Shigella infection causes diarrhoea and fever, and is caught from contact with the faeces (poo) of an infected person. You can pick up the bacteria if you get faecal matter in your mouth during sex – for instance, through rimming (licking) or fingering the anus. Around half of shigellosis cases seen in the UK are caught this way. People who enjoy group sex, such as in private parties or in dark rooms, are more susceptible to shigella.
Rates of shigella, including extremely drug-resistant shigella, are increasing in the UK mainly among gay, bisexual and other men who have sex with men – though the bacteria can be caught by anyone regardless of gender or sexual orientation.
You can also pick up the bacteria if you drink water or swallow food that is contaminated with faecal matter. This isn’t common in the UK and is often associated with overseas travel.
Signs and symptoms of shigella infection (called shigellosis or dysentery) include diarrhoea lasting more than 48 hours (often with blood and mucous in it), usually with stomach cramps and fever. Symptoms usually start within four days of getting infected and are often mistaken for food poisoning.
Shigellosis (dysentery), is a type of gastroenteritis caused by bacteria called Shigella. It is highly infectious and a tiny amount of bacteria can cause severe symptoms.
There are several different types of Shigella, and you can get infected many times especially if you have low immunity.
Shigella is easily passed from one person to another during sex. This can happen if you get even a small amount of faecal matter (poo) in your mouth through practices such as rimming (licking the anus), giving oral sex after anal sex or play, fingering, fisting, and sharing contaminated sex toys – or from bacteria picked up on your hands and fingers during sex. Sex does not have to be 'messy' for Shigella to be passed on.
You can reduce your risk by:
- washing your hands after sex (and buttocks, groin and penis too if you can by taking a shower), especially if you’re fingering or handling used condoms, sex toys or douching equipment
- changing condoms between anal and oral sex
- using a barrier for rimming (such as a square of latex)
- using latex gloves for fingering or fisting
How will I know if I have shigella?
Getting a test will tell you whether the infection is caused by Shigella. It’s important to get a diagnosis as shigella easily be passed on to others on contaminated household surfaces, through food preparation as well as through sexual contact.
People who work in health or social care or whose work involves preparing or serving food should stay away from work until their illness has resolved for 48 hours.
When should I have a test for shigella?
- If diarrhoea persists for more than 3 days
- If you notice blood in the diarrhoea
- If you develop a high fever
- If your cramping and abdominal pains become severe and constant
- If you have a weakened immune system e.g. HIV infection, cancer, medication like steroids or chemotherapy, older age, or immunosuppression due to any other reason
What does the test involve?
The test involves taking a sample of your faeces/diarrhoea and sending it to a laboratory for testing.
How accurate are the tests?
No tests are 100% accurate, but shigella tests should pick up almost all infections if done soon as possible after onset of symptoms, before taking antibiotics.
Where can I get a test?
Visit (or contact) your doctor or a sexual health clinic to get tested, explaining you may have picked up a gut infection from sex, possibly Shigella. The doctor needs to know this so you get the right tests and treatment. A full sexual health check-up including an HIV test is also a good idea.
Will I have to pay for tests and treatment?
All tests are free through NHS services. Treatment is also free but if you get a test at a general practice you might have to pay a prescription charge or go to another service for the treatment.
What’s the treatment for shigella?
Anyone with a bad case of diarrhoea should:
- drink fluids to stop losing too much water
- not go back to work until Shigella infection has been ruled out by a doctor, if work involves handling food or contact with patients
For most people this is an unpleasant illness that gets better on its own after 3 to 7 days. But some people can have a severe illness. If your symptoms are severe or persistent, a GP may prescribe a short course of antibiotics. If you have very severe dysentery, you may need treatment in hospital for a few days. It’s important to be tested for shigella so that the right antibiotics can be used to treat the infection.
Do I need to have a test to check that the shigella has gone?
If your work involves handling food or contact with patients you cannot go back to work until given the all clear by a public health official. This will require a test to show that the infection has gone. Anyone who has been diagnosed with shigella should wait 48 hours after the symptoms stop before going back to work.
What happens if the shigella isn’t treated? / Can shigella go away without treatment?
Most people won’t need treatment for shigella and it will get better on its own within a week or so. However, you should see a GP if your symptoms are severe or they do not start to improve after a few days.
If the test shows that you have shigella then it’s very important that your current sexual partner(s) and any other recent partners are informed. You should be contacted by your local public health team (as Shigella is a notifiable infection) – who will collect details of your close contacts, including household contacts, so they can contact them and advise on hygiene and testing if necessary.
How soon can I have sex again?
Wait to have sex (vaginal, anal or oral) for one week after you no longer have diarrhoea. Because Shigella germs may remain in faeces for several weeks, follow safe sexual practices, or ideally avoid having sex, for several weeks after you have recovered
What other steps should I take?
if you have Shigella (or any diarrhoea), wash your hands frequently. Do this after using the toilet and before eating or preparing food. Use warm water and soap. While you’re ill or until (and for) a week after symptoms stop – avoid:
- preparing food for other people
- sharing towels (use separate towels at home, and clean all taps, door handles, toilet handles, levers and seats with hot soapy water frequently)
- shared spas/jacuzzis/hot tubs (you might contaminate the water and infect others)
- swimming
How can I protect myself from shigella and other sexually transmitted infections?
It's possible to get a sexually transmitted infection (STI) by having sex with someone who has an STI, even if they have no symptoms.
The following measures will help protect you from most STIs including chlamydia, gonorrhoea and HIV.
If you have a sexually transmitted infection they’ll also help prevent you from passing it on to someone else.
- Use external condoms or internal condoms every time you have vaginal or anal sex.
- If you have oral sex, use a condom to cover the penis, or a latex or polyurethane (soft plastic) square to cover the anus or female genitals.
- Avoid sharing sex toys. If you do share them, wash them or cover them with a new condom before anyone else uses them.
For general advice on managing symptoms of shigella infection, preventing spread and re-infection:
https://www.nhs.uk/conditions/dysentery/
For advice on shigella aimed at gay and bisexual men:
https://www.gov.uk/government/publications/shigella-leaflet-and-poster
This website can only give you general information about contraception. The information is based on evidence-guided research from the World Health Organization and The Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists. All methods of contraception come with a Patient Information Leaflet which provides detailed information about the method.
Remember – contact your doctor, practice nurse or a contraception clinic if you're worried or unsure about anything.