Cluster of shigellosis in men in Berlin in 2001

Shigellosis is an acute bacterial disease of the large and small intestine caused by one of four shigella species. Shigella serotypes are transmitted by direct or indirect faecal-oral contact, and outbreaks of shigellosis are traditionally associated with conditions of crowding or where personal hygiene is poor, such as prisons, day care centres, and psychiatric institutions. Outbreaks among men who have sex with men (MSM) have become more common in recent years, along with increases in high risk sexual behaviour, sexually transmitted infections, and HIV (1-5). Shigellosis in MSM was first described in San Francisco in 1974 (6). By the early 1980s, shigella infections in men supplanted cycles of shigellosis in more traditionally recognised risk groups, suggesting the importance of shigella infections transmitted by MSM (7).