Toronto Public Health has received reports of antibiotic-resistant or extensively drug-resistant (XDR), Shigella cases among gay, bisexual and other men who have sex with men. Antibiotic resistance happens when germs no longer respond to certain antibiotics, making it harder to treat the infection.

Shigellosis (Shigella) is an intestinal infection caused by Shigella bacteria. Shigella bacteria is found in the feces of an infected person and is spread through the fecal-oral (butt-mouth) route, including ingesting contaminated food or liquids, touching a contaminated surface, and through exposure to feces during sexual contact. You do not need to encounter much of the Shigella bacteria to make you sick.

Shigella bacteria spreads through the fecal-oral (butt-mouth) route. You can get Shigella by swallowing the Shigella bacteria. Some ways Shigella can get into your mouth are:

  • Getting Shigella on your hands and touching your mouth. Shigella can get on your hands by:
    • Touching surfaces contaminated with Shigella bacteria, such as toys, bathroom fixtures, changing tables and diaper pails.
    • Changing the diaper of a child with Shigella.
    • Taking care of a person with Shigella, including cleaning up after the person uses the toilet.
  • Eating food prepared by someone with Shigella.
  • Swallowing contaminated water you swim or play in, such as lake or swimming pool water that is not regularly treated.
  • Swallowing contaminated drinking water, such as water from a well that’s been contaminated with sewage or flood water.
  • Exposure to feces during sexual contact with someone with Shigella or who has recently recovered from Shigella. This can happen during sexual activity through:
    • Anal or oral sex, or anal play (rimming, fingering).
    • Handling contaminated objects, such as sex toys, used condoms or barriers, and douching material.

Symptoms usually start around one to three days after being exposed, but can start anywhere from 12 hours to seven days after exposure. Symptoms usually last four to seven days.

Symptoms are very uncomfortable and can include:

  • Diarrhea (can be bloody)
  • Stomach pain
  • Fever
  • Nausea and vomiting

Anyone can get Shigella but gay, bisexual, and other men who have sex with men, young children, and people travelling to countries with poor sanitation are at higher risk of infection.

People with weakened immune systems can get a more serious illness.

A severe Shigella infection can spread into the blood, which can be life-threatening.

If you think you have Shigella, it is important to:

Take Care of Yourself

  • Drink lots of fluids and get plenty of rest
  • Contact your health care provider if symptoms persist or worsen
  • Antibiotics are only recommended if you have severe illness or a weakened immune system

Take Steps to Prevent Spread

  • Stay home while you are sick
  • Wash your hands often
  • Do not prepare or share food with others
  • Avoid sexual contact with others while you are sick
    • To reduce the chance of spreading Shigella, wait at least seven days after symptoms end to have sex
    • Always wash your hands, genitals and anus before and after sex
  • Avoid public swimming facilities such as pools, hot tubs, and splash pads


Your doctor will test you for Shigella if they think you have the bacteria. Shigella is diagnosed with laboratory tests of the stool.


Most people with Shigella, including those infected with antibiotic-resistant Shigella, recover on their own by drinking lots of fluids and getting plenty of rest. Antibiotics may be prescribed in severe cases. Doctors need to consult with the lab to ensure they treat someone with serious Shigella with the right antibiotics.

Recently, labs in Toronto have detected Shigella bacteria that are no longer killed by antibiotics that used to work against them. Gay, bisexual, and other men who have sex with men are particularly at risk for infections with antibiotic-resistant, or extensively drug-resistant (XDR), Shigella. Antibiotic resistance happens when germs no longer respond to certain antibiotics, making it harder to treat the infection.