Shigellosis among MSM
The Victorian Department of Human Services has recognised an increase in the number of shigellosis cases amongst men who have sex with men (MSM). Please consider the diagnosis of shigellosis in any MSM patients presenting with gastroenteritis.
Transmission of Shigella is by the faecal-oral route, and the incubation period is usually 1-3 days. It is important to emphasise the importance of handwashing (with soap and water) after any sexual contact. Cases remain infectious while bacteria are present in the faeces, which can persist for up to four weeks after symptoms resolve.
Appropriate antibiotic treatment is recommended as it usually reduces the duration of carriage to a few days. However, recently notified cases have shown resistance to multiple antibiotics, some of which are recommended in the Therapeutic Guidelines as treatment for shigellosis.
Most outbreak associated isolates have been resistant to sulphonamides and trimethoprim (including co-trimoxazole) and also decreased susceptibility to ciprofloxacin and norfloxacin. They have generally been sensitive to ampicillin. Please seek advice from your diagnostic laboratory on the results of antibiotic susceptibility testing for your patient.
Food handlers, child care workers and health care workers should be excluded from work until two successive faecal specimens (collected 24 hours apart but not sooner than 48 hours following cessation of antibiotics) are free of Shigella.
Under the Health (Infectious Diseases) Regulations 2001, shigellosis is required to be notified to the Department of Human Services by medical practitioners within five days. Notifications can be made online, via telephone on 1300 651 160 or faxed on 1300 651 170.
