Is E. coli a type of STD?

The recent popular Netflix documentary shedding light on contaminated food supplies and pathogens such as E. coli (Escherichia coli) has heightened awareness of these bacteria. Interestingly, at times, patients present with genito-urinary symptoms.

After a series of clinical tests, the diagnosis often points to an E. coli infection. This article delves into the less-discussed connection between E. coli and sexually transmitted diseases (STDs). This aims to inform you about the potential link between E. coli and certain STD symptoms, emphasising the importance of understanding this connection for your overall health and well-being.

What is E. coli?

Escherichia coli, known as E. coli, is a type of bacteria present in various sources such as raw foods, vegetables, undercooked meats (particularly beef and pork), contaminated water, and the digestive systems of both humans and animals [1].

In most cases, E. coli is harmless. However, certain strains of E. coli can be pathogenic and cause infections [2]. These infectious strains can penetrate the mucous membranes and blood vessels in the human body, leading to various infections. This includes those affecting the respiratory, gastrointestinal, and urinary systems.

It is important to be aware of the potential risks associated with specific types of E. coli to take appropriate precautions and seek medical attention if needed.

Is E. coli sexually transmitted?

In technical terms, STDs (sexually transmitted diseases) are infections primarily transmitted through sexual intercourse, including oral, vaginal and anal intercourse [3].

While E. coli infections are not typically classified as STDs, they can be triggered during sexual activity [4]. E. coli bacteria naturally reside in the genito-anal region as part of a person’s normal bacterial flora. However, during sexual intercourse, these bacteria can be transferred to the urinary tract (this is in both men and women) or the vaginal area (in women), potentially causing an infection [5]. So, yes, E. coli can be sexually transmitted.

It is worth noting that compared to more common STD pathogens such as chlamydia, gonorrhoea, mycoplasma genitalium, ureaplasma urealyticum, or trichomonas, E. coli infections acquired through sexual contact are less prevalent.

Can E. coli be transmitted through oral sex, too?

As previously mentioned, E. coli is a common bacterium found in the human gastrointestinal tract and can also exist in the perianal area and faeces. When engaging in oral intercourse, which involves direct contact between the mouth’s mucous membranes and the genital or anal region, there is a potential risk of acquiring an E. coli bacterial infection through cross-contact with your partner. 

Therefore, it is indeed possible for E. coli infection to be transmitted through oral sex. It is essential to be aware of this risk and practice safe hygiene and sexual precautions to reduce the likelihood of infection transmission during intimate activities.

What is the risk of acquiring an E. coli infection?

Anyone exposed to the E. coli bacteria can potentially develop an infection.

You may be more predisposed towards an E. coli infection if you have the following risk factors:

• Weakened immune system: if you have a weak immune system due to conditions such as diabetes, HIV/AIDS, cancer, or long-term use of immunosuppressant medications, you are at a higher risk of E. coli infection.
• Extreme age groups: the very young and the elderly are more vulnerable to severe E. coli symptoms because their immune systems are generally weaker.
• Consuming contaminated food: ingesting contaminated food, such as raw vegetables, undercooked beef or pork, soft cheeses, or water contaminated with E. coli increases the risk of infection.

What are the symptoms of an E. coli infection?

Generally, E. coli infections are mild and only cause transient symptoms such as diarrhoea. However, a specific strain known as E. coli 0157:H7 has the potential to lead to more severe symptoms [6]. This includes bloody diarrhoea, abdominal pain, and vomiting, which can progress to systemic issues such as kidney or organ failure.

Common symptoms of E. coli infection include:

• Diarrhoea
• Abdominal cramping or pain
• Nausea
• Vomiting
• Fever
• Painful urination, increased urinary frequency
• Urethral discharge
• Lower pelvic/abdominal pain/lower back pain
• Testicular pain/swelling in men (less common)

When should I see my doctor if I am concerned about an E. coli infection?

You should seek medical attention if you notice persistent abdominal cramps or pain with associated profuse diarrhoea, blood in stools, persistent vomiting, lethargy, fever, or abnormal urinary symptoms.

How can I prevent acquiring an E. coli infection?

General advice for everyone includes:

• Practice good hand hygiene
• Ensure proper food preparation
• Avoid cross-contamination of food preparation areas
• Ensure all fruits and vegetables are thoroughly washed well under clean running water
• Cook meat, especially pork and beef, thoroughly, using a food thermometer to confirm a minimum safe internal temperature of 62.6℃
• Avoid consuming raw or unpasteurised milk, dairy products, and juices
• Refrain from swallowing water from pools, lakes, or river streams

General advice for sexually active individuals includes:

• Using barrier contraception such as condoms during sexual intercourse. Change condoms appropriately when switching between different modes of sexual activity to reduce the risk of bacterial infection spread (e.g., use a different condom for anal, vaginal, and oral intercourse)
• Clean and sanitise your sex toys and avoid sharing them with your partner 
• Urinate before and after sexual activity to help prevent urinary tract infections

What is the treatment for E. coli infections?

