Staph Infections from Wrestling: Everything You Need to Know

July 10, 2020

2 wrestlers competing in a match

Contact sports, including wrestling, are frequently associated with Staphylococcus aureus, or “staph” infections. Staph is a colonizing bacteria, meaning that it can live on the skin without causing infections. Roughly 30% of the general population1 carry staph asymptomatically. Staph prevalence jumps to about 50% among college athletes, and those who participate in contact sports are 61% more likely to carry staph than athletes in non-contact sports.2,3,4

Staph bacteria thrive in warm, moist, areas on and around the body. The nose is one of the primary sites of staph colonization since it provides an ideal environment and is not often disturbed or cleansed. If a colonized person touches their nose and then touches something or someone else, staph bacteria can be transferred.

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph that has developed resistance to some antibiotics, making it challenging to treat with conventional methods (e.g. antibiotics)5. MRSA used to be associated almost exclusively with hospitals, but community-acquired MRSA infections recently overtook hospital-acquired infections in prevalence.6

MRSA is particularly prominent among wrestlers and other athletes who participate in contact sports4. One study found that the prevalence of MRSA colonization among college athletes fluctuated with the athletic season, ranging from 8% to 29 %.7 This is significantly higher than the 1% MRSA colonization in the general population.8

Why do wrestlers get staph infections?

Wrestlers face several unique risks associated with staph: In addition to sharing locker rooms and athletic facilities with other athletes, wrestlers have frequent skin-to-skin contact with opponents and wrestling mats, increasing the risk for transmission.

Staph can live on wrestling mats for days or even weeks, so if mats are not decontaminated at least daily, every wrestler who steps foot on one risks exposure.9,10 Contact with a mat generally won’t cause an infection as long as the skin is intact. However, a mat burn can be enough to let staph bacteria under the skin, increasing the risk of  infection.

A person who carries staph bacteria can also cause a staph infection within their own body. By some estimates, autoinfection rates may be as high as 86%.11 Staph frequently colonizes the nose, so anytime a carrier touches their nose they can transmit staph to their hand. If they go on to touch another part of their body, particularly a cut or an abrasion, the transferred staph could cause an infection.

What are the symptoms of staph infections?

Staph skin infections usually have a characteristic set of symptoms, including12:

●      Development of a pimple, boil, or abscess (often resembling a spider bite)

●      Redness and swelling

●      Pain and tenderness

●      Pus or drainage that may crust over the infection site

Some staph infections are deeper than skin level. Infections in soft tissue (muscles, tendons, joints), bone, or blood can be incredibly dangerous, even life threatening. Early signs of a serious infection include fever, chills, rash, fatigue, and aching muscles.

Wrestlers are also at risk for a knee injury called prepatellar bursitis13. The front of the kneecap is cushioned by a fluid-filled sac called the bursa that rupture if they take too much abuse. A similar injury in the elbow is called olecranon bursitis.14 If staph gets into a ruptured bursa, a dangerous infection called septic bursitis can set in that, if not treated quickly, can spread into the bloodstream.15

How can wrestlers treat staph infections?

Any wrestler who is concerned about a staph infection should  tell their coach or a medical professional16. Most staph infections are relatively mild and resolve without incident, but there are cases where seemingly minor staph infections can lead to serious, even life-threatening, conditions.

A minor staph skin infection should be kept clean, dry, and covered. Antibiotics should never be taken to treat a staph infection unless they were specifically prescribed to treat that infection (i.e. don’t take old antibiotics or antibiotics that were prescribed to someone else). More serious infections need to be seen by a doctor, who will outline an effective treatment plan.

If a minor staph infection seems to be getting worse or spreading, see a doctor immediately. Staph infections can become invasive, meaning that they get into the bloodstream (bacteremia), where they can infect the lungs (pneumonia) or the heart (endocarditis), which are potentially fatal conditions.

How can wrestlers prevent staph infections?

The best way to prevent staph infections is to maintain good hygiene at all times16. Specific steps include:

●      Frequent handwashing and use of alcohol-based hand sanitizers

●      Use alcohol-based nasal decolonization

●      Showering before and after a match

●      Disinfecting all equipment between uses

●      Avoid sharing towels or athletic equipment

●      Don’t share water bottles

●      Don’t leave damp equipment in a bag

●      Cuts and abrasions must be kept clean, dry, and covered

Wrestling mats are a key vector for staph transmission. A recent study commissioned by the National Wrestling Coaches Association evaluated the most effective strategy to prevent infection transmission via wrestling mats10. Their recommendations include:

●      Backward mopping of the mats with a cleaner and a residual disinfectant (a disinfectant that continues to work after the initial application)

●      Allow mats to dry before walking on them

 

Alcohol-based nasal decolonization

Nasal decolonization (i.e., sanitize the nose) is a strategy to prevent the transmission of bacteria, including staph. Clinical trials in hospitals have consistently shown that alcohol-based nasal antiseptics can reduce staph levels, including MRSA, by more than 90%.17,18

The principle of nasal decolonization is to target the bacteria at a key source of colonization – the nose. This can help disrupt transmitting staph into the environment.

