A gut infection spreading through sex is becoming harder to treat as antibiotic-resistant Shigella strains rise. The Centers for Disease Control and Prevention (CDC) analyzed nearly 17,000 Shigella samples from 2011 to 2023. In 2023, 8.5% of these samples were classified as extensively drug-resistant (XDR), resistant to all five antibiotics defined by the CDC. This marks a significant increase from zero cases between 2011 and 2015.
Dr. Tyler Evans, a California-based infectious disease specialist, noted the problem stems from bacteria changing, not an increase in infections. Though there is no FDA-approved oral antibiotic for XDR Shigella, transmission occurs when small amounts of stool reach someone’s mouth, often through contaminated food, water, or unwashed hands.
Dr. Andi Toufexis, a Texas family medicine physician, mentioned Shigella is not typically considered a sexually transmitted infection. However, it can spread through sexual contact if fecal matter is involved. The disease has been documented to spread sexually since the 1970s. Most XDR Shigella patients were adult men, particularly impacting men who have sex with men.
The CDC found that 86% of XDR patients were men, with a median age of 41. Nearly half of those with known HIV status were living with HIV. Others at higher risk include homeless individuals and people with weakened immune systems. Dr. Evans urges caution, not panic, regarding this infection.
While most Shigella infections resolve without intervention, severe cases may require treatment. Dr. Michael Aziz, an internist in New York City, suggests consulting a doctor if Shigella is suspected, advising against antidiarrheal medicines like Imodium due to their potential to slow the gut.
Preventive measures include handwashing, safe sex practices, and avoiding sexual activity if diarrhea symptoms are present until they have subsided for at least two weeks. Experts emphasize that feeling better doesn’t always mean the infection is gone.