A case of intercurrent shigellosis and rectal gonorrhea in an acutely unwell febrile returned traveler.

Abstract

Both acute traveler's diarrhea and sexually transmitted infections are common causes of fever in the returned traveler, with the male sex corresponding to two-fold increased odds of a sexually transmitted infection (STI) diagnosis related to travel. Shigella flexneri is the most common cause of shigellosis in low- and middle-income countries, while within the men who have sex with men (MSM) population, outbreaks of S. flexneri 3a, S. flexneri 2a, and S. sonnei have been reported. We herein present a case of a febrile returned MSM traveler with a predominantly gastrointestinal presentation and proctocolitis whose microbiological work-up confirmed coinfection with S. flexneri and rectal gonorrhea. Based on his travel history and epidemiologic risk factors, it is unclear if food- and waterborne shigellosis versus transmission via sexual contact was the major route of acquisition. This case highlights the broad differential for proctocolitis and the importance of consideration of intercurrent infections.