Sexual Health STDs Can You Get MRSA During Sex? By Elizabeth Boskey, PhD facebook twitter linkedin Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases. Learn about our editorial process Elizabeth Boskey, PhD Medically reviewed by Medically reviewed by Matthew Wosnitzer, MD on December 27, 2020 twitter linkedin Matthew Wosnitzer, MD, is board-certified in urology. He is an attending physician at Yale New Haven Health System, Northeast Medical Group and teaches at the Frank Netter School of Medicine. Learn about our Medical Review Board Matthew Wosnitzer, MD on December 27, 2020 Print In 2008, the newswires were rife with reports about an outbreak of a new strain of the "flesh-eating" MRSA bacteria 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. What made the 2008 event so unusual was that many of the reported infections were passed during anal sex. In the San Francisco area alone, 588 MRSA infections were confirmed in the Castro District, of which 25% were highly resistant to antibiotic treatment. 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. How Bad Can MRSA Infections Get? Tara Moore / Getty Images MRSA vs. STDs Despite the fact that the 2008 outbreak was facilitated by sexual contact, MRSA is not considered a sexually transmitted disease (STD). By definition, STDs are diseases in which sexual contact is a predominant mode of transmission. These include such common and uncommon STDs as: Chlamydia Crabs Gonorrhea Hepatitis B virus (HBV) Herpes simplex virus (HSV) HIV Human papillomavirus (HPV) Mycoplasma genitalium Syphilis Trichomoniasis Ureaplasma urealyticum 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 non-sexual contact. How MRSA Is Diagnosed Factors for Transmission Most MRSA infections are acquired while in hospital (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 hospital (known as community-acquired MRSA), even casual contact can transmit the infection. By and large, people who are immune-suppressed—such as the elderly or people living with HIV—are more likely to become infected than those with intact immune systems. To this end, HIV is believed to play a large part in the 2008 outbreak given that men who have sex with men (MSM) account for over 80% of new infections in the United States each year. According to the San Francisco Department of Public Health, the Castro District had an HIV incidence of 181 out of every 100,000 residents in 2017. That is no less than 14 times the HIV incidence of the general U.S. population (12.3 per 100,000). Immunosuppression coupled with anal sex and multiple sexual partners created something of a "perfect storm" for MRSA infection in communities hard hit by HIV. With that being said, it doesn't entirely explain how the outbreak started in the first place. Crystal Meth Use Researchers believe that the rise in the used of injected crystal methamphetamine ("crystal") among MSM is to blame. According to a 2012 study in the AIDS Behavior, which evaluated the crystal meth epidemic in San Francisco in 2008, no less than 35% of MSM reported crystal meth use in the previous 12 months. While it unknown how many of these men inhaled or injected the drug, the practice of "slamming" (injecting) crystal is well known among gay circuit partygoers. Not only is sharing needles is a major risk factor for HIV and hepatitis C but facilitates MRSA infection by introducing the bacteria under the skin. A 2009 study in Clinical Infectious Diseases reported that crystal meth was independently linked to the risk of MRSA in 795 MSM coinfected with HIV. Once MRSA infection is established, it can be readily passed to others whether they are drug users or not. A 2017 study in LGBT Health found that MSM with MRSA often had no initial symptoms but nevertheless had active bacterial reservoirs in the rectum, nasal passages, and other mucosal tissues. The transmission of the bacteria through anal sex is made all the easier if there are multiple sex partners, broken or inflamed skin, shared toys, or unprotected sex. Under these circumstances, a few isolated cases can suddenly turn into a community crisis. Prevention Despite the risk of sexual exposure, MRSA is a rare occurrence even in groups considered to be at high 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 the 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. Doing so not only suppresses the virus but allows your body to rebuild its immune defenses. 8 Serious Infections You Can Get in Hospital Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Hassoun A, Linden PK, Friedman B. Incidence, prevalence, and management of MRSA bacteremia across patient populations-a review of recent developments in MRSA management and treatment. Crit Care. 2017;21(1):211. doi:10.1186/s13054-017-1801-3 Zeller JL, Golub RM. MRSA Infections. Jama. 2011;306(16). doi:10.1001/jama.306.16.1818 Clark T, Marquez C, Hare CB, John MD, Klausner JD. Methamphetamine use, transmission risk behavior and internet use among HIV-infected patients in medical care, San Francisco, 2008. AIDS Behav. 2012;16(2):396-403. doi:10.1007/s10461-010-9869-7 Szumowski JD, Wener KM, Gold HS, et al. Methicillin-resistant Staphylococcus aureus colonization, behavioral risk factors, and skin and soft-tissue infection at an ambulatory clinic serving a large population of HIV-infected men who have sex with men. Clin Infect Dis. 2009;49(1):118-21. doi:10.1086/599608 Additional Reading Antoniou T, Devlin R, Gough K et al. Prevalence of Community-associated Methicillin-resistant Staphylococcus Aureus Colonization in Men Who Have Sex With Men. Int J STD AIDS. 2009;20(3):180-3. doi:10.1258/ijsa.2008.008243. Clark T, Marquez C, Hare B et al. Methamphetamine Use, Transmission Risk Behavior and Internet Use Among HIV-Infected Patients in Medical Care, San Francisco, 2008. AIDS Behav. 2012 Feb;16(2): 396-403. doi:10.1007/s10461-010-9869-7. Leung NS, Vidoni ML, Robinson DA et al. A Community-Based Study of Staphylococcus aureus Nasal Colonization and Molecular Characterization Among Men Who Have Sex with Men. LGBT Health. 2017 Oct;4(5):345-351. doi:10.1089/lgbt.2017.0016. Mediavilla JR, Chen L, Mathema B, Kreiswirth BN. Global epidemiology of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Curr Opin Microbiol. 2012 Oct;15(5):588-95. doi:10.1016/j.mib.2012.08.003. San Francisco Department of Health Population Health Division. (2018) HIV Epidemiology: Annual Report 2017. San Francisco, California: San Francisco Department of Health Szumowski JD, Wener KM, Gold HS et al. Methicillin-resistant Staphylococcus aureus colonization, behavioral risk factors, and skin and soft-tissue infection at an ambulatory clinic serving a large population of HIV-infected men who have sex with men. Clin Infect Dis. 2009 Jul 1;49(1):118-21. doi:10.1086/599608.