Shigellosis awareness and diagnosis in community surveys of men who have sex with men and trans women, San Francisco, California, United States

BACKGROUND: Shigellosis has increasingly and disproportionately affected sexual and gender minority populations. Although historically considered a food- and waterborne illness, Shigella can also be transmitted sexually. This study assessed awareness of shigellosis among men who have sex with men (MSM) and trans women, and examined the burden of infection and treatment among MSM in San Francisco. METHODS: Data were drawn from the most recent National HIV Behavioral Surveillance (NHBS) cycles conducted among MSM (June-November 2023) and trans women (July 2023-May 2024) in San Francisco. The MSM cycle included three Shigella-related items (awareness, history of diagnosis, and treatment), while the trans women cycle included two items (past and recent history of diagnosis). Multivariable logistic regression was conducted to examine factors associated with shigellosis awareness among MSM. RESULTS: Among 545 MSM, 35.4% were aware of shigellosis, 5.5% reported ever having the infection, and 5.1% sought treatment. Among 339 trans women, 1.2% reported ever having shigellosis, and 0.3% within the past 12 months. Among MSM, awareness was higher among White participants, those with postgraduate education, those who saw a healthcare provider, and those who tested positive for a bacterial STI in the past 12 months. CONCLUSIONS: Despite global outbreaks among MSM, awareness of shigellosis within sexual and gender minority communities remains low, and the burden of infection is likely underestimated. Tailored, stigma-sensitive sexual health promotion integrating shigellosis into broader STI prevention efforts, alongside improved provider training, is essential to ensure equitable care and reduce future outbreak risk.