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S14.4 The role of sexual networks in the global spread of antimicrobial-resistance enteric infections
  1. Nigel Field
  1. University College London, Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, London, UK


In high-income countries, enteric pathogens have typically affected returning travellers or children, or spread from contaminated point sources. However, sexually transmitted enteric infections (STEI) are now well documented, particularly among men who have sex with men (MSM). The phenomenon was recognised in patients with HIV/AIDS in the early 1970’s as arising from direct/indirect ingestion of faecal matter via sexual contact. Bacteria (Shigella spp., Salmonella spp., Campylobacter spp., Escherichia coli), viruses (Hepatitis A), and protozoa (Giardia spp., Cryptosporidium spp., Entamoeba histolytica) have all been implicated. Following a nadir during the 90’s and early-2000’s, new epidemics of enteric pathogens affecting MSM have been reported internationally. Facilitated by global travel, these have familiar characteristics (oral-anal behaviours and HIV-associations), but also important new features (associations with ‘chemsex’, social media use, PrEP, syndemic STIs, and transmission in the absence of HIV). For some STEIs, notably Shigellosis, a worrying new feature is resistance to multiple antimicrobial classes found in most isolates from MSM. This may be collateral to frequent antibiotic exposure acting as a selection pressure among the sexual networks affected. Understanding of these sexual networks has been informed by a wide range of approaches, from qualitative patient interviews, through scrutiny of national surveillance trends (male-to-female ratios, gender excess, geographical distributions) and electronic data linkage, to population-level pathogen phylogenomics. These are challenging infections to study, not least due to being sometimes asymptomatic, as well as patient and clinician unawareness about sexual transmission leading to missed or mis-diagnoses, the hidden nature of the affected population, and stigma. Moreover, many questions remain about the prevalence, transmission, duration of infection, clinical implications, drivers of antimicrobial resistance, and effective public health and clinical interventions. Embracing transdisciplinary approaches to understand the sexual networks affected and the behavioural and pathogen-associated drivers seems essential if we are to move from observation to control.

Disclosure No significant relationships.

  • networks
  • enteric infections
  • antimicrobial resistance
  • Shigella

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