Meningitis Not 'a Gay Disease'

After the death of a homosexual man in West Hollywood this weekend, a city councilman conjured and addressed potential homophobic misunderstanding. Bacterial meningitis is an equal-opportunity pestilence.
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Neisseria meningitidis, bacteria that causes deadly meningitis [BioQuell]

Before 1913, bacterial meningitis was nearly 100 percent fatal. Now that rate is around 16 percent in the U.S. Not more than a few hundred people in the country are diagnosed with bacterial meningitis every year, and most who die from it are older. It made national news this weekend when 33-year-old lawyer Brett Shaad died, though. He reportedly began to feel sick last Monday, was diagnosed with bacterial meningitis on Wednesday, and was pronounced brain dead by Friday.

SHARK300200.jpgBrett Shaad

On the occasion of Shaad's passing, after reportedly tweeting prematurely that Shaad had died, West Hollywood City Councilman John Duran spoke at a press conference held by the AIDS Healthcare Foundation. Not every death from meningitis commands a press conference, but in this case it fed preexisting concerns.

This year's White Party, the "largest gay dance music festival in the world," brought about 30,000 people to Palm Springs on March 29. Shaad was apparently among them. About a week later, he got sick, and some believe that's where he contracted the infection. So Duran issued a warning, "We want to get the word out to any gay men that were at the White Party, that if they have any of these symptoms, go see their physician immediately."

In the context of a recent outbreak of deadly meningitis among gay men in New York City -- at least 22 cases since 2010 with seven fatalities -- there is growing talk of associations and misunderstandings about how the disease spreads.

As Duran went on to say, though, importantly, "Please don't call this a gay disease."

Bacterial meningitis is indeed no more a "gay disease" than the flu would be if there happened to be an outbreak in a gay community. The two spread in the same basic ways -- meningitis infection comes in through your nose and mouth -- except that the flu is more contagious, so it would rapidly break out of an identified community. Nothing about being gay makes one inherently more or less prone to meningitis; likewise nor does being straight lower risks. The bacteria spreads from respiratory secretions, kissing, sharing food, and generally being in very close contact with someone who has it. 

Just because some high profile stories are getting media attention and calling us to note the relatively high number of cases among gay men in recent years, it's important to emphasize that it happens everywhere to everyone. There have been five deaths from cases tracked to Tijuana this year already, for example, in addition to one 18-year-old woman who had to have all of her limbs amputated

The symptoms are usually vague at the start: fever, headache, poor appetite, nausea, sore throat, etc. Roughly 12 to 15 hours later, things can start to look more unique: neck stiffness, sensitivity to light -- kids especially can get leg pain, cold hands and feet, and changes in skin color. 42 to 70 percent will then develop a classic rash that's associated with Neisseria meningitidis, the bacteria that killed the aforementioned people. By 24 hours, we can see unconsciousness, delirium, or seizures. 

But even that timeline is hazy, and there are case reports where people go from initial symptoms to death within hours.

That's terrifying, I know. How do you know when to take vague cold-like symptoms seriously? Well, first thing to note, there is a vaccine. The AIDS Healthcare Foundation is setting up vaccination clinics around Los Angeles right now, though apparently they are already running out of vaccines. And again the fact that it's the AIDS Healthcare Foundation does not mean meningitis spreads like HIV.

AIDS Healthcare Foundation's meningitis vaccination clinics in Los Angeles

Neisseria meningitidis vaccination is generally recommended for all adolescents, college freshmen living in dorms, military recruits, people traveling to places where infection is common, and people without functioning spleens. But as with anything like this, ask your doctor about it. People who were in close contact with someone diagnosed with Neisseria meningitidis will be treated with antibiotics regardless of symptoms. People who have been someplace where they have reason to believe they could have been exposed, like at the White Party or the Equinox on Sunset Boulevard on April 6, should keep an especially low threshold for getting the above symptoms checked out. 

At the moment that threshold happens to be lower within New York and southern California's the gay communities, but that is the extent of any association between sexual orientation and this disease.

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James Hamblin, MD, is a senior editor at The AtlanticHe is the host of If Our Bodies Could Talk.

 
 
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