Prevention of illness is always better than a cure, and never more so than with an infection that has become resistant to multiple drugs. A current outbreak of the sexually-transmitted bowel infection shigellosis has proven just so, with almost a third of recent cases drug resistant.
Which is why health authorities are pleading with people to use safe sexual practices – and not just when it comes to standard penetrative sex.
The use of condoms alone may be ineffective to prevent the spread of Shigella.
Shigella is a highly contagious bacteria spread through infected faecal matter, which means that while anyone can contract it, it tends to be far more easily transmitted through the sexual practices of gay and bisexual men; and use of condoms alone may be ineffective.
Nicolas Parkhill, chief executive of LGBTI health organisation ACON, said infection takes place when tiny particles of contaminated faeces enter the mouth.
"This can happen through sexual contact such as rimming, by getting infected faeces on your fingers and then touching your mouth or by putting contaminated objects like food, pens and cigarettes into your mouth," he said.
"If you experience symptoms, it’s important that you see your doctor so you can get tested and be treated."
Shigellosis, the bowel infection that results from Shigella exposure, can result in vomiting, stomach cramps, diarrhoea, fever and nausea. Symptoms can appear between 12 hours and four days after exposure, and can last between four and seven days.
People with HIV or who have an otherwise compromised immune system may experience a more severe illness.
Out of 91 cases of shigellosis cases in NSW from November to April, almost a third demonstrated resistance to six classes of antibiotics – meaning there is no oral antibiotic that will work on this strain. People suffering the drug-resistant strain of shigellosis may need intravenous antibiotics to kill the infection, according to NSW Health.
NSW Health Medical Epidemiologist Dr Christine Selvey said it's likely the number of recorded cases of shigellosis don't reflect the true number of people with the infection, as many will not seek medical attention or be tested – symptoms often disappear without antibiotics in healthy individuals.
Antibiotics, however, can reduce infectiousness and the severity of symptoms.
"We want gay men to be aware of ways that can reduce the risk of getting and spreading Shigella," Dr Shelvey said.
"The most effective way is to wash hands thoroughly with soap and water after any sexual activity, touching equipment like used condoms and sex toys, going to the toilet, and before handling food."
Anyone who has contracted the infection should avoid sexual activity while they have symptoms and for seven days afterwards.
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