Infection Risks from Shared Equipment
Infections spread through shared equipment are among the most preventable health harms in sport and fitness. They range from fungal skin infections picked up from mats and towels to blood-borne viruses transmitted through shared injecting equipment. Our editorial team outlines the main risks, the evidence from UK surveillance and the simple measures that cut transmission.
Why shared equipment matters
Any object that contacts skin, blood or body fluids and then passes to another person can carry microbes. The risk depends on the type of contact: surface contact with intact skin carries a far lower risk than anything that breaches the skin.
In gyms and sports clubs, the commonest problems are skin infections such as athlete’s foot, ringworm (tinea), impetigo and bacterial infections including methicillin-resistant Staphylococcus aureus (MRSA). A review of outbreaks in competitive sport by Turbeville and colleagues found skin infections, particularly in contact sports, to be a recurrent problem.
A more serious category involves blood-borne viruses — hepatitis B, hepatitis C and HIV. These can be transmitted when needles, syringes or other injecting equipment are shared, but also, less commonly, through razors, nail clippers or tattooing equipment contaminated with blood.
In the UK, people who inject image- and performance-enhancing drugs (IPEDs) are now a substantial group using needle and syringe programmes, which is why public health bodies pay attention to this population.
Blood-borne viruses and injecting equipment
Hope and colleagues carried out a large cross-sectional study of men in the UK who inject image- and performance-enhancing drugs. They found evidence of exposure to HIV, hepatitis B and hepatitis C, with rates higher than in the general population, and identified sharing of injecting equipment among the risk factors.
Transmission does not require visibly shared needles. Viruses, particularly hepatitis C, can survive in tiny amounts of blood on syringes, vials, filters, water and surfaces. Multi-dose vials that are accessed with different needles can become contaminated for everyone who uses them afterwards.
| Infection | Main shared-equipment routes | Key point |
|---|---|---|
| Hepatitis C | Needles, syringes, vials, other injecting equipment | Often symptomless for years; effective NHS treatment available |
| Hepatitis B | Needles, razors, toothbrushes | Preventable by vaccination |
| HIV | Needles and syringes | Lower transmission efficiency than hepatitis C, but lifelong without treatment |
| Bacterial abscesses and sepsis | Non-sterile injection, poor technique | Can require surgery; sepsis is life-threatening |
| MRSA and staph infections | Towels, razors, mats, benches | Spread by skin contact and contaminated surfaces |
| Fungal infections (tinea) | Mats, showers, towels, footwear | Common in combat sports |
Bacterial infections at injection sites are another major issue. UK Health Security Agency reports on injecting-related harms consistently show abscesses and other bacterial infections as frequent problems among people who inject drugs. Non-sterile products from illicit sources add further risk.
This article does not provide guidance on using unlicensed substances. The safest choice is not to inject drugs that have not been prescribed. For anyone who does, harm-reduction services exist precisely to reduce infections and other harms.
UK harm-reduction services
Needle and syringe programmes (NSPs) operate across the UK, often in pharmacies and drug services. NICE public health guideline PH52 recommends that these services be accessible to everyone who injects, including people using IPEDs.
- Sterile equipment free of charge and safe disposal of used items.
- Confidential testing for hepatitis B, hepatitis C and HIV.
- Hepatitis B vaccination.
- Advice on wound care and recognising infection early.
- Referral to GPs, sexual health and specialist services.
National surveys of IPED users led by Liverpool John Moores University have tracked behaviours and service use over time, helping services adapt to this population.
Hepatitis C is now curable in most cases with short courses of oral antiviral medicines available on the NHS. Testing is the first step, and many services offer simple finger-prick tests.
Anyone who has ever shared injecting equipment, even once and many years ago, should consider testing. Early diagnosis protects both personal health and other people.
Everyday hygiene in gyms and sports clubs
For the majority of gym users, the main shared-equipment risk is skin infection. Kirkland and Adams reviewed MRSA in athletes and highlighted skin trauma, shared items and close contact as key risk factors.
- Wipe benches, mats and handles before and after use.
- Use your own towel and never share razors or nail clippers.
- Wear flip-flops in changing rooms and showers.
- Cover cuts and grazes with a clean dressing.
- Shower promptly after training, especially after contact sports.
- Wash training kit after every session.
Clubs in combat sports often carry out skin checks before training or competition. Athletes with suspicious lesions should avoid contact training until assessed.
Signs that need medical attention include a red, hot, swollen or painful area of skin, pus, spreading redness, fever or feeling generally unwell.
Tattoos, piercings and other procedures
Tattooing and piercing involve breaking the skin and therefore carry potential blood-borne virus risks if equipment is not sterile. In the UK, tattoo and piercing businesses must be registered with their local authority, which sets hygiene standards.
Choose licensed premises, check that single-use needles are opened in front of you, and avoid informal or home tattooing.
Cosmetic injections, including fillers and anti-wrinkle treatments, should be performed by appropriately qualified practitioners. Complications from unregulated providers have prompted government action in England to tighten oversight.
Whatever the setting, the principle is the same: anything that breaks the skin should be sterile and single-use or properly sterilised between clients.
Conclusions of the editorial team
Shared equipment can spread infections ranging from athlete’s foot to hepatitis C and HIV. The risk rises sharply when equipment breaks the skin or contacts blood.
UK data show that people injecting image- and performance-enhancing drugs face elevated rates of blood-borne viruses and bacterial infections. Not injecting unprescribed substances is the safest choice; free NHS and local services exist to reduce harm and offer testing.
In gyms, simple hygiene — own towel, no shared razors, wiping equipment, covering cuts — prevents most skin infections.
You might also read our articles on liver blood tests, on the HPG axis, and on ursodeoxycholic acid.
References
- Hope VD, McVeigh J, Marongiu A, et al. Prevalence of, and risk factors for, HIV, hepatitis B and C infections among men who inject image and performance enhancing drugs: a cross-sectional study. BMJ Open. 2013;3(9):e003207.
- National Institute for Health and Care Excellence. Needle and syringe programmes. Public health guideline PH52. London: NICE; 2014.
- Turbeville SD, Cowan LD, Greenfield RA. Infectious disease outbreaks in competitive sports: a review of the literature. Am J Sports Med. 2006;34(11):1860–1865.
- Kirkland EB, Adams BB. Methicillin-resistant Staphylococcus aureus and athletes. J Am Acad Dermatol. 2008;59(3):494–502.
- Begley E, McVeigh J, Hope V. Image and performance enhancing drugs: 2016 national survey results. Liverpool: Liverpool John Moores University; 2017.
- UK Health Security Agency. Shooting Up: infections and other injecting-related harms among people who inject drugs in the UK. London: UKHSA (published annually).
