You have probably heard of oral herpes, also known as a cold sore, as well as genital herpes. Did you know that there is a type of herpes that is specific to wrestlers? It is particularly common in secondary and college student wrestlers, who may call it “mat herpes.”

The symptoms of herpes gladiatorum are similar to the symptoms of other herpes simplex viruses. It often begins with a few pimples that are painful but not itchy. The pimples spread and as the disease progresses they will break open and leak fluid. This is followed by scab formation (crusting), with skin erosions when the pimple resolves. The rash is most likely to appear on the head, face, neck, chest or shoulders on the right side of the body. It may be accompanied by fever, enlarged lymph nodes, and sore throat.

Because the lesions most often appear on the right side, it is believed that herpes gladiatorum (HG) is spread by direct skin-to-skin contact, often in a position that wrestlers term “the lock-up.” Another way it can be transmitted is through towels and wrestling equipment (such as headgear). According to the NCAA, an estimated 40% of wrestlers get HG.

Herpes gladiatorum is often misdiagnosed at first and complications can develop without the correct treatment. These potential complications include eye infection, encephalitis, hepatitis, and pneumonitis. Also, a serious infection that is not HG is MRSA, or methicillin-resistant staphylococcus aureus, which is also transmitted by direct contact. Thus, any wrestler who develops a rash should see a health care provider as soon as possible.

Herpes simplex virus, once acquired, never goes away; like a cold sore, HG can recur, especially during an illness with fever, times of stress, or exposure to ultraviolet light. Because of this, the NCAA has established standards for competition by wrestlers with HG. These are designed to prevent transmission of the virus to other students, and include the following: a) no signs of viral infection such as fever or lymph node enlargement, b) no new sores for 3 or more days, c) all sores must be fully crusted, and d) at least 5 days of antiviral therapy. The preferred drug for HG is acyclovir (Zovirax), which will reduce pain and speed the healing of lesions.

Antiviral drugs and restrictions on competition are not enough to prevent HG from spreading. Hygiene is very important – wrestlers should be taught from the very beginning not to share towels or gear, and to keep towels and gear clean. In addition, wrestlers and trainers should practice frequent hand-washing (using proper techniques) and clean the mats with a bleach solution. These practices will not prevent skin-to-skin transmission, of course, so trainers and athletes must be educated and vigilant about symptoms of HG so it can be identified and treated as early as possible.