P026 Sexually Transmitted Shigella flexneri and Shigella sonnei in men who have sex with men

Abstract

<h3></h3> Shigella outbreaks in MSM are associated with sexual networks involving transmission of other sexually transmitted infections (STIs), geosocial app use for meeting sexual partners and chemsex. There is increasing antimicrobial resistance (AMR) in Shigella amongst MSM. We aimed to describe cases and patterns of AMR amongst MSM with Shigella between 2016–2019. There were 33 cases of shigellosis in MSM identified, with a median age of 38-years (IQR 34–47). 11/33(33%) reported recent chemsex use, 14/33(42%) were HIV positive. Of the 19/33 HIV negative MSM, 7/19(37%) were using HIV pre-exposure prophylaxis. The mean number of sexual partners in the previous 3 months was six. 15/33(45%) had Shigella sonnei, 5/33(15%) Shigella flexneri, and 13/33(39%) were DNA-PCR positive but culture negative. 14/33(42%) were diagnosed with at least one other STI. MSM with Shigella flexneri were more likely to be HIV positive than Shigella sonnei(p&lt;0.05). Antimicrobial sensitivities were only available in 11/15 cases of Shigella sonnei[fully sensitive(9%), resistant to ciprofloxacin(9%), resistant to azithromycin(36%), resistant to ciprofloxacin and azithromycin(45%)]. 7/33(21%) were treated presumptively on the day of presentation with intramuscular ceftriaxone 2g for 1–3 days followed by oral ciprofloxacin. No MSM with ciprofloxacin resistance received ciprofloxacin; the remaining 26/33 (78%) did not receive antimicrobials and their diarrhoea resolved. We have shown that Shigella flexneri is more frequently seen in HIV positive MSM and is associated with chemsex, and resistance to both azithromycin and ciprofloxacin is common in Shigella sonnei. The increasing use of PCR culture independent diagnostic tests make it more difficult to identify cases and clusters within sexual networks in MSM of multi-drug resistant shigellosis: clinicians and microbiologists should be vigilant when managing MSM with diarrhoea to prevent large outbreaks of highly resistant shigellosis.