Susan London

MEXICO CITY — When raltegravir (Isentress) is used as part of combination antiretroviral therapy in treatment-naive patients infected with HIV, its efficacy is sustained and similar to that of efavirenz (Sustiva) and it appears to have a better safety profile, according to updated results of a randomized trial.

Raltegravir is an oral inhibitor of the viral integrase enzyme and has been shown to be active against a variety of HIV isolates, Dr. Martin Markowitz, lead author, said at the International AIDS Conference. The aim of the phase II trial was to compare the drug's safety and efficacy with those of efavirenz.

In the trial, patients were treated with raltegravir (100, 200, 400, or 600 mg twice daily) or efavirenz, added to the backbone of tenofovir (Viread/TDF) plus lamivudine (Epivir/3TC), reported Dr. Markowitz, a staff investigator with the Aaron Diamond AIDS Research Center in New York. The results observed with raltegravir were indistinguishable across doses at the 48-week analysis, so all of the patients were treated with the 400-mg dose thereafter.

The updated, 96-week analysis was based on data from 160 patients who were treated with raltegravir and 38 patients who were treated with efavirenz, who had a mean age of 36 years. The low dropout rate of about 15% over 96 weeks of therapy “speaks to the tolerability of both regimens,” Dr. Markowitz said.

The percentage of patients who had fewer than 400 copies/mL of viral RNA (the trial's primary end point) was identical in the raltegravir and efavirenz groups, at 84%. The percentage with fewer than 50 copies/mL was also similar, at 83% and 84%, respectively.

One patient in each trial arm experienced treatment failure in the second half of the 96-week period. Genotyping showed that the patient taking raltegravir had wild-type virus, whereas the patient taking efavirenz had resistance mutations consistent with exposure to that drug.

The rate of drug-related adverse events was 51% with raltegravir and 74% with efavirenz. The difference was driven mainly by a difference in neuropsychiatric events, Dr. Markowitz said, most of which occurred by 48 weeks. The rate for raltegravir was half of that for efavirenz at 96 weeks (16% vs. 32%).

Cancers occurred with nearly equal rates in the raltegravir and efavirenz arms (2% vs. 3%, respectively), and grade 3/4 laboratory abnormalities were uncommon for both drugs, with individual abnormalities occurring in 8% of patients at most.

However, efavirenz was associated with significantly greater unfavorable changes from baseline in levels of total cholesterol—an increase of 24%, compared with an increase of 1% with raltegravir—and low-density lipoprotein cholesterol—an increase of 4%, compared with a decrease of 6% with raltegravir.

Dr. Markowitz concluded that with the combination therapy used, raltegravir has a sustained antiretroviral efficacy similar to that at 48 weeks and to that achieved with efavirenz. In addition, it was generally well tolerated and seemed to be associated with a lower rate of adverse events.

An attendee asked if the earlier report of the more rapid virologic suppression achieved with raltegravir had any clinical importance now that the two drugs seem to have similar efficacy. Dr. Markowitz replied that differing antiviral mechanisms may explain that early finding, but the clinical importance of more rapid suppression remains uncertain.

Another attendee asked why all of the patients were put on the 400-mg dose of raltegravir if lower doses were equally efficacious, and whether a trial of once-daily dosing might not be reasonable. Dr. Markowitz replied that pharmacokinetic data show marked interpatient and intrapatient variability in drug levels, and exposure to this drug is reduced by some of the other drugs HIV-positive patients take.

The 400-mg dose was chosen in an effort to ensure that most of the patients were receiving exposures that would “appear to be consistent with a good virologic response,” he explained.

Addressing the once-daily dosing issue, he noted that the development plan for raltegravir focused on previously treated patients, but that the drug is now being used in the treatment-naive population.

“It's rare in HIV that we have actually developed drugs with different dosing plans for different patient populations. However, I think that's an interesting thought and one that certainly should be [considered] for raltegravir perhaps and other drugs, particularly as we try to roll some of these drugs out to less developed areas,” he said.

Dr. Markowitz reported that he received research grants and speaker fees from Merck Research Laboratories, which manufacturers raltegravir, and that he serves as a paid consultant for the company.

MEXICO CITY — When raltegravir (Isentress) is used as part of combination antiretroviral therapy in treatment-naive patients infected with HIV, its efficacy is sustained and similar to that of efavirenz (Sustiva) and it appears to have a better safety profile, according to updated results of a randomized trial.

Raltegravir is an oral inhibitor of the viral integrase enzyme and has been shown to be active against a variety of HIV isolates, Dr. Martin Markowitz, lead author, said at the International AIDS Conference. The aim of the phase II trial was to compare the drug's safety and efficacy with those of efavirenz.

In the trial, patients were treated with raltegravir (100, 200, 400, or 600 mg twice daily) or efavirenz, added to the backbone of tenofovir (Viread/TDF) plus lamivudine (Epivir/3TC), reported Dr. Markowitz, a staff investigator with the Aaron Diamond AIDS Research Center in New York. The results observed with raltegravir were indistinguishable across doses at the 48-week analysis, so all of the patients were treated with the 400-mg dose thereafter.

The updated, 96-week analysis was based on data from 160 patients who were treated with raltegravir and 38 patients who were treated with efavirenz, who had a mean age of 36 years. The low dropout rate of about 15% over 96 weeks of therapy “speaks to the tolerability of both regimens,” Dr. Markowitz said.

The percentage of patients who had fewer than 400 copies/mL of viral RNA (the trial's primary end point) was identical in the raltegravir and efavirenz groups, at 84%. The percentage with fewer than 50 copies/mL was also similar, at 83% and 84%, respectively.

One patient in each trial arm experienced treatment failure in the second half of the 96-week period. Genotyping showed that the patient taking raltegravir had wild-type virus, whereas the patient taking efavirenz had resistance mutations consistent with exposure to that drug.

The rate of drug-related adverse events was 51% with raltegravir and 74% with efavirenz. The difference was driven mainly by a difference in neuropsychiatric events, Dr. Markowitz said, most of which occurred by 48 weeks. The rate for raltegravir was half of that for efavirenz at 96 weeks (16% vs. 32%).

Cancers occurred with nearly equal rates in the raltegravir and efavirenz arms (2% vs. 3%, respectively), and grade 3/4 laboratory abnormalities were uncommon for both drugs, with individual abnormalities occurring in 8% of patients at most.

However, efavirenz was associated with significantly greater unfavorable changes from baseline in levels of total cholesterol—an increase of 24%, compared with an increase of 1% with raltegravir—and low-density lipoprotein cholesterol—an increase of 4%, compared with a decrease of 6% with raltegravir.

Dr. Markowitz concluded that with the combination therapy used, raltegravir has a sustained antiretroviral efficacy similar to that at 48 weeks and to that achieved with efavirenz. In addition, it was generally well tolerated and seemed to be associated with a lower rate of adverse events.

An attendee asked if the earlier report of the more rapid virologic suppression achieved with raltegravir had any clinical importance now that the two drugs seem to have similar efficacy. Dr. Markowitz replied that differing antiviral mechanisms may explain that early finding, but the clinical importance of more rapid suppression remains uncertain.

Another attendee asked why all of the patients were put on the 400-mg dose of raltegravir if lower doses were equally efficacious, and whether a trial of once-daily dosing might not be reasonable. Dr. Markowitz replied that pharmacokinetic data show marked interpatient and intrapatient variability in drug levels, and exposure to this drug is reduced by some of the other drugs HIV-positive patients take.

The 400-mg dose was chosen in an effort to ensure that most of the patients were receiving exposures that would “appear to be consistent with a good virologic response,” he explained.

Addressing the once-daily dosing issue, he noted that the development plan for raltegravir focused on previously treated patients, but that the drug is now being used in the treatment-naive population.

“It's rare in HIV that we have actually developed drugs with different dosing plans for different patient populations. However, I think that's an interesting thought and one that certainly should be [considered] for raltegravir perhaps and other drugs, particularly as we try to roll some of these drugs out to less developed areas,” he said.

Dr. Markowitz reported that he received research grants and speaker fees from Merck Research Laboratories, which manufacturers raltegravir, and that he serves as a paid consultant for the company.

MEXICO CITY — When raltegravir (Isentress) is used as part of combination antiretroviral therapy in treatment-naive patients infected with HIV, its efficacy is sustained and similar to that of efavirenz (Sustiva) and it appears to have a better safety profile, according to updated results of a randomized trial.

Raltegravir is an oral inhibitor of the viral integrase enzyme and has been shown to be active against a variety of HIV isolates, Dr. Martin Markowitz, lead author, said at the International AIDS Conference. The aim of the phase II trial was to compare the drug's safety and efficacy with those of efavirenz.

In the trial, patients were treated with raltegravir (100, 200, 400, or 600 mg twice daily) or efavirenz, added to the backbone of tenofovir (Viread/TDF) plus lamivudine (Epivir/3TC), reported Dr. Markowitz, a staff investigator with the Aaron Diamond AIDS Research Center in New York. The results observed with raltegravir were indistinguishable across doses at the 48-week analysis, so all of the patients were treated with the 400-mg dose thereafter.

The updated, 96-week analysis was based on data from 160 patients who were treated with raltegravir and 38 patients who were treated with efavirenz, who had a mean age of 36 years. The low dropout rate of about 15% over 96 weeks of therapy “speaks to the tolerability of both regimens,” Dr. Markowitz said.

The percentage of patients who had fewer than 400 copies/mL of viral RNA (the trial's primary end point) was identical in the raltegravir and efavirenz groups, at 84%. The percentage with fewer than 50 copies/mL was also similar, at 83% and 84%, respectively.

One patient in each trial arm experienced treatment failure in the second half of the 96-week period. Genotyping showed that the patient taking raltegravir had wild-type virus, whereas the patient taking efavirenz had resistance mutations consistent with exposure to that drug.

The rate of drug-related adverse events was 51% with raltegravir and 74% with efavirenz. The difference was driven mainly by a difference in neuropsychiatric events, Dr. Markowitz said, most of which occurred by 48 weeks. The rate for raltegravir was half of that for efavirenz at 96 weeks (16% vs. 32%).

Cancers occurred with nearly equal rates in the raltegravir and efavirenz arms (2% vs. 3%, respectively), and grade 3/4 laboratory abnormalities were uncommon for both drugs, with individual abnormalities occurring in 8% of patients at most.

However, efavirenz was associated with significantly greater unfavorable changes from baseline in levels of total cholesterol—an increase of 24%, compared with an increase of 1% with raltegravir—and low-density lipoprotein cholesterol—an increase of 4%, compared with a decrease of 6% with raltegravir.

Dr. Markowitz concluded that with the combination therapy used, raltegravir has a sustained antiretroviral efficacy similar to that at 48 weeks and to that achieved with efavirenz. In addition, it was generally well tolerated and seemed to be associated with a lower rate of adverse events.

An attendee asked if the earlier report of the more rapid virologic suppression achieved with raltegravir had any clinical importance now that the two drugs seem to have similar efficacy. Dr. Markowitz replied that differing antiviral mechanisms may explain that early finding, but the clinical importance of more rapid suppression remains uncertain.

Another attendee asked why all of the patients were put on the 400-mg dose of raltegravir if lower doses were equally efficacious, and whether a trial of once-daily dosing might not be reasonable. Dr. Markowitz replied that pharmacokinetic data show marked interpatient and intrapatient variability in drug levels, and exposure to this drug is reduced by some of the other drugs HIV-positive patients take.

The 400-mg dose was chosen in an effort to ensure that most of the patients were receiving exposures that would “appear to be consistent with a good virologic response,” he explained.

Addressing the once-daily dosing issue, he noted that the development plan for raltegravir focused on previously treated patients, but that the drug is now being used in the treatment-naive population.

“It's rare in HIV that we have actually developed drugs with different dosing plans for different patient populations. However, I think that's an interesting thought and one that certainly should be [considered] for raltegravir perhaps and other drugs, particularly as we try to roll some of these drugs out to less developed areas,” he said.

Dr. Markowitz reported that he received research grants and speaker fees from Merck Research Laboratories, which manufacturers raltegravir, and that he serves as a paid consultant for the company.

SEATTLE — Methicillin-resistant Staphylococcus aureus is found in one-third of cases of perineal and buttock abscesses in women, and it accounts for fully half of the monomicrobial abscesses, according to one hospital's experience.

"MRSA is a common problem in our hospitals and in our community, and it certainly commands our attention," study author Dr. Susan M. Lareau told attendees of the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology. She noted that a previous report found that MRSA was the leading cause of skin and soft-tissue infection in most emergency rooms but did not address the proportion of perineal infections caused by this pathogen (N. Engl. J. Med. 2006;355:666–74).

