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Yes. Some infections that cause diarrhea can spread during sexual activity when stool reaches the mouth or another person. Shigella is a well-documented example; “sexually transmitted diarrhea” is a colloquial description, not a single diagnosis or a separate STI category. Drug resistance is a real concern, but the available US figures do not show that sexually acquired diarrhea overall is “exploding.”
How diarrhea-causing infections can spread during sex
Shigella lives in stool. Infection can occur when someone swallows even a small amount of stool or material contaminated by it. Sexual contact that can create this exposure includes oral-anal, oral-genital, anal-genital and digital-anal contact. Shared sex toys can also transmit germs if they are not washed after each use. CDC notes that Shigella may remain in stool for up to two weeks after diarrhea ends, and germs can be present on skin around the anus and genitals, including the thighs and buttocks; contamination is not necessarily visible.
CDC also discusses Campylobacter in guidance on sexually transmitted enteric infections, including multidrug-resistant Campylobacter. These are intestinal infections transmitted through fecal exposure, not a single condition called “sexually transmitted diarrhea.” CDC’s STI guidance on sexually transmitted enteric infections addresses Shigella and Campylobacter in this context.
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CDC estimates about 450,000 Shigella infections occur in the United States each year, and estimates that 242,000 of them are antimicrobial-resistant. Those 2024 estimates cover Shigella infections overall, not just infections acquired through sex. The cited sources do not establish a current national trend showing that sexually acquired diarrhea overall is rapidly increasing. CDC’s clinical overview of shigellosis provides the estimates and clinical context.
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Resistance figures need similar care. In a 2023 health alert, CDC reported that the share of reported US Shigella infections caused by extensively drug-resistant (XDR) strains rose from 0% in 2015 to 5% in 2022. CDC described those figures as preliminary, based on sequenced isolates submitted to PulseNet and susceptibility testing and/or resistance markers from whole-genome sequences. This is a measure of reported Shigella infections overall—not a finding that 5% of sexually transmitted diarrhea cases were XDR. Read CDC Health Alert Network 00486.
Why resistance matters for treatment
CDC says multidrug resistance to trimethoprim-sulfamethoxazole, ciprofloxacin and azithromycin is widespread. Its NARMS monitoring also shows that the percentage of isolates resistant to both azithromycin and ciprofloxacin has increased since 2017. These are resistance findings about Shigella isolates; they do not identify how an individual infection was acquired.
Many people with shigellosis recover without antibiotics. When a clinician decides antibiotics are needed, CDC advises selecting treatment based on susceptibility testing of the individual isolate or, during a local outbreak, resistance information for the outbreak strain. Do not use leftover antibiotics or assume a previously effective drug will work for a new infection. A clinician can arrange stool testing, which can identify Shigella, and use the result and relevant local resistance information to guide care. CDC’s clinical overview describes testing and treatment; its STI guidance advises clinicians evaluating relevant patients with diarrhea to request laboratory examinations, including stool culture.
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- Avoid sex while you or a partner has bloody or prolonged diarrhea.
- Wait at least two weeks after diarrhea ends before having sex. Shigella can still be present in stool after symptoms stop.
- Wash hands, genitals and anus with soap and water before and after sexual activity.
- Wash shared sex toys after each use.
These steps reduce opportunities for fecal exposure; they are not a guarantee against Shigella or other infections. CDC’s full prevention guidance for sexually active people gives additional context.
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When to seek medical advice
Contact a healthcare professional if you develop diarrhea after a possible exposure, particularly if it is bloody or prolonged. Mention the timing of symptoms and any sexual contact involving possible fecal exposure; that information can help guide testing. Seek medical advice rather than starting antibiotics on your own, because the appropriate treatment depends on whether antibiotics are needed and, when they are, on susceptibility or local resistance information.
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