Shigella

Shigella is a type of intestinal illness. Other intestinal illnesses include giardiasis, salmonellosis, and amoebiasis. Shigella is often asymptomatic and is very easily passed on. While Shigella is not exclusively a sexually transmitted illness, one common route of transmission is through sexual contact. When Shigella is left untreated, it can cause serious and potentially lethal health problems, such as severe dehydration, blood infections and intestinal complications. In some states and territories, the number of drug resistant Shigella notifications have increased. A significant number of these cases have been acquired through male to male sexual contact. The risk of transmission of Shigella can be significantly reduced through safer sex and increased hygiene practices. 

Transmission 

Shigella is very infectious and easily passed on. It is present in the faeces of a person who is carrying the bacteria in their body. It is transmitted from person to person through faecal particles entering the mouth. This can happen during sexual contact in a number of ways. Shigella can enter your system directly when rimming. You can also transmit Shigella through your fingers by contaminating your fingers when fisting, fingering or touching contaminated objects, such as used condoms and sex toys, and then placing your fingers in your mouth. Shigella can get into your system through putting other contaminated objects in 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. 

Signs and symptoms 

Symptoms for Shigella are characterised by stomach pains and cramps, frequent watery  diarrhoea (sometimes with pus or blood), fever and nausea. Symptoms can appear between 12 hours and four days after exposure. 

Shigella often does not show any symptoms, but it is still very infectious, even if symptoms are not present. 

Testing 

Testing for Shigella and other gut infections involves a laboratory test with a stool  sample. 

Treatment 

Shigella is usually self-limiting and resolves without any antibiotic treatment. However, for some people diagnosed (such as those living with HIV and others with chronic illness) with Shigella symptoms may be more serious and need treatment or even hospitalisation.  To help with dehydration, you may also be advised to drink lots of fluid. You can take over-the-counter oral-hydration treatments to assist with your rehydration. Generally, treatments to reduce the diarrhoea are not advised as they can be harmful. 

There have been a number of Shigella cases identified in Australia that are multi-drug resistant.  For this reason your doctor may want to wait for the result of antibiotic resistance testing before starting antibiotics.  Patients diagnosed with multi-drug resistance Shigella often need intravenous antibiotics in the hospital. 

Prevention

The risk of transmission of Shigella and other gut infections, like Giardia, can be significantly reduced by using safer sex practices, including using dental dams when rimming, using gloves when fisting and fingering, and washing your hands, toys, and other objects with disinfectant after engaging in any activity that may cause you to come into contact with another person’s faecal matter. 

Reference

Lane, C. R., Sutton, B., Valcanis, M., Kirk, M., Walker, C., Lalor, K., & Stephens, N. (2015). Travel destinations and sexual behavior as indicators of antibiotic resistant Shigella strains—Victoria, Australia. Clinical Infectious Diseases62(6), 722-729. 

Department of Health Victoria. (2010). Victorian Infectious Diseases Bulletin. 13(4). 

Department of Health NSW. (N/A). Shigellosis fact sheet. Retrieved from https://www.health.nsw.gov.au/Infectious/factsheets/Pages/shigellosis.aspx on 110419

Ending HIV 2020. (N/A). Shigella. Retrieved from https://endinghiv.org.au/sti/shigella/ on 110419.