Rise of Antibiotic-Resistant Shigella Infections Raises Concerns

<p>A gut infection known as Shigellosis, which can spread during sexual activity, is becoming increasingly difficult to treat due to the emergence of antibiotic-resistant strains. An April report from the Centers for Disease Control and Prevention (CDC) tracked nearly 17,000 Shigella samples collected between 2011 and 2023. In 2023, 8.5% of Shigella samples with resistance data were classified as extensively drug-resistant (XDR), meaning they are resistant to all five antibiotics defined by the CDC, compared to none from 2011 to 2015.</p><p>Dr. Tyler Evans, an infectious disease physician and CEO of Wellness Equity Alliance, noted that the findings indicate a growing resistance problem rather than a surge in overall infections. "The infection is not surging. The bacteria are changing," Evans stated. He added that there is currently no FDA-approved oral antibiotic for XDR Shigella.</p><p>Shigella bacteria can spread when small amounts of stool reach someone's mouth, which may occur through contaminated food or water, unwashed hands, or sexual activity. Dr. Andi Toufexis, a family medicine physician specializing in sexual health, explained that while Shigella is not typically classified as a sexually transmitted infection, it can be transmitted through sexual contact when one partner comes into contact with the other's fecal matter.</p><p>Sexual transmission of Shigella has been documented since the 1970s, but the proportion of tested samples classified as XDR is increasing. The CDC report indicated that most individuals with XDR Shigella were adult men, with 86% of patients being men and a median age of 41. Among those with known HIV status, nearly half were living with HIV. Individuals experiencing homelessness and those with weakened immune systems may also be at higher risk.</p><p>Children under the age of 5 are particularly susceptible to Shigella, with many outbreaks in the U.S. linked to child care facilities and schools. Historically, outbreaks primarily affected children and involved strains that were susceptible to antibiotics. According to the CDC report, 37.6% of patients with hospitalization data were hospitalized due to the antibiotic-resistant infection, although no deaths were reported among the analyzed XDR cases. The CDC noted that infections may be undercounted as not all positive specimens were cultured or tested for resistance.</p><p>Evans advised that Americans should be "concerned, not panicked" about the infection, while Toufexis mentioned that most Shigella infections resolve on their own, although severe cases may require treatment. Dr. Michael Aziz, an internist at Lenox Hill Hospital, emphasized the importance of seeking medical advice if Shigella is suspected and advised against taking antidiarrheal medications like Imodium, stating, "You want to flush out the bacteria, you want to get it out of your system."</p><p>To minimize the risk of infection, doctors recommend washing hands, genitals, and the anal area before and after sex, using condoms or dental dams, and cleaning sex toys after each use. If an individual or their partner has diarrhea, it is advised to avoid sexual activity and wait at least two weeks after symptoms have resolved before resuming sexual contact.</p>