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By Mara Betsch

THURSDAY, March 26, 2009 (Health.com) — Food poisoning typically causes nausea, vomiting, and similar symptoms. However, in a small North Carolina outbreak linked to fish consumption, six out of seven people reported sexual pain along with other more common symptoms of food poisoning, according to a report released Thursday by the Centers for Disease Control and Prevention (CDC).

In the 2007 outbreak, nine people fell ill due to ciguatera fish poisoning (CFP), which can occur after consuming predatory ocean fish—such as barracuda, amberjack, red snapper, and grouper—that have eaten contaminated plant-eating fish. Each year there are about 50,000 CFP cases reported worldwide.

Unlike other types of food poisoning, CFP can cause neurological symptoms, such as the reversal of hot and cold sensations, fatigue, and itching and tingling, in addition to typical gastrointestinal symptoms like nausea, vomiting, cramps, and diarrhea. Sexual pain is generally not considered to be a symptom of CFP.

“It could be an unusual side effect of CFP,” says the report’s coauthor Ricky Langley, MD, an internal medicine physician in Burlington, N.C. Or it’s possible that sexual pain is a common side effect of CFP, but people may be “reluctant to talk about sexual side effects or doctors don't ask the questions,” says Dr. Langley.

Six out of seven people who were sexually active said they had painful intercourse as a symptom of CFP. Two men reported painful ejaculation, and four women described a burning sensation during and after intercourse. The sexual symptoms lasted anywhere from one week to one month, according to the report published in the CDC’s Morbidity and Mortality Weekly Report.

Next page: How you can avoid CFP

Treatment for CFP includes intravenous mannitol, a drug often used to manage kidney failure. In this outbreak, it helped reduce the patients’ other neurological symptoms. However, it’s not clear if the drug is effective for treating the sexual side effects, according to Dr. Langley.

Fish-lovers beware: The toxin responsible for CFP has no odor or taste and can’t be detected before eating fish. The poison has nothing to do with spoilage of the fish or the method of preparation.

Though CFP is endemic to warm water locales such as Puerto Rico, it is less common in cooler waters. However, that may be changing. “There is concern that global warming and global commerce may increase cases in new areas. Fish caught off the coast in North Carolina were contaminated,” says Dr. Langley.

Though the exact amount of ciguatera toxin necessary to trigger severe side effects is unknown, the more toxin you get, the worse you feel, according to Lorraine Backer, a senior environmental epidemiologist at the CDC.

“If you’re concerned about CFP, try to limit consumption of certain types of fish, like barracuda,” says Backer. “Be cognizant of what you’re eating.”

Other more common causes of sexual pain in women are vulvodynia, vaginismus, birth control, and even menopause. Men can also experience sexual pain due to skin conditions, Peyronie's disease, or inflammation of the prostate gland.


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