On a monday night three years ago, a rash appeared on the back of Scott Perkins's left forearm—about 48 hours after the high school sophomore had participated in a citywide wrestling tournament in Albuquerque. The next day the 15-year-old novice wrestler showed the blistery half-dollar-sized patch to a local dermatologist, who attributed it to impetigo, a minor bacterial infection. Perkins took the news in stride; he decided to wear long-sleeved shirts and sit out wrestling practice until the unsightly lesions went away.
But he soon had more to worry about than missing practice. Later that day Perkins's temperature inexplicably rose to 102°, and his mother ordered him to bed. On Wednesday white canker sores popped up on the back of his throat, and a cold sore covered more than half of his lower lip. Too sick to hold down food, he lived on water for 4½ days.
On Friday the fever soared to 105°, and Perkins took to a tub of cold bathwater to bring it down. He also decided that it would be a good idea to call his mom at work. "I was in a quandary as to whether I'd get him to the emergency room in time or whether he'd have a seizure in the car," says his mother, Barbara Thorpe, who was then a nurse at the University of New Mexico Medical Center. Fortunately, Scott's temperature dropped in the cold bath, returning to normal so quickly, in fact, that he was back in school by the following Monday. But the bizarre illness left its mark: He now weighed 14 pounds less than he had a week earlier.
What Perkins and his mother had yet to learn was that he had received something more than a spirited tussle on the mat during the Albuquerque tournament; he had also picked up a case of herpes gladiatorum, a lifelong viral infection so little known outside the sports of wrestling and rugby that most physicians are unfamiliar with the disease.
March 11, 1991
Too often when people hear the word herpes, they immediately think "sexually transmitted disease." In fact, the herpes gladiatorum infection, which is caused by the herpes simplex type 1 virus, is spread through the kind of skin-to-skin contact that occurs during wrestling. The infection begins when the virus—the same herpes virus that causes cold sores—enters a wrestler's body through a break in the skin after he touches an opponent's herpes-related rash or cold sore. (Wrestlers with a history of these infections pose little risk of passing along the disease as long as they show no signs of active lesions.) The disease also can travel indirectly from one wrestler to another when an athlete competes on a wrestling mat contaminated with the secretions from another athlete's rash or cold sore.
"If somebody gets his shoulder or face pushed into the mat with enough force to abrade it, that can drive the virus into the skin," says Dr. Jack Harvey of the Orthopedic Center for the Rockies in Fort Collins, Colo. Harvey is chief physician for U.S.A. Wrestling, the Colorado Springs-based national governing body for the amateur sport.
After an incubation period of two to seven days, the virus creates a tingling and burning sensation on the skin, and the infected wrestler develops a rash or cold sore—generally on the face, upper arm or torso. It's not unusual for the same skin irritation to flare up several times per season and to take about two weeks to disappear. While suffering the infection, the wrestler may also have a headache, fever, swelling of the lymph glands, chills and a feeling of general malaise. Many wrestlers never experience anything more uncomfortable than feeling slightly under the weather, but some, such as Perkins, fare much worse. Herpes rashes can leave permanent scarring, and while the fever and fatigue seldom return after the first attack, the virus resides in the infected person's body for the rest of his life and can provoke recurrences of the rash or cold sores—particularly during times of physical and mental stress. That phenomenon creates an untimely dilemma for wrestlers, who frequently have their greatest number of outbreaks just before or during a high-pressure competition. This, of course, is when the disease has the best chance of zapping athletes on other teams.
"I had one wrestler who got so stressed at the time of the district and state competitions that he popped out in herpes two out of three years," says Dr. Harvey.
The type of uniform that athletes wear also has a lot to do with the odds of catching the disease. Those in sports such as football and hockey face fewer risks from infected opponents or teammates because their helmets, pads and jerseys help prevent the virus from reaching the skin. "You're not going to get any more body contact than with wrestling," says Jim Hoegh, the team trainer at the University of Iowa, a perennial wrestling power. He estimates that 13 of the 45 wrestlers on his team had flare-ups this past season, and that about the same number were infected the year before. "It's a high-risk population," he says.
Given the nature of the sport, the disease can move through a wrestling squad faster than chicken pox through a kindergarten class. In 1989, for example, herpes gladiatorum infected 60 of the 175 wrestlers at a Minnesota wrestling camp. In 1988 the disease hit 16 Wisconsin high school wrestlers as well as their coach, and then spread to five wrestlers on two other teams that competed against this first group.
In the early 1980s, to find out how pervasive the disease was, a group of six medical researchers affiliated with Emory University and the Centers for Disease Control in Atlanta launched a nationwide study to measure the incidence of herpes skin infections among college and high school wrestlers. The scientists interviewed 95 randomly selected athletic trainers by telephone. Then they evaluated written responses from another 294 trainers. They surveyed all the members of four Southeastern Conference wrestling teams and took blood samples from every athlete on one of those teams.
What they found was dismaying. According to the 1988 report published in the American Journal of Sports Medicine, during the 1984-85 wrestling season, 65% of U.S. college wrestling teams and 25% of the high school teams surveyed had at least one member with herpes gladiatorum—twice the rate that had been found among Northeastern college wrestling teams in a survey conducted 20 years earlier. Within the 1984-85 national population of wrestlers, 7.6% of the college wrestlers and 2.6% of the high school wrestlers had the disease.
The sweep of the disease surprised even the researchers who conducted the survey. "I didn't think it would be a widespread problem," says Dr. Thomas Becker, formerly an epidemiologist with the Centers for Disease Control and now an assistant professor of medicine at the University of New Mexico Medical Center. "But as it turned out, herpes gladiatorum is certainly an occupational hazard of wrestling." Dr. Becker, who headed the survey team and who is widely considered to be a top authority on the infection, also believes that the disease's persistence means that thousands of current and former wrestlers are now infected.
