What is Shigella—and why should gay men know about it?

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Health experts in the UK have warned of a rise in antibiotic-resistant Shigella. The gut infection is passed on through any sort of fecal-oral contact (i.e. getting a tiny bit of infected poo into your mouth).

This is often through food contamination—but also some sexual practices. Around half the cases in the UK are linked to sex, and it disproportionately affects gay and bisexual men.

Despite this, it’s an infection that many men know little about compared to STIs like chlamydia and gonorrhea.

The UK Health Security Agency (UKHSA) issued its warning after detecting 47 cases in the four months between September 1, 2021 and January 10, 2022. That’s three times as many cases as in the 17 months before this (April, 2020 to August 2021).

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UKHSA has tracked this particular strain of Shigella since 2018 and says recent cases show that resistance to antibiotics is increasing.

In the US, figures from 2018 state that Shigella causes an estimated 500,000 illnesses, 6,000 hospitalizations, and 40 deaths annually. The CDC has also noted a rise in Shigella resistant to antibiotics.

So what is it and how concerned should you be?

What is Shigella?

Shigella is a bacteria that causes gut problems and stomach upsets (often called shigellosis). Symptoms usually include diarrhea—which may be bloody—stomach cramps and fever. If there’s blood in your diarrhea, it’s often referred to as dysentery.

Some people will have no symptoms or just mild ones. The symptoms usually start 1-2 days after infection and can last up to a week. People often mistake a Shigella infection for food poisoning.

How do you catch it?

The bacteria is found in feces (poo). It can be passed on through food contamination or sex. The latter includes rimming, touching a used condom, handling sex toys, or if you finger someone’s butt and then happen to touch your mouth. Consuming just a tiny amount of bacteria can lead to infection.

What should I do if I think I’ve got Shigella?

Most cases of Shigella will resolve themselves without the need for medical intervention. However, if you think you’ve got it, speak to your physician. If infected, you’re advised to stay away from work and to avoid having sex for a week until after the symptoms go away.

Be sure to wash your hands thoroughly after going to the toilet and before you touch food.

Do not prepare food for others while you are ill, and wash your clothes, bedsheets and towels at a high temperature to kill any infection. Also, if you’re infected, take care to clean door handles and toilet flushes often if you share your living space.

Avoid sharing towels, flannels, hot tubs and swimming pools to minimize the risk of passing the infection on.

To help with the symptoms, drink plenty of fluids and use oral rehydration solutions if necessary to avoid dehydration.

How do I reduce my risk of catching Shigella?

Experts recommend wearing condoms during sex and ensuring you wash your hands afterward.

Avoid touching your hands to your face if you’ve been playing with a guy’s butt or sex toys. Consider wearing latex gloves if fingering or fisting someone, or, if rimming, using some sort of barrier, like a dental dam.

We don’t know any gay men who are fans of dental dams, and many have also stopped using condoms, but we can all try to keep ourselves clean, both before and after sex. And if you’ve had any sort of stomach upset, warn your partner so they can decide whether they want to rim or avoid that area.

Dr. Gauri Godbole, Consultant Medical Microbiologist at UKHSA, said: “Practising good hygiene after sex is really important to keep you and your partners safe. Avoid oral sex immediately after anal sex, change condoms between anal or oral sex and wash 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.”

Is it worth getting tested if the infection tends to pass on its own?

Shigella is highly infectious, so if you’ve got it, being diagnosed and taking the necessary steps to avoid passing it on is the most community-minded thing to do. It might not impact you badly, but it could be worse for others.

Speak to a doctor if, after a sexual encounter, you have diarrhea which lasts for more than three days, if you notice blood in your diarrhea, or if you have a fever or bad stomach cramps. If you have symptoms and have a weakened immune system, it’s also wise to seek medical advice. Explain to them that you’re concerned about Shigella so they make sure you get the right tests.

If you have a bad case of Shigella, you may be put on antibiotics or may need hospital treatment. Being tested for the bug ensures you get the right sort of antibiotics.

Lastly, if you are diagnosed with Shigella, tell your recent sexual partners so they can be tested, too.

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