Dr. Lareau of the Magee-Womens Hospital in Pittsburgh used diagnostic codes to identify retrospectively all cases of perineal and buttock abscesses seen at the hospital between 2003 and 2007 and then reviewed their characteristics. She included cases involving the vulva, Bartholin glands, and buttocks, and excluded cases involving the perianal and rectal areas.

The process identified 126 patients, Dr. Lareau reported. This group consisted of 64 patients (51%) with vulvar abscesses, 41 patients (33%) with Bartholin gland abscesses, 19 patients (15%) with buttock abscesses, and 2 patients (2%) with combined buttock and vulvar abscesses.

Cultures had been obtained in 72 of the patients and were positive for MRSA in 33%. By site, MRSA was found in 64% of buttock abscesses, 50% of combined buttock and vulvar abscesses, 33% of vulvar abscesses, and 7% of Bartholin gland abscesses.

"It's generally been thought that vulvar abscesses are polymicrobial, and that has driven our treatment, when necessary," Dr. Lareau said. However, most (69%) of the 72 cases were monomicrobial. MRSA accounted for fully 50% of these infections; the next most-common pathogens were group B streptococcus and methicillin-susceptible Staphylococcus aureus, each of which accounted for only 14% of these infections.

Age, race, body mass index, pregnancy, and several comorbidities (diabetes, cancer, and coronary artery disease) did not significantly predict MRSA infection, but site did, according to Dr. Lareau. Relative to patients with Bartholin gland abscesses, patients with buttock abscesses were significantly more likely to be positive for MRSA (odds ratio 28) and patients with vulvar infections were nonsignificantly more likely to be MRSA positive (OR 7). However, Dr. Lareau said, confidence intervals were wide, probably because of the small sample size.

"We wanted to look at the outcomes associated with MRSA to see if this was a more virulent and more difficult to treat infection," Dr. Lareau explained. In fact, the data did not support such associations, showing that MRSA-positive and -negative patients had identical median lengths of hospital stay (2 days) and did not differ significantly with respect to the rate of abscess drainage in the operating room (29% vs. 71%).

An analysis of trends over the 5-year study period showed that the total number of cases of perineal abscess seen at the hospital increased from about 20 to 55 per year. At the same time, the number of cases of MRSA perineal abscess, although still modest, increased at a much faster pace, from 1 to 12 per year.

"MRSA is the dominant pathogen in perineal infections at Magee-Womens Hospital," Dr. Lareau concluded, adding that the study was unable to find clear demographic predictors of which patients are most likely to have this infection. "I would advocate considering empiric coverage for MRSA when you have a vulvar abscess that requires treatment," she recommended.

Dr. Lareau reported that she had no conflicts of interest in association with the study.

'I would advocate considering empiric coverage for MRSA when you have a vulvar abscess that requires treatment.' DR. LAREAU

SEATTLE — Methicillin-resistant Staphylococcus aureus is found in one-third of cases of perineal and buttock abscesses in women, and it accounts for fully half of the monomicrobial abscesses, according to one hospital's experience.

"MRSA is a common problem in our hospitals and in our community, and it certainly commands our attention," study author Dr. Susan M. Lareau told attendees of the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology. She noted that a previous report found that MRSA was the leading cause of skin and soft-tissue infection in most emergency rooms but did not address the proportion of perineal infections caused by this pathogen (N. Engl. J. Med. 2006;355:666–74).

Dr. Lareau of the Magee-Womens Hospital in Pittsburgh used diagnostic codes to identify retrospectively all cases of perineal and buttock abscesses seen at the hospital between 2003 and 2007 and then reviewed their characteristics. She included cases involving the vulva, Bartholin glands, and buttocks, and excluded cases involving the perianal and rectal areas.

The process identified 126 patients, Dr. Lareau reported. This group consisted of 64 patients (51%) with vulvar abscesses, 41 patients (33%) with Bartholin gland abscesses, 19 patients (15%) with buttock abscesses, and 2 patients (2%) with combined buttock and vulvar abscesses.

Cultures had been obtained in 72 of the patients and were positive for MRSA in 33%. By site, MRSA was found in 64% of buttock abscesses, 50% of combined buttock and vulvar abscesses, 33% of vulvar abscesses, and 7% of Bartholin gland abscesses.

"It's generally been thought that vulvar abscesses are polymicrobial, and that has driven our treatment, when necessary," Dr. Lareau said. However, most (69%) of the 72 cases were monomicrobial. MRSA accounted for fully 50% of these infections; the next most-common pathogens were group B streptococcus and methicillin-susceptible Staphylococcus aureus, each of which accounted for only 14% of these infections.

Age, race, body mass index, pregnancy, and several comorbidities (diabetes, cancer, and coronary artery disease) did not significantly predict MRSA infection, but site did, according to Dr. Lareau. Relative to patients with Bartholin gland abscesses, patients with buttock abscesses were significantly more likely to be positive for MRSA (odds ratio 28) and patients with vulvar infections were nonsignificantly more likely to be MRSA positive (OR 7). However, Dr. Lareau said, confidence intervals were wide, probably because of the small sample size.

"We wanted to look at the outcomes associated with MRSA to see if this was a more virulent and more difficult to treat infection," Dr. Lareau explained. In fact, the data did not support such associations, showing that MRSA-positive and -negative patients had identical median lengths of hospital stay (2 days) and did not differ significantly with respect to the rate of abscess drainage in the operating room (29% vs. 71%).

An analysis of trends over the 5-year study period showed that the total number of cases of perineal abscess seen at the hospital increased from about 20 to 55 per year. At the same time, the number of cases of MRSA perineal abscess, although still modest, increased at a much faster pace, from 1 to 12 per year.

"MRSA is the dominant pathogen in perineal infections at Magee-Womens Hospital," Dr. Lareau concluded, adding that the study was unable to find clear demographic predictors of which patients are most likely to have this infection. "I would advocate considering empiric coverage for MRSA when you have a vulvar abscess that requires treatment," she recommended.

Dr. Lareau reported that she had no conflicts of interest in association with the study.

'I would advocate considering empiric coverage for MRSA when you have a vulvar abscess that requires treatment.' DR. LAREAU

SEATTLE — Methicillin-resistant Staphylococcus aureus is found in one-third of cases of perineal and buttock abscesses in women, and it accounts for fully half of the monomicrobial abscesses, according to one hospital's experience.

"MRSA is a common problem in our hospitals and in our community, and it certainly commands our attention," study author Dr. Susan M. Lareau told attendees of the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology. She noted that a previous report found that MRSA was the leading cause of skin and soft-tissue infection in most emergency rooms but did not address the proportion of perineal infections caused by this pathogen (N. Engl. J. Med. 2006;355:666–74).

Dr. Lareau of the Magee-Womens Hospital in Pittsburgh used diagnostic codes to identify retrospectively all cases of perineal and buttock abscesses seen at the hospital between 2003 and 2007 and then reviewed their characteristics. She included cases involving the vulva, Bartholin glands, and buttocks, and excluded cases involving the perianal and rectal areas.

The process identified 126 patients, Dr. Lareau reported. This group consisted of 64 patients (51%) with vulvar abscesses, 41 patients (33%) with Bartholin gland abscesses, 19 patients (15%) with buttock abscesses, and 2 patients (2%) with combined buttock and vulvar abscesses.

Cultures had been obtained in 72 of the patients and were positive for MRSA in 33%. By site, MRSA was found in 64% of buttock abscesses, 50% of combined buttock and vulvar abscesses, 33% of vulvar abscesses, and 7% of Bartholin gland abscesses.

"It's generally been thought that vulvar abscesses are polymicrobial, and that has driven our treatment, when necessary," Dr. Lareau said. However, most (69%) of the 72 cases were monomicrobial. MRSA accounted for fully 50% of these infections; the next most-common pathogens were group B streptococcus and methicillin-susceptible Staphylococcus aureus, each of which accounted for only 14% of these infections.

Age, race, body mass index, pregnancy, and several comorbidities (diabetes, cancer, and coronary artery disease) did not significantly predict MRSA infection, but site did, according to Dr. Lareau. Relative to patients with Bartholin gland abscesses, patients with buttock abscesses were significantly more likely to be positive for MRSA (odds ratio 28) and patients with vulvar infections were nonsignificantly more likely to be MRSA positive (OR 7). However, Dr. Lareau said, confidence intervals were wide, probably because of the small sample size.

"We wanted to look at the outcomes associated with MRSA to see if this was a more virulent and more difficult to treat infection," Dr. Lareau explained. In fact, the data did not support such associations, showing that MRSA-positive and -negative patients had identical median lengths of hospital stay (2 days) and did not differ significantly with respect to the rate of abscess drainage in the operating room (29% vs. 71%).

An analysis of trends over the 5-year study period showed that the total number of cases of perineal abscess seen at the hospital increased from about 20 to 55 per year. At the same time, the number of cases of MRSA perineal abscess, although still modest, increased at a much faster pace, from 1 to 12 per year.

"MRSA is the dominant pathogen in perineal infections at Magee-Womens Hospital," Dr. Lareau concluded, adding that the study was unable to find clear demographic predictors of which patients are most likely to have this infection. "I would advocate considering empiric coverage for MRSA when you have a vulvar abscess that requires treatment," she recommended.

Dr. Lareau reported that she had no conflicts of interest in association with the study.

'I would advocate considering empiric coverage for MRSA when you have a vulvar abscess that requires treatment.' DR. LAREAU

VANCOUVER, B.C. — Both exercise-induced asthma and vocal cord dysfunction produce shortness of breath in young athletes, and being able to differentiate between them is key to ensuring appropriate treatment.

Exercise-induced asthma (EIA) is a well-established condition affecting at least 15%–20% of athletes, according to Dr. Joseph A. Congeni, medical director of sports medicine at Akron Children's Hospital, Ohio. In contrast, vocal cord dysfunction (VCD) is a more recently recognized condition affecting 2%–5% of young athletes, though “these numbers are continuing to go up.”

EIA affects the small airways, and its etiology is linked to dry air; allergens, pollutants, and irritants; and cold air, Dr. Congeni said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics. Typically, it has multiple triggers besides exercise, but if exercise is the only or primary trigger, it is referred to as exercise-induced bronchospasm (EIB).

VCD affects the trachea, and its etiology is linked to laryngeal irritants, psychogenic disorders, and neurogenic conditions.

Because the two conditions produce overlapping symptoms, such as shortness of breath and cough, history is key to distinguishing them. Athletes with EIA may have wheezing, chest pain, and excess mucus production; their counterparts with VCD may have inspiratory stridor and voice changes, and may be pale or flushed. Of note, the cough of VCD is croupy and barklike.

“These kids sound like they are choking, and they can't catch their breath. It's very loud and noisy. EIA is not nearly as noisy,” said Dr. Congeni. “The VCD presentation may be much more dramatic” and these athletes can wind up in the emergency department.

The timing of symptoms also may help differentiate between the two conditions, he noted.

EIA/EIB can often be diagnosed with an exercise challenge test (in which a reduction of pulmonary function by at least 15% is diagnostic), a eucapnic voluntary hyperventilation challenge (the preferred method used by the International Olympic Committee), a pharmacologic challenge, or an osmotic challenge. However, all of these tests are plagued by an inability to reproduce field conditions and may therefore yield equivocal results, he said.

“VCD is difficult to diagnose, and it is a diagnosis of exclusion,” Dr. Congeni said. The best procedure for diagnosis is visualizing the cords while the athlete is symptomatic; however, it is rare to see attacks in the clinic. Pulmonary function testing may show a flattened or variable inspiratory curve—but this is seen clinically in only 20%–30% of cases. Other diagnoses that must be excluded are cardiac conditions, structural vocal cord abnormalities, and gastrointestinal reflux.

EIA/EIB is managed both with pharmacologic measures, primarily inhaled short-acting β₂-agonists, and with nonpharmacologic measures. The latter include environmental alterations, masks, nose breathing, warm-up before exercise, and dietary manipulations, such as increasing the intake of caffeine and antioxidants, and decreasing the intake of salt.

A VCD attack is managed by urging the athlete to pant, to exhale making a soft “s” sound, and to use diaphragmatic breathing. Oxygen and sedatives may be given in the emergency department.

Education is essential to preventing future attacks of VCD, Dr. Congeni said, citing recommendations for management (Phys. Sportsmed. 1998;26:63–74).