Treatment for E. coli infection typically involves supportive care. Your doctor will often prescribe medications to relieve gastrointestinal symptoms and emphasise the importance of staying well-hydrated. In cases where severe diarrhoea leads to dehydration, hospitalisation may be necessary for more extensive treatment.

For E. coli-related urinary tract infections or those acquired through sexual contact, oral antibiotics such as ciprofloxacin, co-trimoxazole (Bactrium), nitrofurantoin, or ampicillin may be recommended based on the results of bacterial culture and sensitivity testing.

It is essential to follow your doctor’s guidance and complete the prescribed antibiotics course if they are necessary. Adequate hydration and rest are crucial elements of recovery from E. coli infections, whether they affect the gastrointestinal system or urinary tract.

What will happen if I do not treat E. coli infections?

Although rare, an untreated E. coli infection can become a life-threatening condition called haemolytic uremic syndrome (HUS). This risk is associated with a specific strain of E. coli known as Shiga toxin-producing E. coli (STEC), primarily affecting young individuals and those with weakened immune systems [7]. HUS is characterised by the destruction of red blood cells, leading to systemic clotting issues and kidney failure. It is an infrequent complication resulting from E. coli-related diarrhoea.

Patients with HUS experience more severe E. coli symptoms, including blood diarrhoea, abdominal pain, vomiting, fever, chills, rigours, and headaches. This condition involves multiple organs, such as kidneys, brain, and blood vessels, leading to symptoms such as lethargy, elevated blood pressure, bleeding, neurological issues, abnormal urination, reduced consciousness, coma, or even death. HUS patients typically require hospitalisation.

In complex E. coli infections, aside from the usual gastrointestinal symptoms, the infection can ascend, causing bladder infection (cystitis) or kidney infections (pyelonephritis), potentially resulting in chronic urinary tract inflammation or scarring.

It is crucial to understand that E. coli infection is preventable and treatable. Seeking prompt medical attention is vital to avoid complications, especially if you experience severe symptoms or suspect an infection.

Can E. coli infection lead to infertility?

In women, while uncommon, chronic E. coli infections can lead to pelvic inflammatory diseases (PIDs) [8]. This condition may manifest as persistent lower pelvic pain, irregular menstrual cycles, unusual vaginal discharge, or urinary symptoms. Chronic inflammation and scarring of the pelvis and the linings of the uterus and fallopian tubes resulting from the bacterial infection can ultimately lead to infertility in women.

In men, chronic E. coli infections, although rare, can be associated with inflammation of the prostate (prostatitis) or inflammation of the testicles (orchitis) [9]. Symptoms may include abnormal urethral discharge, painful urination, altered urinary flow, testicular pain and swelling, and decreased semen or sperm quality. These infections can contribute to fertility problems in men.

It is important to recognise that chronic E. coli infections, while infrequent, can have severe consequences for both men and women, affecting reproductive health. To prevent potential complications, seeking medical attention and appropriate treatment for persistent or recurrent symptoms is essential.

Is there a vaccine to prevent E. coli infection?

Currently, there is no vaccination or medication to prevent E. coli infection. The best way to avoid E. coli infection is to ensure preventive measures are practised at all times.

Final message…

While we often ‘zoom in’ and fixate on common STD pathogens such as chlamydia and gonorrhoea, it is worth noting that E. coli, while not a typical STD, can pose a higher risk through sexual activity. Infections can be avoided by properly understanding the bacteria and its associated symptoms and practising preventive measures in daily life and sexual activities.

If you have any concerns regarding E. coli-related infection or STDs, it is important to address the concerns by consulting your doctor.

References

1. Centers for Disease Control and Prevention. (2023, April 25). E. coli and Food Safety. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/foodsafety/communication/ecoli-and-food-safety.html
2. Matthew Mueller, C. R. (2023). Escherichia coli Infection. Florida: StatPearls Publishing.
3. Michael Ray Garcia, S. W. (2023). Sexually Transmitted Infections. Florida: StatPearls Publishing.
4. Michael Dan, T. G. (2012). Sexually transmitted Escherichia coli urethritis and orchiepididymitis. Sexually Transmitted Diseases, doi: 10.1097/OLQ.0b013e31823156a0.
5. Betsy Foxman, S. D. (2002). Uropathogenic Escherichia coli Are More Likely than Commensal E. coli to Be Shared between Heterosexual Sex Partners. American Journal of Epidemiology, 1133–1140.
6. Ji Youn Lim, J. W. (2010). A Brief Overview of Escherichia coli O157:H7 and Its Plasmid O157. Journal of Microbiology and Biotechnology, 5-14.
7. James L. Smith, P. M. (2014). Chapter Three - Shiga Toxin-Producing Escherichia coli. Advances in Applied Microbiology, 145-197.
8. Alison Laura King, N. S. (2020). Concurrent Escherichia coli tubo-ovarian abscess and Campylobacter jejuni gastroenteritis: A case report. Case Reports in Women's Health, doi: 10.1016/j.crwh.2020.e00192.
9. Chaudhary Ehtsham Azmat, P. V. (2023). Orchitis. Florida: StatPearls Publishing.