Shigellosis in men who have sex with men - high rates of antimicrobial resistance and sexually transmitted coinfections: a case series

Objective The aim of this study was to explore sexually transmitted infection (STI) coinfections, antimicrobial resistance patterns and antimicrobial prescribing in men who have sex with men (MSM) with sexually transmissible shigellosis. Method We conducted a case series of MSM diagnosed with shigellosis between 2019 and 2024 presenting to the sexual health clinic in Brighton, UK. Demographics, sexual behaviour, reported recreational drug use, concurrent STI diagnoses, antimicrobial resistance and prescribed antimicrobials were collected and analysed. Results Overall, there were 62 cases of shigellosis in 61 MSM with a median age of 40 (IQR=34–54) years. 29 (47%) were living with HIV, 29/33 (88%) HIV-negative MSM were using HIV-PrEP and 14 (23%) were using proton pump inhibitors. The median number of sex partners was 4 (IQR=1–8), 24 (38%) reported recreational drug use, 13 (21%) reported group sex, seven (11%) reported attendance at sex-on-premises venues and eight (13%) reported recent travel. 25 (40%) had a concurrent STI ( Neisseria gonorrhoeae (n=12), Chlamydia trachomatis (n=8), HSV (n=6), Treponema pallidum (n=6), incident HIV (n=2), Mycoplasma genitalium (n=1)). Seven (11%) had a concurrent enteric infection ( Campylobacter (n=6), diarrhoeagenic Escherichia coli (n=1), Cryptosporidium (n=1), Giardia duodenalis (n=1)). Overall, 26 (42%) cases (15/18: Shigella sonnei, 11/13: Shigella flexneri ) had available antimicrobial sensitivities; 23/26 (88%, 95% CI 71 to 96) had antimicrobial resistance and three (12%) had multidrug resistance. 25 (40%) were treated with antimicrobials (13 (21%) specifically for Shigella ); MSM living with HIV with shigellosis were significantly older (p<0.01), had fewer sex partners (p<0.01), were more likely to use crystal meth (p=0.02) and were less likely to be treated with antimicrobials than HIV-negative MSM (28% vs 52%, p=0.04). Conclusions This study demonstrates high rates of STI coinfection, antimicrobial resistance, and antimicrobial prescribing in MSM with sexually transmissible shigellosis.