These athletes also should be taken off any unnecessary medications. “Most have been on inhalers, which provide little, if any, benefit.”

The three therapies for VCD are speech therapy (which focuses on breathing patterns), psychotherapy, and relaxation therapy with biofeedback. Dr. Congeni reported he had no disclosures in association with his presentation.

Children with VCD 'sound like they're choking … It's very loud and noisy. EIA is not nearly as noisy.' DR. CONGENI

VANCOUVER, B.C. — Both exercise-induced asthma and vocal cord dysfunction produce shortness of breath in young athletes, and being able to differentiate between them is key to ensuring appropriate treatment.

Exercise-induced asthma (EIA) is a well-established condition affecting at least 15%–20% of athletes, according to Dr. Joseph A. Congeni, medical director of sports medicine at Akron Children's Hospital, Ohio. In contrast, vocal cord dysfunction (VCD) is a more recently recognized condition affecting 2%–5% of young athletes, though “these numbers are continuing to go up.”

EIA affects the small airways, and its etiology is linked to dry air; allergens, pollutants, and irritants; and cold air, Dr. Congeni said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics. Typically, it has multiple triggers besides exercise, but if exercise is the only or primary trigger, it is referred to as exercise-induced bronchospasm (EIB).

VCD affects the trachea, and its etiology is linked to laryngeal irritants, psychogenic disorders, and neurogenic conditions.

Because the two conditions produce overlapping symptoms, such as shortness of breath and cough, history is key to distinguishing them. Athletes with EIA may have wheezing, chest pain, and excess mucus production; their counterparts with VCD may have inspiratory stridor and voice changes, and may be pale or flushed. Of note, the cough of VCD is croupy and barklike.

“These kids sound like they are choking, and they can't catch their breath. It's very loud and noisy. EIA is not nearly as noisy,” said Dr. Congeni. “The VCD presentation may be much more dramatic” and these athletes can wind up in the emergency department.

The timing of symptoms also may help differentiate between the two conditions, he noted.

EIA/EIB can often be diagnosed with an exercise challenge test (in which a reduction of pulmonary function by at least 15% is diagnostic), a eucapnic voluntary hyperventilation challenge (the preferred method used by the International Olympic Committee), a pharmacologic challenge, or an osmotic challenge. However, all of these tests are plagued by an inability to reproduce field conditions and may therefore yield equivocal results, he said.

“VCD is difficult to diagnose, and it is a diagnosis of exclusion,” Dr. Congeni said. The best procedure for diagnosis is visualizing the cords while the athlete is symptomatic; however, it is rare to see attacks in the clinic. Pulmonary function testing may show a flattened or variable inspiratory curve—but this is seen clinically in only 20%–30% of cases. Other diagnoses that must be excluded are cardiac conditions, structural vocal cord abnormalities, and gastrointestinal reflux.

EIA/EIB is managed both with pharmacologic measures, primarily inhaled short-acting β₂-agonists, and with nonpharmacologic measures. The latter include environmental alterations, masks, nose breathing, warm-up before exercise, and dietary manipulations, such as increasing the intake of caffeine and antioxidants, and decreasing the intake of salt.

A VCD attack is managed by urging the athlete to pant, to exhale making a soft “s” sound, and to use diaphragmatic breathing. Oxygen and sedatives may be given in the emergency department.

Education is essential to preventing future attacks of VCD, Dr. Congeni said, citing recommendations for management (Phys. Sportsmed. 1998;26:63–74).

These athletes also should be taken off any unnecessary medications. “Most have been on inhalers, which provide little, if any, benefit.”

The three therapies for VCD are speech therapy (which focuses on breathing patterns), psychotherapy, and relaxation therapy with biofeedback. Dr. Congeni reported he had no disclosures in association with his presentation.

Children with VCD 'sound like they're choking … It's very loud and noisy. EIA is not nearly as noisy.' DR. CONGENI

VANCOUVER, B.C. — Both exercise-induced asthma and vocal cord dysfunction produce shortness of breath in young athletes, and being able to differentiate between them is key to ensuring appropriate treatment.

Exercise-induced asthma (EIA) is a well-established condition affecting at least 15%–20% of athletes, according to Dr. Joseph A. Congeni, medical director of sports medicine at Akron Children's Hospital, Ohio. In contrast, vocal cord dysfunction (VCD) is a more recently recognized condition affecting 2%–5% of young athletes, though “these numbers are continuing to go up.”

EIA affects the small airways, and its etiology is linked to dry air; allergens, pollutants, and irritants; and cold air, Dr. Congeni said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics. Typically, it has multiple triggers besides exercise, but if exercise is the only or primary trigger, it is referred to as exercise-induced bronchospasm (EIB).

VCD affects the trachea, and its etiology is linked to laryngeal irritants, psychogenic disorders, and neurogenic conditions.

Because the two conditions produce overlapping symptoms, such as shortness of breath and cough, history is key to distinguishing them. Athletes with EIA may have wheezing, chest pain, and excess mucus production; their counterparts with VCD may have inspiratory stridor and voice changes, and may be pale or flushed. Of note, the cough of VCD is croupy and barklike.

“These kids sound like they are choking, and they can't catch their breath. It's very loud and noisy. EIA is not nearly as noisy,” said Dr. Congeni. “The VCD presentation may be much more dramatic” and these athletes can wind up in the emergency department.

The timing of symptoms also may help differentiate between the two conditions, he noted.

EIA/EIB can often be diagnosed with an exercise challenge test (in which a reduction of pulmonary function by at least 15% is diagnostic), a eucapnic voluntary hyperventilation challenge (the preferred method used by the International Olympic Committee), a pharmacologic challenge, or an osmotic challenge. However, all of these tests are plagued by an inability to reproduce field conditions and may therefore yield equivocal results, he said.

“VCD is difficult to diagnose, and it is a diagnosis of exclusion,” Dr. Congeni said. The best procedure for diagnosis is visualizing the cords while the athlete is symptomatic; however, it is rare to see attacks in the clinic. Pulmonary function testing may show a flattened or variable inspiratory curve—but this is seen clinically in only 20%–30% of cases. Other diagnoses that must be excluded are cardiac conditions, structural vocal cord abnormalities, and gastrointestinal reflux.

EIA/EIB is managed both with pharmacologic measures, primarily inhaled short-acting β₂-agonists, and with nonpharmacologic measures. The latter include environmental alterations, masks, nose breathing, warm-up before exercise, and dietary manipulations, such as increasing the intake of caffeine and antioxidants, and decreasing the intake of salt.

A VCD attack is managed by urging the athlete to pant, to exhale making a soft “s” sound, and to use diaphragmatic breathing. Oxygen and sedatives may be given in the emergency department.

Education is essential to preventing future attacks of VCD, Dr. Congeni said, citing recommendations for management (Phys. Sportsmed. 1998;26:63–74).

These athletes also should be taken off any unnecessary medications. “Most have been on inhalers, which provide little, if any, benefit.”

The three therapies for VCD are speech therapy (which focuses on breathing patterns), psychotherapy, and relaxation therapy with biofeedback. Dr. Congeni reported he had no disclosures in association with his presentation.

Children with VCD 'sound like they're choking … It's very loud and noisy. EIA is not nearly as noisy.' DR. CONGENI

SEATTLE — Methicillin-resistant Staphylococcus aureus is found in one-third of cases of perineal and buttock abscesses in women, and it accounts for fully half of the monomicrobial abscesses, according to one hospital's experience.

“MRSA is a common problem in our hospitals and in our community, and it certainly commands our attention,” study author Dr. Susan M. Lareau told attendees of the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

She noted a previous report found that MRSA was the leading cause of skin and soft-tissue infection in most emergency rooms but did not address the proportion of perineal infections caused by this pathogen (N. Engl. J. Med. 2006;355:666–74).

Dr. Lareau of the Magee-Womens Hospital in Pittsburgh used diagnostic codes to identify retrospectively all cases of perineal and buttock abscesses seen at the hospital between 2003 and 2007 and then reviewed their characteristics.

She included cases involving the vulva, Bartholin glands, and buttocks, and excluded cases involving the perianal and rectal areas.

The process identified 126 patients, Dr. Lareau reported. This group consisted of 64 patients (51%) with vulvar abscesses, 41 patients (33%) with Bartholin gland abscesses, 19 patients (15%) with buttock abscesses, and 2 patients (2%) with combined buttock and vulvar abscesses.

Cultures had been obtained in 72 of the patients and were positive for MRSA in 33% of the cases. By site, MRSA was found in 64% of buttock abscesses, 50% of combined buttock and vulvar abscesses, 33% of vulvar abscesses, and 7% of Bartholin gland abscesses.

“It's generally been thought that vulvar abscesses are polymicrobial, and that has driven our treatment, when necessary,” Dr. Lareau said.

However, most (69%) of the 72 cases were monomicrobial. MRSA accounted for 50% of these infections; the next most-common pathogens were group B streptococcus and methicillin-susceptible Staphylococcus aureus, each of which accounted for only 14% of these infections.

Age, race, body mass index, pregnancy, and several comorbidities (diabetes, cancer, and coronary artery disease) did not significantly predict MRSA infection, but site did, according to Dr. Lareau.

Relative to patients with Bartholin gland abscesses, patients with buttock abscesses were significantly more likely to be positive for MRSA (odds ratio 28) and patients with vulvar infections were nonsignificantly more likely to be MRSA positive (OR 7). However, confidence intervals were wide, probably because of the small sample size.

“We wanted to look at the outcomes associated with MRSA to see if this was a more virulent and more difficult to treat infection,” Dr. Lareau explained.

In fact, the data did not support such associations, showing that MRSA-positive and -negative patients had identical median lengths of hospital stay (2 days) and did not differ significantly with respect to the rate of abscess drainage in the operating room (29% vs. 71%).

An analysis of trends over the 5-year study period showed that the total number of cases of perineal abscess seen at the hospital increased from about 20 to 55 per year. At the same time, the number of cases of MRSA perineal abscess, although still modest, increased at a much faster pace, from 1 to 12 per year.

“MRSA is the dominant pathogen in perineal infections at Magee-Womens Hospital,” Dr. Lareau concluded.

The study was unable to find clear demographic predictors of which patients are most likely to have this infection, she said. “I would advocate considering empiric coverage for MRSA when you have a vulvar abscess that requires treatment.”

Dr. Lareau reported that she had no conflicts of interest in association with the study.

Site predicted MRSA infection, with patients with buttock abscesses significantly more likely to test positive for MRSA. DR. LAREAU

SEATTLE — Methicillin-resistant Staphylococcus aureus is found in one-third of cases of perineal and buttock abscesses in women, and it accounts for fully half of the monomicrobial abscesses, according to one hospital's experience.

“MRSA is a common problem in our hospitals and in our community, and it certainly commands our attention,” study author Dr. Susan M. Lareau told attendees of the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

She noted a previous report found that MRSA was the leading cause of skin and soft-tissue infection in most emergency rooms but did not address the proportion of perineal infections caused by this pathogen (N. Engl. J. Med. 2006;355:666–74).

Dr. Lareau of the Magee-Womens Hospital in Pittsburgh used diagnostic codes to identify retrospectively all cases of perineal and buttock abscesses seen at the hospital between 2003 and 2007 and then reviewed their characteristics.

She included cases involving the vulva, Bartholin glands, and buttocks, and excluded cases involving the perianal and rectal areas.

The process identified 126 patients, Dr. Lareau reported. This group consisted of 64 patients (51%) with vulvar abscesses, 41 patients (33%) with Bartholin gland abscesses, 19 patients (15%) with buttock abscesses, and 2 patients (2%) with combined buttock and vulvar abscesses.

Cultures had been obtained in 72 of the patients and were positive for MRSA in 33% of the cases. By site, MRSA was found in 64% of buttock abscesses, 50% of combined buttock and vulvar abscesses, 33% of vulvar abscesses, and 7% of Bartholin gland abscesses.

“It's generally been thought that vulvar abscesses are polymicrobial, and that has driven our treatment, when necessary,” Dr. Lareau said.

However, most (69%) of the 72 cases were monomicrobial. MRSA accounted for 50% of these infections; the next most-common pathogens were group B streptococcus and methicillin-susceptible Staphylococcus aureus, each of which accounted for only 14% of these infections.

Age, race, body mass index, pregnancy, and several comorbidities (diabetes, cancer, and coronary artery disease) did not significantly predict MRSA infection, but site did, according to Dr. Lareau.

