Clinic warns D.C. doctors, as cases appear nationwide

'Too many gay men are once again acting totally irresponsibly, and hideous diseases and physical manifestations are once again appearing,' said longtime AIDS activist Larry Kramer, about the conduct that apparently is resulting in the mysterious spread of drug-resistant staph infections among gay men.


The Whitman-Walker Clinic has warned D.C. area doctors that a drug resistant skin infection that has surfaced among gay men across the country could be transmitted, among other ways, through sharing drug paraphernalia used to inhale drugs through the nose.

In a Feb. 28 e-mail alert sent to doctors who treat gay men in D.C. and the surrounding suburbs, Whitman-Walker noted that Methicillin-Resistant Staphylococcus Aureus, or MRSA, is frequently found in the noses of large numbers of people in a non-infective state. The Whitman-Walker alert noted that the MRSA bacteria could be spread among people who share drug paraphernalia such as spoons, straws, or other devices used to inhale drugs such as cocaine or crystal methamphetamine ("Tina").

Gay men who use recreational drugs also routinely share "bumpers," small plastic devices through which they inhale recreational drugs like ketamine ("Special K") and cocaine.

Although MRSA and other forms of staph bacteria usually remain dormant in the nose, the bacteria could be spread from the nose to other parts of the body through poor hygiene, according to the U.S. Centers for Disease Control and Prevention.

Doctors who treat gay men in the District told the Blade last week that they diagnosed MRSA in at least seven gay men during the past few weeks. The skin condition, which is resistant to commonly prescribed antibiotics, began surfacing in gay men in Los Angeles and San Francisco late last year.

"When we first learned about this, we called our colleagues in the gay health clinics to discuss how we should address this," said Michael Cover, Whitman-Walker communications director.

Cover said the e-mail alert released by the clinic last week included a fact sheet describing the staph infection outbreak among gay men. He said it also urged area doctors to inform their patients about the condition and ways to avoid it as the patients appear for routine visits.

A spokesperson for the D.C. Department of Health said the department had not learned of MRSA infections appearing in D.C. until the Blade contacted the department last week. Dr. Karyn Berry, a communicable disease specialist with the department in charge of monitoring developments such as an MRSA outbreak, did not return a call by press time.

Activists demand response

After confirmation of staph infections among gay men in at least half a dozen U.S. cities in recent weeks, gay health activists are calling for an orchestrated acknowledgement and response from public health officials.

"No one is officially doing MRSA tracking, and that's a real problem," said Dr. Ken Harrel, president of the Gay & Lesbian Medical Association. "This is a large, emerging problem that no one seems to have a handle on."

The infections manifest themselves as boils and abscesses on various parts of sufferers' bodies, including rectal and groin infections. Public health officials in several cities said the infections appear to be spread from skin to skin contact, including sexual contact and public spaces like gyms and bathhouses.

Doctors confirmed cases among gays in Atlanta, Houston, Washington, D.C., Boston and New York City last week.

Until the late 1990s, the skin infection was confined mostly to elderly patients in hospitals and nursing homes, according to the CDC. But since 1997, non-hospital population groups such as prison inmates, members of athletic teams and Native Americans have reported the drug-resistant staph infections.

But CDC epidemiologists have said new cases outside San Francisco and Los Angeles appear to confirm earlier findings by CDC researchers that a new, undetermined factor is causing drug-resistant staph to flourish in a wider group of people that now includes gay men.

No deaths have been recorded from the staph cases reported in gay men, but some patients have been hospitalized. Physicians monitoring the infections say they could produce life-threatening complications if not treated promptly.

Solid information on patterns of infection and the national scope of the disease isn't available, according to health care providers, because MRSA is not widely "reportable" under current data gathering processes. Reporting MRSA diagnoses is not required to state health departments or the CDC like other diseases that could be a public threat.

CDC does have one "surveillance program" involving four states that voluntarily report MRSA findings, according to officials.

