Drug-Resistant Shigella Surges in US: CDC Warns of Antibiotic-Resistant STI

The Centers for Disease Control and Prevention reported that extensively drug-resistant Shigella infections are accelerating across the United States. Between 2011 and October 2023, the CDC analyzed 16,788 Shigella isolates and found 510 cases, or 3%, were extensively drug-resistant and resistant to five commonly used antibiotics. Most concerning: 84% of all drug-resistant cases emerged in just 2022 and 2023, signaling a sharp recent spike.

What is Shigella and how does it spread

Shigella is a highly contagious bacterium that causes shigellosis, an infection that can produce bloody diarrhea, fever, stomach pain, and in rare cases, death. The infection spreads through fecal-oral contact, contaminated food or water, and sexual contact. Exposure to as few as 10 organisms can cause infection. In recent years, transmission through sexual contact has increased, particularly among men who have sex with men.

The drug-resistant strain is spreading rapidly

Extensively drug-resistant (XDR) Shigella is resistant to ampicillin, azithromycin, ceftriaxone, ciprofloxacin, and trimethoprim-sulfamethoxazole. The percentage of isolates classified as XDR jumped from 0% between 2011 and 2015 to 8.5% in 2023. Most drug-resistant cases occurred in 2022 and 2023, with 415 cases representing more than 84% of the total identified since 2011.

Who is most affected and treatment challenges

Nearly 96% of patients with XDR Shigella were at least 18 years old, and 86.2% were men. The CDC estimates 242,000 people contract drug-resistant Shigella strains annually in the US. There are no FDA-approved oral antibiotics specifically available to treat extensively drug-resistant Shigella. Doctors may rely on laboratory testing to determine which medications might work. Most infections resolve without treatment through hydration and rest, but severe cases lasting months may require antibiotics.

Global spread and regional patterns

The problem extends beyond the US. England reported 2,560 laboratory diagnoses of potentially sexually transmitted Shigella in 2025, with more than half of one type testing as extensively drug-resistant. Colorado had 60 XDR Shigella isolates between 2016 and 2023, California had 111, and Oregon had 21. European health officials identified more than 2,300 multidrug-resistant or extensively drug-resistant Shigella infections across 14 countries since 2023.

Final Thoughts

The sharp acceleration of drug-resistant Shigella in 2022 and 2023 signals a public health shift requiring urgent attention. With limited antibiotic options and transmission through sexual contact, prevention and rapid diagnosis are critical. The CDC data underscores why surveillance and treatment guidelines must adapt quickly.

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