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Sexually Transmitted Enteric ‘Gut’ Infections

The basics

Enteric or ‘gut’ infections are caused by bacteria (germs), viruses and parasites that cause inflammation of the intestine or ‘gut’.  Infections can cause diarrhoea (runny poo), abdominal (tummy) pain and bloating, fever (high temperature) or jaundice (yellowing of eyes and skin). Men who have sex with men (MSM) are most commonly affected by these infections; but other groups such as trans people and individuals who have sex with people in these groups.

Infection can cause certain symptoms, depending on the part of the body affected:

Some common sexually transmitted enteric (gut) infections include hepatitis A, shigella, giardia and lymphogranuloma venereum (LGV). 

Whilst most enteric (gut) infections in MSM are thought to be passed through sexual contact, they can be linked to travel, eating contaminated food or drinking water, or recent antibiotic use. Some occupations (food handlers including airline staff, and healthcare workers) may also increase the risk of exposure.

What is diarrhoea?

Diarrhoea is when your poo is not very well formed, and in some cases can be liquid. The diarrhoea may contain blood and you may have little control over when you need to use the toilet (which can be very frequent). It may also cause stomach cramps.

How common are sexually transmitted enteric (gut) infections? 

Sexually transmitted enteric (gut) infections are most commonly seen in gay, bisexual and other men who have sex with men (MSM), including transgender and people who identify as non-binary. They may also affect people identifying as heterosexual where there has been a possible risk. If you have any symptoms described above, it is important to go to your local sexual health service.

How do you get sexually transmitted enteric (gut) infections?

Enteric (gut) infections in MSM are most commonly passed on through sexual contact.  This includes:
1.	Faeco-oral spread (where poo particles enter the mouth from rimming (oral sex of the anus/bum), contaminated skin, fisting (putting your hand/fist inside the bum or vagina) or coprophilia (scat play)
2.	Direct sexual contact (deep kissing, genital touching and penetration by penis, finger or shared sex toy). 
Other factors can increase your risk, including: “Chemsex” (use of drugs to enhance sexual pleasure), booty bump (putting recreational drugs directly into your bum), bare-back (condomless) sex, multiple or frequent changes of partners and HIV status.

What would I notice if I had a sexually transmitted enteric (gut) infection?

Common symptoms include:
•	Diarrhoea (with or without blood)
•	Abdominal pain or bloating
•	Feeling sick (nausea) or vomiting
•	Fever
•	Rectal symptoms (pain in the bum, ulcers, mucus or blood when passing poo, feeling like you have not emptied bowels properly)

Symptoms can start as soon as 1-2 days after infection and may last for several weeks. Diarrhoea is often self-limiting (will clear on its own).  If symptoms do not settle within a few days, and you feel unwell, you may need medication from a doctor or local sexual health service. 

How do I get tested for sexually transmitted enteric (gut) infections? 
If you have been at risk of an infection, have symptoms like those listed above, or have had sexual contact with someone with an infection, it is important you attend your local sexual health service. They will offer you a full sexual health screen and take poo samples if required.

How are sexually transmitted enteric (gut) infections treated? 

Most infections that cause diarrhoea will get better on their own and you do not need antibiotic treatment. Antibiotic treatment should only be taken on the advice of a health professional as they can lead to antimicrobial resistance (meaning some antibiotics will no longer cure the infection) and even make some people more unwell rather than better. 
To avoid becoming dehydrated drink fluids. It is best to use oral rehydration salts which can be bought at a local pharmacy or supermarket. Loperamide (Imodium) is not usually recommended for short term diarrhoea due to infection: talk to your doctor or pharmacist if you think this is needed.  

You may be offered antibiotic treatment if you are in hospital and if your symptoms are severe or prolonged. Everyone who is diagnosed with a sexually transmitted enteric (gut) infection should be tested for other common sexually transmitted infections. If your symptoms are mainly rectal (affecting your bum) you may be offered treatment to cover chlamydia, gonorrhoea and the herpes simplex virus whilst awaiting test results.

Important information about your treatment 

Oral rehydration salts should be taken after each time you poo, for at least 48 hours.
Your local sexual health service will give you specific advice regarding any medications they give you.
You may be followed up by the sexual health clinic 7 days later, to see if your symptoms have settled.

What about my partner? 

If an infection is found, then it is recommended that anyone you have had sexual contact with recently get advice from a sexual health service/clinic. In most cases, if they do not have symptoms, they only need a routine STI screen. This can be done anonymously (keeping your details confidential) with your local sexual health service. This helps to reduce the number of cases in the community and the risk of re-infection in the future.

When can I have sex again? 

If you have had diarrhoea, you should make sure all your symptoms have settled and it is at least 7 days since the diarrhoea started before you have sex again (whichever comes last)..  This includes oral and oral-anal sex (rimming).
Avoid sharing sex toys and ensure these are washed with soap and water thoroughly after use.  If you do share sex toys, ensure condoms are used, and changed between partners.
Make sure you wash your hands with soap and warm water after going to the toilet, and before preparing food.
Do not use a swimming pool, spa or sauna for at least two weeks after diarrhoea has settled.
If you have a sexually transmitted enteric (gut) infection, the sexual health service will advise you when it is safe to have sex again following treatment.

What happens if my infection is left untreated? 

Most sexually transmitted enteric (gut) infections will clear on their own, requiring no treatment.  Occasionally, people may become more unwell depending on the cause. Some studies suggest that people living with HIV are more likely to be unwell and end up in hospital and require antibiotic treatment.  It is important if you are at risk of infection, that you test regularly and follow the advice given by your local sexual health service.

Should I go to work whilst recovering?

If you work in food handling or have contact with the public, stay away from work for at least 48 hours after your diarrhoea has settled. You may be contacted by the public health team who will be able to offer you further advice and support.

Should I isolate at home whilst recovering?

You do not need to isolate but need to be very thorough with handwashing and hygiene to avoid transmission to people you live with or have contact with at home.

Can I get a sexually transmitted enteric (gut) infection again?

Reinfection can be common, particularly if you have sexual contact with someone who has symptoms, or who has a confirmed infection.

Sexually transmitted enteric (gut) infections in pregnancy. 

If there has been a risk or exposure, then gut infections can occur during pregnancy. Whilst most illnesses are self-limiting, hospitalisation may be required if dehydration (loss of fluid) has occurred. Please discuss with a doctor or midwife for more information.

This leaflet was produced by the Clinical Effectiveness Group of the British Association for Sexual Health and HIV (BASHH). The information in the leaflet is based on the ‘British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections 2023’ published by BASHH.

More information: BASHH: 

The leaflet was developed following The Information Standard principles developed by NHS England. 

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Copyright BASHH 2023. This leaflet was first published in 10/2023. Review date 2028.