Can You Get MRSA During Sex?

In 2008, the newswires were rife with reports about an outbreak of a new strain of the flesh-eating MRSA bacteria mainly among gay and bisexual men in San Francisco and Boston. Although MRSA (methicillin-resistant Staphylococcus aureus) has long been considered a major public health threat, it was rarely associated with such a rapid and specific outbreak.

In San Francisco alone, 532 MRSA infections were confirmed. What made the 2008 event so unusual was that many of the reported infections were passed during sexual activity, particularly among men who have sex with men (MSM).

The infections were characterized by the formation of abscesses and ulcers on the buttocks, anus, and genitals, suggesting that sex was a new and unexpected mode of MRSA transmission.

MRSA vs. STIs

Despite the fact that the 2008 outbreak was furthered along by sexual contact, MRSA is not considered a sexually transmitted infection (STI). By definition, STIs are diseases in which sexual contact is a predominant mode of transmission. These include such common and uncommon STIs as:

• Chlamydia
• Pubic lice
• Gonorrhea
• Hepatitis B virus (HBV)
• Herpes simplex virus (HSV)
• HIV
• Human papillomavirus (HPV)
• Mycoplasma genitalium
• Syphilis
• Trichomoniasis

By contrast, MRSA is passed by skin-to-skin contact and is not limited to sexual activity or intimate contact. As such, it is viewed more along the lines of hepatitis A, which can be transmitted during oral-anal sex, or scabies, which can result from sexual or nonsexual contact.

Factors for Transmission

Most MRSA infections are acquired while in a healthcare facility (known as healthcare-associated MRSA). This is not only due to improper handwashing or the contamination of wounds and medical devices but also because hospital patients tend to be immune suppressed and less able to fight infection.

HIV Infection

When MRSA occurs outside of a healthcare facility, is it known as community-acquired MRSA. By and large, people who are immune-suppressed—such as the elderly or people living with HIV (human immunodeficiency virus)—are more likely to become infected than those with healthy immune systems.

Immunosuppression coupled with sexual activity and multiple sexual partners created something of a perfect storm for MRSA infection in communities hard hit by HIV. With that said, it doesn't entirely explain how the outbreak started in the first place.

Prevention

Despite the risk of sexual exposure, MRSA is a rare occurrence even in groups considered to be at higher risk. While every effort should be taken to avoid spreading diseases through sexual networks, the larger concerns are the everyday routes through which MRSA can be spread.

As a rule of thumb, personal hygiene should prevail when it comes to preventing MRSA and other community-transmitted bacteria. Among the precautions:

• Wash your hands frequently with soap and water, especially after going to the bathroom. This will prevent you from moving bacteria from one part of the skin to another.
• Wash with soap and water after sex as well as any other activity in which there was skin-to-skin contact (including sports or dancing).
• Do not share personal care items such as razors or tweezers.
• Keep cuts, scrapes, and scratches clean, dry, and covered.
• When at the gym, clean equipment with an antiseptic spray and use a towel whenever seated on a bench or floor mat.

If you have HIV, you should immediately start and adhere to antiretroviral therapy (ART, a combination of HIV medicines). Doing so not only suppresses the virus but allows your body to rebuild its immune defenses.