LETTER TO THE EDITOR

Shigella flexneri: A Cause of Significant Morbidity and Associated With Sexually Transmitted Infections in Men Who Have Sex With Men

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exually transmitted Shigella flexneri has been reported in men who have sex with men (MSM).1–8 S flexneri is an infectious enterobacteria causing a self-limited diarrheal illness that has been associated with HIV-infection, unsafe-sexual behavior, sexually transmitted infections (STIs), and more recently recreational drug use.5–7 Brighton & Hove is a city in the United Kingdom with a large population of MSM who have an estimated HIV prevalence of 14%.9 We describe a local analysis of cases of S flexneri in MSM in 2013 using both clinical and laboratory data. Through 2013, 24 cases of S flexneri were identified in MSM with no associated travel history. The median age was 43 years (range, 16–77 years). Cases occurred every month; 5 cases occurred in May and August. Twenty-one of 24 reported condom-less anal sex, and 18 of 24 reported sexualized drug use in the past 3 months. Serotype was identified in 10 cases, 3a being the most common (5 cases). Antibiotic sensitivities were available in 4 cases with no cases of ciprofloxacin resistance. Twelve (50%) of 24 required hospital admission, with an average length of hospital stay of 4.3 days (range, 2–7 days). Four (17%) of 24 had an acute kidney injury requiring renal support, and 1 of 24 required 3 days of treatment in the intensive care unit. C-reactive protein was elevated in all 12 patients tested with a median of 153.1 mg/L (range, 43–287 mg/L). Four of (17%) 24 underwent lower gastrointestinal tract endoscopy as investigation of diarrhea. Thirteen of the (54%) 24 MSM were HIV positive including one who was diagnosed during the episode. Ten (77%) of 13 patients were on antiretroviral therapy at the time of Shigella, all with undetectable HIV viral loads (

Shigella flexneri: A Cause of Significant Morbidity and Associated With Sexually Transmitted Infections in Men Who Have Sex With Men.

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