Sexual Health – Shigella
Shigella dysentery on the rise among gay and bisexual men
From: Public Health England
First published: 30th January 2014
PHE raising awareness of Shigella infection risk among gay and bisexual men in England.
A new campaign to warn gay and bisexual men about the risk of Shigella dysentery is being launched today by Public Health England (PHE) in partnership with Terrence Higgins Trust (THT), as new figures show a surge in cases likely to have been sexually-acquired over the past 12 months. In the UK, ‘Shigella flexneri’ usually affects similar numbers of men and women and is linked with overseas travel, but 2013 data show an excess of more than 200 cases of the infection in men with no or unknown travel history, compared to women.
London is most affected.
Shigella is a serious gut infection causing severe, prolonged diarrhoea and stomach cramps. Among gay and bisexual men, Shigella is usually passed on through the faecal-oral route during sex, either directly or via unwashed hands – only a tiny amount of bacteria can spread the infection.
Symptoms often develop around 1 to 3 days after sex, including:
Frequent and explosive diarrhoea lasting more than 48 hours
Feeling feverish with flu like symptoms
Some people report vomiting
Feeling weak and tired (accompanying the gastrointestinal symptoms)
Men experiencing Shigella symptoms are advised to visit their GP or a clinic, specifically mentioning Shigella and requesting a stool sample test. The infection is treatable with antibiotics. Risk of infection can be reduced by avoiding oral contact with faeces during sex and washing hands thoroughly and showering after sex.
Interviews with gay and bisexual men who caught the infection through sex found links to high numbers of partners, often met anonymously online or at sex parties.
For many, using drugs, such as mephedrone, methamphetamine (crystal meth), ketamine and GBL, before or during sex led to lowered inhibitions and riskier sex. Worryingly, 1 in 3 men using these drugs had injected them (known as ‘slamming’). Most of the men interviewed had not heard of Shigella before and thought they had food poisoning.
“Getting Shigella was the lowest point in my life. I suffered uncontrollable bloody diarrhoea with severe stomach cramps.”
“The ferocity of symptoms and dehydration headaches made me think I was going to die.”
“Initially I blamed it on a bad curry and held off visiting my GP for a week, but really wish I had gone straight away. Although it was treatable with antibiotics, the illness cost me a fortune as I had to take 6 weeks off work on statutory sick pay.”
As part of the awareness campaign, posters and leaflets are being distributed in nightclubs, saunas and other gay venues, plus sexual health clinics, highlighting the symptoms of Shigella, how it is transmitted and how to avoid it.
Dr Gwenda Hughes, Head of STI surveillance at PHE, said:
“Shigella is on the rise, so it is vital gay and bisexual men know about it and how to avoid getting it. We’re also seeing increasing HIV and gonorrhoea diagnoses among gay and bisexual men in the UK – indeed, most of the men with Shigella had been diagnosed with other STIs including HIV. This is a reminder how important it is to use a condom when having sex with casual and new partners.”
Cary James, Head of Health Improvement at THT, said:
“Although on paper the number of documented cases of Shigella are quite small, the concern is that not all cases are being reported. Men with symptoms who haven’t heard of Shigella before might assume it’s a particularly bad case of food poisoning. However, the infection can be dangerous, even more so if you’re already living with HIV or Hepatitis C.”
“We would urge anyone who is experiencing symptoms, or who’s concerned they may have been at risk, to call our free helpline THT Direct or visit the THT website.”
Dr Hughes continued:
“The Shigella awareness campaign is part of a broader commitment to helping improve the health of gay and bisexual men, including exploring the links between health and drug use. The level of injecting drug use is a particular concern as we know that this puts men at greatly increased risk of blood-borne viruses such as HIV and Hepatitis C.”
Individuals worried about Shigella or their drug use can find out more on the THT website – including finding a local service to visit for further advice.
Shigella is a severe bacterial gut infection. Infected people can spread the infection to others by direct physical contact or indirectly by contaminating food. Gay and bisexual men are particularly at risk. It is very infectious and can be transmitted through small amounts of faeces getting into the mouth during sex, either directly or via unwashed hands. It is easily treated with antibiotics.
Anyone who thinks they may have Shigella should visit a GP or sexual health clinic. Tell the doctor or nurse that you may have acquired Shigella through recent sex with men and that Public Health England advice states:
You need a stool test for Shigella and may need antibiotics.
Sexual orientation is not routinely collected for cases of Shigella in England and Wales. However, we are able to estimate possible numbers of gay and bisexual men that acquired ‘Shigella flexneri’ sexually in England and Wales by comparing the number of adult male cases with no or unknown travel with adult females with no or unknown travel. In 2009 there was an excess of 43 adult males cases in England and Wales with no or unknown travel, by 2012 this had risen to 172 and to date in 2013 there have already been 224 cases.
