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  Skin Infection Breaks Out Among Gay Men in Los Angeles County
by GayHealth Staff

An outbreak of a drug resistant skin infection among gay men in Los Angeles County has health officials concerned, according to an article in the Los Angeles Times on January 27.

Staph, which is short for staphylococcus aureus, is a bacteria spread through skin-to-skin contact. The infection first caught the attention of health officials early last fall when, for the first time, there was increasing frequency of the infection found among gay men, mostly HIV-positive gay men.

Staph typically breaks out in a cut or opening, however, these infections are originating in unbroken skin, and are attacking uncommon places including the butt, penis, scrotum, legs, hands and face.

The concern, according to Dr. Peter Ruane, an infectious disease specialist in Los Angeles, is that the disease could spread to "the community at large." Meanwhile, Dr. Gary Cohan has seen Staph cases among HIV patients increase from about one a year to two a week. Cohan is the managing director of Pacific Oaks Medical Group Physicians. Ruane also began noticing staph in his gay patients in September, according to the LA Times.

"Staph is ubiquitous in the environment and the rise in resistant organisms is very dramatic," says Susan Ball, MD, MPH, assistant director of the Center for Special Studies, Bernbaum Unit, HIV Care Center, at New York Presbyterian Hospital. "People with HIV are no more or less prone to becoming infected with Staph and generally the treatment for someone who does is the same," she explains.

Perhaps more alarming than the infection itself, which may cause puss filled bumps, swelling and skin abscesses, is the fact that the most common and cheapest antibiotics -- including erythromycin, and fluoroquinolones, such as Cipro and Levaquin -- are not effectively treating the infection. The drugs that are still working include bactrim, rifampin, clindamycin as well as an intravenous medication called vancomycin, which is typically administered as a last resort. However, if the infection becomes resistant to more medications treatment options will be limited even more. Thatís why itís so important to take antibiotics as prescribed if you develop the infection; Skipping doses may lead to further resistance.

"It is hard to know how to interpret this outbreak among gay men," says Dr. Ball. "Unfortunately, we are going to see a lot more of this infection unless somebody comes up with an utterly new antibiotic to defeat it."

"Primary-care doctors and ER doctors need to know about this so that when they encounter these infections, they can prescribe a drug that's active against resistant staph," Ruane said. Physicians can culture the infected area to identify resistance before prescribing medications.

"It's an evolving story," said Ruane. "The aggressiveness of this took us aback," he said.

Currently, most infections require only medication, however patients with more severe cases have been hospitalized.

After analyzing the strain, physicians found a toxin called Panton-Valentine leukocidin also found in resistant strains in France. The toxin may explain why this strain of staph can break through healthy unopened skin.

The strain in LA is also the same one found among 39 hospitalized AIDS patients in 1997 in New York City by microbiologist Barry N. Kreiswirth, a researcher at the nonprofit Public Health Research Institute in Newark, NJ.

"It's only in the past couple of weeks when we got the molecular fingerprinting results that we were able to go back and connect the dots," said Dr. Elizabeth A. Bancroft, a medical epidemiologist with the Los Angeles County Health Department who is leading the investigation.

If you notice a skin boil or infection you should visit a physician and have the area cultured.

Updated: Tuesday, January 28th 2003

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