Shigellosis

Shigella are bacteria that occur worldwide and one of the leading causes of bacterial diarrhea. There are four serogroups of Shigella: Shigella dysenteriae, Shigella flexneri, Shigella boydii, and Shigella sonnei. In Berlin, infections are primarily caused by Shigella sonnei (approximately 70% of cases in 2024) and Shigella flexneri (around 20%).

Since 2022, large international outbreaks of shigellosis (infection with Shigella) have been observed, particularly affecting men who have sex with men (MSM). Shigella strains detected in these outbreaks are often resistant to many of the commonly used antibiotics. In Berlin, we have seen an increase in these highly resistant strains since 2023, especially among men.

As at 15.07.2025

Since the beginning of 2023, the number of shigellosis cases has increased significantly in Berlin. According to the European Centre for Disease Prevention and Control (ECDC), a Europe-wide increase in case of shigellosis among men who have sex with men (MSM) was already reported in 2022.

In 2024, 212 cases were reported to LAGeSo, compared to the median number of 97 cases in the pre-pandemic years 2015-2019. In 2024, 88% of cases were male, with a median age of 37 years; 50% were aged between 31 and 45 years old. A total of 27 individuals with shigellosis (13%) required hospitalization.

In the first half of 2025, 153 shigellosis cases were reported in Berlin, which is above both the pre-pandemic median for the first half of the years 2015-2019 (n = 34) and the number reported in the same period in 2024 (n = 90). 81% are male, with a median age of 39 years. 14 individuals (9%) have been hospitalized.

Shigellosis is transmitted via the fecal-oral route. It can spread through contaminated food, or water, as well as through direct person-to-person contact (smear infections). Among men who have sex with men (MSM), transmission often occurs sexually through:

• Direct sexual contact: Anal or oral sex, anilingus (rimming), fingering, or other practices such as scatophilia.
• Indirect sexual contact: Sharing sex toys, condoms, or materials used for anal douching.

The time between the infection with Shigella and the onset of symptoms (incubation period) is usually between 12 and 96 hours. The illness typically lasts three to seven days but can be shortened with targeted antibiotic treatment (see section How is shigellosis treated).

Shigellosis often begins with fever, headache, a general feeling of illness, and cramp-like abdominal pain. This is usually followed by diarrhea, which is often bloody and contains mucus, and may persist for more than 48 hours.

People with shigellosis are contagious during the acute phase of the illness and for as long as the bacteria are shed in the stool. This can continue for one to four weeks after symptoms have resolved.

If you have shigellosis or suspect that you may have been exposed, the following steps are recommended:

• If you have gastrointestinal symptoms, consult a doctor or a sexual health counseling center to get tested.

• Wash your hands thoroughly and regularly, especially after using the toilet, before preparing food, and before eating.

• Refrain from sexual activity for at least 7 days after symptoms have resolved.

• Avoid any fecal-oral contact during sex for up to 4 weeks after the symptoms have gone, due to possible continued bacterial shedding.

• People who are ill or shedding the bacteria should not prepare food for others, even at home.

• In the case of work in the food sector or work with patients, resumption of work is only possible if negative results from bacteriological stool tests are available and approval from the local health authority has been obtained.

• Get tested for gastrointestinal pathogens and avoid sexual activity if you are experiencing gastrointestinal symptoms.

• Wash your hands thoroughly, especially after using the toilet, before preparing food, and before eating.

• Wash your hands, as well as your genital and anal areas, thoroughly before and after sex.

• Use latex gloves during fingering or fisting.

• Change condoms between anal and oral sex.

• Use dental dams for oral-anal contact.

• Do not share sex toys. Clean and disinfect them thoroughly after use and between partners.

Targeted antibiotic therapy should be administered depending on the results of antimicrobial resistance testing. This can help to reduce both the duration of symptoms and the period of bacterial shedding. Alternatively, symptoms such as fever and pain can be managed through adequate fluid intake and the use of fever-reducing medications.

RKI page on Shigella

Sidekicks.Berlin

ECDC- Shigella

ECDC- Rapid risk assessment

CDC – Shigella