Epidemiologic and Genomic Investigation of Sexually Transmitted Shigella sonnei, England

Shigellosis is a bacterial infection that causes enteric illness and can be sexually transmitted, particularly among gay, bisexual, and other men who have sex with men. Multiple extensively drug-resistant Shigella strains have been detected through genomic surveillance and are associated with plasmids carrying the gene variant bla_CTX-M-27 in the United Kingdom. We report an increase in possible sexually transmitted cases of Shigella bacteria carrying the bla_CTX-M-15 gene variant, which was previously associated with travel. In 2023, there were 117 cases belonging to the 10 single-nucleotide polymorphism linkage cluster t10.1814. Although this cluster has been documented in England since August 2019, genetic analyses revealed that the bla_CTX-M-15 gene variant entered the lineage on a novel resistance plasmid coinciding with the first outbreak case. Our analysis highlights the shifting antimicrobial resistance landscape of sexually transmitted Shigella bacteria. Parallel emergence of resistance determinants against third-generation cephalosporins in sexual transmission networks suggests high levels of antimicrobial selection pressure.