An increase in locally acquired Shigella has been recently reported among men who have sex with men (MSM) in Sydney, NSW.

IMAGE: Two naked men embrace

In July 2016, the NSW Ministry of Health (NSW Health) alerted the community and clinicians of a Shigella outbreak amongst gay men in Sydney which was quickly contained. In June 2018, increased cases of locally acquired Shigella have been reported among men who have sex with men (MSM) in Sydney NSW.

What is it?
Shigella is a bacteria that causes a bowel infection, which usually results in diarrhoea, fever, nausea and stomach cramps with symptoms appearing any time between 12 hours and four days after exposure and generally lasts between four and seven days.  

Treatment of Shigella infection with antibiotics clears the bacteria and so makes a person non-infectious after a few days. Some people have no symptoms, but can still pass the infection on to others for weeks after their diarrhoea has stopped.

How is it passed?
Shigella bacteria are found in faeces and can also be present in contaminated food.  Shigella is highly infectious, regardless of whether or not a person is living with HIV (PLHIV).

Shigella is transmitted by contact with very small amounts of human faeces and can happen through sexual contact such as rimming, fingering, fisting, anal sex, handling used sex toys or used condoms, used douching equipment and oral sex or if particles are on your fingers and then touching your mouth.  It can also be transmitted by putting contaminated objects like pens, food, utensils and cigarettes into your mouth.

NSW Health Medical Epidemiologist Dr Christine Selvey said, “it is likely the notifications are just the tip of the iceberg as many people sick with shigellosis will recover without seeing their doctor or getting tested.”

How can I have fun and still prevent shigella?
“Basic hygiene and hand washing will reduce the risk of transmission,” said Craig Cooper, CEO of Positive Life.

- Wash your hands with warm water and soap, after sex, after using the toilet and before preparing food.
- Use a condom for anal sex, latex gloves for fingering and fisting, and a latex square for rimming.
- Share sex toys only if they’re washed and covered by a new condom each time they are used.
- Clean taps, door handles and the toilet with hot soapy water.
- Avoid preparing food for other people while you have symptoms.
- Don’t share towels

Who is at risk?
“The infection can be worse for people with a compromised immune system, such as PLHIV who are more likely to have severe symptoms which can result in hospitalisation,” said Craig Cooper, CEO of Positive Life.

If you have severe diarrhoea; blood in the diarrhoea; and a low CD4 cell count (less than 200 copies), see a doctor urgently.

"The most effective way of reducing the risk of contracting shigellosis is to wash hands thoroughly after any sexual activity,” said Dr Christine Selvey, “after touching equipment like used condoms and sex toys, after going to the toilet, and before handling food."

What can I do?
If you think you might have Shigella, ask your doctor for a test. If you are diagnosed with Shigella, it will usually disappear without antibiotics. Drink plenty of fluids to stay hydrated and rest. You could also use rehydration drinks to replace the salts and water that you have lost.

If you have a severe case of Shigella, your doctor can prescribe antibiotics. It is recommended you avoid having sex for seven days after your symptoms have cleared up.  It is best if you stay away from work, school, college, etc. for at least 48 hours after the last episode of diarrhoea or vomiting. Avoid contact with other people as much as possible while you’re infectious.

It’s also important to tell your recent sexual partner/s so they can get tested and treated. If you want any support to tell partners or fuck-buddies, contact a Positive Life Peer (someone who has been in your shoes) if you have any questions or concerns about STI diagnosis and disclosure on (02) 9206 2177.

More Information
- Shigellosis fact sheet (NSW Health)
- Need support to talk about an STI diagnosis?


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