Shigellosis (Shigella)

How Shigella Spreads

Shigella can make you very sick and spreads easily to others

• The most common way people get Shigella is by eating or drinking contaminated food or water. Swallowing only a small amount of Shigella bacteria can make you sick.
• Shigella can also spread through contact with poop during sexual activity.
• A person with Shigella infection can still have bacteria in their poop for up to four weeks after symptoms have gone away.
• If you or someone you know has or recently had diarrhea, take steps to help prevent the spread of infection. See “What to Do if You Have Symptoms or Shigella” below.

Some ways Shigella can get into your mouth and make you sick

• Getting Shigella bacteria on your hands and then touching your mouth or food.
• Touching surfaces contaminated with Shigella bacteria, such as toys, bathroom doorknobs, changing tables, and diaper pails.
• Changing the diaper of a child with diarrhea.
• Caring for a person with diarrhea, including cleaning up after they use the toilet.
• Eating food prepared by someone with Shigella.
• Swallowing contaminated drinking water or water that you swim or play in, such as lake water or inadequately treated pool or hot tub water.
• Exposure to poop during sexual activity with someone who has diarrhea or recently recovered from diarrhea. This can happen through:
  • Oral or anal sex, rimming, fingering and group play.
  • Handling contaminated objects, such as sex toys, used condoms or barriers, and douching material.

Signs and Symptoms

What to watch for

• Symptoms usually begin one to three days after exposure to Shigella bacteria but can start anywhere from 12 hours to seven days after exposure.
• Symptoms typically last four to seven days.
• Most people recover without treatment. However, some infections can be more serious and may require hospitalization, especially for people with weakened immune systems.
• A serious Shigella infection can spread into the bloodstream and can be life-threatening. Seek medical attention if your symptoms are severe, such as blood in your stool, abdominal pain, or if you are dehydrated.

Symptoms can include

• Diarrhea, which may be new and lasting longer than a week, or bloody
• Stomach pain or cramps
• Fever
• Nausea and vomiting
• Feeling the need to pass stool (poop), even when the bowels are empty

Contact a health care provider if your symptoms worsen, do not improve or if you develop signs of dehydration, such as feeling thirsty, having a dry mouth, dark yellow urine, peeing less often, or feeling unusually tired.

Who is at Risk

Anyone can get Shigella but some groups are at higher risk of infection

• Men who have sex with men (MSM)
• Young children
• People experiencing homelessness
• People travelling to countries with poor sanitation
• People with weakened immune systems are at a higher risk of developing more serious illness.

Reduce Your Risk of Getting Shigella

Wash your hands carefully with soap and water

• Before preparing food or eating.
• After going to the bathroom, changing a diaper, or cleaning up after someone who has used the toilet.

Take care when changing diapers

• Throw diapers away immediately in a covered, lined garbage can.
• Clean up any leaks or spills from the diaper right away.
• Wash your hands and the child’s hands with soap and water immediately after changing a diaper.

Practice good hygiene before and after sexual activity

• Wash your hands, genitals, and anus before and after sex.
• Use latex gloves for fingering or fisting and dental dams during oral-anal sex.
• Avoid sharing sex toys and ensure that they are properly cleaned and disinfected after each use.
• Change condoms between anal and oral sex.

Practice safe food and water habits

• Avoid swallowing water from ponds, decorative fountains, water features, lakes, creeks, rivers or swimming pools. Wash your hands with soap and water or alcohol- based hand sanitizer after swimming or after touching water from these sources.
• When traveling internationally, follow safe food and water practices and wash your hands often with soap and water, or alcohol- based hand sanitizer.

What to Do if You Have Symptoms of Shigella

If you think you have Shigella or have been diagnosed with Shigella, it is important to:

Take care of yourself

• Drink lots of fluids and get plenty of rest.
• Seek medical attention if symptoms continue or worsen Your health care provider may provide you with antibiotics to treat the infection.
• TPH recommends treatment for all Shigella cases.
• People with bloody diarrhea should not use anti-diarrheal medicines, such as loperamide (Imodium) or diphenoxylate with atropine (Lomotil). These medicines may make the illness worse.

If you are sick with diarrhea, or diagnosed with Shigella: help stop the spread

• Stay home while you are sick, especially if you work in food service, healthcare, childcare or work with people at higher risk of infection. Stay home until public health says it is safe to return to work.

• Wash your hands often with soap and water, especially after using the bathroom and before eating or preparing food. If soap and water are not available, use an alcohol-based hand sanitizer.
• Do not prepare or share food with others while you are sick.

• Avoid sexual contact with others while you are sick.

• Do not have sex for two weeks until after your diarrhea ends.

• Avoid mouth to bum contact (rimming) for 4 to 6 weeks after your diarrhea ends.
• Do not swim or use a public hot tub or spa until seven days after your diarrhea ends.

Keep your space clean

• Try to keep your sleeping and bathroom areas separate. Use liquid soap and have your own towel if you need to share the bathroom and disinfect commonly touched surfaces after every use.
• Shower, change bedding and clothing as soon as you can if it gets dirty with poop.

Additional precautions if you are experiencing homelessness:

• Separate living and sleeping areas from toileting areas.
• Where possible, always use a toilet.
• Dispose of garbage (e.g., used wipes or toilet paper) in a garbage bag and place in a trash can.
• Change bedding or clothing as soon as you can if it gets dirty with poop.
• Shower often when possible.
• Do not share personal items, such as cigarettes, food, water, sex toys, needles, syringes, clothing and bedding.

Testing & Treatment

Diagnosis

• Your health care provider may test you for Shigella infection if they suspect you have the infection.
• Shigella infection is diagnosed through laboratory testing of a stool (poop) sample.

Treatment

• TPH recommends treatment for all Shigella cases. If antibiotics are needed, healthcare providers will provide you with antibiotics to treat the infection.

• People with bloody diarrhea should not use anti-diarrheal medicines, such as loperamide (Imodium) or diphenoxylate with atropine (Lomotil). These medicines may make the illness worse.