Homosexuality and MRSA

As in the SFGH HIV clinic population, having male–male sex was a risk factor for multidrug-resistant USA300 infection among patients in the Fenway Community Health sample. All patients in this sample who had multidrug-resistant USA300 infection were men who had sex with men, and none of the more than 3000 men seen at this health center annually who did not have male–male sex had multidrug-resistant USA300 infection, suggesting the exclusive spread of the multidrug-resistant USA300 clone among men who have sex with men....

In summary, we show that multidrug-resistant USA300 has emerged as an important source of disease among men who have sex with men in 2 geographically distinct communities. The high proportion of infection involving the buttocks, genitals, and perineum suggests that community-associated MRSA may be transmitted in the setting of sexual contact among men who have sex with men. The link among USA300, multidrug-resistant USA300, and unsafe sexual risk behaviors should be evaluated further in prospective studies.^[4]

Most MRSA infections occur in hospitals or other health care settings, such as nursing homes and dialysis centers. It's known as health care-associated MRSA, or HA-MRSA. Older adults and people with weakened immune systems are at most risk of HA-MRSA. More recently, another type of MRSA has occurred among otherwise healthy people in the wider community. This form, community-associated MRSA, or CA-MRSA, is responsible for serious skin and soft tissue infections and for a serious form of pneumonia.^[5]

Diep said there is reason to believe that the more drug-resistant strain will make that leap because it is just a slight variant of USA300, which became one of the most common strains of MRSA in the United States only a few years after it was first detected.^[6]

The strains of MRSA described in the recent Annals of Internal Medicine have mostly been identified in certain groups of men who have sex with men (MSM), but have also been found in some persons who are not MSM. It is important to note that the groups of MSM in which these isolates have been described are not representative of all MSM, so conclusions can not be drawn about the prevalence of these strains among all MSM. The groups studied in this report may share other characteristics or behaviors that facilitate spread of MRSA, such as frequent skin-to-skin contact.

CDC’s extensive and continuing study of invasive MRSA in 9 US states indicates that these strains are rare. CDC continues to monitor resistance patterns and strain characteristics in MRSA isolates submitted to CDC for a variety of investigations. Bacteria are able to acquire resistance to antibiotics. It is concerning that these bacteria are becoming resistant to more antibiotics than the typical community associated-MRSA strains because this limits the available treatment options. Fortunately, there are still effective choices available to treat infections when antibiotics are required, including those antibiotics given by mouth. It remains important to do what we can to prevent transmission of these strains and of MRSA in general.

MRSA is typically transmitted through skin-to-skin contact, which occurs during a variety of activities, including sex. There is no evidence at this time to suggest that it MRSA is a sexually-transmitted infection in the classical sense.

Therefore, CDC believes that our recommended prevention measures for CA-MRSA in general are also the most appropriate response to the strains described among MSM.^[8]