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Outbreaks of Shigella sonnei and Shigella flexneri have been reported recently among gay, bisexual and other men who have sex with men (GBMSM), with transmission linked to sexual contact, particularly practices that involve oral-anal contact or faecal-oral exposure.1–8 The emergence of extensively drug-resistant (XDR) S. sonnei harbouring plasmid-encoded blaCTX-M-27 has raised concerns about the potential spread of this extended-spectrum beta-lactamase (ESBL)-producing gene.4–7 Two ESBL+ Shigella strains have been reported in Italy, one in a 10-year-old girl returning from Albania (2018) and one in a hospitalised patient (2021, no epidemiological or clinical data available).9 10
We present the case of a 35-year-old gay man diagnosed with XDR S. sonnei at our centre in Milan in February 2024. The individual was receiving HIV pre-exposure prophylaxis (PrEP) and doxycycline post-exposure prophylaxis (DoxyPEP). Past medical history included three episodes of gonorrhoeal proctitis, one chlamydial proctitis, a syphilis diagnosis and the detection of rectal HPV DNA. He travelled frequently within and outside of Italy. He presented following the acute onset of afebrile profuse mucous and fatty diarrhoea with tenesmus. He described condomless anal-receptive and oral-anal sexual intercourse with >50 partners in the previous month, including 20 days prior to the onset of symptoms with a man visiting Milan from the UK. The man later disclosed an untreated Shigella infection. On the initial presentation, he was treated empirically with a single dose of tinidazole 2 …
Footnotes
Handling editor Anna Maria Geretti
Contributors ARR and SN attended clinically to the individual and contributed to the writing of the manuscript. FS designed the study and contributed to the writing of the manuscript. VB performed laboratory microbiologic analyses on the sample and contributed to the writing of the manuscript. AZ performed bioinformatic analyses and contributed to the writing of the manuscript. DMC supervised the laboratory microbiological analyses and reviewed the manuscript. FDM supervised the bioinformatic analyses and reviewed the manuscript. AC supervised the clinical activities and reviewed the manuscript. SN acted as guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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