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Cold sore makes injecting steroids riskier

Cold sore makes injecting steroids riskier
Scottish doctors had to remove a large amount of dead muscle tissue from the shoulder of a 25-year-old bodybuilder who had injected himself with anabolic steroids and had developed an abscess. The cause: a combination of relatively harmless bacteria, a relatively harmless cold sore – and unhygienic injecting practice.

When the doctors examined the bodybuilder he had a fever and cold shivers. He was short of breath, had palpitations and was confused. His skin was red. The bodybuilder was in septic shock. This occurs when dangerous micro-organisms enter the bloodstream and the organs shut themselves off from the bloodstream. The bodybuilder had a cold sore on his lip, but at first the doctors saw no link between his septic shock and the relatively harmless Herpes Simplex Virus Type 1, which causes cold sores.

Six days earlier the bodybuilder had injected steroids into his left shoulder. He now had a swelling there. On a scan of the bodybuilders’ shoulders the doctors could see pockets of fluid and gas bubbles in the bodybuilder’s soft tissue – it had started to rot.

Cold sore makes injecting steroids riskier

The doctors opened up the swelling and in the pus they identified the bacteria Gemella morbillorum and Veillonella [see below]. Gemella morbillorum is a common bacteria. You have it in your mouth. Veillonella is not as common, but is found in your mouth and your gut.

Cold sore makes injecting steroids riskier

The doctors made a cut in the bodybuilder's upper arm so that the pus would drain. They also examined his blood and found yet another bacteria: Dialister pneumosintes. Like Veillonella, this is not a common bacteria, but if you were to examine all the millions of different bacteria in your mouth, you'd definitely come across this one.

The doctors gave the bodybuilder antibiotics: benzyl penicillin and clindamycine. And they removed the dead muscle tissue. It was quite a lot of tissue, but once his wounds had healed the bodybuilder regained normal use of his left arm.

The medical literature is littered with cases of abscesses in bodybuilders. Most are caused by dangerous bacteria such as Staphylococcus aureus, Streptococcus or Pseudomonas. In the Scottish case, however, the doctors found harmless organisms. They only become dangerous in seriously weakened people, who have undergone a serious operation or have a weak immune system.

The doctors think it was the cold sore that gave the bodybuilder grief. They did a literature survey and found studies in which a cold sore causes some bacteria in the mouth to become dangerous because the herpes virus weakens the immune system.

For steroids users the message is clear: if you inject, hygiene is vitally important. On your skin, in your nose and even in your mouth there are bacteria that don't affect you normally, but will cause serious problems if you introduce them into your bloodstream via a needle. And if you have a cold sore, the risks are even greater.

Int J Infect Dis. 2010 Jul 16. [Epub ahead of print].

Needle swelling in bodybuilders misleads doctors 18.01.2010