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Sweat, shared gear and playing surfaces, coupled with the erratic personal hygiene of adolescents, have combined to ramp up the risk from skin infections in sports at the high school and college level.

At any given moment, about a third of all people in the United States are carrying some strain of staph germ on their skin or in their nasal passages. Normally, this isn't a concern if you have a healthy immune system and intact skin.

But if the skin gets broken, even by the smallest scratch or scrape, bacteria resistant to a large spectrum of antibiotics may enter, and you've got a serious medical problem in the making.

That was the case last January, when Drexel University wrestler Kyle Frey noticed a pimple on his left bicep that within a couple of days grew to the size of a grapefruit.

At that point, his athletic trainer sent him to an emergency room and ultimately a stay in a Philadelphia hospital, where the 21-year-old had the site of the infection surgically cleaned and took a course of high-grade antibiotics. He was out for two weeks.

"It could have been much worse for me, I realize, but it still cost me playing and training time in the middle of my season,'' Frey said recently. "But I can tell I and the rest of my team are a lot more conscious of skin breaks and infection control now."

Contact sports like wrestling, football and rugby have some of the highest incidence of skin infections linked to sports, but the risk is present for athletes taking part in everything from cheerleading and gymnastics to golf and tennis.

The burden is substantial. One review of reported infectious diseases in sports found that skin diseases accounted for 56 percent of all documented cases between 1922 and 2005.

The federal Agency for Health Care Research and Quality found that skin infections were the eighth leading cause of hospitalization among children 17 and younger as of 2006.

One thing that's clear is that it's better to prevent a drug-resistant skin infection than be forced to treat it with ever-more costly and complex antibiotics.

"We're paying a huge cost in every sense of the word from skin diseases," said Steven Zinder, an athletic trainer and assistant professor of exercise and sports science at the University of North Carolina, Chapel Hill.

He led a six-year review of the problem for the National Athletic Trainers Association that concluded this month with the publication of recommendations and guidelines for avoiding, identifying and treating skin infections among athletes at all levels.

Many of the prevention recommendations are simple -- "stuff we learned in the sixth grade," Zinder told a press briefing held during the association's annual meeting in Philadelphia in late June:

Schools need to provide sufficient money and people to run a comprehensive infection control policy. While athletic trainers are the front line resource in many schools, athletic programs should also have at least a consulting dermatologist available to help identify and diagnose suspect skin conditions.

Regular cleaning of locker rooms, practice and competition courts, mats and artificial turf fields, as well as gear, needs to be practiced.

Athletes and coaches need to be educated about and encouraged to follow good hygiene. That means washing and showering regularly and promptly -- not waiting for hours when athletes return to their dorm or home. Athletes need to make regular health checks of their skin.

Discouraging athletes from sharing towels, water bottles, athletic gear, or personal care items like razors or hair clippers.

Laundry and gear need to be washed or disinfected on a daily basis. And if stuff comes home to be washed in a gym bag, make sure the bag gets cleaned, too.

The complete report can be read at http://www.nata.org/statements/position-statements

(Contact Lee Bowman at BowmanL(at)shns.com)

The Medical Journal