'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).
Investigators 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.
The investigators 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.
Investigators from Public Health England wanted to get a clearer understanding of social and sexual risk factors for shigella infection among gay men.
They therefore 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%).
Injecting 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.
Commonly used 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.
The investigators 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 needle-exchange packs.
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.
Gilbart V High-risk drug practices associated with Shigella flexneri 3a infections amongst MSM in England and Wales. 3rd Joint BHIVA with BASHH Conference, Liverpool, 2014.