Increase in Drug-Resistant Shigella Infections Among Gay Men In United Kingdom: A Growing Concern

Gay Health News: Shigellosis, a bacterial infection caused by Shigella species, has traditionally been associated with international travel. However, a recent study published in The Lancet Infectious Diseases reveals a concerning increase in drug-resistant Shigella infections among men who have sex with men (MSM) in England. The research highlights the need for increased awareness and preventive measures within the gay community.

https://www.sciencedirect.com/science/article/pii/S1473309922008076

Shigella species are transmitted through the fecal-oral route, but recent evidence shows that sexual contact among MSM is a common mode of transmission for Shigella sonnei and Shigella flexneri.

Alarmingly, in September 2021, a new strain of Shigella sonnei with extensive drug resistance, known as extensively drug-resistant (XDR) Shigella sonnei, was reported. This strain carries the plasmid-encoded blaCTX-M-27 gene, which produces an extended-spectrum beta-lactamase enzyme, making it resistant to multiple antibiotics.

The study analyzed cases of Shigella flexneri encoding the blaCTX-M-27 gene reported between September 2015 and June 2022 in England. A total of 26 cases were identified, all of which occurred in adult males with a median age of 37 years. It is worth noting that none of these individuals had a recent travel history to endemic regions.

Among the participants who completed questionnaires, 77% identified as MSM, and 54% reported engaging in sexual activities in the week before the onset of symptoms.

The most commonly administered antimicrobials were ciprofloxacin and azithromycin, with 54% of cases receiving antibiotic treatment. About 31% of the patients required hospitalization, with a median stay of five days.

The study also found that the blaCTX-M-27 gene in Shigella flexneri was located on plasmids similar to those found in the XDR Shigella sonnei strain. This suggests the possibility of horizontal transfer of the resistance gene between different Shigella species in community settings.

Interestingly, there was a significant reduction in Shigella flexneri serotype 2a cases in mid-2020, coinciding with the implementation of COVID-19 preventive measures. However, cases resurged later that year and have been increasing since then.

Corresponding and lead author, Ms Katie Thorley MSc from the UK Health Security Agency, London told GayHealth News, “The emergence of drug-resistant Shigella strains among the gay community raises concerns about treatment options and the potential for further spread of antimicrobial resistance. The study highlights the importance of ongoing surveillance and research to better understand the dynamics of Shigella transmission and resistance patterns. It also underscores the need for increased awareness and preventive measures among gay men to reduce the risk of Shigella infections.”

To address this public health issue, healthcare authorities should consider targeted interventions, such as educational campaigns and access to appropriate healthcare services, specifically tailored to the needs of the gay community.

Additionally, healthcare providers should be vigilant in diagnosing and treating Shigella infections, considering alternative antibiotic options when necessary.

The findings of this study serve as a reminder of the ongoing challenges posed by drug-resistant infections and the importance of practicing safe sexual behaviors.

By raising awareness and promoting responsible sexual practices, we can work towards reducing the transmission of drug-resistant Shigella strains and protecting the health and well-being of the gay community.

The study team concluded, “The increase in drug-resistant Shigella infections among the gay community in England is a cause for concern. The study highlights the need for targeted interventions and increased awareness within the gay community to prevent the further spread of antimicrobial resistance. By taking proactive measures and promoting responsible sexual practices, we can mitigate the risk of Shigella infections and safeguard the health of individuals within the gay community.”

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