Shigella

Last updated: March 21, 2023

On March 17, 2023, the Ontario Ministry of Health issued a memo to public health units and people working in sexual health clinics advising them of drug-resistant shigella trends. This follows public health alerts from other regions, including the United States.

Cases have been reported over the last year in Toronto and Waterloo – all were among men who reported having sex with other men, and some had travelled abroad. This doesn’t mean that every person diagnosed with shigella is experiencing the drug-resistant kind – but since some are, we may see more cases in Ontario.

We have compiled information to keep our community informed and will update this page as we learn more.

Shigella: the basics

Shigella is a group of bacteria transmitted through the fecal-oral (butt-mouth) route.

It can be passed on by:

- - Consuming contaminated food or beverages
  - Contact with contaminated surfaces
  - Sexual contact – usually from rimming but also from other sexual activities where you might come in contact with bodily fluids or shit (whether you see it or not)

You do not need to encounter much of the bacteria to make you sick.

SYMPTOMS

Symptoms usually start around one to three days after being exposed but can start anywhere from 12 hours to seven days after exposure. They usually include:

- - Watery or bloody diarrhea, which may contain mucus
  - Severe abdominal cramps
  - Tenesmus- feeling like you need to shit even though you can’t
  - Fever and malaise—generally feeling unwell
  - Nausea and vomiting

The incubation period for shigella is 1-7 days.

Should you be concerned?

Most people recover from shigella without antimicrobial treatment. Oral rehydration is the most common treatment, and antibiotics are only recommended if you have severe disease or have a weakened immune system.

WHAT CAN I DO?

Right now, just keep an eye out for it. If any of your sex partners get symptoms consistent with shigella, hold off from sexual activity and monitor yourself for symptoms for a few days. The incubation period for shigella is 1-7 days.

We all know that sex isn’t always as squeaky clean as it might be on a porn set. Some things you can do to avoid getting or spreading shigella through sex include:

- - Avoid or limit rimming new partners or partners that have had sex with someone else in the last week.
  - Wash your hands well and clean your ass and genital areas before and after sex.
  - Pausing to wash your hands during sex if you’ve touched any shit. That could mean moments like:

- - After pulling off a condom after or during anal sex
  - After applying lube during anal sex
  - After fingering or fisting someone
  - After handling a sex toy that’s been in someone’s ass

The goal is to limit the possibility of small (sometimes invisible) amounts of shit from ending up in someone’s mouth (including your own).

- - Avoiding ass-to-mouth (or ass-to-dick-to-mouth) activities with multiple partners, especially if they’ve had sex with someone else in the last week.
  - Avoid sharing sex toys without washing them thoroughly first in between people.

- - If you’re having sex with multiple people and using condoms, always use a new condom for each new person.

- - If you think you have shigella, seek medical treatment if symptoms get worse or last longer than a week. You should also avoid preparing food for others, having sex, using public pools, or visiting a bathhouse or place where sex happens.

IS IT JUST AFFECTING QUEER MEN?

Shigella typically affects young children, people who travel to places with untreated tap water or inadequate sanitation, people with weakened immune systems—including people with untreated HIV. Outbreaks have also occurred among queer men and homeless populations. In Ontario, drug-resistant cases are being reported among gay, bi, queer, and other men who have sex with men.

FOR MORE INFORMATION

Toronto Public Health:

https://www.toronto.ca/community-people/health-wellness-care/health-programs-advice/shigellosis-shigella/

Public Health Ontario:

https://www.publichealthontario.ca/en/diseases-and-conditions/infectious-diseases/enteric-foodborne-diseases/shigellosis

Center for Disease Control (CDC, USA):

https://emergency.cdc.gov/han/2023/han00486.asp

Check out our main page for detailed info on the virus, the symptoms (including photos), or the vaccine.

And for Ottawa-specific info on the virus, check out the Ottawa Public Health page: ottawapublichealth.ca/en/public-health-topics/monkeypox-virus.aspx.