MDLinxSexually Transmitted Diarrhea is Exploding in the US and is Increasingly Resistant to Treatment

📡 Surveillance / Emerging Signal

US surveillance points to a substantial change in the epidemiology of Shigella: sexual transmission, particularly within some networks of gay, bisexual, and other men who have sex with men, increasingly overlaps with extensively drug-resistant infection. Among nearly 17,000 isolates analyzed by the CDC, resistance to five commonly used antibiotics increased from 0% in 2011 to 8.5% in 2023. The evidence signals an important diagnostic and antimicrobial-resistance challenge rather than a newly identified disease.

Clinical Considerations

• XDR isolates increased from 0% to 8.5% between 2011 and 2023, indicating a meaningful shift in the organism’s resistance profile.
• Sexual exposure should remain part of the history in patients with dysentery even without recent international travel, particularly when epidemiologic context supports that route.
• Antibiotic susceptibility increasingly matters when therapy is required because resistance can make customary empiric choices less reliable.
• More than one-third of reported patients with XDR shigellosis were hospitalized, suggesting clinically consequential disease within the affected surveillance population.
• HIV and other STIs may overlap with sexually transmitted shigellosis, supporting broader clinical assessment when history or presentation raises concern.
• Transmission-route data remain imperfect because clinicians and patients may not recognize Shigella as sexually transmissible and sexual exposure histories may be incomplete.

Practice Applications

• Consider sexually transmitted Shigella in patients presenting with dysentery when sexual exposure history supports that possibility, even without recent travel.
• Review susceptibility results when antimicrobial treatment is warranted rather than assuming traditional antibiotic choices will remain active against resistant isolates.
• Integrate a relevant sexual history and assessment for other STIs when evaluating suspected sexually acquired shigellosis.
• Discuss transmission precautions and current public-health recommendations with affected patients, particularly given the organism’s high transmissibility.
• Recognize that sexual transmission and antimicrobial resistance are overlapping epidemiologic signals, but resistance patterns may vary by strain and population.