Staphylococcus aureus, or Staph, is a bacterium commonly found on the skin and in the nose of about 30% of the population. For most individuals, this presence is considered colonization, meaning the bacteria are carried without causing any symptoms or harm. The nasal passages serve as a primary reservoir where the bacteria can multiply. If the skin barrier is broken, Staph can transition into an active, problematic infection. When Staph causes an active infection or poses a high risk, professional medical evaluation and treatment are required to clear the bacteria.
Identifying Symptoms and Diagnosis
While colonization of S. aureus in the nose is asymptomatic, an active infection presents with noticeable and localized symptoms. Common signs include redness, swelling, and tenderness felt at the entrance of the nostrils or within the nasal vestibule. Patients may observe painful, pus-filled crusts or scabs forming just inside the nose, often accompanied by a small boil or pimple-like lesion known as nasal folliculitis.
An infection is triggered when the skin inside the nose is damaged, perhaps by nose-picking, excessive rubbing, or plucking nasal hairs, allowing the bacteria to enter the tissue. Once an infection is suspected, a healthcare provider will confirm the presence of the bacteria and determine the appropriate treatment through a diagnostic process.
Diagnosis involves a simple, quick nasal swab taken from the inside of the nostrils. This sample is sent to a laboratory for culture to confirm if S. aureus is present. The lab also performs antibiotic sensitivity testing, which determines if the strain is Methicillin-Resistant Staphylococcus aureus (MRSA) or a standard strain, guiding the selection of the most effective medication.
Prescription Treatment Options
Treating an active nasal Staph infection or eradicating colonization requires specific prescription medications directed by a physician. The most common initial approach involves topical decolonization, which directly targets the bacterial reservoir inside the nostrils. This method uses an antibiotic ointment, such as Mupirocin, typically applied twice daily.
Mupirocin ointment works by inhibiting the bacteria’s ability to synthesize proteins, leading to the eradication of S. aureus from the nasal passages. Patients apply a small amount into each nostril, then press the sides of the nose together to spread the ointment throughout the nares. The standard duration for this therapy is short, often just five days, though it may be extended up to ten days based on medical guidance.
For more severe cases, or if the infection has spread beyond the nasal cavity into the deeper layers of the skin or the bloodstream, oral antibiotics may be necessary. The choice of systemic antibiotic is determined by the sensitivity testing results from the initial nasal swab, ensuring the medication is effective against the specific strain of Staph. This tailored approach is important if the infection is identified as MRSA, which requires specific classes of antibiotics for treatment.
Patients must complete the full course of topical or oral medication exactly as prescribed, even if symptoms improve rapidly. Stopping treatment prematurely risks recurrence and promotes the development of antibiotic-resistant strains. If no improvement is seen after three to five days of treatment, the patient should contact their doctor for a re-evaluation.
Hygiene Practices to Prevent Recurrence
Maintaining strict hygiene practices is necessary to prevent Staph from recolonizing the nose after the active infection is cleared. Since the bacteria are easily transmitted via touch, frequent and thorough hand hygiene is the fundamental preventative step. Hands should be washed often with soap and water for at least 20 seconds, especially after touching the nose, before preparing food, or after using the bathroom.
Individuals should avoid sharing objects that come into contact with the skin or nose, as this is a major route of transmission. This includes towels, washcloths, razors, bedding, and nasal spray bottles. Because the bacteria can survive on surfaces, environmental cleaning is also a relevant part of prevention.
During an active infection or decolonization regimen, bedding and towels should be washed frequently in hot water to eliminate shed bacteria. Additionally, any cuts or breaks in the skin should be kept clean and covered with a sterile dressing. This prevents Staph from migrating and causing a widespread skin infection.
For individuals who experience recurrent Staph infections, a healthcare provider may recommend an enhanced decolonization protocol. This involves a short course of intranasal Mupirocin combined with daily body washes using an antiseptic cleanser, such as a chlorhexidine solution, for several days. This comprehensive approach helps reduce the bacterial load on the skin surface, lowering the overall risk of relapse.