With no vaccine in existence to curtail the virus, medical experts and wrestling staffers are facing the challenge of keeping uninfected athletes away from their opponents' rashes and cold sores. But current safeguards vary in effectiveness. From public school bouts to the Olympics, wrestlers are supposed to undergo skin inspections prior to matches. But the screening process is far from infallible. "I'm sure we don't pick up a significant number of these cases because oftentimes the onset is very gradual," says U.S.A. Wrestling's head trainer, Jack Spain, who estimates that 15% to 25% of all wrestlers at the postcollegiate level have herpes gladiatorum. "At most of the major competitions, we'll see 1,000 kids at a weigh-in, and even if we had unlimited financial abilities, it would be difficult to check."
Physicians are on hand to conduct skin inspections at all international-level and most national meets. But often the responsibility is shifted to coaches or trainers at collegiate meets, and coaches alone, typically, handle the chore at high school events. There's considerable doubt, however, whether coaches—particularly those without much training-have the qualifications to perform the task. "In the summertime, coaches will come and ask, 'Is this herpes?' and it turns out to be poison ivy," says Spain. "As you go down in age to the younger athletes and the less-experienced coaches, the more likely it is they'll miss the disease."
Even when the coaches are knowledgeable about skin lesions, they aren't always unblinkingly impartial, particularly when a key wrestler fails the inspection. "The coach has different thought processes depending on whether his third-string wrestler or his possible national champion [is involved]," says Dr. Harvey. "Nobody comes up to me and says, 'My national champion has this rash, and it might be herpes. Do you think I ought to pull him?' My suspicion is that the problem isn't brought to my attention because my answer might be yes."
Infected wrestlers, likewise, may hide their herpes lesions from officials to avoid being disqualified. "You've got to remember, these are highly motivated athletes," says Hoegh. "Some will avoid the disease at all costs. But many will wrestle somebody with it or wrestle with it themselves because they don't see the implications as being very great."
When wrestlers do come forward, team doctors generally prescribe the antiviral drug acyclovir, which may reduce the healing time of lesions to as brief a period as five days. The medication, which is usually administered in tablet form, may also deter rashes from forming when athletes take the pills at the first sign of tingling—a signal that a rash or cold sore is about to appear.
Physicians and trainers often allow wrestlers to compete even before the rash subsides if they can bandage the lesions with a surgical dressing designed to lock in the virus. Not everyone is confident about a bandage's effectiveness. "It depends on what the bandage is made of and how likely it is to stay in place," says Dr. Becker. "Maybe if the rash was on your arm, you could wear a jersey and bandage and be reasonably safe. But, frankly, I wouldn't want to face somebody like that."
Preventing uninfected wrestlers from encountering an active herpes lesion is only half the battle. Trainers at the collegiate and postcollegiate level also try to ward off infections by being as rigorous about scrubbing their wrestling mats as greenskeepers are about mowing their fairways. Wrestling mats are usually mopped with a disinfectant at least once and sometimes as often as three times a day, depending on the number of wrestling sessions. Unused mats are also roped off to prevent pedestrians from tracking the virus on their shoes. Those efforts, however, aren't enough to stop wrestlers from catching the virus from infected athletes who used the mat earlier in the same session.
As a general rule, the lower the level of wrestling, the greater the risk. "We don't use our mats for anything except wrestling practice," says Joe Seay, the wrestling coach at Oklahoma State University. "In high school those mats might be used for a variety of physical education activities." Says Hoegh of Iowa, "I doubt very much that high schools take the measures that collegiate teams do to keep their mats clean."
The concern about viral infections has prompted some members of the wrestling world to suggest more radical methods of halting such diseases. Bobby Douglas, the wrestling coach at Arizona State University, for example, feels strongly that the sport should take a hard look at replacing the current wrestling uniform with a bodysuit, mouth guard and helmet to reduce bleeding and infection. "We need to get ready for the 21st century and stop thinking about what wrestling is like in the 20th," he says, "and one of the areas we need to be concerned about is health."
One athlete who won't have to wait around for a new uniform is Scott Perkins, who is now in his freshman year at Cornell University in Ithaca, NY. Since becoming infected with herpes gladiatorum, he has hung up his wrestling singlet for good. He left the sport primarily to devote his energies to his first love—track and field—and to avoid further damage to an arm that he had injured while playing football. "But [herpes gladiatorum] was obviously a contributing factor," he says. "I'd be lying if I said it wasn't."
Perkins competes in the shot put for Cornell, and every now and again the herpes that he contracted in his former sport is reactivated by, among other things, his current one. A chronic inconvenience caused by the virus are cold sores that engulf most of his lower lip, particularly when he spends a lot of time in the sun—a situation that often occurs during track season. By taking acyclovir tablets at the first sign of tingling, he has reduced the cold-sore flare-ups to one every few months. "They're an esthetic turnoff, but I don't have any emotional scars that make me want to say that people shouldn't wrestle," Perkins says. "Herpes gladiatorum is a first-class nuisance, and it's going to annoy me for life. But it's not going to affect my health adversely to the point where I won't be able to perform. I just have to tote these tablets with me wherever I go."
The virus wastes little time reminding him of its presence when he fails to keep his medicine handy. During a trip to California not long ago, he felt his lower lip begin to tingle. He suddenly realized that he had left his acyclovir at home, and he knew he was in trouble. "Twelve hours later, my lip was so monstrous I looked like I'd been six rounds in a prizefight," says Perkins. "Until I came home a day and a half later, I just had to grin and bear it." For wrestlers unlucky enough to get pinned by herpes gladiatorum, that's often their only option.
David Sharp of Norris, Tenn., is a contributing editor for "In Health" magazine.