In the early 1980s, to find out how pervasive the disease was, a group of six medical researchers affiliated with Emory University and the Centers for Disease Control in Atlanta launched a nationwide study to measure the incidence of herpes skin infections among college and high school wrestlers. The scientists interviewed 95 randomly selected athletic trainers by telephone. Then they evaluated written responses from another 294 trainers. They surveyed all the members of four Southeastern Conference wrestling teams and took blood samples from every athlete on one of those teams.
What they found was dismaying. According to the 1988 report published in the American Journal of Sports Medicine, during the 1984-85 wrestling season, 65% of U.S. college wrestling teams and 25% of the high school teams surveyed had at least one member with herpes gladiatorum—twice the rate that had been found among Northeastern college wrestling teams in a survey conducted 20 years earlier. Within the 1984-85 national population of wrestlers, 7.6% of the college wrestlers and 2.6% of the high school wrestlers had the disease.
The sweep of the disease surprised even the researchers who conducted the survey. "I didn't think it would be a widespread problem," says Dr. Thomas Becker, formerly an epidemiologist with the Centers for Disease Control and now an assistant professor of medicine at the University of New Mexico Medical Center. "But as it turned out, herpes gladiatorum is certainly an occupational hazard of wrestling." Dr. Becker, who headed the survey team and who is widely considered to be a top authority on the infection, also believes that the disease's persistence means that thousands of current and former wrestlers are now infected.
With no vaccine in existence to curtail the virus, medical experts and wrestling staffers are facing the challenge of keeping uninfected athletes away from their opponents' rashes and cold sores. But current safeguards vary in effectiveness. From public school bouts to the Olympics, wrestlers are supposed to undergo skin inspections prior to matches. But the screening process is far from infallible. "I'm sure we don't pick up a significant number of these cases because oftentimes the onset is very gradual," says U.S.A. Wrestling's head trainer, Jack Spain, who estimates that 15% to 25% of all wrestlers at the postcollegiate level have herpes gladiatorum. "At most of the major competitions, we'll see 1,000 kids at a weigh-in, and even if we had unlimited financial abilities, it would be difficult to check."
Physicians are on hand to conduct skin inspections at all international-level and most national meets. But often the responsibility is shifted to coaches or trainers at collegiate meets, and coaches alone, typically, handle the chore at high school events. There's considerable doubt, however, whether coaches—particularly those without much training-have the qualifications to perform the task. "In the summertime, coaches will come and ask, 'Is this herpes?' and it turns out to be poison ivy," says Spain. "As you go down in age to the younger athletes and the less-experienced coaches, the more likely it is they'll miss the disease."
Even when the coaches are knowledgeable about skin lesions, they aren't always unblinkingly impartial, particularly when a key wrestler fails the inspection. "The coach has different thought processes depending on whether his third-string wrestler or his possible national champion [is involved]," says Dr. Harvey. "Nobody comes up to me and says, 'My national champion has this rash, and it might be herpes. Do you think I ought to pull him?' My suspicion is that the problem isn't brought to my attention because my answer might be yes."
Infected wrestlers, likewise, may hide their herpes lesions from officials to avoid being disqualified. "You've got to remember, these are highly motivated athletes," says Hoegh. "Some will avoid the disease at all costs. But many will wrestle somebody with it or wrestle with it themselves because they don't see the implications as being very great."
When wrestlers do come forward, team doctors generally prescribe the antiviral drug acyclovir, which may reduce the healing time of lesions to as brief a period as five days. The medication, which is usually administered in tablet form, may also deter rashes from forming when athletes take the pills at the first sign of tingling—a signal that a rash or cold sore is about to appear.
Physicians and trainers often allow wrestlers to compete even before the rash subsides if they can bandage the lesions with a surgical dressing designed to lock in the virus. Not everyone is confident about a bandage's effectiveness. "It depends on what the bandage is made of and how likely it is to stay in place," says Dr. Becker. "Maybe if the rash was on your arm, you could wear a jersey and bandage and be reasonably safe. But, frankly, I wouldn't want to face somebody like that."
Preventing uninfected wrestlers from encountering an active herpes lesion is only half the battle. Trainers at the collegiate and postcollegiate level also try to ward off infections by being as rigorous about scrubbing their wrestling mats as greenskeepers are about mowing their fairways. Wrestling mats are usually mopped with a disinfectant at least once and sometimes as often as three times a day, depending on the number of wrestling sessions. Unused mats are also roped off to prevent pedestrians from tracking the virus on their shoes. Those efforts, however, aren't enough to stop wrestlers from catching the virus from infected athletes who used the mat earlier in the same session.