A case of reactive arthritis secondary to sexually acquired Shigella flexneri

Abstract

We present the first documented case of reactive arthritis (ReA) secondary to sexually acquired Shigella flexneri infection. The case occurred in the context of a recent change in Shigella epidemiology in England where non-travel associated cases are now contributing the majority of diagnoses. Such non-travel associated cases are occurring predominantly in men who have sex with men with high sexual risk taking behaviour reflecting the importance of the sexual history when assessing a man with Shigella infection who has not travelled. We suggest Shigella can be thought of as a cause of sexually acquired ReA and not just a form of enteric ReA. Referral to sexual health services for further management is essential.

British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections 2023

“…82,88 Reactive arthritis can be triggered by sexually acquired S.flexneri or S.sonnei and Campylobacter spp. 91,92 Toxin mediated encephalitis has been described in an adult MSM with S.flexneri. 93 Acute demyelinating peripheral…”

“…flexneri or S.sonnei and Campylobacter spp. 91,92 Toxin mediated encephalitis has been described in an adult MSM with S.flexneri. 93 Acute demyelinating peripheral neuropathies (Guillain Barre syndrome) is associated with Campylobacter spp.…”

British Association of Sexual Health and HIV national guideline on the management of sexually acquired reactive arthritis 2021

“…21–23 Similarly, Ureaplasma urealyticum has been reported in a few cases of arthritis, but a causal role in the development of SARA has not been established. 24,25 Sexual transmission of enteric pathogens triggering SARA has been reported, 26,27 and Shigella outbreaks have been identified in men that are independent of travel history, thus raising the likelihood of sexual transmission. 28 Therefore, ReA due to Shigella could be acquired through the enteric or sexual route.…”

“…Sexual transmission of enteric pathogens triggering SARA has been reported, 26,27 and Shigella outbreaks have been identified in men that are independent of travel history, thus raising the likelihood of sexual transmission. 28 Therefore, ReA due to Shigella could be acquired through the enteric or sexual route.…”