Other common skin infections in wrestling

Staph infections are not the only common skin infection in wrestling19,20:

Tinea corporis (ringworm)

Ringworm is a common infection among wrestlers, affecting up to 60% of collegiate wresters21. Ringworm starts as a small red spot that grows into a flaky circular lesion with a darker ring around the outer edge. Ringworm is usually transmitted directly by skin-to-skin contact.

Impetigo

Both Staphylococcus and Streptococcus (strep) bacteria can cause impetigo, which appears as blisters and open skin lesions that weep or crust over.21 Like staph, strep is transferred by skin-to-skin contact.

Erysipelas and cellulitis

Staph and strep bacteria can also cause erysipelas and cellulitis, but these conditions are nonpurulent, meaning they don’t have pus or open lesions.21 Erysipelas appears as a bright red, sharply demarcated plaque on the superficial layers of skin, while cellulitis is more diffuse and affects deeper layers of skin.

Herpes simplex virus 1 (HSV1)

HSV1 is the most common cause of skin infections among wrestlers20. Also known as herpes gladiatorum, HSV1 affects between 20-40% of collegiate wrestlers every year, primarily on the face22. It is spread through direct skin-to-skin contact, rather than the mat. An HSV1 infection generally starts with symptoms that are similar to a cold, followed by a rash of blisters on the side of the face. The fingers may also be affected.

 

Examples of staph infections in wrestling

Staph infections can affect   of all ages and skill levels:

●      In early 2020, a MRSA infection outbreak affecting athletes was suspected to have originated after seven schools competed in the Brower County school district in Florida23

●      5 high school wrestlers were infected with MRSA after their school neglected to clean the mats, resulting in a $12 million lawsuit24

●      In 2008, 17-year old Noah Armendariz died as a result of MRSA-related pneumonia that he got while wrestling25

●      In 2019, WWE Champion Jon Moxley (known as Dean Ambrose) developed MRSA-related septic bursitis in his elbow that required surgery and kept him out of the ring26

●      Rulon Gardner missed the 1996 Olympics in Greco-Roman wrestling due to a staph infection, but went on to win the Olympic gold for the USA in 200027

Summary

Wrestlers are colonized with staph at a higher rate than the general population. Minor staph infections typically do not require antibiotics or serious medical treatment, but they should be kept clean, dry, and covered. However, if staph enters the bloodstream, the resulting infection can be dangerous, even fatal.

There are a number of precautions that can be taken to reduce infection risk. These include making sure equipment is disinfected between uses, not sharing equipment, and practicing good hygiene to include nasal decolonization, can help players avoid infection.

 

 

References

1. Sakr, A., et al. (2018). Staphylococcus aureus Nasal Colonization: An Update on Mechanisms, Epidemiology, Risk Factors, and Subsequent Infections. Frontiers in Microbiology. doi:10.3389/fmicb.2018.02419

2. Jiménez-Truque, N., et al. (2016). Longitudinal Assessment of Colonization With Staphylococcus aureus in Healthy Collegiate Athletes. Journal of the Pediatric Infectious Diseases Society, 5(2):105–113. https://doi.org/10.1093/jpids/piu108

3. Mascaro, V., Capano, M. S., Iona, T., Nobile, C., Ammendolia, A., & Pavia, M. (2019). Prevalence of Staphylococcus aureus carriage and pattern of antibiotic resistance, including methicillin resistance, among contact sport athletes in Italy. Infection and Drug Resistance, 12, 1161–1170. doi:10.2147/IDR.S195749

4. Jiménez-Truque, N., et al. (2017). Association Between Contact Sports and Colonization with Staphylococcus aureus in a Prospective Cohort of Collegiate Athletes. Sports Medicine, 47(5), 1011–1019. doi:10.1007/s40279-016-0618-6

5. Centers for Disease Control and Prevention. (n.d.). Information about MRSA skin infections. Retrieved February 8, 2020.

