Overview of Herpes Gladiatorum Among Wrestlers

wrestlers in the ring
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Herpes transmits between people very easily. That is one of the reasons it's such a common disease. People think of herpes as an STD. However, it can also be spread through more casual, but prologned,  skin-to-skin contact, such as during wrestling or rugby. This type of herpes is referred to as mat herpes or, more correctly, herpes gladiatorum. Herpes gladiatorum is most often caused by HSV-1. This is the virus that usually causes oral herpes and can also cause genital herpes.It earns its particular name both by the route of transmission and by the fact that outbreaks occur on skin surfaces that are not commonly found to be infected on non athletes.

 

Herpes gladiatorum is thought to be spread primarily by skin-to-skin contact between wrestlers. Despite the colloquial term of "mat herpes," it is not primarily spread through contact with the mat. Instead, the virus is usually found on the heads, necks, and faces of wrestlers. It can also be found on the arms and hands. There are guidelines available to athletic officials to reduce its spread. However, those guidelines are not always effective. 

In 2016, a study looked at the use of suppressive therapy to reduce outbreaks at a four week wrestling camp. They found that, over a period of 10 years, daily use of valacyclovir reduced the incidence of outbreaks by over 89 percent. While protection was not perfect, it was significant enough to support the use of prophylaxis in at-risk athletes. 

Can You Get Mat Herpes From a Mat? 

There is very little recent data about the transmission of the herpes virus from objects, instead of from person to person.

(This is known as fomite transmission.)  However, studies in the 1980s found that the virus could survive for several hours on plastic surfaces in a humid environment. This suggests that herpes transmission from infected exercise equipment is possible. Therefore, while the mat is not the most common source of mat herpes, it's still worth keeping it clean.

Guidelines for the Reduction of Herpes Gladiatorum in High School Athletes Include:

  • No wrestling with any open sores or swollen lymph nodes.
  • Encourage use of suppressive therapy among athletes who experience outbreaks.
  • Athletes exposed to an outbreak should be isolated from wrestling and watched for symptoms. Exposure includes up to three days before the outbreak appears.
  • Encourage type-specific blood tests to look for people with asymptomatic infections. Those individuals can then also be placed on prophylactic treatment. 

It is worth noting that while attempts at universal pre-exposure prophylactic treatment may be practical for a brief wrestling camp, it is unlikely to be acceptable to parents or athletes for the far longer wrestling season. That is why clinical guidelines focus on suppressive therapy for infected athletes and isolation of athletes when outbreaks occur. 

Sources:

Anderson BJ, McGuire DP, Reed M, Foster M, Ortiz D. Prophylactic Valacyclovir to Prevent Outbreaks of Primary Herpes Gladiatorum at a 28-Day Wrestling Camp: A 10-Year Review. Clin J Sport Med. 2016 Jul;26(4):272-8. doi: 10.1097/JSM.0000000000000255. 

Anderson, BJ. The Epidemiology and Clinical Analysis of Several Outbreaks of Herpes Gladiatorum. Med. Sci. Sports Exerc. 2003 35(11):1809-1814.



Drugge JM, Allen PJ. A Nurse Practitioner's Guide To the Management of Herpes Simplex Virus-1 in ChildrenDermatol Nurs. 2008 Dec;20(6):455-8, 461-6.

National Federation of State High School Associations. (2007) Herpes Gladiatorum Position Statement and Guidelines.

Nerurkar LS, West F, May M, Madden DL, Sever JL. Survival of herpes simplex virus in water specimens collected from hot tubs in spa facilities and on plastic surfaces. JAMA. 1983 Dec 9;250(22):3081-3.

Wei EY, Coghlin DT. Beyond Folliculitis: Recognizing Herpes Gladiatorum in Adolescent Athletes. J Pediatr. 2017 Jul 17. pii: S0022-3476(17)30912-5. doi: 10.1016/j.jpeds.2017.06.062.

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