Herpes Gladiatorum Is Common Among Wrestlers

From the WebMD Archives

Jan. 10, 2000 (Atlanta) -- Herpes simplex virus type 1 (HSV-1) acquired during wrestling is one of the most common infections caused by personal contact during athletic activity, according to a report in the December issue of The Pediatric Infectious Disease Journal. Physicians say the condition, called herpes gladiatorum, causes skin lesions on the head, neck, and shoulders that are often misdiagnosed.

After learning of a possible outbreak in a Washington state high school, the CDC encouraged surrounding counties to report similar incidents. The researchers conducted interviews with student athletes and obtained laboratory cultures from skin lesions.

The data showed that 12 out of 250 wrestlers in four counties had active herpes gladiatorum, and 40 others had a rash illness. Nine of those with herpes had other symptoms including headache, fever, chills, sore throat, swollen glands, and painful eyes. Eleven of the wrestlers with confirmed cases saw a physician, but only two received viral cultures; most were misdiagnosed with impetigo or a staph infection. The chief investigator says the findings have implications for 700,000 wrestlers, a third of whom are high school students.

"Skin contact is the primary mode of HSV-1 transmission," says Mark Dworkin, MD, MPHTM, a medical epidemiologist with the CDC. "In wrestling, the head and neck are major points of contact, and over 90% of the lesions we observed erupted in this area." Dworkin tells WebMD that "herpes can reactivate over the lifespan in times of physical and emotional stress. Herpes can also result in serious systemic illness and vision loss years later, particularly if immunity is compromised." Sports medicine experts say wrestlers with active lesions should be temporarily excluded from participating in wrestling events.

"Even though it's common sense for an infectious athlete to sit out, sometimes there's pressure on high school kids to continue," says Guy Nicolette, MD, the varsity team physician and clinical assistant professor of family medicine at the University of Florida in Gainesville. "Some are afraid of losing a scholarship. Others are afraid of losing the respect of their coach. That's a lot to handle during adolescence."

Nicolette says infected wrestlers need the support of parents and physicians. "Physicians should consider athletic skin contact as a risk factor for herpes gladiatorum when patients present with rash illnesses and skin lesions. If the patient's history includes wrestling, skin eruptions should be cultured for viruses," says Nicolette. "And parents should reinforce the value of exclusion in preventing spread of the disease to teammates."

According to the investigators, additional research is needed for prevention. "Our findings support previous research that showed HSV-1 is transmitted primarily through skin contact," says Dworkin. "Still, the possibility of transmission through contaminated objects like wrestling mats deserves further study. That'll help determine if routine bleaching is effective in decontaminating the mats."

Dworkin says that the effectiveness of antiviral drugs is also in question. "Treating primary attacks with Zovirax [acyclovir] is becoming more frequent, but there's not a lot of data to support it. And Valtrex [valacyclovir hydrochloride] seems to reduce recurrent attacks, but its value in preventing further spread of herpes is unclear. So both approaches warrant further study." Dworkin says it's also important to recognize that wrestling coaches are at risk as well.

Vital Information:

  • Herpes simplex virus type 1 is one of the most common infections among wrestlers and is often misdiagnosed.
  • Skin contact is the primary mode of transmission, and herpes can reactivate over the lifespan in times of physical and emotional stress.
  • Physicians should consider athletic skin contact as a risk factor for herpes, and athletes with active lesions should temporarily be excluded from wrestling.