6. David, M. Z., Boyle-Vavra, S., Zychowski, D. L., & Daum, R. S. (2011). Methicillin-susceptible Staphylococcus aureus as a predominantly healthcare-associated pathogen: a possible reversal of roles?. PloS one, 6(4), e18217. doi:10.1371/journal.pone.0018217

7. Jiménez-Truque, N., et al. (2016). Longitudinal Assessment of Colonization With Staphylococcus aureus in Healthy Collegiate Athletes. Journal of the Pediatric Infectious Diseases Society, 5(2):105–113. https://doi.org/10.1093/jpids/piu108

8. Kyoung-Bok, M., et al. (2019). Nasal colonization with methicillin-resistant Staphylococcus aureus associated with elevated homocysteine levels in the general US adults. Medicine, 98(18):e15499. doi:10.1097/MD.0000000000015499

9. Neely, A. N., & Maley, M. P. (2000). Survival of enterococci and staphylococci on hospital fabrics and plastic. Journal of clinical microbiology, 38(2), 724–726.

10. Young, L. M., Motz, V. A., Markey, E. R., Young, S. C., & Beaschler, R. E. (2017). Recommendations for Best Disinfectant Practices to Reduce the Spread of Infection via Wrestling Mats. Journal of Athletic Training, 52(2), 82–88. doi:10.4085/1062-6050-52.1.02

11. Coates, T., Bax, R., & Coates, A. (2009). Nasal decolonization of Staphylococcus aureus with mupirocin: strengths, weaknesses and future prospects. Journal of Antimicrobial Chemotherapy. doi:10.1093/jac/dkp159

12. U.S. National Library of Medicine. (2019). Staphylococcal Infections. MedlinePlus. Retrieved February 8, 2020.

13. Nicholas, S. J., & Wyland, D. J. (2010). Wrestling Injuries. American Orthopaedic Society for Sports Medicine.

14. Khodaee, M. (2017). Common Superficial Bursitis. American Family Physician 95(4):224-231.

15. Brumfield E., et al. (2018). Septic Bursitis: A Case Study. Ithaca College, Ithaca, NY. Retrieved February 8, 2020.

16. USA Wrestling. (n.d.). MRSA and Other Infectious Facts. Retrieved February 8, 2020.

17. Steed, L. L., et al. (2014). Reduction of nasal Staphylococcus aureus carriage in health care professionals by treatment with a nonantibiotic, alcohol-based nasal antiseptic. American Journal of Infection Control. https://doi.org/10.1016/j.ajic.2014.04.008

18. Arden, S. (2019). 567-Does Universal Nasal Decolonization with an Alcohol-Based Nasal Antiseptic Reduce Infection Risk and Cost? Poster presented at: IDWeek; 2019 October 2-6; Washington D.C.

19. Davies H. D., Jackson M. A., & Rice S. G. Infectious Diseases Associated With Organized Sports and Outbreak Control. Pediatrics. 2017;140(4):e20172477

20. Herzog, M. M., Fraser, M. A., Register-Mihalik, J. K., & Kerr, Z. Y. (2017). Epidemiology of Skin Infections in Men's Wrestling: Analysis of 2009-2010 Through 2013-2014 National Collegiate Athletic Association Surveillance Data. Journal of Athletic Training, 52(5), 457–463. doi:10.4085/1062-6050-52.2.16

21. Wilson, E. K., Deweber, K., Berry, J. W., & Wilckens, J. H. (2013). Cutaneous infections in wrestlers. Sports Health, 5(5), 423–437. doi:10.1177/1941738113481179

22. Peterson, A. R., Nash, E., & Anderson, B. J. (2019). Infectious Disease in Contact Sports. Sports Health, 11(1), 47–58. doi:10.1177/1941738118789954

23. Smalls II, CI. (2020). All Broward high school gyms and locker rooms sanitized after MRSA scare. Miami Herald, February 6, 2020.

24. Algar, S. (2015). School sued after staph infection spreads among wrestlers. New York Post. Retrieved February 8, 2020.

25. Puente, K. (2008). Wrestler, 17, dies of staph infection. Daily Breeze. Retrieved February 8, 2020.

26. Prokos, H. (2019). 'Moxley' trends after John Moxley announces MRSA infection has returned. Newsweek. Retrieved February 8, 2020.

27. Coffey, W. (2000). Team USA's Rulon Gardner takes 2000 Olympic gold in Greco-Roman wrestling with stunning upset win over Alexander Karelin. NY Daily News. Retrieved February 8, 2020.



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