By Anne Harding

NEW YORK (Reuters Health) - Outbreaks of herpes skin infections among high school wrestlers have become more common in recent years, but coaches and medical professionals can control and even prevent these outbreaks by taking the appropriate steps, a physician and former competitive wrestler advises.

The outbreaks involve herpes simplex virus type 1 (HSV-1), best known for causing cold sores. (This is not about genital herpes, usually caused by HSV-2.)

When a person is exposed to HSV-1 for the first time, the infection can be serious, causing swollen lymph nodes, fever and sore throat, Dr. B. J. Anderson of Boynton Health Service at the University of Minnesota in Minneapolis notes in Current Sports Medicine Reports. Further, he adds, infections that spread to the eye can cause scarring of the cornea or even blindness.

HSV-1 spreads by skin-to-skin contact, Anderson explained in an interview with Reuters Health. And since the late 1970s, when rules were introduced that made high school wrestling more like Olympic freestyle wrestling -- with points awarded for taking one's opponent down and releasing him -- the amount of time these athletes spend in the face-to-face lock-up position has risen sharply, increasing opportunities for HSV spread.

"The sport has a black eye relative to herpes," Anderson noted. But in fact, he said, wrestlers are no more likely to test positive for antibodies to the virus than non-wrestlers -- while girls are more likely to have been exposed than boys.

In his report, Anderson describes the response to a major outbreak of herpes that began after a December 2006 tournament, infecting 24 athletes on 10 high school teams within 30 days.

The Minnesota State High School League suspended all wrestling competition and sparring for eight days, banned skin-to-skin contact among wrestlers, and required coaches and trainers to check athletes daily for signs of infection. Athletes were sent for medical care if HSV-1 was suspected, and anyone with confirmed infection was prescribed oral antiviral drugs.

By the end of the hiatus, a total of 54 athletes were found to be infected, but within the following three weeks, just two more infections were identified.

"Without this preventive intervention, an estimated 180 athletes could have been infected at the time of the state tournament, instead of the 56 who actually were infected," Anderson states in his report.

To prevent outbreaks in the first place, Anderson recommends testing wrestlers every year for antibodies to HSV-1. Anyone testing positive -- which means that they can spread the virus to another person even if they aren't sick themselves--should be prescribed antiviral drugs, he adds, which reduces the risk that they will "shed" the virus.

Also, Anderson notes, while current guidelines allow wrestlers to return to the mat after seven days of antiretroviral treatment for a primary infection, they should be kept out for 10 days, or longer if they still show evidence of infection.

Anderson also recommends athletes with recurrent infections be on antiviral drugs for six to seven days.

Finally, he urges daily skin checks of athletes by coaches and trainers.

One problem with controlling HSV outbreaks, Anderson notes, is that various members of a wrestling team may see several different doctors, especially if they live in a larger city, making it more difficult for medical professionals to recognize an outbreak. In smaller communities, where everyone sees the same doctor, he adds, such outbreaks can be spotted and contained much earlier.

SOURCE: Current Sports Medicine Reports, November/December 2008.

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