Relative to patients with Bartholin gland abscesses, patients with buttock abscesses were significantly more likely to be positive for MRSA (odds ratio 28) and patients with vulvar infections were nonsignificantly more likely to be MRSA positive (OR 7). However, confidence intervals were wide, probably because of the small sample size.

“We wanted to look at the outcomes associated with MRSA to see if this was a more virulent and more difficult to treat infection,” Dr. Lareau explained.

In fact, the data did not support such associations, showing that MRSA-positive and -negative patients had identical median lengths of hospital stay (2 days) and did not differ significantly with respect to the rate of abscess drainage in the operating room (29% vs. 71%).

An analysis of trends over the 5-year study period showed that the total number of cases of perineal abscess seen at the hospital increased from about 20 to 55 per year. At the same time, the number of cases of MRSA perineal abscess, although still modest, increased at a much faster pace, from 1 to 12 per year.

“MRSA is the dominant pathogen in perineal infections at Magee-Womens Hospital,” Dr. Lareau concluded.

The study was unable to find clear demographic predictors of which patients are most likely to have this infection, she said. “I would advocate considering empiric coverage for MRSA when you have a vulvar abscess that requires treatment.”

Dr. Lareau reported that she had no conflicts of interest in association with the study.

Site predicted MRSA infection, with patients with buttock abscesses significantly more likely to test positive for MRSA. DR. LAREAU

SEATTLE — Methicillin-resistant Staphylococcus aureus is found in one-third of cases of perineal and buttock abscesses in women, and it accounts for fully half of the monomicrobial abscesses, according to one hospital's experience.

“MRSA is a common problem in our hospitals and in our community, and it certainly commands our attention,” study author Dr. Susan M. Lareau told attendees of the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

She noted a previous report found that MRSA was the leading cause of skin and soft-tissue infection in most emergency rooms but did not address the proportion of perineal infections caused by this pathogen (N. Engl. J. Med. 2006;355:666–74).

Dr. Lareau of the Magee-Womens Hospital in Pittsburgh used diagnostic codes to identify retrospectively all cases of perineal and buttock abscesses seen at the hospital between 2003 and 2007 and then reviewed their characteristics.

She included cases involving the vulva, Bartholin glands, and buttocks, and excluded cases involving the perianal and rectal areas.

The process identified 126 patients, Dr. Lareau reported. This group consisted of 64 patients (51%) with vulvar abscesses, 41 patients (33%) with Bartholin gland abscesses, 19 patients (15%) with buttock abscesses, and 2 patients (2%) with combined buttock and vulvar abscesses.

Cultures had been obtained in 72 of the patients and were positive for MRSA in 33% of the cases. By site, MRSA was found in 64% of buttock abscesses, 50% of combined buttock and vulvar abscesses, 33% of vulvar abscesses, and 7% of Bartholin gland abscesses.

“It's generally been thought that vulvar abscesses are polymicrobial, and that has driven our treatment, when necessary,” Dr. Lareau said.

However, most (69%) of the 72 cases were monomicrobial. MRSA accounted for 50% of these infections; the next most-common pathogens were group B streptococcus and methicillin-susceptible Staphylococcus aureus, each of which accounted for only 14% of these infections.

Age, race, body mass index, pregnancy, and several comorbidities (diabetes, cancer, and coronary artery disease) did not significantly predict MRSA infection, but site did, according to Dr. Lareau.

Relative to patients with Bartholin gland abscesses, patients with buttock abscesses were significantly more likely to be positive for MRSA (odds ratio 28) and patients with vulvar infections were nonsignificantly more likely to be MRSA positive (OR 7). However, confidence intervals were wide, probably because of the small sample size.

“We wanted to look at the outcomes associated with MRSA to see if this was a more virulent and more difficult to treat infection,” Dr. Lareau explained.

In fact, the data did not support such associations, showing that MRSA-positive and -negative patients had identical median lengths of hospital stay (2 days) and did not differ significantly with respect to the rate of abscess drainage in the operating room (29% vs. 71%).

An analysis of trends over the 5-year study period showed that the total number of cases of perineal abscess seen at the hospital increased from about 20 to 55 per year. At the same time, the number of cases of MRSA perineal abscess, although still modest, increased at a much faster pace, from 1 to 12 per year.

“MRSA is the dominant pathogen in perineal infections at Magee-Womens Hospital,” Dr. Lareau concluded.

The study was unable to find clear demographic predictors of which patients are most likely to have this infection, she said. “I would advocate considering empiric coverage for MRSA when you have a vulvar abscess that requires treatment.”

Dr. Lareau reported that she had no conflicts of interest in association with the study.

Site predicted MRSA infection, with patients with buttock abscesses significantly more likely to test positive for MRSA. DR. LAREAU

MEXICO CITY — African American women who receive an intervention that includes a package of safer-sex options have a large reduction in the incidence of sexually transmitted infections relative to peers who receive general health promotion, researchers reported at the International AIDS Conference.

“Among women in the U.S., marked racial as well as regional disparities [in HIV incidence] exist,” said lead author Gina M. Wingood, Sc.D., M.P.H., of Emory University in Atlanta. “Specifically, women in the deep southern U.S. are severely affected.” A related issue, she noted, is that HIV interventions for women have traditionally focused on the use of condoms and penile-vaginal sex, giving women few options.

To address these issues, Dr. Wingood and her colleagues undertook the STARS (Sisters Talking About Real Solutions) trial. With the database of a health maintenance organization in Georgia, they randomly selected African American women aged 18-29 years and invited those who were sexually active and reported having unprotected vaginal sex in the prior 6 months to participate.

Participating women were randomly assigned to an intervention group or a comparison group, Dr. Wingood said. The intervention, delivered in two 4-hour workshops, focused on fostering ethnic and gender pride (to enhance self-esteem, self-awareness, and self-worth), increasing awareness of healthy and unhealthy relationships (to address the link between abuse and sexually transmitted infections [STIs]), and introducing a package of safer-sex options known as AMOUR (Abstain from unsafe sex and douching; Mutual stimulation, meaning nonpenetrative sex; Oral sex with protection; Uninfected partners, referring to ensuring that partners do not have STIs; and Regular condom use and reduction of number of partners). The comparison group received a single 4-hour workshop that focused on general health promotion.

The women enrolled in the trial were an average of 24 years old, 57% lived with a family member, and 89% had completed high school. Fully 86% were in relationships, and these relationships were relatively long term, having lasted an average of 23 months. “We know that it is much harder to change your HIV risk practices when you are in a long-term relationship,” she commented.

Intention-to-treat analyses were based on 605 women in the intervention group and 243 women in the comparison group. The workshops were completed by 96% and 100%, respectively, and 75% of women in each group completed the trial's 12-month follow-up assessment.

In terms of biologic outcomes at 12 months, women in the intervention group were significantly less likely to have acquired any of four STIs studied (human papillomavirus type 16 or 18, chlamydia, gonorrhea, or trichomoniasis) relative to their counterparts in the comparison group (odds ratio 0.35). In addition, intervention women were significantly less likely to have acquired human papillomavirus infection individually (OR 0.37) and the other, nonviral STIs individually (OR 0.62).

With respect to behavioral outcomes, women in the intervention group had significantly more favorable levels of each of nine risk behaviors, compared with their peers in the comparison group. For example, they were more likely to have asked their main partner to be tested for STIs (OR 1.41) and to have had protected oral sex (OR 2.05), and they were less likely to have douched (OR 0.38) and to have had sex with more than one partner (OR 0.73) or with casual partners (OR 0.66).

Finally, in terms of psychosocial outcomes, relative to their counterparts in the comparison group, women in the intervention group had significantly higher scores on tests of knowledge regarding prevention of STIs and HIV, greater self-efficacy regarding condom use, and lower levels of barriers to safer sex.

“The intervention results may be attributable to providing women [with] a package of female-controlled or female-initiated safer-sex options and allowing them to combine these strategies,” Dr. Wingood said, adding that offering this group single prevention strategies may not be realistic. “Future HIV interventions for women may consider expanding their options for safer sex and offering prevention packages,” she concluded.

She reported she had no conflicts of interest associated with the study.

MEXICO CITY — African American women who receive an intervention that includes a package of safer-sex options have a large reduction in the incidence of sexually transmitted infections relative to peers who receive general health promotion, researchers reported at the International AIDS Conference.

“Among women in the U.S., marked racial as well as regional disparities [in HIV incidence] exist,” said lead author Gina M. Wingood, Sc.D., M.P.H., of Emory University in Atlanta. “Specifically, women in the deep southern U.S. are severely affected.” A related issue, she noted, is that HIV interventions for women have traditionally focused on the use of condoms and penile-vaginal sex, giving women few options.

To address these issues, Dr. Wingood and her colleagues undertook the STARS (Sisters Talking About Real Solutions) trial. With the database of a health maintenance organization in Georgia, they randomly selected African American women aged 18-29 years and invited those who were sexually active and reported having unprotected vaginal sex in the prior 6 months to participate.

Participating women were randomly assigned to an intervention group or a comparison group, Dr. Wingood said. The intervention, delivered in two 4-hour workshops, focused on fostering ethnic and gender pride (to enhance self-esteem, self-awareness, and self-worth), increasing awareness of healthy and unhealthy relationships (to address the link between abuse and sexually transmitted infections [STIs]), and introducing a package of safer-sex options known as AMOUR (Abstain from unsafe sex and douching; Mutual stimulation, meaning nonpenetrative sex; Oral sex with protection; Uninfected partners, referring to ensuring that partners do not have STIs; and Regular condom use and reduction of number of partners). The comparison group received a single 4-hour workshop that focused on general health promotion.

The women enrolled in the trial were an average of 24 years old, 57% lived with a family member, and 89% had completed high school. Fully 86% were in relationships, and these relationships were relatively long term, having lasted an average of 23 months. “We know that it is much harder to change your HIV risk practices when you are in a long-term relationship,” she commented.

Intention-to-treat analyses were based on 605 women in the intervention group and 243 women in the comparison group. The workshops were completed by 96% and 100%, respectively, and 75% of women in each group completed the trial's 12-month follow-up assessment.

In terms of biologic outcomes at 12 months, women in the intervention group were significantly less likely to have acquired any of four STIs studied (human papillomavirus type 16 or 18, chlamydia, gonorrhea, or trichomoniasis) relative to their counterparts in the comparison group (odds ratio 0.35). In addition, intervention women were significantly less likely to have acquired human papillomavirus infection individually (OR 0.37) and the other, nonviral STIs individually (OR 0.62).

With respect to behavioral outcomes, women in the intervention group had significantly more favorable levels of each of nine risk behaviors, compared with their peers in the comparison group. For example, they were more likely to have asked their main partner to be tested for STIs (OR 1.41) and to have had protected oral sex (OR 2.05), and they were less likely to have douched (OR 0.38) and to have had sex with more than one partner (OR 0.73) or with casual partners (OR 0.66).

Finally, in terms of psychosocial outcomes, relative to their counterparts in the comparison group, women in the intervention group had significantly higher scores on tests of knowledge regarding prevention of STIs and HIV, greater self-efficacy regarding condom use, and lower levels of barriers to safer sex.

“The intervention results may be attributable to providing women [with] a package of female-controlled or female-initiated safer-sex options and allowing them to combine these strategies,” Dr. Wingood said, adding that offering this group single prevention strategies may not be realistic. “Future HIV interventions for women may consider expanding their options for safer sex and offering prevention packages,” she concluded.

She reported she had no conflicts of interest associated with the study.

MEXICO CITY — African American women who receive an intervention that includes a package of safer-sex options have a large reduction in the incidence of sexually transmitted infections relative to peers who receive general health promotion, researchers reported at the International AIDS Conference.

“Among women in the U.S., marked racial as well as regional disparities [in HIV incidence] exist,” said lead author Gina M. Wingood, Sc.D., M.P.H., of Emory University in Atlanta. “Specifically, women in the deep southern U.S. are severely affected.” A related issue, she noted, is that HIV interventions for women have traditionally focused on the use of condoms and penile-vaginal sex, giving women few options.

To address these issues, Dr. Wingood and her colleagues undertook the STARS (Sisters Talking About Real Solutions) trial. With the database of a health maintenance organization in Georgia, they randomly selected African American women aged 18-29 years and invited those who were sexually active and reported having unprotected vaginal sex in the prior 6 months to participate.

