UK | Rise in extremely drug-resistant Shigella in gay and bi men

Health experts in the UK are advising gay and bisexual men to take precautions to minimise the risk of Shigella, a sexually transmitted infection with growing antibiotic resistance.

On Thursday, the UK Health Security Agency (UKHSA) said it had detected a rise in cases of extremely antibiotic-resistant Shigella sonnei infections, mainly in gay, bisexual, and other men who have sex with men (MSM).

Shigella is a gut infection that causes diarrhoea (sometimes mixed with blood), stomach cramps and fever. It is caused by bacteria found in faeces. Sex that may involve anal contact or contact with faeces is one way that the infection can spread.

It is passed on through the faecal-oral route during sex, either directly or via unwashed hands and only a tiny amount of bacteria can spread the infection.

Symptoms are typically seen between one and four days after exposure and are commonly mistaken for food poisoning.

UKHSA said there have been 47 cases in the 4-month period between 1 September 2021 and 10 January 2022, compared to 16 cases in a 17-month period the previous year. UKHSA has been following this strain since 2018, but recent cases show resistance to antibiotics is increasing.

Shigella is very infectious. Although symptoms can be unpleasant, in most cases they will subside within a week, but some individuals need hospitalisation and require intravenous antibiotic treatment. Effective antibiotic treatments are limited for this extremely resistant strain.

Dr Gauri Godbole, Consultant Medical Microbiologist at UKHSA, explained that precautions to avoid Shigella centre on practising good hygiene after sex. This includes avoiding oral sex immediately after anal sex, changing condoms between anal or oral sex and washing your hands with soap after sexual contact.

“It’s important that gay, bisexual and other men who have sex with men do not dismiss their symptoms and speak to their GP or sexual health clinic, mentioning Shigella, if they are unwell,” said Dr Godbole.

Men with Shigella may have been exposed to other STIs including HIV, so a sexual health screen at a clinic or ordering tests online is recommended.

“If you have been diagnosed with Shigella, give yourself time to recover. Keep hydrated and get lots of rest. Don’t have sex until seven days after your last symptom and avoid spas, swimming, jacuzzis, hot tubs and sharing towels as well as preparing food for other people until a week after symptoms stop,” added Dr Godbole.