Public Health England ( PHE ) in partnership with Terrence Higgins Trust ( THT ) have launched an Shigella awareness campaign after new figures reveal an increase in infections in men with no travel history, likely sexually acquired. The species in question, Shigella flexneri, according to the PHE, “usually affects similar numbers of men and women and is linked with overseas travel”.

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 feces getting into the mouth during sex, either directly or via unwashed hands. It is easily treated with antibiotics.

Symptoms often develop around 1 to 3 days after sex and they include frequent and explosive diarrhea lasting more than 48 hours, stomach cramps, feeling feverish with flu like symptoms, some people report vomiting and feeling weak and tired (accompanying the gastrointestinal symptoms).

The PHE reports that in 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.

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.

Risk of infection can be reduced by avoiding oral contact with feces during sex and washing hands thoroughly and showering after sex.

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.”

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