Antimicrobial resistance in sexually transmitted Shigella in men who have sex with men: A systematic review

Abstract

Background Outbreaks of sexually transmitted Shigella flexneri and Shigella sonnei in men who have sex with men (MSM) are a major public health issue. While most cases can be managed conservatively, a minority require antimicrobial treatment. Recent reports have highlighted increasing antimicrobial resistant (AMR) strains of Shigella spp. in men who have sex with men. We aimed to systematically review antimicrobial resistance (and decreased antimicrobial sensitivity) in sexually transmitted shigella in men who have sex with men, focussing on macrolides, quinolones, and third generation cephalosporins. Methods We systematically searched 4 bibliographical databases (EMBASE, medline, EMCARE and CINAHL) from January 2011 to November 2021. We used a 2-stage process to assess eligibility: the primary author conducted an initial screen and then 3 authors conducted independent full-text reviews to determine the final eligible manuscripts. We only included manuscripts in English which included men who have sex with men with sexually transmitted shigella where data on antimicrobial resistance was available. Results Thirty-nine manuscripts met the inclusion criteria. A majority of the manuscripts ( N = 34) described reduced susceptibility or antimicrobial resistant to macrolides, quinolones and third generation cephalosporins in circulating strains of shigella within sexual networks of men who have sex with men. Extensively drug resistant outbreaks of shigella in men who have sex with men have been reported containing genetic markers of ceftriaxone resistance (e.g. BlaCTX-M27) where isolates also contained markers of reduced susceptibility, and antimicrobial resistant to macrolides and quinolones. Conclusion There is little role for macrolides, quinolones or third generation cephalosporins in the management of sexually transmitted shigella in men who have sex with men. More research is needed to develop novel strategies for shigella control in men who have sex with men, as antimicrobial options are diminishing.

Factors and presenting symptoms associated with intestinal spirochaetosis in men who have sex with men: A systematic review

“…has highlighted the importance of sexually transmitted enteric infections, including improving surveillance, antimicrobial testing, the use of genomics to define outbreaks and the need for more robust guidelines for clinicians. 37 Furthermore, the recent outbreak of autochthonous transmission of M.pox virus amongst MSM in high income settings demonstrates that novel infectious agents can rapidly disseminate and cause morbidity in sexual networks of MSM. 38 MSM are also believed to have a great variety of gut microbiota compared to non-MSM, including higher carriage rate of protozoa.…”

Resistance in Enteric Shigella and nontyphoidal Salmonella: emerging concepts

“…Moreover, the proportion of sexually transmitted Shigella infections is very high. Their rates of multidrug resistance are higher than those of Shigella isolates with other modes of transmission, with gradually increasing resistance trends, mainly to ampicillin and trimethoprim, azithromycin, ceftriaxone and ciprofloxacin [29,30,31…”

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

“…8,18,34,35,80,81,88,[97][98][99][100][101][102][103][104][105][106][107][108][109][110] Extensively resistant sexually transmitted shigella has been reported in MSM, including antimicrobial resistance to azithromycin, quinolones, aminoglycosides, co-trimoxazole and ceftriaxone. [111][112][113][114][115][116][117][118][119][120] Campylobacter spp. Sporadic outbreaks of sexually transmitted C. coli and C. jejuni are reported in MSM.…”

“…Extensively drug resistant sexually transmitted Shigella spp., Campylobacter spp., and STEC have been reported and antimicrobials will have a limited effect. 12,82,[111][112][113][114]116,[118][119][120]139 Additionally, there is concern over the use of empirical antimicrobial for cases of STEC and the potential to increase toxin release and HUS. [140][141][142]…”