Participating women were randomly assigned to an intervention group or a comparison group, Dr. Wingood said. The intervention, delivered in two 4-hour workshops, focused on fostering ethnic and gender pride (to enhance self-esteem, self-awareness, and self-worth), increasing awareness of healthy and unhealthy relationships (to address the link between abuse and sexually transmitted infections [STIs]), and introducing a package of safer-sex options known as AMOUR (Abstain from unsafe sex and douching; Mutual stimulation, meaning nonpenetrative sex; Oral sex with protection; Uninfected partners, referring to ensuring that partners do not have STIs; and Regular condom use and reduction of number of partners). The comparison group received a single 4-hour workshop that focused on general health promotion.

The women enrolled in the trial were an average of 24 years old, 57% lived with a family member, and 89% had completed high school. Fully 86% were in relationships, and these relationships were relatively long term, having lasted an average of 23 months. “We know that it is much harder to change your HIV risk practices when you are in a long-term relationship,” she commented.

Intention-to-treat analyses were based on 605 women in the intervention group and 243 women in the comparison group. The workshops were completed by 96% and 100%, respectively, and 75% of women in each group completed the trial's 12-month follow-up assessment.

In terms of biologic outcomes at 12 months, women in the intervention group were significantly less likely to have acquired any of four STIs studied (human papillomavirus type 16 or 18, chlamydia, gonorrhea, or trichomoniasis) relative to their counterparts in the comparison group (odds ratio 0.35). In addition, intervention women were significantly less likely to have acquired human papillomavirus infection individually (OR 0.37) and the other, nonviral STIs individually (OR 0.62).

With respect to behavioral outcomes, women in the intervention group had significantly more favorable levels of each of nine risk behaviors, compared with their peers in the comparison group. For example, they were more likely to have asked their main partner to be tested for STIs (OR 1.41) and to have had protected oral sex (OR 2.05), and they were less likely to have douched (OR 0.38) and to have had sex with more than one partner (OR 0.73) or with casual partners (OR 0.66).

Finally, in terms of psychosocial outcomes, relative to their counterparts in the comparison group, women in the intervention group had significantly higher scores on tests of knowledge regarding prevention of STIs and HIV, greater self-efficacy regarding condom use, and lower levels of barriers to safer sex.

“The intervention results may be attributable to providing women [with] a package of female-controlled or female-initiated safer-sex options and allowing them to combine these strategies,” Dr. Wingood said, adding that offering this group single prevention strategies may not be realistic. “Future HIV interventions for women may consider expanding their options for safer sex and offering prevention packages,” she concluded.

She reported she had no conflicts of interest associated with the study.

VANCOUVER, B.C. — Managing skin infections in young athletes can be more challenging than in the general pediatric population, because close physical contact and use of shared equipment can lead to rapid spread of infections and outbreaks.

In addition, some athletes with skin infections must be cleared by a physician to return to play and will try to hide symptoms. “Realize that you are going to be tricked and that athletes are going to try to make lesions look like something else,” Dr. Andrew Gregory said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics. They may try to abrade lesions with sandpaper, cover them with makeup, or bleach them.

“If methicillin-resistant Staphylococcus aureus [MRSA] is not in your community yet, it is going to be,” Dr. Gregory predicted, noting the prevalence of outbreaks on athletic teams in recent years. “You need to be more aware of this in the athletic population than in the rest of your practice because of the risk of spread.”

Good hygiene is a key to preventing MRSA, said Dr. Gregory of the departments of orthopedics and pediatrics at Vanderbilt University, Nashville, Tenn. Coaches and certified athletic trainers should encourage athletes to shower and clean their equipment regularly with soap and water and to avoid sharing equipment, clothing, towels, and razors. In addition, he recommends cleaning any shared equipment and surfaces with bleach and putting alcohol-based hand-sanitizing gels in training rooms, locker rooms, and bathrooms.

When MRSA is detected in one athlete, coaches and athletic trainers should talk with others on the team to see if any of them have lesions, Dr. Gregory advised. Treatment of MRSA in this population is the same as that in other children and adolescents—incision and drainage and antibiotic therapy appropriate for that specific community. “That's different for every community, so you need to be aware of what the sensitivities are locally,” he said.

According to recommendations from the CDC, athletes with any staphylococcal infection—including MRSA—should receive oral antibiotic therapy for a minimum of 3 days of before returning to play sports involving skin-to-skin contact, he noted (see www.cdc.gov/ncidod/dhqp/ar_MRSA_AthletesFAQ.html

Finally, Dr. Gregory cautioned, physicians and administrators should beware of sales pitches for products such as turf coatings that promise to protect athletes from MRSA. “There is no evidence that they do what they claim,” he said.

Tinea infection, called tinea gladiatorum in wrestlers, was historically attributed to dirty mats, but efforts to culture the fungus from this source have failed, so it is now believed to be passed primarily by skin-to-skin contact, Dr. Gregory said. “These lesions are tough to diagnose when they are pretty small, before they get the central clearing,” he observed.

Treatment consists of topical antifungal agents as first-line therapy and oral ones as second-line therapy. Wrestlers with this infection must be withheld from practice and competition until they have had treatment for 48-72 hours, and simply covering lesions is inadequate, Dr. Gregory said. He also recommended considering antifungal prophylaxis when athletes have recurrences or when outbreaks occur.

Herpes simplex I infection is spread by direct skin-to-skin contact and is also common among wrestlers, in whom the infection is called herpes gladiatorum. Typically, there are lesions on the right side of the head, related to the starting position for this sport, and it is important to prevent infection from spreading to the eye, which may lead to herpes conjunctivitis.

“It is a little bit difficult to tell that this is a herpes infection initially, before you get that characteristic vesicular rash,” he commented. Physicians should be suspicious whenever they see wrestlers with a raised erythematous rash. “The key is to recognize it early and initiate treatment early,” he said, with an appropriate course of an antiviral such as acyclovir. Antiviral prophylaxis should be considered for athletes with recurrences or when outbreaks occur.

Most physicians agree that wrestlers with herpes infections can return to play after all of their lesions have crusted over—usually in 10-14 days—although some advocate waiting until the lesions are completely healed, Dr. Gregory noted.

Dr. Gregory reported that he had no conflicts of interest in association with his presentation.

VANCOUVER, B.C. — Managing skin infections in young athletes can be more challenging than in the general pediatric population, because close physical contact and use of shared equipment can lead to rapid spread of infections and outbreaks.

In addition, some athletes with skin infections must be cleared by a physician to return to play and will try to hide symptoms. “Realize that you are going to be tricked and that athletes are going to try to make lesions look like something else,” Dr. Andrew Gregory said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics. They may try to abrade lesions with sandpaper, cover them with makeup, or bleach them.

“If methicillin-resistant Staphylococcus aureus [MRSA] is not in your community yet, it is going to be,” Dr. Gregory predicted, noting the prevalence of outbreaks on athletic teams in recent years. “You need to be more aware of this in the athletic population than in the rest of your practice because of the risk of spread.”

Good hygiene is a key to preventing MRSA, said Dr. Gregory of the departments of orthopedics and pediatrics at Vanderbilt University, Nashville, Tenn. Coaches and certified athletic trainers should encourage athletes to shower and clean their equipment regularly with soap and water and to avoid sharing equipment, clothing, towels, and razors. In addition, he recommends cleaning any shared equipment and surfaces with bleach and putting alcohol-based hand-sanitizing gels in training rooms, locker rooms, and bathrooms.

When MRSA is detected in one athlete, coaches and athletic trainers should talk with others on the team to see if any of them have lesions, Dr. Gregory advised. Treatment of MRSA in this population is the same as that in other children and adolescents—incision and drainage and antibiotic therapy appropriate for that specific community. “That's different for every community, so you need to be aware of what the sensitivities are locally,” he said.

According to recommendations from the CDC, athletes with any staphylococcal infection—including MRSA—should receive oral antibiotic therapy for a minimum of 3 days of before returning to play sports involving skin-to-skin contact, he noted (see www.cdc.gov/ncidod/dhqp/ar_MRSA_AthletesFAQ.html

Finally, Dr. Gregory cautioned, physicians and administrators should beware of sales pitches for products such as turf coatings that promise to protect athletes from MRSA. “There is no evidence that they do what they claim,” he said.

Tinea infection, called tinea gladiatorum in wrestlers, was historically attributed to dirty mats, but efforts to culture the fungus from this source have failed, so it is now believed to be passed primarily by skin-to-skin contact, Dr. Gregory said. “These lesions are tough to diagnose when they are pretty small, before they get the central clearing,” he observed.

Treatment consists of topical antifungal agents as first-line therapy and oral ones as second-line therapy. Wrestlers with this infection must be withheld from practice and competition until they have had treatment for 48-72 hours, and simply covering lesions is inadequate, Dr. Gregory said. He also recommended considering antifungal prophylaxis when athletes have recurrences or when outbreaks occur.

Herpes simplex I infection is spread by direct skin-to-skin contact and is also common among wrestlers, in whom the infection is called herpes gladiatorum. Typically, there are lesions on the right side of the head, related to the starting position for this sport, and it is important to prevent infection from spreading to the eye, which may lead to herpes conjunctivitis.

“It is a little bit difficult to tell that this is a herpes infection initially, before you get that characteristic vesicular rash,” he commented. Physicians should be suspicious whenever they see wrestlers with a raised erythematous rash. “The key is to recognize it early and initiate treatment early,” he said, with an appropriate course of an antiviral such as acyclovir. Antiviral prophylaxis should be considered for athletes with recurrences or when outbreaks occur.

Most physicians agree that wrestlers with herpes infections can return to play after all of their lesions have crusted over—usually in 10-14 days—although some advocate waiting until the lesions are completely healed, Dr. Gregory noted.

Dr. Gregory reported that he had no conflicts of interest in association with his presentation.

VANCOUVER, B.C. — Managing skin infections in young athletes can be more challenging than in the general pediatric population, because close physical contact and use of shared equipment can lead to rapid spread of infections and outbreaks.

In addition, some athletes with skin infections must be cleared by a physician to return to play and will try to hide symptoms. “Realize that you are going to be tricked and that athletes are going to try to make lesions look like something else,” Dr. Andrew Gregory said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics. They may try to abrade lesions with sandpaper, cover them with makeup, or bleach them.

“If methicillin-resistant Staphylococcus aureus [MRSA] is not in your community yet, it is going to be,” Dr. Gregory predicted, noting the prevalence of outbreaks on athletic teams in recent years. “You need to be more aware of this in the athletic population than in the rest of your practice because of the risk of spread.”

Good hygiene is a key to preventing MRSA, said Dr. Gregory of the departments of orthopedics and pediatrics at Vanderbilt University, Nashville, Tenn. Coaches and certified athletic trainers should encourage athletes to shower and clean their equipment regularly with soap and water and to avoid sharing equipment, clothing, towels, and razors. In addition, he recommends cleaning any shared equipment and surfaces with bleach and putting alcohol-based hand-sanitizing gels in training rooms, locker rooms, and bathrooms.

When MRSA is detected in one athlete, coaches and athletic trainers should talk with others on the team to see if any of them have lesions, Dr. Gregory advised. Treatment of MRSA in this population is the same as that in other children and adolescents—incision and drainage and antibiotic therapy appropriate for that specific community. “That's different for every community, so you need to be aware of what the sensitivities are locally,” he said.

According to recommendations from the CDC, athletes with any staphylococcal infection—including MRSA—should receive oral antibiotic therapy for a minimum of 3 days of before returning to play sports involving skin-to-skin contact, he noted (see www.cdc.gov/ncidod/dhqp/ar_MRSA_AthletesFAQ.html

Finally, Dr. Gregory cautioned, physicians and administrators should beware of sales pitches for products such as turf coatings that promise to protect athletes from MRSA. “There is no evidence that they do what they claim,” he said.

Tinea infection, called tinea gladiatorum in wrestlers, was historically attributed to dirty mats, but efforts to culture the fungus from this source have failed, so it is now believed to be passed primarily by skin-to-skin contact, Dr. Gregory said. “These lesions are tough to diagnose when they are pretty small, before they get the central clearing,” he observed.

Treatment consists of topical antifungal agents as first-line therapy and oral ones as second-line therapy. Wrestlers with this infection must be withheld from practice and competition until they have had treatment for 48-72 hours, and simply covering lesions is inadequate, Dr. Gregory said. He also recommended considering antifungal prophylaxis when athletes have recurrences or when outbreaks occur.

Herpes simplex I infection is spread by direct skin-to-skin contact and is also common among wrestlers, in whom the infection is called herpes gladiatorum. Typically, there are lesions on the right side of the head, related to the starting position for this sport, and it is important to prevent infection from spreading to the eye, which may lead to herpes conjunctivitis.

