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PHE warns of Shigella Dysentery rise in gay and bisexual men

A new campaign to warn gay and bisexual men about the risk of Shigella dysentery is being launched today by Public Health England (PHE) in partnership with Terrence Higgins Trust (THT), as new figures show a surge in cases likely to have been sexually-acquired over the past 12 months.

* Shingella is a serious gut infection
* Can cause prolonged diarrhoea and stomach cramps
* Can be caught through Oral sex and Rimming

In the UK, Shigella flexneri usually affects similar numbers of men and women and is linked with overseas travel, but 2013 data show an excess of more than 200 cases of the infection in men with no or unknown travel history, compared to women. London is most affected.

GUT INFECTION
Shigella is a serious gut infection causing severe, prolonged diarrhoea and stomach cramps. Among gay and bisexual men, Shigella is usually passed on through the faecal-oral route during sex, either directly or via unwashed hands – only a tiny amount of bacteria can spread the infection.

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Symptoms often develop around 1-3 days after sex, including:
· Frequent and explosive diarrhoea lasting more than 48 hours
· Stomach cramps
· Feeling feverish with flu like symptoms
· Some people report vomiting
· Feeling weak and tired (accompanying the gastrointestinal symptoms)
Men experiencing Shigella symptoms are advised to visit their GP or a clinic, specifically mentioning Shigella and requesting a stool sample test. The infection is treatable with antibiotics. Risk of infection can be reduced by avoiding oral contact with faeces during sex and washing hands thoroughly and showering after sex.

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Interviews with gay and bisexual men who caught the infection through sex found links to high numbers of partners, often met anonymously online or at sex parties. For many, using drugs, such as mephedrone, methamphetamine (crystal meth), ketamine and GBL, before or during sex led to lowered inhibitions and riskier sex. Worryingly, one in three men using these drugs had injected them (known as ‘slamming’). Most of the men interviewed had not heard of Shigella before and thought they had food poisoning.

CAUSES OF SHIGELLA
One of the men interviewed, who got Shigella through anal-oral sex (‘rimming’), said: “Getting Shigella was the lowest point in my life. I suffered uncontrollable bloody diarrhoea with severe stomach cramps. The ferocity of symptoms and dehydration headaches made me think I was going to die. Initially I blamed it on a bad curry and held off visiting my GP for a week, but really wish I had gone straight away. Although it was treatable with antibiotics, the illness cost me a fortune as I had to take six weeks off work on statutory sick pay.”
As part of the awareness campaign, posters and leaflets are being distributed in nightclubs, saunas and other gay venues, plus sexual health clinics, highlighting the symptoms of Shigella, how it is transmitted and how to avoid it.

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ON THE RISE
Dr Gwenda Hughes, PHE head of STI surveillance, said: “Shigella is on the rise, so it is vital gay and bisexual men know about it and how to avoid getting it. We’re also seeing increasing HIV and gonorrhoea diagnoses among gay and bisexual men in the UK – indeed, most of the men with Shigella had been diagnosed with other STIs including HIV. This is a reminder how important it is to use a condom when having sex with casual and new partners.”

Cary James, Head of Health Improvement at Terrence Higgins Trust, said: “Although on paper the number of documented cases of Shigella are quite small, the concern is that not all cases are being reported. Men with symptoms who haven’t heard of Shigella before might assume it’s a particularly bad case of food poisoning. However, the infection can be dangerous, even more so if you’re already living with HIV or Hep C. We would urge anyone who is experiencing symptoms, or who’s concerned they may have been at risk, to call our free helpline THT Direct or visit www.tht.org.uk/shigella.”

Dr Hughes continued: “The Shigella awareness campaign is part of a broader commitment to helping improve the health of gay and bisexual men, including exploring the links between health and drug use. The level of injecting drug use is a particular concern as we know that this puts men at greatly increased risk of blood-borne viruses such as HIV and Hepatitis C”
Individuals worried about Shigella or their drug use can find out more on the Terrence Higgins Trust website – including finding a local service to visit for further advice. www.tht.org.uk/shigella

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