Bacterial Skin Infections in Wrestling and Other Combat Sports: Diagnosis, Prevention and Return-to-Play Criteria-A Narrative Review

Abstract

Background: Bacterial skin infections are a health concern in wrestling and other combat sports, where close physical contact, skin trauma, and shared equipment may facilitate transmission.

Aim: To summarize the epidemiology, clinical presentation, diagnosis, management, and prevention of bacterial skin infections in wrestling and other combat sports, and to compare National Collegiate Athletic Association (NCAA) and National Federation of State High School Associations (NFHS) wrestling return-to-play criteria.

Material and methods: This narrative review draws on selected publications identified through PubMed and supplementary guidance from sports governing bodies, public health organizations, and clinical resources. One author assessed and selected publications, and findings were synthesized narratively by topic.

Results: The conditions reviewed include impetigo, bacterial folliculitis, furuncles, carbuncles, cutaneous abscesses, erysipelas, cellulitis, and infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Clinical assessment is central to diagnosis, while microbiological testing supports pathogen identification and antibiotic selection when indicated. Prevention combines early recognition, wound care, personal hygiene, and environmental cleaning. Return-to-play decisions require assessment of lesion status, treatment duration, and the applicable organization’s rules.

Conclusions: Carriage and surface-contamination findings must be distinguished from clinical infection outcomes. Reports of combined outbreak interventions do not establish the effectiveness of individual measures, and evidence from other athletic populations cannot be directly generalized to all combat sports. Further studies should assess clinical infection rates and time lost from sport following preventive interventions.