Herpes is a viral infection that has multiple strains (genetic variants or subtypes) (Fig. 1). All strains are transmitted by direct contact with the virus through either a skin lesion or infected bodily fluids. While the virus stays with a person for life, it can remain dormant within the body; however, symptoms can flare up at any point in time, but especially during events such as stress, fatigue, trauma, or other illnesses that weaken the immune system.
A common form of herpes among the athletic population is herpes gladiatorum, a skin infection caused by HSV1. Because it is particularly prevalent in the wrestling community where it can be easily transmitted through the skin to skin contact that takes place on the wrestling mat, it is often called “mat herpes.” An HSV1 lesion can appear in various sites on the body, but they are typically found on the head, face, neck, or upper extremities and present as clustered, rigid vesicles on a red base. Cold sores commonly found around the mouth are an example of a HSV1 viral infection.
Signs and symptoms
Symptoms usually present around 8 days following exposure to the virus, but some people exhibit no signs or symptoms at all. Those infected may develop flu-like symptoms, fever, swollen lymph nodes, burning and tingling sensations in the affected area, or cluster formations that may or may not become painful. Cluster formations are multiple skin lesions, also known as vesicles, within the affected area, which are generally surrounded by a reddened area that often produces a clear fluid (Fig. 2).
Once the fluid-filled vesicles dry up, a crust, or scab-like cover forms and acts as the body’s own barrier to prevent spreading the virus. If fluid is present in the vesicles, then the virus is highly contagious. These skin lesions generally heal within 7 to 10 days. Transmission rates are high if a person has no symptoms or if the vesicles have not crusted over. Because of their weaker immune systems, younger athletes are at greater risk of contracting the virus. While signs and symptoms can be used to try to find a cause, a definitive diagnosis of herpes can only be made by performing a viral culture from vesicle scrapings.
There is no cure for herpes; however, there are some treatment options, such as the antiviral medication Acyclovir (brand names Zovirax® and Valtrex®) that reduces the outbreak of sores and blisters. If taken in the daily recommended doses, these medications can help reduce the transmission and recurrence of outbreaks. It should also be noted that once the lesions are fully formed, ruptured, and crusted over, antiviral medications are no longer effective. If an athlete does become infected with HSV1 and exhibits signs and symptoms, such as vesicles, he or she should be prohibited from practice and play until symptom free for 72 hours with no new or moist vesicles. To deal with recurrent flare ups, a physician should be consulted and a preventative treatment, such as an antiviral medication may be prescribed.
Prevention in the locker room
Since the virus is highly contagious and easily transmitted through skin contact with lesions, prevention is crucial. The locker room contains a multitude of shared personal items from soap to drinks, any one of which can be a vehicle for virus transmission. For example, if a cell phone is pressed against a lesion when talking on the phone and then handed off to a fellow athlete for use, it could potentially transmit the virus. Technically, any object that is exposed to a lesion can become a means of transmission. Basic prevention begins with not sharing personal items and includes proper hygiene. According to the 2008 NCAA guideline, “Skin Infections in Athletics,” some other ways to reduce exposure in the locker room are:
While prevention begins with athletes practicing good hygiene, a comprehensive prevention program should also involve athletic trainers, coaches, and building maintenance staff. Each plays a role in ensuring a sanitary environment for athletes by using a germicide to clean and disinfect common areas such as showers, benches, practice clothing, treatment tables, water bottles, mats, and equipment. Any shared object should be cleaned daily to prevent the spread of infectious disease. If an athlete has a suspicious skin rash, he or she should consult medical staff prior to practicing in order to prevent the transmission to fellow teammates.
Practicing proper hygiene and frequently cleaning communal areas and shared practice items is the best way to prevent transmission. When a skin rash appears, it is important to have it checked by medical staff prior to participating in sporting activities, especially contact sports, to ensure it is not contagious. If a contagious skin rash is present, such as HSV1, report it to the staff immediately so effective precautions can be taken to prevent any potential spread to teammates, coaches, or staff. The key is prevention and everyone has a role.
Author: Marissa Turturro, MS, ATC, NSCA-CPT and Joanna Sunnes
Reprinted with permission from the Hughston Health Alert, Volume 29, Number 3, Summer 2017.