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By Erin Archer
"Is it a spider bite?" Patients in San Francisco and around the country have been asking doctors that question more often lately.
That's because what may seem like a bug bite or simple skin infection is in rare cases a drug-resistant staph infection called methicillin-resistant Staphylococcus aureus (MRSA), and this infection requires immediate medical attention. In February, a Noe Valley merchant died within a week of noticing a cut infected with MRSA staph (see story below).
MRSA (often pronounced "mer-sah") can be spread through skin contact with infected people or surfaces. It can infect anyone, but there is particular concern for those with weakened immune systems.
Earlier this year, researchers from the University of California, San Francisco, published the results of a study in the medical journal Annals of Internal Medicine. The study identified San Francisco as the potential center of an extremely drug-resistant strain of MRSA. The highest concentration of cases was in zip code 94114, and male-to-male sex appeared to be a risk factor.
In announcing the news, a Jan. 14 headline in the San Francisco Chronicle declared the "S.F. gay community an epicenter for [a] new strain of virulent staph," setting off alarms around the city.
After several other publications ran stories on the subject, members of the Stop AIDS Project organized a forum to talk about MRSA and to combat what they saw as the homophobic "spin" to the news coverage. The Jan. 30 forum, held at the LGBT Center on Market Street, included researchers, physicians, and community activists.
Dr. Ken Katz, of the sexually transmitted diseases division of the San Francisco Department of Public Health, told the audience that MRSA infection was not new. "We have known about this disease for years," he said. "MRSA is not a gay disease. MRSA is not a disease of the Castro or of any neighborhood. MRSA can affect all San Franciscans. This is a conversation we've been wanting to have for a long time."
Rick Loftus, a physician at Davies Medical Center and an expert in gay men's health, apologized for arriving at the forum late. Ironically, he had been diagnosing a case of MRSA pneumonia. He said MRSA was a problem for concern, especially for gay men. However, he noted, "We're not the source of the MRSA problem, but its inadvertent victims.... People with HIV get more skin infections, period. Our community was on low ground. The tsunami came through, and we got drowned."
The experts all agreed that antibiotic-resistant infections are on the rise across the nation. Previously limited to hospitals, MRSA has recently been found at schools, on sports teams, in prisons, and at gyms. Any shared and frequently touched surface can be a means of transmission, and MRSA may sometimes be transmitted during sex.
Dr. Erica Pan, of the Health Department's communicable disease division, suggested that people put some sort of barrier between their skin and the surfaces they have to touch. "Put a towel down at the gym," she said, and make sure that cuts or wounds are covered before engaging in contact sports, martial arts, or sex, "like making sure someone wears a condom."
Advice from Noe Valley Doctors
The UCSF study estimated that in the zip code 94114, which includes the Castro and Noe Valley, one person in 588 was likely to have an infection caused by a particularly aggressive bug within the MRSA strain, one that is resistant to most common antibiotics. (The city as a whole was estimated to have one case for every 3,846 people.)
So should residents in Noe Valley be more alarmed than those in other San Francisco neighborhoods?
"I think 'alarm' is not the right word. I think people should be 'aware'" of the potential for staph infections which can arise from seemingly minor cuts or abrasions, said Dr. Sophia Mirviss, a member of the Pacific Family Practice Medical Group (pacificfamilycare.com) on Church Street.
People may tend to dismiss what looks like a bug bite, for example. "But if it gets a lot bigger and quicker in 24 hours, they should be concerned that it is a staph infection," said Mirviss, who has practiced in Noe Valley for 16 years.
Mirviss said she has not encountered the more dangerous variant in her practice, but has successfully treated a number of other MRSA cases in the past three to four years.
"You have to treat it aggressively, and you have to treat it early," she said.
Like Mirviss, Dr. Jade Schechter of the Noe Valley Clinic on 23rd Street doesn't want to fan people's fears. But she understands their concerns. "No one wants to be the 'epicenter' of anything," she said.
In late February, however, she had yet to treat a single patient with MRSA in Noe Valley. "I haven't seen a ton of it here," she said, "but we've only been here for four months. We have four clinics, and I saw more MRSA when I was working at our clinic in the Financial District. Here, my patient population is pretty healthy. In general, there's an upswing of MRSA, but at this site I don't think I've seen a case yet."
Her best advice to neighborhood residents is to use common sense. "Good general hygiene precautions are still the best prevention," she said.
Schechter notes that MRSA is just one of many organisms that can cause infection. "All bacteria have resistance, and MRSA is just one of them. Still, it's a good reminder: Don't overuse antibiotics. Wash your hands well. Don't share things like towels, and keep wounds clean and covered. Parents should be aware of their kids' wounds. Kids are more susceptible to complications because their immune systems are not as developed. Make sure that your child's wounds are healing appropriately, that they don't have a fever, and that they're acting like themselves."
Dr. Schechter recommends that a patient get medical advice if a cut becomes redder or more swollen, or there is an area of pus. An infected wound may be warm to the touch or more painful than expected. "If a person has a wound with a fever or they're systemically ill," she adds, "they should definitely seek medical attention if they haven't already."
"Keep yourself healthy in all ways," Dr. Schechter advises. "Eat well and get good sleep. This will help your immune system better fight any kind of infection."
Erin Archer is a registered nurse who lives and works in San Francisco. For more information about MRSA, go to the San Francisco Department of Public Health's website at www.mrsasf.org.
How to Avoid MRSA Infection
The staph infection that claimed the life of Mail Boxes Etc. owner Ken Tom is formally known as MRSA, or methicillin-resistant Staphylococcus aureus. It is a highly communicable disease that has proven itself resistant to most antibiotics. There is some evidence, as reported by the San Francisco Department of Public Health, that gay men are at higher risk of getting MRSA. But anyone can become infected--Ken Tom was not gay.
Factors that facilitate MRSA according to the Health Department are:
- Frequent skin-to-skin contact
- Compromised skin (i.e., cuts or abrasions)
- Contaminated items and surfaces
- Lack of cleanliness
Good hygiene can prevent the spread of staph infections. The San Francisco Department of Public Health recommends the following measures to combat MRSA:
- Wash your hands frequently with soap and water. If soap is not available, use hand sanitizer instead.
- Keep wounds covered with clean, dry bandages.
- Do not share personal items such as towels, clothes, or anything else that makes contact with skin.
- Clean and disinfect items that are shared (such as athletic/workout equipment) before and after every use with disinfectant or detergent. A list of products approved by the Environmental Protection Agency that are effective against MRSA is available from the Department of Public Health's website. These products should be used only as directed.
- Use lotion to keep skin moist; damaged skin can provide an opening for infection.
For more information, visit the San Francisco Department of Public Health website www.mrsasf.org.