Oh, Shigella. The gut feeling is that this is not good news. On February 24, the Centers for Disease Control and Prevention (CDC) issued a warning about an increase in the percentage of Shigella infections that have been caused by extensively drug-resistant (XDR) versions of the bacteria. This number has gone from 0% in 2015 up to 5% in 2022. In fact, much of the steadily rise has occurred since 2017. That certainly could be very poopy news if you do end up getting a Shigella infection, otherwise known as Shigellosis. But it could also be bad news should you get a gastrointestinal infection caused by other types of bacteria. That’s because Shigella can serve a bit like tiny, tiny fitness influencers on TikTok. The bacteria can share what makes themselves stronger and more resistant to antibiotics with other bacteria in your gut by exchanging genetic material with them.

So what’s this XDR-factor mean? There are actually four different kinds of Shigella species that can cause illness: Shigella sonnei, Shigella flexneri, Shigella boydii, and Shigella dysenteriae, with Shigella sonnei being the most common one in the United States. The CDC announcement defined “XDR Shigella bacteria as strains that are resistant to all commonly recommended empiric and alternative antibiotics — azithromycin, ciprofloxacin, ceftriaxone, trimethoprimsulfamethoxazole (TMP-SMX), and ampicillin.” That’s quit a lot of commonly used antibiotics. The CDC announcement added that, “Currently, there are no data from clinical studies of treatment of XDR Shigella to inform recommendations for the optimal antimicrobial treatment of these infections. As such, CDC does not have recommendations for optimal antimicrobial treatment of XDR Shigella infections.” While not every case of Shigellosis may need antibiotic treatment, getting a Shigella infection without recommended antibiotics can be kind of like going into a knife fight with only a hot dog.

Shigellosis is not a fun thing to get. The CDC announcement mentioned that, “Shigellosis usually causes inflammatory diarrhea that can be bloody and may also lead to fever, abdominal cramping, and tenesmus.” Now, you may wonder what “tenesmus” means since it probably isn’t a word that comes up often during job interviews, dates, or conversations with you boss. Tenesmus is a medical term for a frequent urgent feeling of having to have a bowel movement even though you just went to the bathroom and seemingly have no more poop to give. That clearly is not a good feeling. If someone were to tell you, “when you are around, I have tenesmus,” that would not be a compliment.

Such symptoms typically begin one to two days after the bacteria has gone down your hatch. Not everyone will end up having symptoms. But if you do have symptoms, most commonly they’ll last around five to seven days, although they could last anywhere from a few days to over four weeks. In fact, in some cases, symptoms have lasted for months, which understandably would be a very poopy situation.

As mentioned earlier, antibiotics aren’t always necessary. Taking antibiotics such as ciprofloxacin or azithromycin can usually cut down the duration of symptoms by an average of around two days. More importantly, though, antibiotics can prevent complications and become very important should such complications occur.

One potential complication is that the bloody diarrhea situation could turn bloody awful. Shigella can do enough damage to the lining of your intestines that it and other bacteria are able to access your bloodstream. This can happen in 0.4% to 7.3% of Shigellosis cases, according to the CDC. When Shigella and other bacteria get into the bloodstream, they can cause all sorts of problems, including life-threatening ones. If you’ve got Shigella in your blood, you should seek medical attention pronto.

Another potential complication is hemolytic-uremic syndrome (HUS), which is relatively rare but can be devastating. This is when the Shigella secretes a Shiga-toxin that ruptures your red blood cells. These red blood cell fragments then end up getting caught up in your kidneys’ filters potentially leading to kidney failure.

A third type of complication is reactive arthritis, which can result in about 2% of certain types of Shigella infections, most commonly Shigella flexneri. This typically will last three to five months but could go on for years. Besides joint pain, you may also suffer eye irritation and painful urination, two things that you may not usually associate with joint pain unless you are a contortionist.

The bottom line is that you don’t want to get a Shigella infection. Speaking of bottom, you can catch an infection via the fecal-oral route, which is a medical way of saying poop to mouth. This can occur via hands, food, water, and other things that have been contaminated with poop containing the bacteria. That why the CDC recommends taking the following precautions at all times:

  • “Carefully wash your hands with soap and water during key times”: Hopefully you’ve figured this out three years into the Covid-19 pandemic.
  • “Take care when changing diapers”: Don’t be flinging around soiled diapers or licking your hands after changing them.
  • “Avoid swallowing water from ponds, lakes, or swimming pools”: Don’t sing the song “Hallelujah” while underwater. Wait until you surface. Keep you mouth shut as much as possible when submerged.
  • “When traveling internationally, follow safe food and water habits and wash hands often with soap and water”: Don’t take a vacation from hand hygiene. And remember, even if you wash your hands, those handling your food and water may not.
  • “If you or your partner has diarrhea, do not have sex”: There is a reason why few romantic songs have the word “diarrhea” in them. It can and should be a mood killer. The same should apply to other potential gastroenteritis symptoms. Someone should not say, “I have tenesmus, take me now.” Of course, the other person may not readily reveal that they are experiencing gastrointestinal symptoms during the lead up to sex. You could try to subtly sneak the questions in like, “You have such beautiful and a hot body. Speaking of hot, do you have a fever?” But it is better to be straightforward and ask directly whether your potential love partner is feeling ill in any way. When someone has been having diarrhea, don’t immediately have sex once that person has had a regular bowel movement. The CDC recommends waiting at least two weeks afterwards.

The rise of Shigella XDR corresponds to the rise of other drug-resistant bacteria. Our society is rapidly running out of antibiotics to treat bacteria infections due to both antibiotic-overuse and the lack of new antibiotics being developed. If something is not done soon to correct these major growing problems, we all could find ourselves in deep you-know-what sometime soon.


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