'Chem sex' (taking recreational drugs during sex) and attendance at sex parties are
commonly reported by UK gay men with shigella infection, according to research
presented to the recent Joint Conference of BHIVA (British HIV Association) with BASHH (British Association for Sexual Health and HIV).
interviewed 42 men recently diagnosed with shigella. Overall,
three-quarters reported recreational drug use and a third reported “slamming”
– injecting drugs. Most of the men used specific sex-seeking websites and
smartphone apps to meet partners, leading to “dense” transmission networks.
believe their findings have important implications for sexual health prevention
work with gay men.
There is an
ongoing outbreak of shigella among gay and other men who have sex with men (MSM) in the UK. It is spread by
oral contact with contaminated faeces.The infection can cause severe diarrhoea
but can be cured with appropriate antibiotic therapy. Shigella cases in the UK
are typically associated with travel to countries where the infection is
endemic. Diagnoses among men in the UK without such a travel history increased
by 750% between 2005 and 2013. Most of these diagnoses involve gay and other MSM.
Public Health England wanted to get a clearer understanding of social and
sexual risk factors for shigella infection among gay men.
conducted in-depth interviews with 42 gay men with confirmed shigella
infection. The interviews were conducted in late 2012 and early 2013.
The interviewees had a
median age of 39 years, 91% were white and 79% were born in the UK. Almost two-thirds
(61%) were living in London and 59% were living with HIV.
The vast majority
(88%) of the men interviewed had not heard of shigella before their diagnosis with the
infection. When symptoms occurred, 56% attended their GPs where the infection
was frequently mismanaged. Symptoms were so severe that 29% presented to
A&E, and a quarter of these patients were admitted for inpatient care.
The men were highly
sexually experienced – the men living with HIV reported a median of 45 sexual
partners in the past year, and the HIV-negative men reported a median of 13 sexual partners.
All the men reported oral sex and oral-anal contact (rimming).
Men living with HIV
were significantly more likely than HIV-negative men to report unprotected
insertive and receptive anal sex in the two weeks before their shigella
diagnosis (p < 0.05). Approximately 60% of the interviewees who had HIV
reported unprotected insertive anal sex and 70% reported unprotected
receptive anal sex.
Men living with HIV
were also significantly more likely to report insertive/receptive fisting than
their HIV-negative counterparts, and were significantly more likely to have attended sex parties (p < 0.05).
Many of the men
reported meeting partners or arranging sex parties via sex-seeking websites and
the use of smartphone apps. The investigators believe this is creating transmission
networks of shigella.
Overall, 76% of
men reported use of recreational drugs. But analysis of drug use according to
HIV status showed that all the men living with HIV used drugs compared
to approximately 40% of the HIV-negative men.
Injecting drugs – slamming – was reported by 31% of interviewees, but rates were again higher among men living with HIV (approximately 40%
vs approximately 5%).
frequently occurred at sex parties and most of those injecting reporting being
injected by another individual. The investigators suggest men called injecting
drug use “slamming” in an attempt to de-stigmatise this behaviour.
recreational drugs included methamphetamine, GHB/GBL, mephedrone and ketamine,
with men living with HIV reporting higher rates of use of methamphetamine and
GHB/GBL compared to HIV-negative men.
believe their findings have implications for health promotion campaigns.
For gay men these
include raising awareness of the impact of drug use on sexual and general
health. The investigators also suggest that health promotion agencies should engage
with sex-seeking websites and that sexual health information should be put in
They also suggest
that GUM (genitourinary medicine) clinicians should discuss drug use with the people in their care and that GPs need
to be educated about the gay man’s increased risk of shigella.