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Shigella is a bacteria that causes an intestinal infection. It’s transmitted when infected faeces (poo) enters the mouth. Shigella is highly contagious and causes diarrhoea. While shigella is not exclusively sexually transmitted, sexual contact is a common transmission route, especially during anal play. Shigella will usually go away on its own, but antibiotic treatment can reduce the duration and severity of symptoms. 

Signs and Symptoms

If you experience symptoms, it will usually be within 12 hours – 4 days of exposure. Shigella often does not show any symptoms, but it is still very infectious when symptoms are not present. Left untreated, shigella can cause serious health problems, such as severe dehydration, blood infections and intestinal complications.

Symptoms and effects of shigella may include:

• Diarrhoea (watery, sometimes with blood and/or mucous)
• Vomiting
• Nausea
• Stomach pain and cramps
• Fever

For people living with HIV, shigella symptoms may be more serious and require hospitalisation. 

Transmission

Shigella is very infectious and easily passed on. It is present in the poo of a person carrying the bacteria in their body. It is transmitted from person to person through poo entering the mouth. You can still pass on or contract Shigella if symptoms are not present.

Sexual transmission of shigella can occur:

• Directly through rimming (anal-to-oral contact) or ass-to-mouth sex 
• Putting contaminated fingers in your mouth after anal fingering or fisting
• Putting contaminated fingers in your mouth after touching contaminated objects, such as used condoms, gloves and sex toys 
• Contact between contaminated objects, such as used condoms and sex toys, and your mouth

Shigella can also get into your body by contact between other contaminated objects and your mouth, such as cigarettes or cups that have come into contact with the bacteria. 

Shigella can also be transmitted indirectly through contaminated food and water. 

Prevention

To prevent shigella, be aware that tiny faeces (poo) particles can easily enter your mouth, especially when biting your nails, lighting a cigarette, preparing food, and sharing utensils such as cups, bottles, and household items. 

To help prevent Shigella transmission, you can:

• Wear gloves for anal play, such as fingering or fisting.
• Use a dam, plastic wrap or other barrier for rimming (you can even cut up a condom to lay it flat for this purpose).
• Change condoms between anal and oral sex with a penis, toy or other object.
• Wash your hands after anal sex.
• Wash your hands after handling condoms, gloves, or sex toys used for anal play.
• Wash and/or disinfect sex toys used for anal play after use.

It is recommended that you always change condoms when going from anal to vaginal or oral sex.

Testing 

Here’s some information about testing for Shigella. You can view a list of sex worker-friendly sexual health clinics on our Where To Test page.

Testing Method

• Stool test (poo sample)

When to Test

• If you have shigella symptoms  

Other Info

• Sexual health clinic testing is often bulk billed, even if you don’t have Medicare, so the test will most likely be free. 
• You may pay a fee or be bulk billed if you see a GP. 

Treatment

Shigella is curable. Here’s what you need to know about treating it.   

Treatment Method/s

• Shigella will usually go away without the need for antibiotic treatment.
• Drink plenty of fluids (use rehydration solutions like Hydralyte if needed) and get enough rest. 
• Oral antibiotics are used to reduce the duration of the symptoms in more serious cases.

Costs and Other Information 

• Treatment costs will depend on which antibiotic you are prescribed.
• Sexual health clinic treatments are often bulk billed, even if you don’t have Medicare, so the treatment may be free. 
• You may pay a fee or be bulk billed if you see a GP. 
• Shigella is curable, but you do not develop any immunity. It is possible to get another shigella infection.

There have been a number of shigella cases identified in Australia that are multi-drug resistant. This means that the available oral antibiotics are not able to cure the shigella infection. In these cases, patients have received intravenous antibiotics in the hospital. 

How might this impact my work? 

Practical Considerations

• You may not feel well enough to work.
• Diarrhoea can make it difficult to work.
• Doctors recommend avoiding sexual contact until after you stop having symptoms, as shigella is highly infectious. 
• If you cannot afford to take this time off work, you can also consider doing non-contact/online or phone sex work. 
• Some antibiotics can reduce the effectiveness of oral contraception (‘the pill’). 
• If you often get thrush when you take antibiotics, you may want to take probiotics during and after your treatment to help prevent this.
• You should inform any recent doubles partners if you test positive for shigella.

Legal and Reporting Considerations

• Shigella is a nationally notifiable disease in Australia, which means that diagnosed cases of shigella are confidentially reported to state or territory health departments. You can find more information on the requirements for your jurisdiction on our BBV, STI and the Law resource.