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Home Topics Infectious Diseases Infections A-Z Shigella

Shigella

Shigella

Shigellosis, also called bacillary dysentery, is caused by 4 species; Shigella dysenteriae, Shigella flexneri, Shigella boydii and Shigella sonnei.

Bacillary dysentery is primarily a human disease often acquired by drinking water contaminated with human faeces or by eating food washed with contaminated water.

Man is the only significant reservoir of Shigella infection. In the UK most cases are associated with foreign travel, however, there are occasional reports of UK-acquired cases associated with sexual transmission, predominantly among men who have sex with men.

Infection can result following ingestion of as few as 10 organisms. The incubation period is between 12 and 96 hours. Illness is characterised by diarrhoea, sometimes with blood and mucus and is common amongst young children although infection can occur in all ages after travel to areas where hygiene is poor. Invasive disease is rare but extra intestinal complications such as Haemolytic Uraemic Syndrome can occur. Cases maintain a low level of infectivity for as long as the organism is excreted in the stool. Shigella species may survive for up to 20 days in favourable environmental conditions and this may lead to transmission through contact with contaminated fomites.

Recent increase in diagnoses seen in men who have sex with men in the UK

In July 2011, an increase in UK acquired cases of Shigella flexneri predominantly among men who have sex with men (MSM), aged between 30-50 years, some of whom were HIV positive, was identified in the Greater Manchester area. In London, an increase in Shigella flexneri was noted during 2010/11, some of which were seen in MSM.

The profile of the patients presenting with Shigella flexneri is similar to that associated with the ongoing outbreak of Lymphogranuloma venereum infection. Sexual transmission is likely to be fuelled by the low infectious dose, immunodeficiency due to HIV infection and serosorting (sex between partners with the same HIV status). Travel may also play a role in introducing Shigella species to at risk populations.

PHE/Terrence Higgins Trust campaign

Due to ongoing concerns about the surge of cases during 2013 among men who have sex with men, Public Health England (PHE) in partnership with Terrence Higgins Trust (THT) has produced a new poster and leaflet for use in clinics, gay bars, and sex-on-premises venues.

Shigella leaflet (PDF, 2.1 MB) 

Shigella posters (PDF, 4.1 MB)

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. These include:

  • frequent and explosive diarrhoea lasting more than 48 hours
  • stomach cramps
  • 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 faecal material during sex
  • washing hands thoroughly and showering after sex

Information for healthcare professionals

Health protection teams and health professionals who work in sexual health have been asked to be alert for cases of Shigella flexneri acquired in the UK among MSM.  A stool culture should be obtained from patients presenting with acute diarrhoea and microbiologists should refer Shigella isolates to the Reference Laboratory, Colindale according to their usual protocol. To help interrupt onward transmission, patients with laboratory confirmed infection should be treated with ciprofloxacin, subject to antimicrobial sensitivity. The emergence of ciprofloxacin resistance should be monitored closely and, if necessary, antimicrobial treatment switched to ensure treatment remains effective.

Further details of the outbreak investigation and recommended measures for infection control are available in the Health Protection Report.

How men can lower the risk of getting Shigella from sex:

  • wash your hands (and anus and penis too if you can) during and after sex, especially if you’re rimming, fingering or handling used condoms and sex toys.
  • using condoms for anal sex and latex gloves for fingering or fisting offers protection. A condom can be cut into a square to make a barrier for rimming.
  • avoid sharing sex toys or douching equipment.
  • there is a risk of Shigella from licking skin which had bacteria on it, like the buttocks, groin, penis or skin near the arse. So after sex having a shower is even better than a wash.

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 three months if changing partners regularly