Gay and bisexual men can reduce the risk of getting HIV or an STI by:
Always using a condom when having sex with casual and new partners
Avoiding overlapping and reducing the number of sexual partners
If having unprotected sex with casual or new partners, getting an HIV/STI screen at least annually, and every 3 months if changing partners regularly
Note to Editors
A PHE letter published in ‘The Lancet’, (Vol 381, Issue 9875) reported the findings of in-depth interviews with men with Shigella. This letter is available from the Lancet website.
PHE data for the UK show a 37% increase in gonorrhoea diagnoses among men who have sex with men (MSM) between 2011 and 2012. HIV diagnoses among MSM have been rising steadily over the last decade and in 2011, the number of new diagnoses among MSM surpassed the number in heterosexuals in the UK for the first time since 1999. After adjusting for missing data, there were 3,250 new diagnoses among men who have sex with men (MSM) in 2012, the highest number ever reported, and a 10% increase from 2960 in 2011. In London, this increase was 14% with 1,400 diagnoses in 2011 and 1,600 in 2012.
For more information on HIV and STI data visit PHE’s dedicated web pages.
Public Health England’s mission is to protect and improve the nation’s health and to address inequalities through working with national and local government, the NHS, industry and the voluntary and community sector. PHE is an operationally autonomous executive agency of the Department of Health. www.gov.uk/phe Follow us on Twitter @PHE_uk
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What is shigellosis?
THT is the largest voluntary sector provider of HIV and sexual health services in the UK, running services out of local centres across Great Britain.
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THT Shigella Information PDF
7 things all gay men need to know about Shigella
10:54 23rd August 2016 by Terrence Higgins Trust
US Centers for Disease Control and Prevention – Medical Illustrator
Here’s a guide to what you need to know about the STI you’ve never heard of… and how to avoid it.
You might think it’s food poisoning…
Shigella causes severe diarrhoea and stomach cramps, and is often mistaken for food poisoning.
One man who got Shigella through rimming, said: “Initially I blamed it on a bad curry and held off visiting my GP for a week, but really wish I had gone straight away. Although it was treatable, I had to take six weeks off work.”
It only takes a tiny amount of bacteria to get Shigella.
“Shigella is caught from bacteria in faeces getting into your mouth during and after sex, either directly or via unwashed hands – and only a tiny amount of bacteria can spread the infection,” explains Cary James, Head of Health Promotion at Terrence Higgins Trust.
You can get Shigella by licking skin, condoms or toys which may have faeces on it – eg. when rimming, or giving oral sex after anal sex. Symptoms often develop around one to three days after sex.
Gay and bisexual men are at risk – especially in London, Brighton and Manchester
“New figures show a surge in cases likely to have been passed on during sex between men, so it’s vital gay and bisexual men know what it is and how to avoid it,” said Cary James.
In England, there was an excess of 500 male cases of Shigella without a known travel history compared to female cases in 2015. This is three times more than the number seen in 2011.
Now wash your hands!
You can lower your risk by washing your hands or taking a shower after sex, especially if your hands have been in or around his anus or you’ve been handling used condoms, sex toys or douching equipment. You should also change condoms between anal and oral sex and use latex gloves for fingering or fisting. To be extra safe, use a barrier for rimming (such as a square of latex).
You’ll need to cancel that spa day….
“A person with Shigella may be infectious for up to a month, so you’ll need to avoid sex, spas, Jacuzzis, hot tubs and sharing towels until a week after symptoms stop,” said Cary James.
“Also remember to wash your hands after using the toilet and before eating or preparing food, using warm water and soap, and avoid preparing food for other people while you’re ill or until a week after symptoms stop.”
“You’ll also need to wait for 48 hours after the symptoms stop before going back to work, or longer if you work with food or patients.”
Its easy to treat.
It’s not all bad news – a Shigella infection is treatable. Cary James advised:
“Visit your doctor or a sexual health clinic to get tested, explaining you may have picked up a gut infection from sex, possibly Shigella. The doctor needs to know this so you get the right tests and treatment. A full sexual health check-up including an HIV test is a good idea.”
You’re not alone.
Cary James added:
“Lots of people have questions about Shigella and how to avoid it, and there’s lots of advice and support out there for men who have sex with men.”
“We’re working with Public Health England on raising awareness of Shigella, highlighting the symptoms, how it is transmitted and how to avoid it.”
“Anyone who is worried can also contact THT Direct on 0808 802 1221 or go to NHS choices.”
You can find out more information about Shigella and get advice on other topics at tht.org.uk