“It is a little bit difficult to tell that this is a herpes infection initially, before you get that characteristic vesicular rash,” he commented. Physicians should be suspicious whenever they see wrestlers with a raised erythematous rash. “The key is to recognize it early and initiate treatment early,” he said, with an appropriate course of an antiviral such as acyclovir. Antiviral prophylaxis should be considered for athletes with recurrences or when outbreaks occur.

Most physicians agree that wrestlers with herpes infections can return to play after all of their lesions have crusted over—usually in 10-14 days—although some advocate waiting until the lesions are completely healed, Dr. Gregory noted.

Dr. Gregory reported that he had no conflicts of interest in association with his presentation.

VANCOUVER, B.C. — Overtraining, disordered eating, and lower extremity injuries are some of the many health issues that physicians who care for young dancers may encounter, according to a pediatric sports medicine specialist.

Several factors increase young dancers' risk of health problems, said Dr. Chris G. Koutures, who is in private practice in Anaheim, California. These young athletes often put in long hours, and they have multiple instructors, so there is a lack of continuity in their training. “I tell the families—parents especially—you must be the arbiter for your child, because each instructor does not know what the previous one was doing,” he said.

In addition, dancers typically train in minimally supportive footwear and on unforgiving surfaces, he noted. Many of them now dance year-round between performances, recitals, and summer dance camps. The training can be intensive, pushing them past their abilities and experience.

Preparticipation evaluations and annual physicals provide good opportunities for anticipatory guidance on dancing and for early detection of health issues, Dr. Koutures said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics (AAP).

Dancers should be encouraged to perform different types of dance (in moderation) for variety, and to take 2–3 months off per year to allow their bodies to grow and recover.

Along those lines, Dr. Koutures said to be alert for signs of overtraining. Affected dancers may have declining dance performance, loss of interest in the activity, sleep and appetite disturbances, a flat affect, and little social interaction.

Considering growth periods also is important, according to Dr. Koutures. During the major growth period—which occurs during ages 10–14 years in girls and ages 12–16 years in boys—dancers may be less flexible, become uncoordinated, and experience anatomic changes, such as widening of the pelvis and lengthening of the limbs. “During this time, it may be more sensible in all activities to back off a little bit,” he said.

When it comes to developmental status, he pointed out that puberty and menarche may be delayed in dancers if their caloric intake does not meet their energy demands. “These are things we bring up with the family,” he commented. “It doesn't have to be this way if they get enough calories.”

Keep a close eye on body mass index. “When you see a young athlete starting to lose weight, really get aggressive in finding out what external factors may be making this occur,” he said.

In addition, in female dancers, menstrual status warrants close watching and prompt intervention in the case of amenorrhea. “The female athlete triad is unfortunately very common in the dance world, and this can give you issues—not just when you are a teenager, but for the rest of your life,” he said.

The female athlete triad is defined as the relationships among energy availability, menstrual function, and bone mineral density associated with athletic training that may manifest into disordered eating, amenorrhea, and osteoporosis, according to the American College of Sports Medicine.

Anemia and iron deficiency are particular concerns in this population because many dancers are vegetarians, Dr. Koutures noted. “If a young person comes in and says 'I don't eat meat,' especially if they are in an image sport, be very quick to screen them with a CBC, and ferritin and iron studies,” he advised.

Dancers also may be at increased risk for low bone mineral density because of some of the factors mentioned above, as well as inadequate calcium intake and inadequate exposure to the sunlight needed to produce vitamin D. He suggested considering a DXA scan in dancers who have stress or low-impact fractures, menstrual irregularity, or disordered eating.

Dr. Koutures reported that he had no disclosures in association with his presentation.

The female athlete triad is very common in the dance world. ©Andrew Ross/

VANCOUVER, B.C. — Overtraining, disordered eating, and lower extremity injuries are some of the many health issues that physicians who care for young dancers may encounter, according to a pediatric sports medicine specialist.

Several factors increase young dancers' risk of health problems, said Dr. Chris G. Koutures, who is in private practice in Anaheim, California. These young athletes often put in long hours, and they have multiple instructors, so there is a lack of continuity in their training. “I tell the families—parents especially—you must be the arbiter for your child, because each instructor does not know what the previous one was doing,” he said.

In addition, dancers typically train in minimally supportive footwear and on unforgiving surfaces, he noted. Many of them now dance year-round between performances, recitals, and summer dance camps. The training can be intensive, pushing them past their abilities and experience.

Preparticipation evaluations and annual physicals provide good opportunities for anticipatory guidance on dancing and for early detection of health issues, Dr. Koutures said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics (AAP).

Dancers should be encouraged to perform different types of dance (in moderation) for variety, and to take 2–3 months off per year to allow their bodies to grow and recover.

Along those lines, Dr. Koutures said to be alert for signs of overtraining. Affected dancers may have declining dance performance, loss of interest in the activity, sleep and appetite disturbances, a flat affect, and little social interaction.

Considering growth periods also is important, according to Dr. Koutures. During the major growth period—which occurs during ages 10–14 years in girls and ages 12–16 years in boys—dancers may be less flexible, become uncoordinated, and experience anatomic changes, such as widening of the pelvis and lengthening of the limbs. “During this time, it may be more sensible in all activities to back off a little bit,” he said.

When it comes to developmental status, he pointed out that puberty and menarche may be delayed in dancers if their caloric intake does not meet their energy demands. “These are things we bring up with the family,” he commented. “It doesn't have to be this way if they get enough calories.”

Keep a close eye on body mass index. “When you see a young athlete starting to lose weight, really get aggressive in finding out what external factors may be making this occur,” he said.

In addition, in female dancers, menstrual status warrants close watching and prompt intervention in the case of amenorrhea. “The female athlete triad is unfortunately very common in the dance world, and this can give you issues—not just when you are a teenager, but for the rest of your life,” he said.

The female athlete triad is defined as the relationships among energy availability, menstrual function, and bone mineral density associated with athletic training that may manifest into disordered eating, amenorrhea, and osteoporosis, according to the American College of Sports Medicine.

Anemia and iron deficiency are particular concerns in this population because many dancers are vegetarians, Dr. Koutures noted. “If a young person comes in and says 'I don't eat meat,' especially if they are in an image sport, be very quick to screen them with a CBC, and ferritin and iron studies,” he advised.

Dancers also may be at increased risk for low bone mineral density because of some of the factors mentioned above, as well as inadequate calcium intake and inadequate exposure to the sunlight needed to produce vitamin D. He suggested considering a DXA scan in dancers who have stress or low-impact fractures, menstrual irregularity, or disordered eating.

Dr. Koutures reported that he had no disclosures in association with his presentation.

The female athlete triad is very common in the dance world. ©Andrew Ross/

VANCOUVER, B.C. — Overtraining, disordered eating, and lower extremity injuries are some of the many health issues that physicians who care for young dancers may encounter, according to a pediatric sports medicine specialist.

Several factors increase young dancers' risk of health problems, said Dr. Chris G. Koutures, who is in private practice in Anaheim, California. These young athletes often put in long hours, and they have multiple instructors, so there is a lack of continuity in their training. “I tell the families—parents especially—you must be the arbiter for your child, because each instructor does not know what the previous one was doing,” he said.

In addition, dancers typically train in minimally supportive footwear and on unforgiving surfaces, he noted. Many of them now dance year-round between performances, recitals, and summer dance camps. The training can be intensive, pushing them past their abilities and experience.

Preparticipation evaluations and annual physicals provide good opportunities for anticipatory guidance on dancing and for early detection of health issues, Dr. Koutures said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics (AAP).

Dancers should be encouraged to perform different types of dance (in moderation) for variety, and to take 2–3 months off per year to allow their bodies to grow and recover.

Along those lines, Dr. Koutures said to be alert for signs of overtraining. Affected dancers may have declining dance performance, loss of interest in the activity, sleep and appetite disturbances, a flat affect, and little social interaction.

Considering growth periods also is important, according to Dr. Koutures. During the major growth period—which occurs during ages 10–14 years in girls and ages 12–16 years in boys—dancers may be less flexible, become uncoordinated, and experience anatomic changes, such as widening of the pelvis and lengthening of the limbs. “During this time, it may be more sensible in all activities to back off a little bit,” he said.

When it comes to developmental status, he pointed out that puberty and menarche may be delayed in dancers if their caloric intake does not meet their energy demands. “These are things we bring up with the family,” he commented. “It doesn't have to be this way if they get enough calories.”

Keep a close eye on body mass index. “When you see a young athlete starting to lose weight, really get aggressive in finding out what external factors may be making this occur,” he said.

In addition, in female dancers, menstrual status warrants close watching and prompt intervention in the case of amenorrhea. “The female athlete triad is unfortunately very common in the dance world, and this can give you issues—not just when you are a teenager, but for the rest of your life,” he said.

The female athlete triad is defined as the relationships among energy availability, menstrual function, and bone mineral density associated with athletic training that may manifest into disordered eating, amenorrhea, and osteoporosis, according to the American College of Sports Medicine.

Anemia and iron deficiency are particular concerns in this population because many dancers are vegetarians, Dr. Koutures noted. “If a young person comes in and says 'I don't eat meat,' especially if they are in an image sport, be very quick to screen them with a CBC, and ferritin and iron studies,” he advised.

Dancers also may be at increased risk for low bone mineral density because of some of the factors mentioned above, as well as inadequate calcium intake and inadequate exposure to the sunlight needed to produce vitamin D. He suggested considering a DXA scan in dancers who have stress or low-impact fractures, menstrual irregularity, or disordered eating.

Dr. Koutures reported that he had no disclosures in association with his presentation.

The female athlete triad is very common in the dance world. ©Andrew Ross/

SEATTLE – A peer-led program appeared to be successful in decreasing the risk of eating disorders among female college athletes, according to early results involving 64 participants.

The risk of eating disorders among female college athletes is at least as high as that among college women generally, said Carolyn B. Becker, Ph.D., of the department of psychology at Trinity University, San Antonio. Female athletes are a unique group with unique issues, she pointed out. “There is certainly a pervasive belief among many athletes and many coaches that weight loss is going to enhance performance,” she said at an international conference sponsored by the Academy for Eating Disorders.

The Female Athlete Body Project was derived in part from a parent program at the university, the Sorority Body Image Program, which found that a peer-led, cognitive dissonance-based intervention reduced risk factors for eating disorders among sorority members, Dr. Becker said (J. Consult. Clin. Psychol. 2008;76:347-54).

The new program uses two interventions–a cognitive dissonance-based intervention and a healthy-weight intervention–that have been modified specifically for female athletes to cover topics such as sport-related body ideals and the female athlete triad. The former intervention focuses on rejecting thin ideals, whereas the latter focuses on embracing the healthy ideal, Dr. Becker explained at the conference, which was cosponsored by the University of New Mexico.

Attendance in the program is mandatory for all women participating in varsity sports and cheerleading at the university. The interventions are delivered in small, interactive group sessions that are conducted within teams, both to facilitate team building and to best address the differences in body image by sport. In the first year, half of the team receives the cognitive dissonance intervention and the other half receives the healthy-weight intervention; in the second year, the groups switch. The interventions are delivered over three sessions lasting for 1 hour and 15 minutes, each led by peers.

Participants are assessed at baseline, at the end of each intervention, and at the 6-week and 1-year follow-ups, according to Dr. Becker. In all, 112 athletes have participated in the program in its first year. She described results for the first 64 participants, who were from the basketball, softball, tennis, swimming/diving, and cross-country teams. Results for the remaining athletes are still being analyzed.

Regardless of the type of intervention received (cognitive dissonance or healthy weight), the athletes significantly improved from baseline in terms of thin-ideal internalization, as measured with the Ideal Body Stereotype Scale-Revised (IBSS-R); negative affect, as measured with the Positive and Negative Affect Schedule-Expanded Form (PANAS-X); eating pathology, as measured with the Eating Disorder Examination Questionnaire-Bulimia Nervosa scale (EDEQ-BN); and body dissatisfaction, as measured with the EDEQ scales for shape concern (EDEQ-SC) and weight concern (EDEQ-WC). With the exception of thin-ideal internalization, all measures were significantly improved from baseline at the 6-week follow-up.

Four athletes approached the head athletic trainer with concerns that they might have the female athlete triad–something that had never happened before during his tenure, Dr. Becker said.

“To us, in fact, that was the most exciting outcome that we had,” she commented. Future goals, according to Dr. Becker, include taking the program through its second year to determine if there are additive benefits of the two interventions, and exploring options for making the program sustainable.

