WHAT YOU NEED TO KNOW
  • The CDC found that 8.5% of Shigella samples with resistance data were extensively drug resistant in 2023.
  • No FDA approved oral antibiotic is available for extensively drug resistant Shigella.
  • Shigella can spread through contaminated food, water, unwashed hands or sexual contact involving fecal matter.
  • Experts recommend medical guidance before using antidiarrheal medicine and advise avoiding sex during diarrhea and for at least two weeks afterward.

A highly contagious gut infection that can spread during sex is becoming more difficult to treat as strains of Shigella develop resistance to antibiotics. The bacterial infection can cause diarrhea, fever and abdominal cramps and spreads when tiny amounts of stool reach another person’s mouth.

An April report from the Centers for Disease Control and Prevention examined nearly 17,000 Shigella samples collected between 2011 and 2023. Shigella causes shigellosis and can spread through contaminated food or water, unwashed hands or sexual activity.

In 2023, 8.5% of Shigella samples with resistance data were classified as extensively drug resistant, or XDR. Such samples resist all five antibiotics included in the CDC’s definition, while no samples collected from 2011 through 2015 received that classification.

Dr. Tyler Evans, a California based infectious disease physician and CEO of Wellness Equity Alliance, said the findings reflect rising resistance rather than an increase in overall infections.

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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, Evans said. The shrinking range of treatment options raises concern even though many Shigella infections resolve without treatment.

Dr. Andi Toufexis, a Texas based family medicine physician specializing in sexual health, explained that Shigella does not fall neatly into the usual category of sexually transmitted infections.

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“Shigella is not considered to be a typical sexually transmitted infection,” Toufexis 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.”

Sexual transmission of Shigella has been documented since the 1970s, according to Toufexis. The significant change identified by the CDC is the growing share of tested samples classified as XDR.

Most people with XDR Shigella in the CDC analysis were adult men. Because sexual exposure data were not routinely collected, the report could not determine exactly how each person contracted the infection.

Previous research has identified sexual contact among men who have sex with men as an important transmission route. Evans noted that 86% of XDR patients were men, their median age was 41, and nearly half of those with a known HIV status were living with HIV.

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People experiencing homelessness and those with weakened immune systems may also face heightened risks, Evans said. Children younger than 5 are especially likely to contract Shigella, and many outbreaks in the United States have been associated with child care settings and schools.

Earlier outbreaks in the United States primarily affected children and involved strains that remained susceptible to antibiotics. The current findings highlight how resistance patterns have changed among the samples studied.

Among patients with hospitalization data, 37.6% were hospitalized for the antibiotic resistant infection. The CDC reported no deaths among the XDR cases analyzed, but said infections may be undercounted because not every positive specimen was cultured or tested for resistance.

Most patients whose travel histories were available reported no recent international travel, although that information was missing for many people. Evans said Americans should be “concerned, not panicked” about the infection.

Toufexis said most Shigella infections clear on their own, though severe illness may require treatment. Dr. Michael Aziz, a Lenox Hill Hospital internist in New York City, urged anyone who suspects Shigella to seek medical advice before using 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. Such medicines can slow the gut, which is why experts advise patients with Shigella not to take them without medical guidance.

Doctors recommend washing hands, genitals and the anal area before and after sex, using condoms or dental dams, and cleaning sex toys after every use. People with diarrhea should avoid sex and wait at least two weeks after symptoms stop before resuming, Toufexis said.

“Feeling better does not always mean that an infection is completely gone,” she said.