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Local and Community News

Skin Infection Spreads Among Gay Men in Los Angeles

January 30, 2003

Large, painful skin infections started turning up early last fall among Los Angeles gay men, then appeared with increasing frequency. Although it took a while to confirm a connection between the cases, doctors now know they are facing an emerging epidemic of drug-resistant Staphylococcus aureus, or staph.

Although the outbreak seems confined primarily to gay men, doctors say at least one woman contracted the infection, probably from a male sex partner. Because they still know so little about the extent of the outbreak, they cannot predict how many people it may eventually affect. The infection, which causes boils, deep abscesses and widespread surrounding inflammation, has proved impervious to common antibiotics. Although it appears to be spread primarily by skin-to-skin contact, including sex, its origins and precise mode of transmission remain a mystery. Doctors treating it caution that it could also be contracted at health clubs, steam rooms and other warm, moist environments.

County health officials, with assistance from CDC, have begun an investigation to understand how the infection is spread, determine who else may be affected, and develop strategies to contain it.

Staphylococcus aureus lives on the skin's surface, usually existing harmlessly. Infections typically start in a cut or other opening. But the infections in L.A. gay men -- the majority with well-controlled HIV/AIDS, but many others in good health -- took hold in unbroken skin.

Federal figures show the percentage of staph specimens resistant to antibiotics increased from 2 percent in 1974 to 50 percent in 1997. But not until 1999 did the public health community begin appreciating the severity of the resistance problem outside hospitals.

Dr. Elizabeth Bancroft, a medical epidemiologist with the Los Angeles County Health Department who is leading the investigation, stressed that until an investigation reveals how the infections are being spread, anyone with a boil or skin infection should maintain good hygiene, washing towels and anything else that comes into contact with infected areas. Any skin infection that looks particularly aggressive should be examined and cultured by a doctor. And, anyone prescribed antibiotics must complete the full course even if they start feeling better.

The L.A. investigation has found the local strain resistant to erythromycin and fluoroquinolones, such as Cipro and Levaquin. That limits the drug arsenal to Bactrim, rifampin, clindamycin, and the drug of last resort, vancomycin, which is administered intravenously. Some doctors use the new antibiotic Zyvox -- but with a single course costing $1,500, they often have trouble persuading insurers to pay for it.

Back to other CDC news for January 30, 2003

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Adapted from:
Los Angeles Times
01.27.03; Jane E. Allen

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This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.