Epidemiologic Notes and Reports
Herpes Gladiatorum at a High School Wrestling Camp -- Minnesota
In July 1989, the Minnesota Department of Health (MDH)
investigated an outbreak of herpes simplex virus type 1 (HSV-1)
dermatitis (herpes gladiatorum) in participants at a Minnesota
wrestling camp. The camp was held July 2 through July 28 and
attended by 175 male high school wrestlers from throughout the
United States. The participants were divided into three wrestling
groups according to weight (group 1, lightest; group 3,
heaviest). During most practice sessions, wrestlers had contact
only with others in the same group. The outbreak was detected
during the final week of camp, and wrestling contact was
subsequently discontinued for the final 2 days.
A case was defined as isolation of HSV-1 from involved skin or
eye or the presence of cutaneous vesicles. To identify cases, a
clinic was held at the camp to obtain viral cultures and examine
skin lesions. Additional clinical data were obtained from review
of emergency department records at the facility where all
affected wrestlers were referred for medical care. A
questionnaire was administered to wrestlers by telephone
following the conclusion of camp.
Clinical and questionnaire data were available for 171 (98%)
persons. The mean age of these participants was 16 years (range:
14-18 years); 153 (89%) were white; 137 (80%) were high school
juniors or seniors. The median length of time in competitive
wrestling was 4 years.
Sixty (35%) persons met the case definition, including 21 (12%)
who had HSV-1 isolated from the skin or eye (Figure 1). All
affected wrestlers had onset during the camp session or within 1
week after leaving camp. Two wrestlers had a probable recurrence
of HSV, one oral and one cutaneous, during the first week of
camp. Lesions were located on the head or neck in 44 (73%)
persons, the extremities in 25 (42%), and the trunk in 17 (28%).
Herpetic conjunctivitis occurred in five persons; none developed
keratitis. Associated signs and symptoms included lymphadenopathy
(60%), fever and/or chills (25%), sore throat (40%), and headache
(22%). Forty-four (73%) persons were treated with acyclovir.
Attack rates increased by weight group: of 55 wrestlers in
group 1, 12 (22%) were affected; of 57 in group 2, 17 (30%); and
of 59 in group 3, 31 (53%) (p=0.01). Thirty-eight (22%) wrestlers
interviewed reported a past history of oral HSV-1 infection. The
attack rate was 24% for wrestlers who reported a past history of
oral herpes and 38% for wrestlers without a history of oral
herpes (relative risk (RR)=0.6; 95% confidence interval
(CI)=0.3-1.0). Twenty-three percent of affected wrestlers
continued to wrestle for at least 2 days after rash onset.
Athletes who reported wrestling with a participant with a rash
were more likely to have confirmed or probable HSV-1 infection
(RR=2.0; 95% CI=1.3-3.1).
Reported by: JL Goodman, MD, EJ Holland, MD, CW Andres, MD, SR
Homann, MD, RL Mahanti, MD, MW Mizener, MD, A Erice, MD, Univ of
Minnesota Hospital and Clinic, Minneapolis; MT Osterholm, PhD,
State Epidemiologist, Minnesota Dept of Health. Div of Field
Svcs, Epidemiology Program Office, CDC.
Editorial Note
Editorial Note: Herpes gladiatorum (cutaneous infection with HSV
in wrestlers and rugby players) was first described in the
mid-1960s (1-3). In 1988, an outbreak of herpes gladiatorum was
reported among three Wisconsin high school wrestling teams (4).
In a national survey of 1477 trainers of athletes, approximately
3% of high school wrestlers were reported to have developed HSV
skin infections during the 1984-85 season (5). Lesions occur most
often on the head and neck. Primary infection may cause
constitutional symptoms with fever, malaise, weight loss, and
regional lymphadenopathy. Ocular involvement includes keratitis,
conjunctivitis, and blepharitis.
Transmission occurs primarily through skin-to-skin contact.
Autoinoculation may lead to involvement of multiple sites.
Previous infection with HSV-1 may reduce the risk of acquiring
herpes gladiatorum (5). However, the prevalence of antibody to
HSV-1 is low among white adolescents (6), and many adolescents
are susceptible when they enter competitive wrestling. Control
methods should include education of athletes and trainers
regarding herpes gladiatorum, routine skin examinations before
wrestling contact, and exclusion of wrestlers with suspicious
skin lesions. The outbreak in the Minnesota camp might have been
prevented if athletes with such lesions had been promptly
excluded from contact competition.
References
Selling B, Kibrick S. An outbreak of herpes simplex among
wrestlers (herpes gladiatorum). N Engl J Med 1964;270:979-82.
Porter PS, Baughman RD. Epidemiology of herpes simplex among
wrestlers. JAMA 1965;194:998-1000.
Wheeler CE Jr, Cabaniss WH Jr. Epidemic cutaneous herpes
simplex in wrestlers (herpes gladiatorum). JAMA 1965;194:993-7.
Wisconsin Division of Health. Herpes gladiatorum in high
school wrestlers. Wis Epidemiol Bull 1989;11:1-3.
Becker TM, Kodsi R, Bailey P, et al. Grappling with herpes:
herpes gladiatorum. Am J Sports Med 1988;16:665-9.
Johnson RE, Nahmias AJ, Magder LS, Lee FK, Brooks CA, Snowden
CB. A seroepidemiologic survey of the prevalence of herpes
simplex virus type 2 infection in the United States. N Engl J Med
1989;321:7-12.
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