Typhoid fever was sexually transmitted to seven gay men, some of whom were HIV-positive in the United States in summer 2000, according to a report in the July 1st edition of the journal Clinical Infectious Diseases.
Food and waterborne transmission of typhoid fever can be caused by faecal contamination with the Salmonella enterica serotype Typhi bacteria, and most cases in the US occur amongst individuals who have traveled to countries where typhoid fever is endemic.
Symptoms of typhoid fever include fever, weight loss, headache, malaise, nausea, abdominal pain, dry cough and muscle pain.
In August 2000 the Ohio health department reported a cluster of four men with typhoid fever. All the men were gay and none reported foreign travel. This led health officials to initiate hospital and laboratory surveillance for typhoid fever. Hospital emergency department records were also reviewed for probable cases.
A total of six symptomatic cases, two probable cases and one asymptomatic case (patient A) were identified.
Some of the men were also HIV-positive (the number is not supplied by the investigators), and had an average CD4 cell count of 530 cells/mm3 and HIV viral load of 57,000 copies. None were taking HAART.
Public health officials attempted to establish a source for the outbreak and asked the men which venues serving food and drink they had used and about their sexual practices.
All but one man reported having sex with patient A in the month before they became ill. Although the other man denied having had sex with patient A, he had been his weekend houseguest.
Patient A had experienced a typhoid-like illness in May 2000 after returning from Puerto Rico, when he went to a hospital emergency department with a three day history of fever, chills, malaise and muscle pain. He made a full recovery within days and no specimens were obtained for culture at this time. However, stool samples obtained after the man was identified as the probable source of the outbreak confirmed the presence of typhoid fever.
The seven men who had sex with patient A as the source of their infection reported having had oral–anal, oral-genital, or protected anal sex with him.
All the men responded to antibiotic treatment.
The investigators conclude “that this outbreak of infection resulted from sexual transmission of S. Typhi amongst men.” They note that other gut infections can be spread by oral-anal and oral-genital sex and that there were two earlier case reports of probable sexual transmission of typhoid fever amongst gay men in 1977, although investigators did not ask specific questions about the types of sex the men were having.
Traditional HIV safer sex methods did not prevent the current outbreak. Although none of the men reported unprotected anal sex, “oral-anal or penile-oral contact after anal insertive intercourse can allow ingestion of enteric pathogens whether or not a condom is used.”
Further information on this website
Preventing infections - factsheet
Reller ME et al. Sexual transmission of typhoid fever: a multistate outbreak among men who have sex with men. Clinical Infectious Diseases 37 (on-line edition), 2003.