Dr. Becker reported that the study was supported by a grant from the National Institute of Mental Health. She did not have any conflicts of interest to disclose.

Cognitive dissonance-based and healthy-weight interventions have been modified specifically for female athletes. DR. BECKER

SEATTLE – A peer-led program appeared to be successful in decreasing the risk of eating disorders among female college athletes, according to early results involving 64 participants.

The risk of eating disorders among female college athletes is at least as high as that among college women generally, said Carolyn B. Becker, Ph.D., of the department of psychology at Trinity University, San Antonio. Female athletes are a unique group with unique issues, she pointed out. “There is certainly a pervasive belief among many athletes and many coaches that weight loss is going to enhance performance,” she said at an international conference sponsored by the Academy for Eating Disorders.

The Female Athlete Body Project was derived in part from a parent program at the university, the Sorority Body Image Program, which found that a peer-led, cognitive dissonance-based intervention reduced risk factors for eating disorders among sorority members, Dr. Becker said (J. Consult. Clin. Psychol. 2008;76:347-54).

The new program uses two interventions–a cognitive dissonance-based intervention and a healthy-weight intervention–that have been modified specifically for female athletes to cover topics such as sport-related body ideals and the female athlete triad. The former intervention focuses on rejecting thin ideals, whereas the latter focuses on embracing the healthy ideal, Dr. Becker explained at the conference, which was cosponsored by the University of New Mexico.

Attendance in the program is mandatory for all women participating in varsity sports and cheerleading at the university. The interventions are delivered in small, interactive group sessions that are conducted within teams, both to facilitate team building and to best address the differences in body image by sport. In the first year, half of the team receives the cognitive dissonance intervention and the other half receives the healthy-weight intervention; in the second year, the groups switch. The interventions are delivered over three sessions lasting for 1 hour and 15 minutes, each led by peers.

Participants are assessed at baseline, at the end of each intervention, and at the 6-week and 1-year follow-ups, according to Dr. Becker. In all, 112 athletes have participated in the program in its first year. She described results for the first 64 participants, who were from the basketball, softball, tennis, swimming/diving, and cross-country teams. Results for the remaining athletes are still being analyzed.

Regardless of the type of intervention received (cognitive dissonance or healthy weight), the athletes significantly improved from baseline in terms of thin-ideal internalization, as measured with the Ideal Body Stereotype Scale-Revised (IBSS-R); negative affect, as measured with the Positive and Negative Affect Schedule-Expanded Form (PANAS-X); eating pathology, as measured with the Eating Disorder Examination Questionnaire-Bulimia Nervosa scale (EDEQ-BN); and body dissatisfaction, as measured with the EDEQ scales for shape concern (EDEQ-SC) and weight concern (EDEQ-WC). With the exception of thin-ideal internalization, all measures were significantly improved from baseline at the 6-week follow-up.

Four athletes approached the head athletic trainer with concerns that they might have the female athlete triad–something that had never happened before during his tenure, Dr. Becker said.

“To us, in fact, that was the most exciting outcome that we had,” she commented. Future goals, according to Dr. Becker, include taking the program through its second year to determine if there are additive benefits of the two interventions, and exploring options for making the program sustainable.

Dr. Becker reported that the study was supported by a grant from the National Institute of Mental Health. She did not have any conflicts of interest to disclose.

Cognitive dissonance-based and healthy-weight interventions have been modified specifically for female athletes. DR. BECKER

SEATTLE – A peer-led program appeared to be successful in decreasing the risk of eating disorders among female college athletes, according to early results involving 64 participants.

The risk of eating disorders among female college athletes is at least as high as that among college women generally, said Carolyn B. Becker, Ph.D., of the department of psychology at Trinity University, San Antonio. Female athletes are a unique group with unique issues, she pointed out. “There is certainly a pervasive belief among many athletes and many coaches that weight loss is going to enhance performance,” she said at an international conference sponsored by the Academy for Eating Disorders.

The Female Athlete Body Project was derived in part from a parent program at the university, the Sorority Body Image Program, which found that a peer-led, cognitive dissonance-based intervention reduced risk factors for eating disorders among sorority members, Dr. Becker said (J. Consult. Clin. Psychol. 2008;76:347-54).

The new program uses two interventions–a cognitive dissonance-based intervention and a healthy-weight intervention–that have been modified specifically for female athletes to cover topics such as sport-related body ideals and the female athlete triad. The former intervention focuses on rejecting thin ideals, whereas the latter focuses on embracing the healthy ideal, Dr. Becker explained at the conference, which was cosponsored by the University of New Mexico.

Attendance in the program is mandatory for all women participating in varsity sports and cheerleading at the university. The interventions are delivered in small, interactive group sessions that are conducted within teams, both to facilitate team building and to best address the differences in body image by sport. In the first year, half of the team receives the cognitive dissonance intervention and the other half receives the healthy-weight intervention; in the second year, the groups switch. The interventions are delivered over three sessions lasting for 1 hour and 15 minutes, each led by peers.

Participants are assessed at baseline, at the end of each intervention, and at the 6-week and 1-year follow-ups, according to Dr. Becker. In all, 112 athletes have participated in the program in its first year. She described results for the first 64 participants, who were from the basketball, softball, tennis, swimming/diving, and cross-country teams. Results for the remaining athletes are still being analyzed.

Regardless of the type of intervention received (cognitive dissonance or healthy weight), the athletes significantly improved from baseline in terms of thin-ideal internalization, as measured with the Ideal Body Stereotype Scale-Revised (IBSS-R); negative affect, as measured with the Positive and Negative Affect Schedule-Expanded Form (PANAS-X); eating pathology, as measured with the Eating Disorder Examination Questionnaire-Bulimia Nervosa scale (EDEQ-BN); and body dissatisfaction, as measured with the EDEQ scales for shape concern (EDEQ-SC) and weight concern (EDEQ-WC). With the exception of thin-ideal internalization, all measures were significantly improved from baseline at the 6-week follow-up.

Four athletes approached the head athletic trainer with concerns that they might have the female athlete triad–something that had never happened before during his tenure, Dr. Becker said.

“To us, in fact, that was the most exciting outcome that we had,” she commented. Future goals, according to Dr. Becker, include taking the program through its second year to determine if there are additive benefits of the two interventions, and exploring options for making the program sustainable.

Dr. Becker reported that the study was supported by a grant from the National Institute of Mental Health. She did not have any conflicts of interest to disclose.

Cognitive dissonance-based and healthy-weight interventions have been modified specifically for female athletes. DR. BECKER

MEXICO CITY — About one-third of HIV-positive adults have recently engaged in sexual behavior that could put others at risk for infection, but the factors associated with such behavior differ for women, heterosexual men, and men who have sex with men, according to a new study.

“We have set out to deliver a small contribution to understanding sexual risk behavior among men and women living with HIV, as we believe this is an important contribution to support them, both in preventing onward HIV transmission as well as in improving their sexual and reproductive health,” lead author Christiana Nöstlinger, Ph.D., said at the International AIDS Conference.

The cross-sectional study was conducted at 16 HIV treatment sites in 13 European countries. The investigators developed an anonymous questionnaire on factors potentially affecting sexual risk and protective behavior and administered it to consecutive individuals visiting the treatment sites in 2007. The investigators also analyzed the results of focus group discussions conducted among HIV-positive individuals, said Dr. Nöstlinger, head of health promotion at the Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium.

The response rate was 39%, yielding a sample of 1,212 respondents. About 24% were women, 18% were heterosexual men, and 58% were men who had sex with men. Their median ages ranged from 38 to 43 years.

About 30% of women, 25% of heterosexual men, and 37% of men who had sex with men reported at least one instance of sexual risk behavior (unprotected vaginal or anal intercourse) in the previous 6 months, a significant difference, Dr. Nöstlinger reported.

In bivariate analyses, women were significantly more likely to have engaged in sexual risk behavior if they were younger, used marijuana, wanted a child, or had a main partner who was also HIV positive.

Heterosexual men were significantly more likely to have had risky sex if they had less education, had been HIV positive for a shorter period of time, or had an HIV-positive main partner, whereas they were significantly less likely to have done so if they had higher levels of anxiety or stress, according to Dr. Nöstlinger.

Finally, men who had sex with men were significantly more likely to have engaged in sexual risk behavior if they were younger, had a job, used erection-enhancing medication or recreational drugs, were not on highly active antiretroviral therapy, had an HIV-positive main partner, or had greater perceived satisfaction with sexual desire.

In a multivariate analysis, respondents were significantly less likely to have engaged in risky sexual behavior if they had a detectable viral load versus an unknown one (odds ratio, 0.35), if they intended to use condoms at the next sexual encounter (odds ratio, 0.58), and if they had peers or partners who supported condom use (odds ratio, 0.83).

The findings, which are similar to those of other studies on risk behavior, suggest that “sexual risk behavior in different target groups is associated with quite different factors that act as mediators, and intervention strategies should take these mediators into account,” Dr. Nöstlinger commented. For example, greater integration of HIV care with reproductive health services may be needed for HIV-positive women who want children.

“Counseling strategies should also target the variables that have been shown to lead to behavior change, such as intention to use condoms or peer norms related to condom use,” Dr. Nöstlinger advised. She reported that she had no conflicts of interest in association with the study.

MEXICO CITY — About one-third of HIV-positive adults have recently engaged in sexual behavior that could put others at risk for infection, but the factors associated with such behavior differ for women, heterosexual men, and men who have sex with men, according to a new study.

“We have set out to deliver a small contribution to understanding sexual risk behavior among men and women living with HIV, as we believe this is an important contribution to support them, both in preventing onward HIV transmission as well as in improving their sexual and reproductive health,” lead author Christiana Nöstlinger, Ph.D., said at the International AIDS Conference.

The cross-sectional study was conducted at 16 HIV treatment sites in 13 European countries. The investigators developed an anonymous questionnaire on factors potentially affecting sexual risk and protective behavior and administered it to consecutive individuals visiting the treatment sites in 2007. The investigators also analyzed the results of focus group discussions conducted among HIV-positive individuals, said Dr. Nöstlinger, head of health promotion at the Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium.

The response rate was 39%, yielding a sample of 1,212 respondents. About 24% were women, 18% were heterosexual men, and 58% were men who had sex with men. Their median ages ranged from 38 to 43 years.

About 30% of women, 25% of heterosexual men, and 37% of men who had sex with men reported at least one instance of sexual risk behavior (unprotected vaginal or anal intercourse) in the previous 6 months, a significant difference, Dr. Nöstlinger reported.

In bivariate analyses, women were significantly more likely to have engaged in sexual risk behavior if they were younger, used marijuana, wanted a child, or had a main partner who was also HIV positive.

Heterosexual men were significantly more likely to have had risky sex if they had less education, had been HIV positive for a shorter period of time, or had an HIV-positive main partner, whereas they were significantly less likely to have done so if they had higher levels of anxiety or stress, according to Dr. Nöstlinger.

Finally, men who had sex with men were significantly more likely to have engaged in sexual risk behavior if they were younger, had a job, used erection-enhancing medication or recreational drugs, were not on highly active antiretroviral therapy, had an HIV-positive main partner, or had greater perceived satisfaction with sexual desire.

In a multivariate analysis, respondents were significantly less likely to have engaged in risky sexual behavior if they had a detectable viral load versus an unknown one (odds ratio, 0.35), if they intended to use condoms at the next sexual encounter (odds ratio, 0.58), and if they had peers or partners who supported condom use (odds ratio, 0.83).

The findings, which are similar to those of other studies on risk behavior, suggest that “sexual risk behavior in different target groups is associated with quite different factors that act as mediators, and intervention strategies should take these mediators into account,” Dr. Nöstlinger commented. For example, greater integration of HIV care with reproductive health services may be needed for HIV-positive women who want children.

“Counseling strategies should also target the variables that have been shown to lead to behavior change, such as intention to use condoms or peer norms related to condom use,” Dr. Nöstlinger advised. She reported that she had no conflicts of interest in association with the study.

MEXICO CITY — About one-third of HIV-positive adults have recently engaged in sexual behavior that could put others at risk for infection, but the factors associated with such behavior differ for women, heterosexual men, and men who have sex with men, according to a new study.

“We have set out to deliver a small contribution to understanding sexual risk behavior among men and women living with HIV, as we believe this is an important contribution to support them, both in preventing onward HIV transmission as well as in improving their sexual and reproductive health,” lead author Christiana Nöstlinger, Ph.D., said at the International AIDS Conference.

