Under the microscope, the micro organism Shigella sonnei appears a bit like a worm. It’s an extended, rod-shaped construction that causes abdomen issues, resembling diarrhea and gastric ache, and is one in all the essential culprits behind meals poisoning outbreaks. But this small bacillus in the Enterobacteriaceae household (which additionally contains E. coli) has been quickly spreading in a number of international locations in Europe not via contaminated meals however via sexual transmission.
The scenario is of such concern that the European Centre for Disease Prevention and Control (ECDC) has released a report warning of an increase in shigellosis instances. The infection attributable to the micro organism can result in intestinal issues, and in the worst-case situation, gastric ulcers and dysentery (diarrhea containing blood or mucus). The ECDC doc famous that this rise has been notably notable amongst “males who’ve intercourse with males (MSM)” and warned that a few of the instances detected have been resistant to antibiotics.
The United Kingdom was the first to boost the alarm: in 4 months, between September 2021 and January 2022, it reported 47 instances of extensively-drug resistant Shigella sonnei infections. This determine was triple the quantity that had been reported in the earlier 17 months, when solely 16 instances have been detected. British authorities additionally warned that most of the infections have been affecting males who’ve intercourse with males. Following this warning, the ECDC known as on all European Union states to collect info on the unfold of the micro organism of their territories.
Between 2020 and February 17 of this yr, the European well being group registered no less than 147 instances of shigellosis with the identical antibiotic resistance or that have been genetically associated to the group of infections detected in the UK. These instances, reported in 9 international locations (Austria, Belgium, Denmark, France, Germany, Italy, Ireland, Norway and Spain), additionally shared the identical profile: affecting MSM, and spreading via sexual transmission.
The essential methods the micro organism is unfold is via ingesting contaminated meals and water or via the so-called fecal-oral route, explains José Luis Blanco, a specialist in infectious ailments at Clínic Hospital in Barcelona, in the Spanish area of Catalonia. “Transmission via the fecal-oral route may very well be as a result of direct contact, in anal intercourse, or as a result of oblique contact, following anal intercourse relations, when dildos are used, or fisting or analingus are practiced,” he says.
According to British authorities, in outbreaks the place there was details about the supply of the contagion, personal intercourse events and loos have been the probably websites of transmission. Both the Spanish Health Ministry and the ECDC have additionally raised warnings about chemsex, a observe that includes utilizing medication to have sexual relations over an extended time period. Experts warn these dynamics are linked to shigellosis outbreaks, as drug consumption can enhance the chance of high-risk sexual practices.
In Spain, medical doctors say they haven’t seen any noticeable rise in shigellosis infections. A March report from Spain’s National Microbiology Center recognized 19 instances in 2021 and 7 in 2022, with the identical antibiotic resistance. But Jorge García, a specialist in infectious ailments at the Vall d’Hebron Hospital in Barcelona, says that he has seen occasional instances of “gastroenteritis as a result of Shigella” and admits “the resistance has elevated.” Indeed, a study on infections in Barcelona amongst males who’ve intercourse with males between 2015 and 2019 already warned that the pathogen was turning into more and more proof against antibiotics. “The ECDC has seen that these micro organism have a drug-resistance profile and the concern is that they can unfold,” says García.
Most shigellosis infections are gentle, however there may be concern over how drug resistance will have an effect on the most extreme instances. “Normally, we use [antibiotic treatments such as] fluoroquinolones or azithromycin in opposition to shigellosis: the affected person takes it at dwelling and doesn’t have to be admitted,” explains Blanco. “But when the illness is enteroinvasive [it is more severe and enters the intestinal wall], we use third-generation cephalosporins [a class of antibiotic derived from a fungus].” The downside is that outbreaks resembling the one recorded in the UK are proof against all these medication and extra. In these instances, medical doctors flip to carbapenems, the closing antibiotic tool against these superbacteria.
“Sexually transmitted infections are of utmost curiosity to the World Health Organization given the affect that potential outbreaks might trigger on public well being and the threat that they unfold drug resistance,” says Blanco.
For MSM who’ve caught the infection, the ECDC recommends refraining from sexual relations till every week has handed since the disappearance of signs. It additionally proposes rising hygiene measures, resembling washing genital and anal areas earlier than and after intercourse, utilizing latex gloves when training fisting and recommends in opposition to sharing intercourse toys. Symptoms of shigellosis can final between 5 and 7 days, however the micro organism can stay in the system for an additional 4 to 6 weeks.