Man develops arthritis from sexually transmitted bacterial infection

High-risk sexual behaviour may be to blame

In a case that initially stumped doctors, a man in England has become the first documented person to develop arthritis as a result of sexually transmitted shigella flexneri.

Although more commonly spread through food or travel, shigella flexneri, which causes diarrhoea, abdominal pain and flu-like symptoms, can also be spread through sexual intercourse.

Recently, there has been an increase in shigella outbreaks seen in men who have sex with men in England.

Shigella flexneri often leads to shigellosis, the most common type of dysentery in the UK, according to the NHS.

The bacterial infection is often treatable with an antibiotic.

However, in this case, after treating and discharging the man in question for shigella flexneri, four days later he returned with multiple painful joints, inability to weight-bear, and red eyes.

After undergoing multiple tests, subsequent fluid analysis resulted in a surprising diagnosis, which has been published in the Oxford Medical Case Reports journal - reactive arthritis, secondary to shigella flexneri.

English man catches shigella flexineri through unprotected sex

Reactive arthritis, while extremely painful, often clears up within six months, unlike other forms of the condition.

Although the cause of the condition is still unknown to scientists, many believe it stems from the immune system reacting to an infection. Infections that have been linked to reactive arthritis include STIs such as gonorrhoea and syphilis, and while shigella flexneri is well known to cause reactive arthritis in susceptible individuals, this is the first reported episode of sexually acquired shigella-associated reactive arthritis.

In this case, the man - who is homosexual - had a six-year history of well-controlled HIV but frequently engaged in high-risk sexual behaviour, including sexual activity with multiple partners, as well as sexual activity while on drugs - all of which could have played a part in the spread of the shigella flexneri.

And while this is the first reported case, this “may not represent rarity of the condition but rather lack of realisation that shigella can be sexually acquired.”