If you have kids who are athletes, you probably worry about them suffering a concussion or breaking a bone. But infections—especially those transmitted through the skin—are a health risk for them, too.

A new report out today in the journal Pediatrics offers guidelines for doctors and parents to help minimize the spread of infections in young athletes.

Not only can infections spread in sports and cause harm to an individual child, they can potentially stop a competitive season for an entire team, especially in close-contact sports. 

“Injuries are certainly more common, but you can get outbreaks of herpes or staph infections that can lead to major problems in terms of athletes’ ability to participate,” says Dele Davies, M.D., lead author of the report and a professor of pediatrics and public health at the University of Nebraska Medical Center in Omaha. Outbreaks have been seen in wrestlers, rugby and football players, and judo competitors, among other athletes.

According to the report, 10 to 15 percent of time lost from practice or competition at the college level is due to skin infections, the most common of which are MRSA (methicillin-resistant staphylococcus aureus), herpes, Group A B-hemolytic streptococcus, and fungal infections such as athlete’s foot and jock itch.  

How Infections Spread

“In most cases, when you get one of these infections you just have to use a topical or oral antibiotic or anti-fungal,” Davies says. “But some of these infections can spread and potentially enter the bloodstream, which can be life-threatening." 

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According to the report, up to 23 percent of athletes have been found to have MRSA—a common antibiotic-resistant infection—colonization, which is when MRSA lives on the skin (usually in the nose) but doesn’t cause illness. These people are at higher risk of getting a full-blown MRSA infection and spreading it to others. For example, someone could have a very mild MRSA infection and not know it and transfer the bacteria to another athlete who has eczema, where the skin has micro breaks and isn’t as protective. That person could end up with a serious MRSA infection.

“With herpes, another common skin infection in athletes, once you get it, it’s there for life,” says William O. Roberts, M.D., a professor in the department of family medicine and community health at the University of Minnesota Medical School in Minneapolis. “If you have the rash on your skin and it’s active, it can spread to another person.” Herpes gladiatorum (also called "mat" herpes, found in wrestlers) and herpes rugbiorum (found in rugby players) are both caused primarily by the same virus that causes cold sores (herpes simplex type 1), but the infection shows up on other areas of the body. One study showed close to 8 percent of college wrestlers have it and almost 3 percent of high school grapplers.

Even sports that don’t involve close contact can pose risks for infection. Athlete’s foot is common in runners and swimmers, for example. “Each sport has its own unique issues, but it’s really the contact sports, like wrestling, football, and rugby, where if someone has a skin infection, you can pass it to someone else,” Davies says. 

Minimizing Infection Risk

Team coaches and trainers are responsible for ensuring that equipment is cleaned and disinfected regularly, checking for skin lesions, and setting (and enforcing) clear policies about participation during active infections.

In 2007 an outbreak of herpes gladiatorum shut down high school wrestling temporarily in Minnesota. “We now have really strict skin rules for wrestlers,” Roberts says. “The coaches inspect the wrestlers every day, and there are physicians on hand before big tournaments. Most family medicine doctors and pediatricians are aware of the risk, but there are still some physicians out there who haven’t gotten the message.”

Parents, too, can play an important role in keeping young athletes safe from infection:

• Teach your children to do daily skin checks, especially if they participate in higher-risk activities. According to the American Academy of Dermatology, they should look for cuts, sores, redness, swelling, and pus, and tell their coach—and you— if they find anything.

• Emphasize good hygiene, such as washing hands frequently, showering daily, wearing clean workout clothes, and using sandals in the locker room. (One simple tip for people with athlete’s foot to avoid spreading it to other areas of the body is to put on socks before slipping on underwear.)

• Remind your child to avoid sharing water bottles, cups, soap, razors, sponges, or other personal-care items.

• Be aware of the coach’s attitude toward illness. “You don’t want your kids thrown into a close situation with kids who are sick,” Roberts says. “If an athlete is ill or has an active infection, stay home.” An athlete shouldn’t be punished for that or pressured to participate when it’s not safe.

• Stay up to date on immunizations. Airborne viruses like measles, mumps, meningitis, chicken pox, and pertussis can also be passed between athletes, although it’s less common. According to the Centers for Disease Control and Prevention, preteens and teens may need booster shots of childhood vaccines, such as DTaP, as well as a meningitis vaccine and booster. Talk to your doctor about the current recommendations given your child’s sports involvement.