Gay and bisexual men in UK warned of Shigella outbreak

Michael Carter
Published: 30 January 2014

Gay and bisexual men in the UK are being targeted with a new health information campaign warning them about a serious gut infection.

The joint Public Health England (PHE) and Terrence Higgins Trust (THT) campaign informs gay/bisexual men about the risks and symptoms of Shigella dysentery.

The infection is spread through oral-faecal contact and is usually linked to foreign travel. In 2009 there were only 43 cases among men in the UK that didn’t have a link to travel. But the number surged to 224 cases in 2013, and further reports are expected.

“Shigella is on the rise, so it is vital gay and bisexual men know about it and how to avoid getting it,” said Dr Gwenda Hughes, head of STI surveillance at PHE.

Posters and leaflets informing men about the infection are being distributed to nightclubs, saunas and bars and other gay venues, as well as sexual health clinics.

Shigella is a bacterial gut infection that causes severe, prolonged diarrhoea and stomach cramps. In gay and bisexual men, it is spread through oral contact with faeces, either directly due to sexual activities such as rimming (oral-anal contact) or via unwashed hands. Only tiny amounts of the bacteria can transmit the infection.

Symptoms usually develop one to three days after infection and include:

  • Frequent diarrhoea lasting more than 48 hours.
  • Stomach cramps.
  • Feeling feverish.
  • Vomiting.
  • Feeling weak and tired.

The infection can pose a serious health risk to HIV-positive individuals with weak immune systems.

Gay and bisexual men are being urged to avoid oral-faecal contact and to wash their hands thoroughly and shower after sex.

The potential severity of the symptoms is apparent in the experiences of one gay man who acquired the infection via rimming. “Getting Shigella was the lowest point of my life,” he said. “I suffered uncontrollable bloody diarrhoea with severe stomach cramps. The severity of the symptoms and dehydration headaches made me think I was going to die.”

Gay and bisexual men experiencing Shigella symptoms are urged to go to their GP or a clinic, mentioning Shigella and requesting a stool sample test.

The infection is treatable with antibiotics.

Interviews with men diagnosed with the infection have identified several risk factors:

  • High numbers of anonymous sexual partners met online or at sex parties.
  • Use of drugs during sex, including mephedrone, methamphetamine, ketamine and GBL.
  • Injecting drug use.

Most of the men with Shigella were also diagnosed with another sexually transmitted infection or HIV. “This is a reminder of how important it is to use a condom when having sex with casual and new partners,” said Hughes. “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 it puts men at greatly increased risk of blood-borne viruses such as HIV and hepatitis C.”

Cary James, head of health improvement at THT, expressed concern that not all cases of the infection were being reported. “Men with symptoms who haven’t heard of Shigella before might assume it’s a particularly bad case of food poisoning,” he said. “However, the infection can be dangerous, even more so if you’re already living with HIV or hep C.”

Further information about Shigella can be found here www.tht.org.uk/shigella and here www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Shigella

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