The cross-sectional study was conducted at 16 HIV treatment sites in 13 European countries. The investigators developed an anonymous questionnaire on factors potentially affecting sexual risk and protective behavior and administered it to consecutive individuals visiting the treatment sites in 2007. The investigators also analyzed the results of focus group discussions conducted among HIV-positive individuals, said Dr. Nöstlinger, head of health promotion at the Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium.

The response rate was 39%, yielding a sample of 1,212 respondents. About 24% were women, 18% were heterosexual men, and 58% were men who had sex with men. Their median ages ranged from 38 to 43 years.

About 30% of women, 25% of heterosexual men, and 37% of men who had sex with men reported at least one instance of sexual risk behavior (unprotected vaginal or anal intercourse) in the previous 6 months, a significant difference, Dr. Nöstlinger reported.

In bivariate analyses, women were significantly more likely to have engaged in sexual risk behavior if they were younger, used marijuana, wanted a child, or had a main partner who was also HIV positive.

Heterosexual men were significantly more likely to have had risky sex if they had less education, had been HIV positive for a shorter period of time, or had an HIV-positive main partner, whereas they were significantly less likely to have done so if they had higher levels of anxiety or stress, according to Dr. Nöstlinger.

Finally, men who had sex with men were significantly more likely to have engaged in sexual risk behavior if they were younger, had a job, used erection-enhancing medication or recreational drugs, were not on highly active antiretroviral therapy, had an HIV-positive main partner, or had greater perceived satisfaction with sexual desire.

In a multivariate analysis, respondents were significantly less likely to have engaged in risky sexual behavior if they had a detectable viral load versus an unknown one (odds ratio, 0.35), if they intended to use condoms at the next sexual encounter (odds ratio, 0.58), and if they had peers or partners who supported condom use (odds ratio, 0.83).

The findings, which are similar to those of other studies on risk behavior, suggest that “sexual risk behavior in different target groups is associated with quite different factors that act as mediators, and intervention strategies should take these mediators into account,” Dr. Nöstlinger commented. For example, greater integration of HIV care with reproductive health services may be needed for HIV-positive women who want children.

“Counseling strategies should also target the variables that have been shown to lead to behavior change, such as intention to use condoms or peer norms related to condom use,” Dr. Nöstlinger advised. She reported that she had no conflicts of interest in association with the study.

VANCOUVER, B.C. — Managing skin infections in young athletes can be more challenging than in the general pediatric population, because close physical contact and use of shared equipment can lead to rapid spread of infections and outbreaks.

In addition, some athletes with skin infections must be cleared by a physician to return to play and will try to hide symptoms. "You are going to be tricked and … athletes are going to try to make lesions look like something else," Dr. Andrew Gregory said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics. They may try to abrade lesions with sandpaper, cover them with makeup, or bleach them.

"If methicillin-resistant Staphylococcus aureus [MRSA] is not in your community yet, it is going to be," Dr. Gregory predicted, noting the prevalence of outbreaks on athletic teams in recent years.

Good hygiene is key to preventing MRSA, said Dr. Gregory of the departments of orthopaedics and pediatrics at Vanderbilt University, Nashville, Tenn.

Coaches and certified athletic trainers should encourage athletes to shower and clean their equipment regularly with soap and water and to avoid sharing equipment, clothing, towels, and razors. In addition, he recommends cleaning any shared equipment and surfaces with bleach and putting alcohol-based hand-sanitizing gels in training rooms, locker rooms, and bathrooms.

When MRSA is detected in one athlete, coaches and athletic trainers should talk with others on the team to see if any of them have lesions, Dr. Gregory advised. Treatment of MRSA in this population is the same as that in other children and adolescents—incision and drainage and antibiotic therapy appropriate for that specific community.

According to recommendations from the Centers for Disease Control and Prevention, athletes with any staphylococcal infection—including MRSA—should receive oral antibiotic therapy for a minimum of 3 days of before returning to play sports involving skin-to-skin contact, he noted (see www.cdc.gov/ncidod/dhqp/ar_MRSA_AthletesFAQ.html

Dr. Gregory cautioned, physicians and administrators should beware of sales pitches for products such as turf coatings that promise to protect athletes from MRSA. "There is no evidence that they do what they claim," he said.

Tinea infection, called tinea gladiatorum in wrestlers, was historically attributed to dirty mats, but efforts to culture the fungus from this source have failed, so it is now believed to be passed primarily by skin-to-skin contact, Dr. Gregory said. "These lesions are tough to diagnose when they are pretty small, before they get the central clearing," he observed.

Treatment consists of topical antifungal agents as first-line therapy and oral ones as second-line therapy. Wrestlers with this infection must be withheld from practice and competition until they have had treatment for 48–72 hours, and simply covering lesions is inadequate, Dr. Gregory said. He also recommended considering antifungal prophylaxis when athletes have recurrences or when outbreaks occur.

Herpes simplex I infection is spread by direct skin-to-skin contact and is also common among wrestlers, in whom the infection is called herpes gladiatorum. Typically, there are lesions on the right side of the head, related to the starting position for this sport, and it is important to prevent infection from spreading to the eye. "It is a little bit difficult to tell that this is a herpes infection initially, before you get that characteristic vesicular rash," he commented.

Physicians should be suspicious whenever they see wrestlers with a raised erythematous rash. "The key is to recognize it early and initiate treatment," Dr. Gregory said, with an appropriate course of an antiviral such as acyclovir. Antiviral prophylaxis should be considered for athletes with recurrences or when outbreaks occur.

Most physicians agree that wrestlers with herpes infections can return to play after all of their lesions have crusted, he said.

He reported having no conflicts of interest in association with his presentation.

'You are going to be tricked and … athletes are going to try to make lesions look like something else.' DR. GREGORY

VANCOUVER, B.C. — Managing skin infections in young athletes can be more challenging than in the general pediatric population, because close physical contact and use of shared equipment can lead to rapid spread of infections and outbreaks.

In addition, some athletes with skin infections must be cleared by a physician to return to play and will try to hide symptoms. "You are going to be tricked and … athletes are going to try to make lesions look like something else," Dr. Andrew Gregory said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics. They may try to abrade lesions with sandpaper, cover them with makeup, or bleach them.

"If methicillin-resistant Staphylococcus aureus [MRSA] is not in your community yet, it is going to be," Dr. Gregory predicted, noting the prevalence of outbreaks on athletic teams in recent years.

Good hygiene is key to preventing MRSA, said Dr. Gregory of the departments of orthopaedics and pediatrics at Vanderbilt University, Nashville, Tenn.

Coaches and certified athletic trainers should encourage athletes to shower and clean their equipment regularly with soap and water and to avoid sharing equipment, clothing, towels, and razors. In addition, he recommends cleaning any shared equipment and surfaces with bleach and putting alcohol-based hand-sanitizing gels in training rooms, locker rooms, and bathrooms.

When MRSA is detected in one athlete, coaches and athletic trainers should talk with others on the team to see if any of them have lesions, Dr. Gregory advised. Treatment of MRSA in this population is the same as that in other children and adolescents—incision and drainage and antibiotic therapy appropriate for that specific community.

According to recommendations from the Centers for Disease Control and Prevention, athletes with any staphylococcal infection—including MRSA—should receive oral antibiotic therapy for a minimum of 3 days of before returning to play sports involving skin-to-skin contact, he noted (see www.cdc.gov/ncidod/dhqp/ar_MRSA_AthletesFAQ.html

Dr. Gregory cautioned, physicians and administrators should beware of sales pitches for products such as turf coatings that promise to protect athletes from MRSA. "There is no evidence that they do what they claim," he said.

Tinea infection, called tinea gladiatorum in wrestlers, was historically attributed to dirty mats, but efforts to culture the fungus from this source have failed, so it is now believed to be passed primarily by skin-to-skin contact, Dr. Gregory said. "These lesions are tough to diagnose when they are pretty small, before they get the central clearing," he observed.

Treatment consists of topical antifungal agents as first-line therapy and oral ones as second-line therapy. Wrestlers with this infection must be withheld from practice and competition until they have had treatment for 48–72 hours, and simply covering lesions is inadequate, Dr. Gregory said. He also recommended considering antifungal prophylaxis when athletes have recurrences or when outbreaks occur.

Herpes simplex I infection is spread by direct skin-to-skin contact and is also common among wrestlers, in whom the infection is called herpes gladiatorum. Typically, there are lesions on the right side of the head, related to the starting position for this sport, and it is important to prevent infection from spreading to the eye. "It is a little bit difficult to tell that this is a herpes infection initially, before you get that characteristic vesicular rash," he commented.

Physicians should be suspicious whenever they see wrestlers with a raised erythematous rash. "The key is to recognize it early and initiate treatment," Dr. Gregory said, with an appropriate course of an antiviral such as acyclovir. Antiviral prophylaxis should be considered for athletes with recurrences or when outbreaks occur.

Most physicians agree that wrestlers with herpes infections can return to play after all of their lesions have crusted, he said.

He reported having no conflicts of interest in association with his presentation.

'You are going to be tricked and … athletes are going to try to make lesions look like something else.' DR. GREGORY

VANCOUVER, B.C. — Managing skin infections in young athletes can be more challenging than in the general pediatric population, because close physical contact and use of shared equipment can lead to rapid spread of infections and outbreaks.

In addition, some athletes with skin infections must be cleared by a physician to return to play and will try to hide symptoms. "You are going to be tricked and … athletes are going to try to make lesions look like something else," Dr. Andrew Gregory said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics. They may try to abrade lesions with sandpaper, cover them with makeup, or bleach them.

"If methicillin-resistant Staphylococcus aureus [MRSA] is not in your community yet, it is going to be," Dr. Gregory predicted, noting the prevalence of outbreaks on athletic teams in recent years.

Good hygiene is key to preventing MRSA, said Dr. Gregory of the departments of orthopaedics and pediatrics at Vanderbilt University, Nashville, Tenn.

Coaches and certified athletic trainers should encourage athletes to shower and clean their equipment regularly with soap and water and to avoid sharing equipment, clothing, towels, and razors. In addition, he recommends cleaning any shared equipment and surfaces with bleach and putting alcohol-based hand-sanitizing gels in training rooms, locker rooms, and bathrooms.

When MRSA is detected in one athlete, coaches and athletic trainers should talk with others on the team to see if any of them have lesions, Dr. Gregory advised. Treatment of MRSA in this population is the same as that in other children and adolescents—incision and drainage and antibiotic therapy appropriate for that specific community.

According to recommendations from the Centers for Disease Control and Prevention, athletes with any staphylococcal infection—including MRSA—should receive oral antibiotic therapy for a minimum of 3 days of before returning to play sports involving skin-to-skin contact, he noted (see www.cdc.gov/ncidod/dhqp/ar_MRSA_AthletesFAQ.html

Dr. Gregory cautioned, physicians and administrators should beware of sales pitches for products such as turf coatings that promise to protect athletes from MRSA. "There is no evidence that they do what they claim," he said.

Tinea infection, called tinea gladiatorum in wrestlers, was historically attributed to dirty mats, but efforts to culture the fungus from this source have failed, so it is now believed to be passed primarily by skin-to-skin contact, Dr. Gregory said. "These lesions are tough to diagnose when they are pretty small, before they get the central clearing," he observed.

Treatment consists of topical antifungal agents as first-line therapy and oral ones as second-line therapy. Wrestlers with this infection must be withheld from practice and competition until they have had treatment for 48–72 hours, and simply covering lesions is inadequate, Dr. Gregory said. He also recommended considering antifungal prophylaxis when athletes have recurrences or when outbreaks occur.

Herpes simplex I infection is spread by direct skin-to-skin contact and is also common among wrestlers, in whom the infection is called herpes gladiatorum. Typically, there are lesions on the right side of the head, related to the starting position for this sport, and it is important to prevent infection from spreading to the eye. "It is a little bit difficult to tell that this is a herpes infection initially, before you get that characteristic vesicular rash," he commented.

Physicians should be suspicious whenever they see wrestlers with a raised erythematous rash. "The key is to recognize it early and initiate treatment," Dr. Gregory said, with an appropriate course of an antiviral such as acyclovir. Antiviral prophylaxis should be considered for athletes with recurrences or when outbreaks occur.

Most physicians agree that wrestlers with herpes infections can return to play after all of their lesions have crusted, he said.

He reported having no conflicts of interest in association with his presentation.

'You are going to be tricked and … athletes are going to try to make lesions look like something else.' DR. GREGORY