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.
One of the men interviewed, who got Shigella through anal-oral sex (‘rimming’), said:
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 of 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