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Sex and shigellosis

Sex and shigellosis

Health Alert

In 2016, there have been several cases of shigellosis reported in King County that have been serious enough to lead to hospitalization.  Most of these cases were among gay and bisexual men who contracted Shigella in bathhouse settings or through anonymous sexual contact.  While Shigella bacteria are often transmitted through improper hygiene and travel to areas with contaminated water and food, among gay and bisexual men, the primary transmission route is through oral-anal contact – including rimming and anal intercourse. The bacteria can be spread from hand to mouth, such as through the handling of used condoms, fingering or sharing of sex toys or equipment.  Left untreated, shigellosis is of particular danger to those living with HIV.

Gay and bisexual men who've experienced 48 hours or longer of diarrhea are encouraged to visit their primary health care provider and get tested for Shigella. Without proper treatment, shigellosis can be serious – especially to HIV+ individuals. Avoid hospitalization by seeking treatment early in the illness.

Shigellosis is sometimes asymptomatic and even in cases where the symptoms have cleared, infected persons can still transmit the bacteria to others for up to two weeks, either through poor hygiene or sexual contact. Protect your partners by avoiding sexual contact until advised by your physician and maintain good hygiene by washing your hands with soap and water after using the restroom.

What is shigellosis?

Shigellosis is a highly contagious infection caused by a group of bacteria called Shigella. The bacteria are commonly found in the feces (poop) of infected people and up to two weeks after their symptoms have gone away. Some people have no symptoms, but can spread the disease to others.

What are the symptoms?

  • Diarrhea (often bloody)
  • Stomach cramps
  • Fever

How do you get it?

  • You can get shigellosis through contact with another person when the bacteria pass from his/her feces or fingers that haven't been washed into your mouth. This can happen during oral/anal sex play or oral stimulation of the anus.
  • You can also get shigellosis by eating food or drinking water that was contaminated by someone who has this infection.

Who gets it?

  • Anyone can get shigellosis, but men who have sex with other men (MSM) are more likely than other adults to get shigellosis. MSM also are more likely to get infected with Shigella that are resistant to some antibiotics (medicines used to treat this infection).
  • People with weakened immune systems (e.g., HIV +, cancer, etc) often get sicker than others and can develop a life-threatening blood infection from these bacteria.

How can I avoid shigellosis?

  • Avoid sexual activity with anyone who has diarrhea or who has recently had diarrhea.
  • Wash genitals, anus, and surrounding areas before, after, and between sex play.
  • Use condoms or other barriers like latex gloves or dental dams during oral sex, oral-anal sex, or anal fingering/fisting.
  • Use condoms with sex toys and wash with soap and water before, after, and between sex play.
  • Wash your hands with lots of soap and warm water often, especially before eating, before and after sex, or after helping someone who has gone to the bathroom (e.g. changing diapers).
  • While traveling overseas, follow food and water safety recommendations and wash hands with soap often.

What should I do if I think I have shigellosis?

  • See your doctor. Your doctor can test your stool to determine if you are infected, give you medicine to treat your infection if needed, and also test whether your infection is resistant to any antibiotics.
  • Wash your hands well with soap and warm water after going to the bathroom.
  • Don't have sex until 7 days after you no longer have diarrhea or other symptoms. You might have the bacteria in your feces for a couple of weeks after you are feeling better, so wash your hands and body well before having sex.
  • During oral-anal sex ("rimming"), use barriers, such as condoms, natural rubber latex sheets, dental dams, or cut-open non-lubricated condoms between your rectum and your partner's mouth to prevent your partner from getting sick. Use condoms during anal sex.
  • Don't prepare food for others while you are sick. After you are feeling better, be sure to wash your hands well with soap and warm water before preparing food for others.

NOTE: Washington state law requires health departments to restrict the activities of persons with Shigella in certain settings.

  • Food handlers, child care workers and healthcare workers with direct patient care should not perform these activities until they are no longer ill and have been instructed that it is safe to return to these activities by their local public health department.