By JANE E. BRODY, Published: August 2, 2010
When you go to the gym, do you wash your hands before and after using the equipment? Bring your own regularly cleaned mat for floor exercises? Shower with antibacterial soap and put on clean clothes immediately after your workout? Use only your own towels, razors, bar soap, water bottles?
If you answered “no” to any of the above, you could wind up with one of the many skin infections that can spread like wildfire in athletic settings. In June, the National Athletic Trainers’ Association, known as N.A.T.A., issued a position paper on the causes, prevention and treatment of skin diseases in athletes that could just as well apply to anyone who works out in a communal setting, be it a school, commercial gym or Y.
The authors pointed out that “skin infections in athletes are extremely common” and account for more than half the outbreaks of infectious diseases that occur among participants in competitive sports. And if you think skin problems are minor, consider what happened to Kyle Frey, a 21-year-old junior and competitive wrestler at Drexel University in Philadelphia.
Mr. Frey noticed a pimple on his arm last winter but thought little of it. He competed in a match on a Saturday, but by the next morning the pimple had grown to the size of his biceps and had become very painful.
His athletic trainer sent him straight to the emergency room, where the lesion was lanced and cultured. Two days later, he learned he had MRSA, the potentially deadly staphylococcus infection that is resistant to most antibiotics.
Mr. Frey spent five days in the hospital, where the lesion was surgically cleaned and stitched and treated with antibiotics that cleared the infection. He said in an interview that he does not know how he acquired MRSA: “The wrestling mat might have been contaminated, or I wrestled with someone who had the infection.”
If it could happen to Mr. Frey, who said he has always been health-conscious in the gym and careful about not sharing his belongings, it could happen to you.
Recreational athletes as well as participants in organized sports are prone to fungal, viral and bacterial skin infections. Sweat, abrasion and direct or indirect contact with the lesions and secretions of others combine to make every athlete’s skin vulnerable to a host of problems. While MRSA may be the most serious skin infection, athlete’s foot, jock itch, boils, impetigo, herpes simplex and ringworm, among others, are not exactly fun or attractive.
Athletes who are infected should be kept from competing in matches for a week or more until treatment renders them noninfectious. The authors of the trainers’ study warned against simply covering infections like herpes and active bacterial lesions in order to return to competition.
Likewise, people like you and me who work out at a facility or swim in a public pool should stay away until cleared by a doctor who is well versed in skin diseases.
Steven M. Zinder, a trainer at the University of North Carolina at Chapel Hill and chief author of the new paper, said in an interview that these recommendations are not esoteric.
“It’s what we all learned — or should have learned — in sixth-grade health class,” he said. “It’s all common sense. You need to keep yourself and your equipment clean. You never know who last used the equipment in a gym. It can be a great breeding ground for these bugs, some of which are pretty nasty.”
The report, published in the August issue of The Journal of Athletic Training, stated, “Athletes must shower after every practice and game with an antibacterial soap and water over the entire body.”
Dr. Zinder noted that after a workout, women tend not to shower at the facility, while men, who are more likely to shower, often fail to cleanse their entire bodies, including their feet. Well-equipped facilities should provide antibacterial liquid soap.
“You should be showering at the gym and putting on clean clothes that are kept separate from the dirty ones,” he said. In fact, he added, it’s best to have two bags, one only for clean clothes, and to wash the dirty-clothes bag now and then.
Jack Foley, athletic trainer and director of sports medicine at Lehigh University in Bethlehem, Pa., and co-author of the report, said athletes should always assume they are exposed to skin infections.
At any given time, he said in an interview, one person in three in the United States suffers from a skin disease that can be spread to others, even while in the incubation stage.
The report noted that there had been “an alarming increase in the prevalence of MRSA” in the noses of both healthy children and adults. Thus, sneezing into one’s hand or blowing one’s nose without washing with an antibacterial cleanser afterward may spread these dangerous bacteria to others.
While hand hygiene is most important over all , avoiding fungal infections requires a daily change of athletic socks and underwear; carefully drying the armpits and groin and between toes (perhaps blow-drying the feet on low heat); and using foot powder. Shower shoes can help prevent infection as long as they don’t keep you from soaping your feet.
A viral infection called molluscum contagiosum may not be on the popular tongue, but it is commonly seen in young children and , spread through skin-to-skin contact, is not uncommon among athletes, including swimmers, cross-country runners and wrestlers, the report stated.
Prevention of this highly contagious infection requires “meticulous hygiene” after contact with secretions from other athletes through benches, towels and mats.
If you plan to work out in a gym or use a locker room, Mr. Foley suggested that before choosing a facility, you quiz the management about the cleaning agents used (they should be approved by the Environmental Protection Agency) and daily cleaning schedule for all surfaces and equipment. If exercise mats are not cleaned between classes, he suggested bringing your own. Antibacterial wipes or spray bottles should be provided and used by everyone to clean equipment after a workout.