Cases of drug-resistant shigellosis are on the rise according to a recent CDC Health Advisory which urges individuals to take precautions and healthcare providers to be vigilant in reporting suspected cases.
Shigellosis is an infection caused by Shigella bacteria. It is passed through feces (poop) and can be transmitted in many non-sexual ways including contaminated food, drinking water, swimming pools, and even a handshake with someone who didn’t wash their hands thoroughly. Many cases, however, are linked to sexual activities in which someone’s mouth comes in contact with an anus, hand, penis, or sex toy that has not been fully cleaned (even microscopic amounts of infected poop can make someone sick).
Most shigellosis surveillance systems don’t ask about sexual behavior, so it is hard to know how many of the estimated 450,000 cases each year in this country are sexually transmitted. In recent years, however, the CDC has noted a number of outbreaks among men who have sex with men.
The primary symptoms of shigellosis are diarrhea (often bloody), intestinal cramping, and fever. While most cases of shigellosis resolve on their own in a few days, some require medication which can shorten the number of days a person suffers from diarrhea. This can be important from a public health perspective because it also shortens the number of days a person is contagious and can spread the infection.
Some strains of Shigella—called XDR—have become resistant to many of the available drugs, including ampicillin, azithromycin, ciprofloxacin, ceftriaxone, and trimethoprim-sulfamethoxazole (TMP-SMX). In 2015, there were no cases of shigellosis caused by XDR strains in the United States, but by 2022 these antibiotic-resistant cases made 5% of all cases in country. Because there is not yet research on what antibiotics or combination of antibiotics might work best in cases of drug-resistant Shigella, the CDC does not have specific recommendations for providers.
The good news is that while it spreads quickly, shigellosis is preventable. Frequent handwashing, especially after going to the bathroom, can help stop the spread. People who have diarrhea should avoid preparing food, swimming, or using a hot tub until seven days after the symptoms subside.
The best way to avoid sexually transmitted Shigella is to wash all body parts and sex toys frequently. You never want to put anything (finger, penis, or sex toy) that has been near or in the anus directly into someone’s mouth without washing it first. Condoms can also help prevent infection because you can use a new one every time you change sexual activities.
Shigellosis is often misdiagnosed since it presents more like a stomach bug than an STI. If you’re experiencing symptoms, you should let your doctor know about any sexual activity that may have exposed you to Shigella. Healthcare providers should also ask patients with potential shigellosis symptoms about their recent sexual behavior.