Shigella Infection Among Gay, Bisexual, and Other Men Who Have Sex with Men (MSM)

Did you know the diarrhea germ Shigella can be spread through sexual activity? For MSM.

Note: Content below contains mature language.

Gay, bisexual, and other men who have sex with men† are among groups at high risk for infection with Shigella germs, which cause an infection called shigellosis. Shigella germs spread easily and rapidly among people, including during sexual activity.

Shigella germs are increasingly resistant to antibiotic treatment, and men who have sex with men are particularly at risk for infections with resistant Shigella.

Shigella by the Numbers

CDC estimates that Shigella germs cause nearly 450,000 infections in the United States each year. CDC estimates that 1 in 5 of those infections are resistant to multiple antibiotics used to treat severe infections. We do not know how many of these infections are among men who have sex with men. However, multiple outbreaks of Shigella among men who have sex with men have been reported worldwide.

Antibiotic-resistant Shigella

In recent years, multiple outbreaks of drug-resistant Shigella have occurred among gay, bisexual, and other men who have sex with men.

Infections with multidrug-resistant Shigella have been on the rise in the United States since 2013. Most people with Shigella infection—including those infected with resistant Shigella—recover within 5 to 6 days without antibiotics. However, some people need antibiotics, including people who have a severe or long-lasting infection or are at risk of one.

People at risk of a severe or long-lasting infection include those with a weakened immune system due to certain medical conditions (such as infection with HIV) or treatments (such as chemotherapy for cancer). These people are also at increased risk for the infection spreading into the blood, which can be life-threatening.

Shigella Germs Can Spread During Sexual Activity

Shigella germs pass from the poop (stool) or unclean fingers of one person to the mouth of another person. This can happen during sexual activity through:

  • Direct sexual contact: Anal or oral sex, or anal play (rimming, fingering)
  • Indirect sexual contact: Handling contaminated objects, such as sex toys, used condoms or barriers, and douching materials

Symptoms typically start 1 to 2 days after swallowing the germs and include diarrhea, fever, and abdominal pain. However, not everyone with Shigella infection has symptoms.

Shigella germs can be found in the poop of people with diarrhea and can continue to be found in their poop for up to two weeks after the diarrhea has gone away.

Protect Yourself and Your Partner

Take steps to reduce oral contact with poop during sex:

  • Wash your hands, genitals, and anus with soap and water before and after sexual activity. Wash hands, especially after touching sex toys, used condoms or barriers, and douching materials.
  • Use barriers like condoms or dental dams during oral sex and oral-anal sex.
  • Use latex gloves during anal fingering or fisting.
  • Wash sex toys with soap and water after each use and wash hands after touching used sex toys.

If you or your partner has diarrhea, do not have sex. To reduce the chance of Shigella germs spreading, wait at least two weeks after diarrhea ends to have sex.

Talk with Your Doctor

Talk with your doctor if you think you might have Shigella infection (shigellosis). Your doctor can test your poop to determine if you are sick with shigellosis. They can also order an additional test at the same time to check whether your type of infection is resistant to antibiotics.

If You’ve Been Diagnosed with Shigella infection (shigellosis)

If you’ve been diagnosed with Shigella infection (shigellosis), take the following steps to prevent spreading it to others.

  • Wash hands often, especially:
    • Before eating or preparing food.
    • After using the bathroom.
  • Do NOT prepare food if you are sick or share food with anyone.
  • Do not swim.
  • Do NOT have sex for at least two weeks after you no longer have diarrhea.
  • Stay home from school or from healthcare, food service, or childcare jobs while sick or until your health department says it’s safe to return.

†CDC uses the term “men who have sex with men” to indicate behaviors that spread Shigella infection, rather than how individuals self-identify in terms of their sexuality. This web content uses the term “gay and bisexual men” to represent gay, bisexual, and other men who reported male-to-male sexual contact.