The outbreak among gay men in Los Angeles, San Francisco and Boston of a drug-resistant strain of bacteria called Staphylococcus aureus—commonly referred to as staph—has caused a minor medical scare among doctors, who are concerned that the drug-defiant bacteria could tear through the gay community at break-neck pace. The infection can cause unusually large and painful skin infections that manifest as puss-filled boils, abscesses, and red, hardened skin. The infections are not only unusual in their resistance to standard antibiotics, but in their aggressiveness in the body and in spreading from person to person. In some cases, patients have had to be hospitalized and given intravenous drugs to put a halt to the bacteria. And though there have so far been no reported fatalities in this episode, death is a possible worst-case scenario.
Along with the medical concerns, doctors and gay men alike are going through a different kind of crisis with respect to the infections. There is a delicate and highly explosive question that some are asking—and others are ignoring: Is the staph infection a sexually transmitted disease? How that question is answered could have important political as well as health ramifications for gay men.
It's hard to know just how widespread the outbreak is. Dr. Peter Ruane, an infectious disease specialist at Tower Infectious Disease Medical Associates in Los Angeles, who was the first to recognize and then later identify the bacterial infections in his gay male patients as far back as September, told me that he personally knows of at least 50 cases in Los Angeles. Being conservative, he estimated there are 'dozens' more cases. Dr. Bill Owen, an internist in San Francisco's Castro neighborhood, told the San Francisco Chronicle he suspected as many as 300 cases among gay men in that city. In Boston, only three cases were reported in the past four months.
Let's get down some of the basics about the infections so far. This is not the first time that a drug-resistant strain of staph has surfaced. Periodically, it's seen in nursing homes and prison inmates—populations that share close quarters. It's also been seen in women and children as well as adult men. And while Dr. Ruane estimated that about 80 percent of his patients who came down with it recently were HIV-positive, it is showing up in HIV-negative men as well. Dr. Ruane pointed out that the vast majority of HIV-positive gay men who had contracted the staph were in good health, with their HIV under control.
So back to the tough question: Is the staph sexually transmitted?
The answer isn't an outright yes—but it isn't an outright no, either. However, fearful of the political backlash and the politically correct police in the gay community, health officials are reluctant to make any kind of sex connection at all.
It's understandable why gay politicos and health activists are so touchy about what information gets out to the general public, and how it is perceived. The last thing any of us want to do is label gay men as somehow 'responsible' for another 'epidemic' that is 'caused' by our sexual behavior. All the worst nightmares of the misunderstandings and prejudices of the AIDS epidemic come flooding to mind. Doctors and gay men alike are right to be cautious that factual, responsible information is given out, both to gay men and to the general public.
But at the same time, gay men need the hard truth about how this infection is being spread so that we can make objective, informed decisions about what we can and can't do to protect ourselves from it. Gay activists and health officials do gay men a disservice by getting squeamish around the issue of the role of sex in transmitting the infection. I thought we would have learned that from the early stages of denial in the AIDS epidemic, as well.
Dr. Nolan Lee, a medical epidemiologist at the Los Angeles County Health Department, went to great lengths to underscore that his agency did not look at this as a sexually transmitted disease. 'It is not a sexually transmitted disease in the traditional sense, but it can be transmitted through skin to skin contact,' he said. 'It's important to emphasize this is not some sort of new 'gay disease.' We've seen this in hospital settings for four decades.' When I asked him why there was a current outbreak among gay men, he said, 'We have no idea.'
The Los Angeles County Health Department is currently doing a study looking into the staph infections, and Dr. Lee said he hoped the investigation would yield some answers by April.
Similarly, in a three-page advisory put out by the San Francisco Department of Public Health on Feb. 4, sex was mentioned just once—parenthetically, at the very end of the press release.
But Dr. Ruane, who is more concerned about the health consequences of the outbreak than the political consequences, has a very strong idea why gay men are seeing the brunt of the outbreak at this time: Gay men, he is convinced, are getting it from skin-to-skin contact from each other during sex.
Does that make it a sexually transmitted disease? 'Well,' he said, for the first time hesitating, 'that gets into semantics.' Dr. Ruane agrees that it is not sex per se that spreads the infection. And it isn't 'sexually transmitted' in the classic sense—it does not require semen, or even something as socially and politically innocuous as saliva, to be transmitted. All it requires is skin to skin contact.
But, he adds, it's probably not casual skin to skin contact. Sure, it's possible that you could get it from sharing a towel or a gym bench or a sauna with another person. But does that really explain the burst of cases in gay men? Are possibly hundreds of us coming down with this nasty infection because we go to the gym? Because we wrestle?
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No, of course not. The gay population is probably coming down with a notable number of cases because some go to bathhouses —which are wet and dark, the classic breeding conditions for this kind of staph infection—and because some gay men have a large number of sexual partners, meaning they have a lot of body contact with a lot of different people, said Dr. Ruane in brave and blunt honesty.
He also points out that in the vast majority of cases he's seen so far in his gay male patients, the infections are occurring in historically unusual places—places that suggest sexual contact, like the penis, scrotum, butt, chest and thighs.
'We've never seen this on the penis or scrotum before,' he says.
At this point, some of the PC-consciousness hit the good doctor, and he went out of his way to stress that 'this didn't start in the gay community, and it's not confined to the gay population.' But he admitted that 'it's been moving very actively in the gay community. I'd say it's had explosive growth in the gay population.' It would do us all well to recognize that reality, and try honestly and forthrightly to explain why.
Much to his credit, Dr. Ruane is totally nonjudgmental in his statements about the probable role of sex in the spread of drug-resistant staph among gay men. There's no reason that he, or anyone else, should pass judgement. Dr. Ruane simply thinks, as do I, that gay men should be honestly told the best known facts that medical science so far has to offer about the situation.
There's no simple solution to preventing staph infections, like there is to stopping the transmission of HIV by wearing a condom. When I asked Dr. Ruane what advice he would give gay men to reduce their chances of contracting the infection, he gave a whole list of tips, including 'Don't pick your nose—staph lives in the nose,' and 'Wash your hands regularly,' and 'Don't share towels.' But the fist thing that popped out of his mouth without having to think about it: 'Minimize the number of sexual contacts with others. And avoid the baths.'
Mubarak Dahir receives email at MubarakDah@aol.com
