SPECIAL REPORT: The Drug-Resistant Infection Spreading Through Sex — What Atlanta Needs to Know
By The BeltLine News | October 19, 2026
ATLANTA — There is a highly contagious bacterial infection spreading across the United States that most people have never heard of. It causes severe diarrhea. It is increasingly spreading through sexual contact. And the antibiotics doctors have relied on for decades are starting to fail against it.
It is called shigellosis, and federal health officials say it deserves far more attention than it gets.
What is shigellosis?
Shigellosis is an intestinal infection caused by Shigella bacteria. Symptoms include severe diarrhea — sometimes bloody — along with fever, stomach cramps, nausea, and a persistent urge to have a bowel movement. Symptoms typically begin one to two days after exposure, though some infected people show no symptoms at all.
The bacteria spread through the fecal-oral route: when tiny amounts of infected fecal matter enter another person's mouth. That can happen through contaminated food, water, or surfaces — and through sexual activity, particularly oral-anal contact, anal intercourse, or shared unwashed sex toys.
What makes Shigella especially dangerous is how little of it it takes. As few as 10 to 100 organisms can cause a full infection, making it one of the most contagious intestinal bacteria known.
The CDC estimates Shigella causes approximately 450,000 infections in the United States every year.
The drug-resistance problem
For years, shigellosis was considered a routine childhood illness — the kind that spread in daycares and cleared up with a standard course of antibiotics. That era is ending.
According to a CDC study published in April 2026, the share of tested Shigella samples classified as extensively drug-resistant (XDR) rose from zero percent between 2011 and 2015 to 8.5 percent in 2023. These strains resist five commonly prescribed antibiotics: azithromycin, ciprofloxacin, ceftriaxone, ampicillin, and trimethoprim-sulfamethoxazole.
The CDC has warned that there is currently no FDA-approved oral antibiotic specifically for XDR shigellosis, leaving clinicians with limited treatment options for the toughest cases.
The consequences are real. About one-third of patients identified with extensively drug-resistant infections were hospitalized. Dr. Ferric Fang, professor at the University of Washington School of Medicine, told CIDRAP News that roughly 20 percent of those infected end up hospitalized with dysentery or dehydration.
Who is most affected?
The face of this disease has changed. The CDC's analysis found that most extensively drug-resistant cases occurred among adults — and men accounted for 86.2 percent of patients.
"Most XDR cases occurred among adult men," the CDC noted. The infection is spreading largely among men who have sex with men, where sexual transmission has become a dominant route.
"We've known for decades that there are a number of enteric pathogens that can be sexually transmitted almost exclusively between men who have sex with men," Dr. Fang told CIDRAP. He added that Shigella "falls through the cracks in public health between sexually transmitted infections and foodborne infections."
"I think a lot of men who have sex with men don't realize that it's sexually transmitted," Fang said.
Is it surging? An honest answer
You may have seen alarming headlines this month describing the illness as "surging" or "exploding." Here is what the numbers actually show: according to the most recent CDC data, 13,921 Americans had been diagnosed with shigellosis in 2026 as of September 26 — roughly on par with the 14,277 total cases in 2025.
So no — the country is not in the middle of a sudden new outbreak. The current wave of attention comes largely from renewed focus on the CDC's April 2026 drug-resistance findings.
But public health experts say that does not mean the threat is overblown. The trend is what worries them: resistance climbing from zero to 8.5 percent in a decade, sexual transmission overtaking other routes, and a disease most people — and many clinicians — still do not recognize as sexually transmissible. A July study found sexual spread grew 15 percent faster year over year between 2015 and 2020 than spread through travel, food, or daycare outbreaks.
The problem is serious. It is just quieter than the headlines suggest.
What about Georgia?
Shigella is a nationally notifiable disease, and cases are tracked in every state, including Georgia. Health officials in several states have published local case counts this year as part of the renewed national attention.
What matters for Atlanta readers is the pattern, not a single local case count: this is a national, ongoing public health issue moving through sexual networks in major cities — exactly the kind of urban centers Atlanta belongs to. Anyone who is sexually active should know this infection exists and how it spreads.
How to protect yourself
The CDC's guidance is straightforward:
• Wash your hands thoroughly with soap and water after restroom use and before handling food.
• If you have diarrhea, abstain from sex — anal, oral, penile, and vaginal — during the illness and for two weeks after it ends. The bacteria can keep spreading after symptoms stop.
• When resuming sexual activity, practice safer sex for at least two additional weeks.
• Do not take leftover antibiotics. Drug-resistant Shigella requires clinical testing to determine which drugs, if any, will work. Taking the wrong antibiotic can make things worse.
• See a doctor if you have bloody diarrhea, high fever, or severe cramping. Tell your provider about any sexual exposure — clinicians may not think to ask.
Most people recover from shigellosis within five to seven days without antibiotics. But severe or drug-resistant cases need professional medical evaluation.
The bottom line
"Sexually transmitted diarrhea" sounds like an internet joke. It is not. It is a real, highly contagious bacterial infection whose toughest strains are outrunning our medicines — and it is moving through sexual contact in communities that largely do not know it exists.
The good news: it is preventable, it is diagnosable, and most cases resolve on their own. The bad news: silence and stigma are helping it spread.
Talk about it. Get tested if you have symptoms. And do not assume a diarrheal illness cannot be sexually transmitted — because this one can.
The BeltLine News Special Report. This article is for informational purposes only and is not medical advice. If you are experiencing symptoms, contact a healthcare provider or your local health department.
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