A highly contagious gut infection that can spread during sex is becoming harder to treat as antibiotic-resistant strains become more common.
An April report from the Centers for Disease Control and Prevention tracked nearly 17,000 Shigella samples, which causes Shigellosis, which and can bring on diarrhea, fever and abdominal cramps, collected between 2011 and 2023. In 2023, 8.5% of Shigella samples with resistance data were classified as extensively drug-resistant, or XDR — resistant to all five antibiotics in the CDC’s definition — compared with none from 2011 to 2015.
The findings point to a growing resistance problem, not a surge in overall infections, noted Dr. Tyler Evans, a California-based infectious disease physician and CEO of Wellness Equity Alliance.
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“The infection is not surging. The bacteria are changing,” Evans told Fox News Digital. “Case counts can hold steady while the treatment options quietly disappear.”
There is no FDA-approved oral antibiotic for XDR Shigella, he said.
Shigella bacteria can spread when tiny amounts of stool reach someone’s mouth, including through contaminated food or water, unwashed hands or sexual activity.
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“Shigella is not considered to be a typical sexually transmitted infection,” Dr. Andi Toufexis, a Texas-based family medicine physician who specializes in sexual health, told Fox News Digital. “However, this gastrointestinal bacteria can be spread through sex when one partner comes into contact with the other’s fecal matter.”
Shigella is not new, and sexual transmission has been documented since the 1970s, Toufexis said. What is changing is the growing share of tested samples classified as XDR.
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The CDC report found that most people with XDR Shigella were adult men. Sexual exposure data were not routinely collected, so the report could not establish exactly how each infection was contracted but previous research has found sexual contact among men who have sex with men as an important transmission route.
Eighty-six percent of XDR patients were men, with a median age of 41, and of those with a known HIV status, nearly half were living with HIV, Evans noted. People experiencing homelessness and those with weakened immune systems may also face heightened risks, he said.
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Children younger than 5 are especially likely to get Shigella, according to the CDC, and many outbreaks in the U.S. have been linked to child care and schools. Earlier U.S. outbreaks primarily affected children and involved strains that were susceptible to antibiotics.
According to the CDC report, 37.6% of patients with hospitalization data were hospitalized for the antibiotic-resistant infection. The CDC reported no deaths among the XDR cases analyzed and said infections may be undercounted because not all positive specimens were cultured or tested for resistance. Most patients with available travel histories reported no recent international travel, though travel information was missing for many.
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Evans said Americans should be “concerned, not panicked” about the infection.
Most Shigella infections resolve on their own, Toufexis added, but severe illness may need treatment.
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Dr. Michael Aziz, an internist at Lenox Hill Hospital in New York City and author of “The Perfect 10 Diet” and “The Ageless Revolution,” urged people who suspect Shigella to seek medical advice before taking antidiarrheal medicine such as Imodium. “You want to flush out the bacteria, you want to get it out of your system,” Aziz told Fox News Digital.
To reduce the chance of infection, doctors recommend washing hands, genitals and the anal area before and after sex, using condoms or dental dams, and cleaning sex toys after each use. If you or a partner has diarrhea, avoid sex and wait at least two weeks after symptoms end before resuming, Toufexis said.
“Feeling better does not always mean that an infection is completely gone,” she said.
