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Shigella on the rise among gay and bisexual men

PHE launches campaign to inform gay men about Shigella dysentery

Ingrid Torjesen

Thursday, 30 January 2014

There has been a surge in cases of Shigella dysentery which is likely to have been sexually acquired in the past 12 months, new figures show.

As a result Public Health England has launched a new campaign in partnership with the Terrence Higgins Trust to warn gay and bisexual men about the risk of Shigella dysentery.

In the UK, Shigella flexneri usually affects similar numbers of men and women and is linked with overseas travel, but there has increasingly been an excess of the infection in men with no or unknown travel history, compared to women. These men affected were most likely to live in London.

In 2009 there was an excess of 43 adult male cases in England and Wales with no or unknown travel, by 2012 this had risen to 172 and in 2013 there were at least 224 cases and likely to be more, as information has not been collated yet on all cases for 2013.

Among gay and bisexual men, Shigella is usually passed on through the faecal-oral route during sex, either directly or via unwashed hands. Symptoms often develop around 1 to 3 days after sex and include frequent and explosive diarrhoea lasting more than 48 hours, stomach cramps, feverish flu-like symptoms and occasional vomiting. The infection is treatable with antibiotics and 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. Most of the men interviewed had not heard of Shigella before and thought they had food poisoning.

Cary James, head of health improvement at 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 Gwenda Hughes, head of STI surveillance at Public Health England, said the Shigella campaign was part of a wider initiative to reinforce the need for gay men to practice safe sex. “Shigella is on the rise, so it is vital gay and bisexual men know about it and how to avoid getting it,” she said. “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.”

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