Shigella

Shigella is a bacteria that causes an infection called shigellosis. Symptoms include diarrhea, which can be bloody or prolonged (lasting more than 3 days), fever, stomach pain, and feeling the need to poop even when the bowels are empty. It is very easily transmitted and even a small exposure can result in illness.

Background

Shigella is the leading cause of bacterial diarrhea worldwide and is typically spread via the fecal-oral route. This is usually through getting Shigella on your hands and then touching your mouth, eating food prepared by someone with the infection, swallowing contaminated water, or through exposure to the fecal matter of someone who currently has or has recently recovered from the infection during sexual contact.

Common ways that Shigella can be spread during sexual contact can be through having anal sex with someone who is infected, performing fellatio on someone who has had sex with someone who is infected, or through anal play such as fisting or fingering someone who is infected. It can also be spread through sharing contaminated lube.

Symptoms and treatment

It has very similar symptoms to Giardia: chronic diarrhoea, stomach cramps, bloating and nausea within 12 to 24 hours of infection.  Because of the risk of infecting others, and in terms of trying to track and manage the spread, if you have chronic diarrhoea for more than 48 hours you should contact your doctor or sexual health clinic and ask for a test.

Because of the chronic diarrhoea it is important that you keep hydrated, drink plenty of water and use a rehydration powder like Dioralyte to replace lost salts and electrolytes. Because of stomach cramps, bloating and nausea you may find it difficult to eat, in which case eating soup or protein or meal replacement shakes may help as a temporary measure.

Some strains of Shigella are antibiotic resistant, so testing is important to identify which antibiotics to use to treat the infection. In late 2023, the UK Health Security Agency reported that there ha been a rise in extremely drug-resistant Shigella sonnei bacteria.

You should not drink alcohol with the antibiotics for treating shigella. It is not a good idea to take Loperamide as your body is trying to get rid of the infection and doing so will inhibit this. The antibiotics should make you start to feel better in 2 to 3 days, but make sure you complete the full course of tablets because of the risk of resistance. If you are not sure you are fully recovered after completing the course of antibiotics, request a re-test from your sexual health clinic or doctor.

In the UK on testing positive for shigella, you will be contacted by the UK Health Security Agency via text message to track infections. They will ask you to complete a survey, but this is not required.

Risks

Chronic diarrhoea can result in dehydration, which if severe can result in hospitalisation. Stay hydrated, and use a rehydration powder to replace lost salts and electrolytes.

You may be unable to sleep through the night and carry out normal day to day activities with chronic diarrhoea.

Shigella is very easily spread through sexual contact, contaminated surfaces and inadequate hygiene. Hygiene is of the upmost importance, especially if living and sharing bathrooms with others.

Risk mitigation

Because Shigella is so easily spread, be very on top of your personal hygiene and clean the toilet after use and wash hands thoroughly, keep sinks and handwashing materials clean and use separate towels and wash them frequently.

When possible, use condoms, gloves, and avoid sharing lube.

Check with your partners about sexual health and ensure they are feeling well and healthy while before playing.

Typically Shigella is picked up at clubs and events where more anonymous sexual encounters are taking place and sexual health questions may not be asked. You need to evaluate your own risk acceptance of such play along with other sexual health measures.

External links

• https://www.cdc.gov/shigella/