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Shigella dysentery on the rise in gay and bisexual men

An increasing number of sexually-acquired shigella dysentery cases have been reported in men who have sex with men (MSM), leading Public Health England to launch a new campaign. 

Last year, more than 200 additional cases were reported in men, compared to women. These men had no history of travel, although Shigella flexneri is usually associated with overseas travel. 

Shigella is a serious gut infection causing severe, prolonged diarrhoea and stomach cramps. 

Among MSM the infection 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 one to three days after sex, including: 

 - 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 faeces during sex and washing hands thoroughly and showering after sex.

'Food poisoning'

Interviews with MSM 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) or ketamine before or during sex led to lowered inhibitions and riskier sex. 

One in three 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.

Posters and leaflets are being distributed in nightclubs, saunas and other 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 the Terrence Higgins Trust, 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."

Dr Hughes added: “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.”