Hygiene. Simply cleaning our hands, face and body. Soap and water. Sometimes taken for granted in all aspects of life including medicine and sports.
In sports, wrestling is the sport that comes to mind where cleanliness is so important. Rugby, football, hockey, boxing, and the new player on the field MMA can be impacted as well.
In the most recent years Herpes Gladiatorum (HG) caused by Herpes Simplex Type 1 virus (HSV-1) has received a lot of attention. This is due to its ability to quickly spread (within 6.8days of contact) and the long lasting consequences on an athlete it might have. In some cases finishing his or her career. Recent data suggests that 29.8% of college wrestlers had reported previous HSV infection. There has been some suggestion that for wrestling camps all participants be placed on prophylactic antiviral medication to prevent outbreaks.
HSV-1 also known as Herpes Labialis is the agent of vesicle like lesions that are commonly called cold sores. HSV-1 can cause disease in other anatomic locations. Inoculation at mucosal surface or skin sites permits entry of HSV-1 into the epidermis, the dermis and on into the sensory and nerve endings. The primary onset after this is sudden with multiple vesicular lesions on top of an inflamed erythematous base. This infection may be seen with fever and fatigue. Lesions can last 10-14days. Most primary HSV-1 infections are asymptomatic. The virus as we know lives in a latent state in nerve bodies. Unlike primary HSV-1, recurrent HSV-1 is rarely associated with systemic signs or symptoms. Most patients are aware of its reactivation with such sensation as pain, burning, tingling or puritis. Triggers are predictable for the individual and tend to recur at the same site. SUBCLINICAL SHEDDING IS COMMON! Factors that induce HSV-1 recurrence include trauma to the area of primary infection, sunlight, fever, menstruation and emotional stress. Surely trauma and stress are seen in wrestling and rugby! Of note primary ocular HSV infection can occur in less than 5% of patients. On diagnosis of these lesions, antiviral medications such as acyclovir, valacyclovir and famciclovir are treatments of choice.
There are other skin infectious offenders such as MRSA, tinea (ringworm) and molluscum contagiosum that can spread quickly on sports teams. The name of the game is to stop them from spreading. Both the NCAA and the National Federation of State High School Associations (NFHS) are active in this pursuit. Through a webinar placed on the NFHS website with the NWCA (National Wrestling Coaches Association) and NATA (National Athletic Trainers Association) all coaches, trainers, athletes, and team doctors can learn how to prevent the spread of these sometime life long infectious agents. This Preventing Skin Infections webinar talks about breaking the infection matrix with .the wash cycle. This matrix is the contact made between athletes, their equipment and their environment. As it points out, athletes, team managers, trainers, coaches, families of athletes and YES even doctors need to work together to break the possibility of these infections.
The Wash Cycle includes the 3 E’s; Epidermis, Equipment and Environment.
Epidermis is of course the athlete’s envelope against infectious intruders. All athletes, especially those who have close skin to skin contact should wash their bodies from head to toe. I would argue before and after participating in close skin to skin contact. Whether the A.D. and the coaches would allow this is another debate!
Equipment needs to be kept clean and that includes elbow pads, knee pads, braces, mouth guards, head gear, helmets, uniforms and towels. Gear used against the body needs to be sprayed down after each use. Mouth guards need to be cleansed. Dirty and smelly towels need to be placed in the laundry bins and sent to the washer.
Environment includes the mats, weight training devices, exercise equipment, weight benches, equipment bags, lockers, locker rooms and showers. Anything that has contact with the skin needs to be wiped down with the proper cleanser after every use. Showers and locker rooms need to be kept clear of all kinds of debris, mud (from cleats), dirty towels and uniforms. These areas should be cleaned on a regular basis.
This all seems so simple and common sense but all too often these measures are overlooked. It could mean the difference between a championship season for an individual athlete and one spent sitting the bench watching the team on the field of competition.
- Anderson BJ: Med.Sci.Sports Exerc. 2003; 35: 1809-1814.
- Anderson BJ: Curr. Sports Med. Rep. 2008;7(6): 323-327
- Up to Date: www.uptodate.com/clinical-manifestations-and-diagnosis-of-herpes-simplex1-infection
- National Federation of State High School Associations Sports Medicine: www.nfhs.org/sportsmed.aspx.
Thomas G Ward, M.D. is a pediatrician at Bristol Pediatric Center of ProHealth Physicians in Bristol, CT and a member of the CSMS Committee on Sports Medicine.