of the UCSF study speculated in their discussion that certain behaviors could be at play.

"It is not clear whether the behavior potentiating these infections among men who have sex with men is anal sex … skin-abrading sexual practices or increased frequency of skin-to-skin contact; prevention messages may therefore need to suggest caution in each of these practices," the UCSF researchers wrote.

But confirmation of a link between such practices and the spread of the disease remain tenuous at best, as noted in a Jan. 16 press release from the U.S. Centers for Disease Control and Prevention.

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

Beating an Epidemic -- With Common Sense

In the face of the concerns over MRSA, what is the appropriate course of action? While mention of the word "epidemic" may have some people shopping for protective suits and stocking up the bomb shelter larders, Pallin offers a different suggestion.

"It's really a question of simple hygiene," he says. "People should keep their hands clean, keep their bodies clean, and if they notice any skin infection, see their doctor within a couple of days."

Pallin adds that it is also important for people to realize that MRSA can be acquired in the gym and around the home -- not just in hospitals. And he notes that even if a person suspects that he or she is infected with MRSA, such an infection is far from a death sentence.

"The majority of these conditions are skin abscesses or other conditions that are unlikely to be fatal," Pallin says. "These are really rare cases, and they make it into the news because it's alarming and it makes good press."

He estimates that less than 1 percent of the cases of MRSA that show up at emergency rooms are potentially fatal -- though he says the medical community still has an obligation to do whatever is possible to limit the spread of the disease.

"The most important thing the medical community has to do is to develop and maintain hygienic protocols," he notes. "That prevents staff workers at hospitals from transmitting it from one person to another.

"Also, doctors need to be judicious with their prescription of antibiotics. If doctors are using antibiotics when they are not necessary, then you have the chance of having the appearance of resistant types."

Along with these measures, Pallin says, the best prescription is likely a deep breath and a moment of calm.

"We don't want people to think this infection is going to be immediately fatal," he says. "Most doctors are comfortable in dealing with this infection. There is no need for a midnight ambulance ride with you see a red spot on your skin in most cases."