在英國和美國檢測到多重抗藥的志賀氏痢疾桿菌，主要是在男同性戀者中

邁克爾.卡特; 發佈時間：2019年1月22日；資料來源：aidsmap news；財團法人台灣紅絲帶基金會編譯

英國公共衛生當局已發出警告，指出一種嚴重的細菌性腸道感染的高度耐藥菌株，可通過性行為感染。

在去年3月至11月期間，檢測到17例對數種第一線抗生素具有抗藥性的志賀氏痢疾捍菌。

傳播似乎聚集在男同性戀者和其他男男性接觸者（MSM）之間。英國17起案件中有14起案件涉及男性，美國已發現另外9起案件，均涉及男男間性接觸者。

標準治療的第一線抗生素如阿奇黴素（亦有譯為阿齊紅黴素，一種屬於大環內酯的抗生素）和頭孢曲松可能效果不佳，但其他口服抗生素仍然有效。

志賀氏菌會引起嚴重的長期腹瀉和胃痙攣。它係透過與極少量的人類糞便接觸而傳播，並可在某些性活動中傳播。從舔肛、指交、拳交、肛交、處理肛交使用後之性玩具，到偶爾口交都可能帶來風險；細菌可能透過從手指傳播到口腔。

症狀通常在接觸後三天內發生，包括：

經常腹瀉超過48小時

胃痙攣

發燒

嘔吐

全身無力和疲倦。

對於CD4計數較低的HIV陽性個案，志賀氏痢疾桿菌尤其嚴重。

提到志賀氏菌，有這些症狀的人應該去他們的一般科醫生或性健康診所看診。醫生則應要求取糞便樣本進行適當的檢測（糞便PCR和培養）。

英國去年3月至11月期間發現了多重抗藥病例，其中8例發生在倫敦，但在英國其他所有地區中也診斷出少數的病例。

當醫生診治嚴重腹瀉患者時需要警覺到這一主要集中在男性群體的多重抗藥病例，並詢問患者的性活動和近期旅遊史。如果合適，應取得樣本進行實驗室測試以檢查抗藥性。針對此一部份強化公共衛生之監督業已啟動。

儘管已使用抗生素治療，但這種多重抗藥志賀氏菌株的症狀通常包括持續超過一周的腹瀉。雖然對幾種抗生素有抗藥性，但該菌株仍然易受其他藥物的影響，包括氯黴素，厄他培南（商品名益滿治，一種碳青黴烯類抗生素），替莫西林（一種6-甲氧基青黴素; 也是一種羧芐青黴素），和磷黴素。

避免糞 – 口之接觸、勤洗手和性行為後洗澡，可以減少性傳播的風險。指交、舔肛和拳交時使用保護措施，包括使用手套和口肛交間更換新的保險套，也有助於降低傳播的風險。

英國公共衛生部門尚未完整的收集與抗藥菌株感染有關風險因素之相關信息。然而， 2014年在英國男男間性接觸者中所爆發嚴重的志賀氏痢疾桿菌之疫情，則有幾種行為特徵，包括：

在網路或性愛聚會上與大量性伴侶相遇。

藥愛 (Chemsex)，特別是使用甲氧麻黃酮（又名4-甲基甲基卡西酮，常被稱為喵喵），甲基安非他命、愷他命和GBL（γ–丁內酯，被用作具有與巴比妥類似效果的娛樂性麻醉劑）。

採注射方式吸毒。

Multi-drug resistant Shigella detected in the UK and USA, mostly in gay men

Michael Carter; Published: 22 January 2019

Public health authorities in the UK have issued a warning about a highly drug-resistant strain of a serious bacterial gut infection that can be contracted through sex.

Between March and November last year, 17 cases of Shigella dysentery with resistance to several first-line antibiotics were detected.

It appears that transmission is clustered among gay and other men who have sex with men (MSM). Fourteen of the 17 UK cases involve men and nine further cases have been identified in the United States, all involving MSM.

Standard treatment with first line antibiotics such as azithromycin and ceftriaxone may not be effective, though other oral antibiotics will still work.

Shigella causes severe, prolonged diarrhoea and stomach cramps. It’s transmitted by contact with very small amounts of human faeces and can be passed on during certain sexual activities. Rimming, fingering, fisting, anal sex, handling sex toys after use in the anus, and occasionally oral sex can all carry a risk. The bacteria may pass from fingers to the mouth.

Symptoms typically occur within three days of exposure and include:

     Frequent diarrhoea lasting more than 48 hours

     Stomach cramps

     Fever

     Vomiting

     General weakness and tiredness.

Shigella can be especially serious in HIV-positive individuals who have a low CD4 count.

Individuals who have these symptoms should see their GP or a sexual health clinic, mentioning Shigella. The doctor should request a stool sample for appropriate tests (faecal PCR and culture).

The multi-drug resistant cases were identified between March and November last year. Eight of the cases were in London, but smaller numbers have also been diagnosed in all other UK regions.

Doctors treating patients with severe diarrhoea need to be aware of this predominately male cluster of multi-drug resistant cases, and ask patients about their sexual activity and recent travel. If appropriate, samples should be obtained for laboratory testing to check for resistance. Enhanced public health surveillance has also been activated.

Symptoms of this strain of multi-drug resistant shigella typically include diarrhoea lasting for more than a week, despite treatment with antibiotics. Although resistant to several antibiotics, the strain remains susceptible to other drugs including chloramphenicol, ertapenem, temocillin, mecillinam and fosfomycin.

The risk of sexual transmission can be reduced by avoiding oral-faecal contact and by washing hands and showering after sex. Using protection for fingering, rimming and fisting, including gloves and changing condoms between anal and oral sex also help reduce the risk of transmission.

Public Health England have yet to assemble full information about the risk factors associated with contracting the drug-resistant strain. However, several behavioural characteristics were associated with a serious outbreak of Shigella among MSM in the UK in 2014, including:

     High numbers of sexual partners met online or at sex parties.

     Chemsex, especially the use of mephedrone, methamphetamine, ketamine and GBL.

     Injecting drug use.