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We would like to follow up by including sexually transmissible enteric infections (STEI) among the pathogens whose transmission may be associated with chemsex. Shigella, which causes a range of gastrointestinal symptoms in humans2, is the primary example here although verocytotoxin producing Escherichia coli has also been described.3 Until recently, Shigella infections in England were primarily associated with travel to endemic areas. However, in the past decade, a Shigella epidemic has been documented in men who have not travelled, thought due to faecal-oral transmission during sex, in men who have sex with men (MSM).4 Chemsex may influence willingness to engage in sexual practices that increase the risk of faecal-oral transmission.
Gilbart et al5 reported an investigation into a Shigella case series in adult men between 2012 and 2013. Of 42 patients interviewed, 34 were MSM, many of whom were HIV positive, reported multi-partner condomless sex at sex parties and chemsex. Importantly, more than half of these men first presented to their GP, emphasising the importance of increasing understanding about this epidemic both within and outside of specialised sexual health clinics.
In the event of a diagnosis of Shigella and no recent travel to an endemic area, we recommend sensitively ascertaining a sexual history from men, particularly in L...
Competing Interests: None declared.