Mixed martial artists aren’t averse to risk or to pain. Cuts, bruises, and occasional broken bones are the price they willingly pay for a sport they love. However, injuries aren’t the only concern in such a close-contact sport. In mixed martial arts (MMA), staph infections can often pose a greater threat.
Even in the Ultimate Fighting Championship (UFC) — the largest MMA promotion company in the world — many fighters have publicly battled serious, life-threatening staph infections. For example, former UFC middleweight champion Robert Whittaker developed a life-threatening staph infection in his stomach in 2017. When he was first hospitalized, UFC President Dana White released the following statement: “He had staph infection in his stomach. From what I understand it wasn’t treated properly and started to eat away at parts of his organs. He’s in serious condition, so it’s going to be a minute before he’s back, I think. Hopefully, it turns around quick, but that stuff is life-threatening if not treated the right way.”
It actually took Whittaker nearly a year to recover. A decade earlier, fighter Kevin Randleman was sidelined for more than a year when a staph infection under his arm leaked into his bloodstream. The infection left a gaping hole under his arm, shut down his liver and kidney, put him in a coma, and nearly killed him.
Then there’s featherweight Cole Escovedo, who battled a spinal staph infection in 2007. It took three years for him to fully recover from the infection, which temporarily paralyzed him and almost ended his fighting career for good.
Professional MMA fighters aren’t the only ones at risk for staph infection. So are the 977,000 amateurs who compete in the sport, and the nearly 2.4 million who practice MMA for fitness.
What is staph infection? Why does it plague MMA fighters? How can the industry better prevent staph infections, and what can athletes do to protect themselves?
What Are Staph Infections?
Staph infections are caused by Staphylococcus aureus — a bacteria that often lives on the ground, on surfaces, and on human skin (especially in the nose). In fact, roughly one-third of the general population is “colonized” with staph — meaning they have the bacteria on their skin or in their noses, but they don’t show symptoms of an infection. That’s because staph is usually harmless unless it finds its way into an open wound, and that’s far more likely to happen in a bare-chested contact sport where athletes are regularly wounded.
Once staph gets under the skin, it can cause blisters, boils, and more serious skin infections such as cellulitis. Worse yet, if staph gets into the bloodstream, it can be life-threatening. More than 119,000 people suffered bloodstream staph infections in 2017, and 20,000 of them died, according to the Centers for Disease Control and Prevention (CDC).
If caught early, staph infections can usually be treated with antibiotics, but some staph strains are resistant to front-line antibiotics. These strains — called methicillin-resistant Staphylococcus aureus (or MRSA) — are more well-known, but the CDC warns that any staph infection has the potential to be deadly.
Anyone can get a staph infection, but contact athletes are at a greater risk than the general public.
Why Do MMA Fighters Get Staph Infections?
Two reasons: They’re more likely to be colonized with staph, and they’re more likely to spend time around colonized people and surfaces.
Only one percent of the general population is colonized with MRSA, but 6 percent of athletes carry the superbug, according to a Brown University study of collegiate athletes. The rates are even higher for contact sports, with 22 percent of collegiate wrestlers carrying MRSA. Another study, of Italian contact sport athletes, found that 54.8 percent of martial artists were colonized with staph.
MMA fighters also spend a lot of time in places where staph thrives. The CDC calls these places the “5 Cs” — environments where there is:
- Crowding
- Frequent skin-to-skin Contact
- Compromised skin
- Contaminated items and surfaces
- Lack of Cleanliness
The average MMA fighter might experience exposure to many if not all five Cs on a daily basis — in mixed martial arts rings and gyms, and even in the locker room.
How Do MMA Fighters Get Staph Infections?
An MMA fighter can get a staph infection in one of three ways:
- Self-infection
Most people who are colonized with staph never know it, because they never get an infection. Then again, most people don’t tend to have open wounds, large hematomas, and other frequent injuries that allow staph to pass through the skin.
The average MMA fighter does, so if they’re colonized, they can infect themselves. In fact, roughly 80 percent of MRSA-infected wounds contain DNA from the person’s own nose.
- Close contact with a colonized or infected competitor
Fighters don’t know they’re colonized until they get an infection. Even then, symptoms can take one to 10 days to appear, so infected athletes might unknowingly spread it to others.
Sometimes they do know, and fight anyway — even the pros. MMA announcers called out Kevin Lee in real-time for fighting with an obvious staph infection in 2017, after failing to disclose it on his pre-fight medical questionnaire. But health forms and public shaming haven’t stopped others from following suit. Just last year, middleweight title challenger Kelvin Gastelum was planning to fight with a visible staph infection before his opponent forfeited.
If staph infection doesn’t automatically shut down professional fights, it’s probably safe to say that amateur fighters can just as easily (if not more easily) slip through pregame health checks.
- Close contact with infected surfaces
Staph can live for days to weeks on surfaces like mats and gym equipment, unless those surfaces are regularly and thoroughly sanitized.
MMA medical consultant and columnist Dr. Johnny Benjamin (a.k.a., the Fight Doc) puts it this way: “Wrestling (including all common grappling styles in MMA, Brazilian jiu jitsu, etc.) gyms are the perfect breeding grounds, and thus, they are ground zero. These facilities are usually kept very warm, have sweaty mats from intense training, and by definition, require close sustained bodily contact. In this setting, a scrape, pimple or simple hair bump can go bad very quickly.”
How to Prevent Staph Infection in MMA
Staph infections have always been a problem in MMA, and to be fair, professional fighting organizations like the UFC have cancelled plenty of fights to prevent infected fighters from transmitting the bacteria. Still, staph affects many MMA fighters — from the champions to the amateurs. Colonized athletes pass it back and forth to each other and spread it around rings and gyms.
There are many ways to help prevent staph infection for MMA fighters and other high-risk groups. Gyms can regularly and thoroughly sanitize equipment, bench fighters with signs of infection, and supply plenty of hand sanitizer and cleaning products for athletes. Fighters can practice proper handwashing, shower before and immediately after fighting or using gym equipment, and not sharing personal items that touch skin, such as razors, towels, or bar soap.
These strategies help prevent the transmission of staph, but they don’t solve the colonization problem. Showering doesn’t sanitize a fighter’s nose — the most common colonization site — so the bacteria lingers, and the fighter continues putting himself and others at risk for infection. Staph thrives in the nose and upon touching with the hand, it becomes a vector to spread on the rest of the body and beyond to surfaces and others.
In the Brown study, colonized athletes were seven times more likely than non-colonized athletes to develop MRSA infections, but decolonized athletes reduced their MRSA risk by one-third. The other two-thirds were eventually recolonized because of repeated exposure to MRSA in their sport.
Staph infection in MMA isn’t a problem that will go away on its own. To keep fighters safe, the industry and the athletes themselves will need to up their game. That means adopting better sanitization protocols, instituting better screening methods to bench infected players, and decolonizing everyone who steps into the ring. After all, it’s better to be safe than sorry, especially when the stakes are so high.
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