Potential Infections Related to Anabolic Steroid Injection in Young Adolescents

Abstract

To the Editor. In their article “Anabolic Steroid Use by Male and Female Middle School Students,” Faigenbaum et al1 indicate that 2.7% of middle school students (grades 5 through 7) report anabolic steroid use. Anabolic-androgenic steroids (AS) can be administered orally or intramuscularly; the latter is the route of administration for 50% of AS users.2 It has been indicated previously that 25% of students who report AS use share needles for injection.3 Therefore, this young and relatively uneducated AS user group is potentially at risk for infections related to injection. We conducted a MEDLINE (1966–1998) and AIDSLINE (1980–1998) world literature review to examine references that attributed infections to AS injection.We found infections attributable to the multi-person use of needles and syringes and improper injection techniques in 11 individuals. None of these cases were among children or younger adolescents. The mean age of these individuals was 25 years (mean, 18–37 years). Three separate cases of human immunodeficiency virus (HIV) infection occurred in male, heterosexual bodybuilders who shared needles that were used for AS injection on multiple occasions.4–6 One of the individuals who was diagnosed with HIV infection also acquired hepatitis B through shared AS needles.4 Two cases of thigh abscesses were discovered in male and female professional weight lifters who injected a veterinary preparation of stanozolol contaminated with Mycobacterium smegmatis.7 Two case reports of staphylococcal gluteal abscesses developed in young bodybuilders 18 and 21 years of age.8 The steroids were injected by other weight lifters who were not trained in sterile injection technique. A staphylococcal abscess occurred in a 24-year-old bodybuilder who reported, for financial reasons, reusing needles on multiple occasions.9 Pectoral and deltoid abscesses were reported in a 20-year-old AS injector who had injected his AS preparation and then returned the needle to the vial to inject into another muscle group.10 The patient was thought to have contaminated his multi-dosage vial with skin flora and subsequently spread the infection.10 A counterfeit AS preparation contaminated with Pseudomonas spp was responsible for a deep gluteal abscess in one AS injector.11 Immune suppression secondary to long-term AS use may have contributed to Candida albicans endophthalmitis in a 24-year-old athlete who reported a 2-year history of injecting AS.12Serious infections attributable to AS injection have been reported in young adult professional and recreational athletes. Many of these young adult athletes appeared to have limited education about sterile injection technique and limited access to sterile needles and syringes. It is doubtful that adolescent middle school students have better education or easier access to needles and syringes. Although a harm reduction model may be appropriate for older athletes with a longer history of use, it is of paramount importance to encourage adolescents to abstain from AS use and injection. Intervention strategies to lower the intent to use AS among adolescents should include education regarding the potential infectious complications related to injection. Further studies that examine the prevalence and incidence of blood-borne pathogens and behavioral studies of the injection practices among AS users are needed.This work was supported in part by the National Institutes of Health, National Institute on Drug Abuse K20 Grant DA00268 to Dr Josiah D. Rich.