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Bloodborne pathogens and sports

Christopher McGrew, MD
Section Editor
Francis G O'Connor, MD, MPH, FACSM
Deputy Editor
Jonathan Grayzel, MD, FAAEM


The bloodborne pathogens of greatest concern for potential transmission during sporting competition include human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). The epidemiology of these pathogens in sport, prevention of bloodborne infection in sport, and the screening and management of such infections in athletes are reviewed below. The diagnosis and management of specific bloodborne infections are reviewed separately. (See "Management of nonoccupational exposures to HIV and hepatitis B and C in adults" and "Epidemiology, transmission, and prevention of hepatitis B virus infection" and "Epidemiology and transmission of hepatitis C virus infection".)


Overall risk — The transmission of bloodborne infections during sport is rare. Bloodborne pathogens of concern for potential transmission in sport include human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). All three may cause symptomatic or asymptomatic acute infections. Once contracted, HIV is a lifelong illness, but the disease can be well controlled with medication and proper medical care. Acute HBV and HCV infections may spontaneously clear, but a variable number of individuals go on to develop chronic infection and remain infectious to others. (See "Acute and early HIV infection: Clinical manifestations and diagnosis" and "The natural history and clinical features of HIV infection in adults and adolescents" and "Epidemiology, transmission, and prevention of hepatitis B virus infection" and "Hepatitis B virus: Overview of management" and "Epidemiology and transmission of hepatitis C virus infection" and "Overview of the management of chronic hepatitis C virus infection".)

There is a theoretical risk of bloodborne infections being transmitted during sports from the bleeding or exudative skin wounds of an infected athlete to other athletes via injured skin or mucous membranes. Although data is limited, the general consensus is that the likelihood of such transmission is extremely low [1-5]. Combative sports (eg, boxing, mixed martial arts) represent the highest theoretical risk, because of the higher rates of bleeding injuries and prolonged close-body contact [6]. Although not the equivalent of sanctioned combative sports, such as boxing and mixed martial arts, street fights entail a risk of HIV and HCV transmission, as documented in case reports [7-9]. HBV transmission has been documented in Japan in five members of a high school sumo wrestling club [10].

The prevalence of bloodborne pathogens among athletes has not been studied extensively. A 1995 study evaluated the prevalence of HBV infection among South Australian football (soccer) players and found no difference with a group of blood donors of the same age [11]. A 2008 study examined the prevalence of HCV among 208 former professional and amateur Brazilian football (soccer) and basketball players and reported an overall prevalence of 7.2 percent, with values of 11 percent among professionals and 5.5 percent among amateurs [12]. The study found a close correlation between the use of injectable stimulants and HCV infection rates. Athletes who did not inject such drugs had a prevalence of only 0.6 percent, suggesting that sport participation itself had little to do with the relatively high overall prevalence rates. A 2011 study involving 420 male wrestlers and 205 volleyball and soccer players found no evidence that participation in wrestling entailed higher rates of HBV or HCV transmission compared with low- to moderate-contact sports [13].

HIV transmission in sports — There are no well-documented, confirmed reports of HIV transmission during sport. The theoretical risk for transmission of HIV during National Football League (NFL) matches has been calculated to be less than 1 per 85 million game contacts [14]. This estimate was calculated using the following data: (a) estimated prevalence of HIV among athletes; (b) risk of percutaneous HIV transmission in health care; and (c) risk of a bleeding injury in American football. However, this calculation may overestimate the risk because it involves extrapolation from reports of needlestick injuries, which are likely to pose a much greater risk than sport-related skin injuries [15]. Although not the equivalent of sanctioned combative sports such as boxing and mixed martial arts, street fights entail a risk of HIV transmission, as documented in case reports [7,8]. Of note, transmission risk is lower if the HIV-infected athlete is being treated. (See "HIV infection: Risk factors and prevention strategies".)