Scott Fridkin, a CDC medical epidemiologist and MRSA expert, said lack of reporting "isn't really the issue. It's the clinic recognition we're after, recognizing the need to do an appropriate test, the appropriate therapy and to have close follow-up with patients."

Learning from AIDS

Some gay health advocates compared the mysterious emergence of the cyst-like boils and abscesses on gay men to the early days of the AIDS epidemic.

"When I first heard about the staph infections among gay men, it reminded me of the first stories in the early '80s about a 'new cancer' appearing among gay men," Chris Parsons, director of advocacy and community relations for AID Atlanta, Atlanta's oldest and largest HIV/AIDS agency, said last week.

The type of conduct that apparently spreads the new staph infections among gay men parallels the risky behavior enjoyed by some before HIV, according to Larry Kramer, the nationally recognized writer who co-founded Gay Men's Health Crisis in New York and ACT UP, the AIDS advocacy and protest organization.

"Too many gay men are once again acting totally irresponsibly, and hideous diseases and physical manifestations are once again appearing," Kramer said.

But such comparisons could contribute to public hysteria about staph, said Cleve Jones, founder of the NAMES Project and the AIDS Memorial Quilt.

"It's certainly worrisome, but I would be cautious drawing parallels between this and HIV," Jones said. "This resistance has been well documented for decades, and we know this is an issue facing medical professionals, which is very different than at the beginning of the HIV pandemic where we knew nothing."

The lack of coordinated public health response is both telling and predictable, said Eric Rofes, author of ÒReviving the Tribe: Regenerating Gay Men's Sexuality and Culture in the Ongoing Epidemic," and an organizer of last year's GLBT Health Summit.

"I think that what this story reveals that is most interesting is the consequences of not having a specific entity that feels knowledgeable and responsible for gay men's health," he said. "Whose job is it in the national and even on a local and state context to provide oversight, planning and responsiveness for gay men?

"Is it the traditional public health system, which has traditionally been homophobic and has not prioritized this community?" he asked. ÒIs it the GLBT system, which has not been as organized and networked as they could be?"

Call for reporting

Some private physicians have called for quick action on the part of the public health care system.

"This is the time to jump on it and get out in front of it," said Douglas Ward, a Washington, D.C., physician whose office has treated at least three gay men for drug-resistant staph infections since late last year. "The sort of study that needs to be done doesn't go real quickly anyway, so the sooner the better.

"It's also going to be a lot tougher down the road to study thousands and thousands of cases and cross-analyze contacts and places of origin compared to doing it now, when maybe there is only a couple of hundred," Ward said.

Ward talked to his local health department officials who said they will "fully investigate" the cases, he said.

Public health epidemiologists working for state agencies have also joined in the call for mandatory reporting.

Centers for Disease Control & Prevention
1600 Clifton Rd.
Atlanta, GA 30333

One public health official urged state agencies to become more involved in the push to make staph infections a reportable medical condition.

"What is the dimension of the problem? We don't know," said Matthew Boulton, the state epidemiologist for Michigan. "What populations are we seeing it occur in? We don't know. What are the risk factors? We don't know."

Boulton spearheaded the move to make MRSA reportable by drafting a resolution for the Council for State & Territorial Epidemiologists. CSTE maintains the list of reportable diseases in the U.S. and works as an advisory body to the CDC.

The resolution, which Boulton has not publicly released, was turned in to CSTE last month, he said. It is scheduled to be voted on in June, and if passed could go to the CDC as early as this fall. CDC could send new reportable lists including MRSA to states early next year, he said.

CSTE officials declined an interview to confirm the resolution through CDC spokesperson Nicole Coffin-Ott.

With national reporting, the CDC or another agency could begin the kind of in-depth study gay health activists seek.

"I don't know of anybody who is doing MRSA contact tracing, and I think it would be a fantastic study," said Harrel of the GLMA. "The really important work is to compare the strains from city to city and see if they're the same. Right now we don't do any of that."


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