By TheDoctor – MuscleTalk Moderator
Infection can be a potential complication of any injection, due to the very nature of traversing the protective barrier of the skin when injecting. It is imperative to inject under strict sanitary and sterile conditions, to avoid transmitting infectious organisms/ foreign particles into the body.
Common infective complications of those injecting Anabolic Steroids include cellulitis and abscesses1.
The word ‘cellulitis’ literally means inflammation of the cells (not to be confused with cellulite – the lumpy fat often found on thighs, and buttocks). It generally indicates an acute spreading infection of the skin (dermis and subcutaneous tissues) resulting in pain, erythema (redness), oedema, and warmth of the affected area.
Cellulitis can spread in the skin and involve the lymphatic system causing lymphangitis. Swollen glands (lymphadenopathy) may also be present. It can be caused by many different types of bacteria, but the most common are Streptococcus and Staphylococcus aureus.
Specific oral antibiotics are given to control the infection, and analgesics may be needed to control pain. Elevating the infected area to minimize swelling and resting until symptoms improve, aid recovery which usually takes 7 to 10 days. In severe cases the patient may need to be hospitalized and receive antibiotics through the veins (intravenously).
An abscess is a localized collection of pus in any part of the body, usually caused by an infection. Abscesses occur when an area of tissue becomes infected and the body is able to ‘wall off’ the infection to keep it from spreading. During this process ‘pus’ forms, which is an accumulation of fluid, living and dead white blood cells, dead tissue, and bacteria or other foreign invaders or materials.
The majority of abscesses are septic (i.e. caused by an infection) but sterile abscesses can also occur which are not caused by germs but by non-living irritants such as drugs. If an injected drug, especially oil based ones such as many anabolic steroids are not fully absorbed, it stays where it was injected and may cause enough irritation to generate a sterile abscess.
Sterile abscesses are quite likely to turn into hard, solid lumps as they scar, rather than remaining pockets of pus2.
Superficial abscesses are readily visible and are red, swollen, painful and warm. Abscesses in other areas of the body may not be obvious and may produce only generalized symptoms such as fever and discomfort.
A sterile abscess may cause only a painful lump, for example deep in the buttock where a shot was given. If the abscess is small (less than 1 cm or less than a half-inch across), applying warm compresses/hot soaks to the area for about 30 minutes 4 times daily can help.
A culture or examination of any drainage from the lesion may help identify what organism is causing it. Most will continue to get worse without care. The infection can spread to the tissues under the skin and even into the bloodstream, resulting in septicaemia which can be very serious and life threatening3.
Unlike other infections, antibiotics alone will not cure a well developed abscess. In general an abscess must open and drain in order for it to improve. Sometimes draining occurs on its own, but generally it must be cut open by a doctor in a procedure called incision and drainage.
Once the sore has drained, the doctor will insert some packing into the remaining cavity to minimize any bleeding and keep it open for a day or two. With time the cavity will heal and one can expect to be out of action for a number of weeks. The healing process will involve scar tissue formation, and this may lead to a residual weakness in that muscle.
Searching the literature I found a number of cases of abscess complications, a few of which are mentioned below to highlight the pitfalls which should be avoided4.
Two cases of thigh abscesses were discovered in male and female professional weight lifters who injected a veterinary preparation of stanozolol contaminated with Mycobacterium smegmatis5.
A staphylococcal abscess occurred in a 24-year-old bodybuilder who reported, for financial reasons, reusing needles on multiple occasions6.
Two case reports of staphylococcal gluteal abscesses developed in young bodybuilders 18 and 21 years of age. The steroids were injected by other weight lifters who were not familiar with sterile injection technique7.
Pectoral and deltoid abscesses were reported in a 20-year-old anabolic steroid (AS) injector who had injected his AS preparation and then returned the needle to the vial to inject into another muscle group. The patient was thought to have contaminated his multi-dosage vial with skin flora and subsequently spread the infection8.
A counterfeit AS preparation contaminated with Pseudomonas spp was responsible for a deep gluteal abscess in one AS injector9.
The risk of contracting human immunodeficiency virus (HIV) or other blood borne diseases is rare. However there have been cases reported in the literature of this occurring10,11. Three separate cases of HIV infection occurred in male, heterosexual bodybuilders who shared needles that were used for AS injection on multiple occasions. One of the individuals who was diagnosed with HIV infection also acquired hepatitis B through shared AS needles11.
It is interesting to note that these cases were predominantly from the 1980’s and possibly the drug culture was different at the time, being much more underground. From my own experiences with steroid users and confirmed by research, sharing needles has never been prevalent in bodybuilding culture in the UK, compared with other drug users12.
With needles being cheap to buy and available for free at needle exchanges, there really shouldn’t be a risk of contracting blood borne infections by sharing injecting equipment. Unfortunately amongst a minority, there is still a trend to reuse needles and syringes and this should be actively discouraged in order to avoid the complications highlighted in this article.
Precautions to take
- Inject under strict sanitary conditions
- Use correct injection technique
- Avoid sharing or reusing needles
- Ensure medication is legitimate
- Evans NA. Local complications of self administered anabolic steroid injections. Br J Sports Med. 1997 Dec; 31(4): 349-50.
- Al-Ismail K, Torreggiani WC, Munk PL, Nicolaou S. Gluteal mass in a bodybuilder: radiological depiction of a complication of anabolic steroid use. Eur Radiol. 2002 Jun; 12(6): 1366-9.
- Herr A, Rehmert G, Kunde K, Gust R, Gries A. A thirty-year old bodybuilder with septic shock and ARDS from abuse of anabolic steroids. Anaesthetist. 2002 Jul; 51(7): 557-63.
- Dickinson BP, Mylonakis E, Strong LL, Rich JD. Potential infections related to anabolic steroid injection in young adolescents. Pediatrics. 1999 Mar;103(3):694.
- Plaus WJ, Hermann G The surgical management of superficial infections caused by atypical mycobacteria. Surgery. 1991; 110:99-105
- Maropis C, Yesalis CE Intramuscular abscess: another anabolic steroid danger. The Physician and Sports Medicine. 1994; 22:105-110
- Rastad J, Joborn H, Ljunghall S, Akerstrom G. Gluteal infection in weight lifters after injection of anabolic steroids. Lakartidningen. 1985 Oct 2; 82(40): 3407.
- Krauss MD, Van Meter CD, Robertson DW Be alert for “spot shot’ complications. Your Patient and Fitness. 1995; 9:12-14
- Bergman RT Contaminated drug supply. The Physician and Sports Medicine. 1993; 21:8
- Scott MJ, Scott MJ Jr. HIV infection associated with injections of anabolic steroids. JAMA 1989;262:207-8.
- Sklarek HM, Mantovani RP, Erens E, Heisler D, Niederman MS, Fein AM.AIDS in a bodybuilder using anabolic steroids. N Engl J Med 1984;311: 1701.
- Crampin AC, Lamagni TL, Hope VD, Newham JA, Lewis KM, Parry JV, Gill ON. The risk of infection with HIV and hepatitis B in individuals who inject steroids in England and Wales. Epidemiol Infect. 1998 Oct; 121(2): 381-6.