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Literature review current through: Oct 2017. | This topic last updated: Dec 20, 2016.
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  1. Human immunodeficiency virus and other blood-borne pathogens in sports. The American Medical Society for Sports Medicine (AMSSM) and the American Academy of Sports Medicine (AASM). Clin J Sport Med 1995; 5:199.
  2. http://www.fims.org/files/6314/2056/2140/PS2-AIDS-and-Sports.pdf (Accessed on February 05, 2015).
  3. Human immunodeficiency virus and other blood-borne viral pathogens in the athletic setting. Committee on Sports Medicine and Fitness. American Academy of Pediatrics. Pediatrics 1999; 104:1400.
  4. http://casem-acmse.org/wp-content/uploads/2013/07/HIV-as-it-relates-to-Sport-2007.pdf (Accessed on February 05, 2015).
  5. Mast EE, Goodman RA, Bond WW, et al. Transmission of blood-borne pathogens during sports: risk and prevention. Ann Intern Med 1995; 122:283.
  6. Kordi R, Wallace WA. Blood borne infections in sport: risks of transmission, methods of prevention, and recommendations for hepatitis B vaccination. Br J Sports Med 2004; 38:678.
  7. O'Farrell N, Tovey SJ, Morgan-Capner P. Transmission of HIV-1 infection after a fight. Lancet 1992; 339:246.
  8. Ippolito G, Del Poggio P, Arici C, et al. Transmission of zidovudine-resistant HIV during a bloody fight. JAMA 1994; 272:433.
  9. Abel S, Césaire R, Cales-Quist D, et al. Occupational transmission of human immunodeficiency virus and hepatitis C virus after a punch. Clin Infect Dis 2000; 31:1494.
  10. Kashiwagi S, Hayashi J, Ikematsu H, et al. An outbreak of hepatitis B in members of a high school sumo wrestling club. JAMA 1982; 248:213.
  11. Siebert DJ, Lindschau PB, Burrell CJ. Lack of evidence for significant hepatitis B transmission in Australian Rules footballers. Med J Aust 1995; 162:312.
  12. Passos AD, Figueiredo JF, Martinelli Ade L, et al. Hepatitis C among former athletes: association with the use of injectable stimulants in the past. Mem Inst Oswaldo Cruz 2008; 103:809.
  13. Kordi R, Neal K, Pourfathollah AA, et al. Risk of hepatitis B and C infections in Tehranian wrestlers. J Athl Train 2011; 46:445.
  14. Brown LS Jr, Drotman DP, Chu A, et al. Bleeding injuries in professional football: estimating the risk for HIV transmission. Ann Intern Med 1995; 122:273.
  15. McGrew CA. Blood-borne pathogens and sports. In: Medical Problems in Athletes, Fields KB, Fricker PA (Eds), Blackwell Science, Oxford 1997. p.64.
  16. Tobe K, Matsuura K, Ogura T, et al. Horizontal transmission of hepatitis B virus among players of an American football team. Arch Intern Med 2000; 160:2541.
  17. Ringertz O, Zetterberg B. Serum hepatitis among Swedish track finders. An epidemiologic study. N Engl J Med 1967; 276:540.
  18. Beltrami EM, Williams IT, Shapiro CN, Chamberland ME. Risk and management of blood-borne infections in health care workers. Clin Microbiol Rev 2000; 13:385.
  19. McGrew CA. Blood-borne pathogens in sports. In: and Practices of Primary Care Sports Medicine, Garrett WE, Kirkendall DT, Squire DL (Eds), Lippincott Williams & Wilkins, Philadelphia 2001. p.247.
  20. www.cdc.gov/HAI/settings/outpatient/outpatient-care-gl-standared-precautions.html (Accessed on February 05, 2015).
  21. Guideline 2L: Blood-borne pathogens. In: 2014-15 NCAA Sports Medicine Handbook, Parsons JT (Ed), The National Collegiate Athletic Association, Indiana 2014. p.74.
  22. Brkich M. Infectious waste disposal plan of the high school athletic trainer. J Athl Train 1995; 30:208.
  23. Colgate B. Section 2, Article 7. In: National Federation of High School Associations (NFHSA) Wrestling Rules Book. 2014-15. http://www.cif-la.org/ourpages/auto/2014/7/14/63309800/2014-15%20Wrestling%20Rule%20Book.pdf (Accessed on February 20, 2015).
  24. Section 4 Article 17. In: International Traditional Wrestling Regulations. International Federation of Associated Wrestling Styles (FILA). January 2012. http://unitedworldwrestling.org/sites/default/files/2-international_traditional_wrestling_regulations.pdf (Accessed on February 20, 2015).
  25. Bubb RG. Rule 6.1.5 Bleeding Timeout. In: NCAA Wrestling 2010 and 2011 Rules and Interpretations. http://matref0.tripod.com/Articles/2010NCAA_Rules_Book.pdf (Accessed on February 20, 2015).
  26. FIFA Law # 5: The Referee. http://www.fifa.com/mm/document/afdeveloping/refereeing/law_5_the_referee_en_47411.pdf (Accessed on February 20, 2015).
  27. Colgate B. Appendix D, Communicable Disease Procedures. In: National Federation of High School Associations (NFHSA) Wrestling Rules Book. 2014-15. http://www.cif-la.org/ourpages/auto/2014/7/14/63309800/2014-15%20Wrestling%20Rule%20Book.pdf (Accessed on February 20, 2015).
  28. www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/hepatitis-b-virus-infection-screening-2004 (Accessed on February 05, 2015).
  29. U.S. Preventive Services Task Force. Screening for hepatitis C virus infection in adults: recommendation statement. Ann Intern Med 2004; 140:462.
  30. www.hivandhepatitis.com/hepatitis-b/hepatitis-b-topics/hbv-testing-diagnosis/4521-new-guidelines-for-hepatitis-b-screening (Accessed on February 05, 2015).
  31. www.uspreventiveservicestaskforce.org/uspstf/uspshivi.htm (Accessed on February 05, 2015).
  32. www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm (Accessed on February 05, 2015).
  33. www.associationofringsidephysicians.org/ARP%20BBID.pdf (Accessed on March 02, 2015).
  34. Jaworski CA, Donohue B, Kluetz J. Infectious disease. Clin Sports Med 2011; 30:575.
  35. Dimeff RJ. Human immunodeficiency virus and sports. In: ACSM’s Sports Medicine: A Comprehensive Review, O’Conner FG, Casa DJ, Davis BA, et al (Eds), Lippincott Williams & Wilkins, China 2013. p.806.