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There is an outbreak of drug-resistant Shigella among gay and bisexual men in Victoria, a state in southeast Australia.
Victoria recorded 171 cases of the disease between January 2018 to mid-year 2019, and the majority have been among men who have sex with men, according to a recent article in The New England Journal of Medicine. There were relatively few reports of Shigella before 2018.
Shigella is a highly contagious gastrointestinal disease, similar to E.coli, that is spread through stool. An individual can contract Shigella by changing a diaper, consuming contaminated foods or water, or through sexual contact, according to the Centers for Disease Control and Prevention.
Gay and bi men who engage in sexual activities like rimming or fingering, which would transfer stool to mouth, are particularly at risk. "Just two or three bacteria can make you really sick, which is why it's so easily transmitted, particularly in men who have sex with men," said Deborah Williamson, the study's lead author and professor at the University of Melbourne.
Symptoms, which include diarrhea, fever, and stomach pain, can persist up to a week; in serious cases, symptoms last a month. An individual can remain contagious for up to two weeks after symptoms disappear.
Normally, a regimen of antibiotics can treat Shigella. However, the Victorian strain has been extremely drug-resistant and requires hospitalization, which is "of enormous concern" to public health, said Dr. Brett Sutton, Victoria's chief health officer, in a statement.
"Antibiotic treatment should be reserved for priority cases, such as those who are immunosuppressed, those who have severe disease and people who work in high-risk settings for onward transmission," Sutton said.
"As always, it is important to emphasize hygiene and safe sex messages in advice to cases as well as recommending exclusion from work until symptoms cease," he added.
Those diagnosed with Shigella should wait up to two weeks before having sex. Health experts also recommend using condoms for oral sex, applying dental dams for rimming, and washing hands after sexual contact.
California's San Diego County has also seen an outbreak of the gastrointestinal disease among MSM. County health officials reported 334 cases in 2017 -- the highest count in 20 years.