It starts like a bad stomach bug: cramps, fever and diarrhea that won’t let up, sometimes with blood. Most people recover within a week. But a growing share of cases now involve a strain of bacteria that common antibiotics can no longer touch, and doctors say it’s increasingly spreading through sexual contact rather than contaminated food or water.
Key Takeaways
- Shigella is a highly contagious bacterial infection that causes diarrhea, fever and stomach cramps. It sickens an estimated 450,000 Americans a year.
- “Extensively drug-resistant” (XDR) strains rose from 0% of tested U.S. samples in 2011–2015 to 8.5% in 2023, according to a CDC report published in April 2026. These strains resist all five antibiotics commonly used to treat it.
- Most XDR cases were in adult men, many of whom hadn’t traveled abroad, which points to spread within the U.S. Research has identified sexual contact, especially among men who have sex with men, as a key route.
- More than a third of people with XDR shigella were hospitalized, though no deaths were reported in the CDC data.
- Prevention is simple: wash hands with soap, avoid sex and food preparation while sick and for two weeks after recovering, and tell your doctor about recent sexual contact if you develop dysentery.
What’s happening
The CDC analyzed nearly 17,000 shigella samples submitted to its national lab surveillance network from 2011 to late 2023. Of those with resistance data, 510 were extensively drug-resistant, meaning the bacteria resisted ampicillin, azithromycin, ceftriaxone, ciprofloxacin and trimethoprim-sulfamethoxazole, the antibiotics doctors normally reach for. More than 80% of those XDR cases were reported in just 2022 and 2023.
The patients looked very different from shigella’s traditional profile. Shigella has long been associated with outbreaks among young children in daycare. But 86% of the XDR patients were men, with a median a