A strain of the bacteria Staphylococcus aureus which is resistant to all but the most aggressive antibiotic treatment has been detected in approximately 20 HIV-positive gay men in Los Angeles.
The Los Angeles Times has reported that since September last year, doctors in the city have been seeing an increasing number of gay men with boils, abscesses and inflammation on their legs, hands and genitals caused by a highly drug resistant form of the Staphlococcus aureus, or staph, bacteria.
A total of 40 cases have been reported so far, and over half the men affected are HIV-positive.However doctors are reporting that many are otherwise well and responding well to anti-HIV therapy.
Treatment with penicillin and erythromycin has proved ineffective, with doctors turning to the powerful anti-TB drug rifampacin, or the rarely used antibiotic vancomycin, which is normally the antibiotic of last resort.
The US Center for Disease Control is monitoring the outbreak, and tests have confirmed that it is caused by the same strain of the staph bacteria which caused an outbreak amongst HIV-positive in-patients in New York in 1997, and amongst newborn babies and young athletes in Los Angeles in 2002.
Sexual transmission of the resistant bacteria is possible, but as it can be spread by any skin-to-skin contact, any form of body contact could lead to the bacteria being passed on.
As well as being resistant to first-line antibiotic therapy, the strain of staph in the Los Angeles outbreak also causes unusual symptoms. Staph normally only causes skin problems when the skin is broken, however the drug resistant strain attacks otherwise healthy skin and affects unusual parts of the body, including the legs, buttocks, penis and scrotum.
The outbreak appears to be spreading, with cases in Los Angeles increasing steadily since September. Doctors in Los Angeles are advising gay men to contact their doctor if they notice any unusual skin conditions, to practice good hygiene and not to share towels. They are also eager to prevent any further resistant strains of the bacteria developing and are stressing the importance of completing a course of antibiotics even if symptoms have disappeared.
Dr Mike Youle, of the Royal Free Hospital in London, which has one of
the
UK's largest HIV clinics, told aidsmap that he had treated a case of drug
resistant
staph in a gay man who had recently visited San Francisco. A link with
the
Los Angeles outbreak has not been proposed, but Dr Youle said that in
the
light of the Los Angeles reports, gay men should be alert to unusual
skin
conditions, especially if they had visited the West Coast of the USA
recently.