From Streets to Bedrooms: How Shigella Spreads in America

From Streets to Bedrooms: How Shigella Spreads in America

The last time I reported on Shigella, a bacterial disease that spreads through human feces, Portland, Oregon, was contending with a serious outbreak after decriminalizing homeless encampments.

In that report, I noted that Shigella infections lead to profuse diarrhea, fever, and stomach pains…and these symptoms can last for weeks. Sometimes, bowel habits (frequency and stool consistency) do not return to normal for several months.

This disease is typically reported in developing regions of Africa and Asia. But concerns about its presence in this country are rising in the wake of reports that the bacteria are becoming resistant to antibiotics.

A drug-resistant bacterial infection has been on the rise in the U.S. in recent years, according to an alert from the Centers for Disease Control and Prevention (CDC).

Shigella, a gram-negative bacteria, causes a diarrheal illness called shigellosis. Drug-resistant incidences of the infection have “increased substantially” in the U.S. between 2011 and 2023.

Researchers analyzed over 16,000 Shigella samples, testing them for antibiotic resistance to determine how many would not respond to commonly used antibiotics.

In 2011, there were no cases of highly drug-resistant Shigella infections; by 2023, approximately 8.5% of infections met that criteria.

“Between 2011 and 2015, zero samples contained XDR Shigella, they found. By 2023, however, 8.5% of the samples submitted that year were extensively resistant.” https://t.co/jgRVNoWQBG

— Amesh Adalja (@AmeshAA) April 14, 2026

And while infection with the bacteria generally occurs via contact with contaminated fecal material, it is also known to be transmitted sexually. Outbreaks of the drug-resistant variety appear to be tied to this mode of transmission.

It’s estimated that 450,000 Americans are infected with Shigella bacteria every year. Though Shigella is typically spread from eating contaminated food and water, it can also be transmitted through close sexual contact, particularly if it involves anal sex. The latter seems to be one major reason why recent outbreaks of XDR [Extensively Drug Resistant] Shigella have been concentrated among men who have sex with men.

It’s not just the bacteria themselves that are a problem, but the genes they’ve evolved to develop this resistance. Some of these same resistance genes can potentially be passed onto other bacteria commonly found in the gut. This risk, coupled with how highly contagious these bacteria are, only further heightens their danger to the public, the researchers say.

In fact, the UK Health Security Agency (UKHSA) recently reported increases in sexually transmitted Shigella cases in 2025.

Sexually transmitted Shigella predominantly affects gay and bisexual (men who have sex with men). Symptoms usually appear within 1 to 4 days and include diarrhea (sometimes with blood), stomach cramps and fever. It is often mistaken for food poisoning.

Diagnoses of S. flexneri and S. sonnei that were potentially acquired during sexual contact have increased in recent years- a rise from 2,052 in 2023 and 2,318 in 2024 to 2,560 last year.

More than half the cases were reported in London last year (1381)- London (54%), followed by Thames Valley (6%) and Surrey and Sussex (6%).

In addition, many of the cases involved Shigella strains that were antibiotic resistance- 86% of Shigella sonnei samples and 94% of Shigella flexneri samples tested showed resistance to antibiotics.

Shigella is a nationally notifiable disease because it poses significant public health importance and needs ongoing monitoring across states. The Centers for Disease Control and Prevention (CDC) urges stronger surveillance.

Given the rising prevalence of XDR strains and their transmission potential, CDC highlighted the need for strengthened surveillance, routine antimicrobial susceptibility testing, and timely reporting of shigellosis, which is a nationally notifiable disease.

The agency also called for targeted prevention strategies to limit further spread of XDR Shigella infections.

The growing prevalence of drug-resistant Shigella underscores a troubling erosion of public health barriers once taken for granted in developed nations during the “golden age” of medicine.

What was once a disease largely confined to regions with poor sanitation is now spreading through multiple channels in the U.S. and abroad, fueled by homelessness, inadequate hygiene, and sexual transmission.

As antibiotic resistance expands, so does the potential for Shigella to become far harder to treat, turning what was once a routine infection into a complex medical challenge.

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