2023-07-25 19:49:00
Since April 2023, more than 300 cases of shigelloseincluding a large number of infections Shigella sonnei multidrug-resistant, have been reported to the European Center for Disease Prevention and Control (ECDC).
These cases are linked to seven distinct national and international microbiological clusters, with chains of transmission primarily, but not exclusively, among gay, bisexual and other men who have sex with men (gbMSM). Cases have been reported in Belgium (26), Denmark (13), Germany (33), Ireland (50), the Netherlands (21), Spain (>60) and the United States (106). Most of the cases were recorded during the period 2022-2023, but some date back to 2016.
An increase in XDR Shigella sonnei infections among gbMSM has already been noted during the period 2020-2022.
All strains in these seven clusters show resistance to first- and second-line antibiotics, such as third-generation cephalosporins, fluoroquinolones, sulfamethoxazole and trimethoprim. The azithromycin resistance of some of the strains linked to these clusters is of particular concern, as it limits the possibilities for effective treatment.
The risk of transmission of shigellosis and other sexually transmitted infections (STIs) among gbMSM increases with the number of sexual contacts, for example during Pride and other international events. The spread of shigellosis among gbMSM also increases the risk of infection for their close contacts outside the gbMSM community.
Prevention and control
To minimize the risk of Shigella infection during sexual activity, practicing safer sex and practicing good personal hygiene are recommended. Appropriate use of protective measures against Shigellosis infection within the gbMSM community includes disposable gloves for fingering or fisting, dental dams during oral-anal sex, as well as changing condoms between anal and oral sex. It is recommended not to share sex toys and to ensure proper cleaning and disinfection after use and between partners. It is also important to wash your hands, genitals and anal areas before and after sexual contact.
If a person develops gastrointestinal symptoms, it is recommended that they abstain from sexual activity, pay close attention to personal hygiene, and seek health care to get tested for gastrointestinal pathogens and other STIs. It is important to inform the doctor that the infection may have been acquired through sexual activity. People with gastrointestinal symptoms should not handle or prepare food in eating establishments, and should avoid using public swimming pools, spas, and hot tubs while experiencing gastrointestinal symptoms.
Additionally, the gbMSM who has been diagnosed with shigellosis should avoid sexual activity for at least seven days after symptoms have completely resolved and oral-anal contact during intercourse for four to six weeks, as Shigella can be passed in the stool for up to six weeks. Additionally, sexual partners of patients diagnosed with shigellosis should be informed and encouraged to contact a healthcare professional, particularly if they work in settings requiring close interaction with the general public (e.g. healthcare, child care, food service establishments) or if they develop symptoms of infection.
It is important to educate clinicians and microbiology laboratories on the international spread of multidrug-resistant Shigella bacteria and to study the antibiotic susceptibility of Shigella for gastroenteritis cases in gbMSM to guide antimicrobial therapy. Physicians should be aware that in young adult males the route of acquisition may be sexual (particularly in those without a history of travel to a country with a known increased risk of shigellosis). It is essential to report cases of shigellosis to public health authorities and to send Shigella isolates to national reference laboratories in order to monitor the development of antimicrobial resistance and allow early detection and investigation of treatment failures. These should be reflected in updates to national and international treatment guidelines.
Source: European Center for Disease Prevention and Control (ECDC).
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