(Editor’s Note: The following story was originally printed in the Oct. 31, 2003 issue of Wrestling International Newsmagazine (Vol. 10, No. 1) and is being reprinted here after the Minnesota State High School League (MSHSL) ordered wrestling across the state suspended for eight days so that an outbreak of the herpes gladiatorum virus could be controlled.)

By Dr. B.J. Anderson, Special to W.I.N.
Every sport has its own problems. Whether you’re talking about knee injuries in football or repetitive concussions in boxing, a dark secret exists.
In wrestling it’s no different, but the entity isn’t a broken bone, torn ligament or head injury. Instead, skin infections plague this sport and Herpes Gladiatorum has been called its own little dark secret. Ringworm (T. tonsurans) is a fungal infection that 85 percent of all wrestlers will get each year. Consequences are minimal and treatment is long.
Contrast this with Herpes Gladiatorum (HG), caused by Herpes Simplex Type-1, the same virus that causes cold sores. Once you get it, you’ve got it for life. Estimations are that 33 percent of all teenagers from 13-18 years of age have this virus. Yet, only three percent know it.
With cold sores, recurrent vesicle formation is the rule, not the exception. It usually develops on the lip or surrounding the nose or face. It usually lasts three to seven days and goes away on its own only to reoccur at sometime in the future.
Spread by direct contact with an infected individual, usually from kissing a significant other, it becomes more of a nuisance. Contrast this with HG: The estimation that 20-40 percent of Division I wrestlers knowingly get recurrent infections which usually involve areas on the face and around the eye.
Due to the nature of this sport, it spreads where direct contact is at its greatest and usually on the face. With involvement around the eye, recurrent outbreaks can be quite serious. Damage to the cornea, in the form of scarring from recurrent outbreaks, can threaten a wrestler’s vision later in life. More serious, yet rare, is retinal involvement and potential blindness.
In the 1970s, the American-style of wrestling had evolved into more of a freestyle format. This has increased the “lock-up” position from 24 to 39 percent of a six-minute match or a 63 percent increase in face-to-face contact.
Recent studies show that 49 percent of all outbreaks occur on the right side of the head and/or face and 94 percent of the lesions are on the front side of the body. Spread is due to direct skin-to-skin contact, not from the mat. Thus, indicating eye involvement with HG is at a greater risk in the sport of wrestling due to changes implemented over the past 30 years.
Facial presentation of Primary HG includes sore throat, fever (101.5 degrees Fahrenheit), redness, swollen lymph nodes and finally vesicle formation. It resolves in 10-14 days, regardless of treatment. Recurrent outbreaks are much smaller and last three to seven days.
A sensation of “pins and needles” is common, followed by vesicle formation. It is usually misdiagnosed as folliculitis (a bacterial infection) and treated with antibiotics. A lack of clearance by four to five days prompts changing medications, for fear of a resistant organism. When it clears in another four to five days, the assumption usually is that it was a resistant bacteria when it really is a normal presentation of HG.
Being a virus, HG won’t clear with antibiotics. As with cold sores, antiviral medications help to clear an outbreak. With the use of Valtrex, an oral antiviral medication, an outbreak can clear up in about six days versus eight on a placebo (25 percent reduction in time off mat).
Also note that a common mistake is to assume a crusted lesion isn’t infectious. Recent clinical studies we performed showed that on the average, physicians cleared a wrestler to “return to competition” after three days on Valtrex. This false assumption would allow another three days to expose other wrestlers and risk transmission.
Proper skin checks, treatment and prevention will help control the spread of HG. Skin checks should be done before every practice. All wrestlers and coaches with any history of cold sores or HG should be on antiviral medication during the wrestling season.
With any outbreak the individual should be off the mat for six days, provided the lesions have cleared. If any two or more on a team has an outbreak, consider shutting down the room and not competing for one week.
Maine, Pennsylvania and Washington have had outbreaks in the past and showed excellent results in stopping the spread by stopping competition and possible contact. A 1999 outbreak in Minnesota wasn’t as lucky. A total of 61 wrestlers and three coaches contracted HG over 42 days.
Public persecution of the young high school wrestlers by unknowing parents, whose children shared a classroom with the athletes, caused severe depression and withdrawal of several individuals from the sport.
The following is an HG antiviral regimen that has produced a desired effect:
For primary HG, take 1 gm Valtrex twice a day for 7-10 days.
For recurrent HG, take 500 mg of Valtrex twice a day for seven days.
Then there are prophylactic treatments, which helps to prevent future outbreaks:
If HG occurs in less than two years, take 1 gm once a day.
If HG happens more than two years, 500 mg once a day. If there is breakthrough at this dose, increase to 1 gm a day.
Prophylactic treatment with Valtrex has shown a 94-96 percent prevention in an outbreak.
Treatment protocol has also shown excellent results in reducing an outbreak by 20 percent, a significant amount of time considering that collegiate wrestlers spend 12 percent of the whole season out of competition due to skin infections.
Herpes infections are quite common in our society. But due to the nature of this sport, it has potential for dire consequences. Proper precautions and education can keep it under control. Taking it lightly may prove to be the death of this sport.
(Dr. B.J. Anderson is a former wrestler and the former team physician for the Augsburg and Minnesota wrestling teams and serves as medical advisor for Minnesota/USA Wrestling. He is also a consultant for the MSHSL.)