Anal Warts: What you have always wanted to know, but were too embarrassed to ask.

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Anal warts are definitely not a topic for polite conversation. As an affliction upon one of the more intimate parts of the human body, patients frequently have multiple concerns regarding cosmetic appearance, stigmatization, personal health and sexual relationships. It is also not commonly brought up to their spouses or doctors. We are here to find out more about this extremely common condition and dispel common misconceptions about it.

What are Anal Warts?

Anal warts are common skin growth around or inside the anal canal caused by a virus known as the Human Papillomavirus (HPV). They come in all shapes and sizes, ranging from a small pinhead-like growth to big cauliflower-like lesions. They usually do not cause patients much pain or discomfort and patients might not be aware that anal warts are present because of the nature of the location

What is HPV and how is it spread?

HPV is the most common sexually transmitted disease (STD) in the world. It is a family of viruses with more than 200 types. They are typically divided into low-risk and high-risk types based on associated risk for cancer in any body areas. The low-risk types HPV 6 and/or 11 are detected in around 90 percent of anal warts.

HPV is transmitted through contact with infected skin. Anal HPV infection is almost always acquired through sexual contact. Anal warts by themselves are not required for transmission but are highly infectious.

Common myths about anal warts

Myth #1 – My partner has anal warts, he/she is cheating on me!

This myth is responsible for a great deal of anxiety and anger. HPV infection can lie dormant in the body for months and years before causing anal warts. There is no way to find out when the infection was acquired. 

Myth #2 – Anal warts can lead to anal cancer.

Anal warts are almost always benign. They are caused by low-risk HPV types 6, 11, 42, 43 and 44 and do not develop into cancer. 

 

Myth #3 – HPV is incurable, and recurrence of anal warts are common.

It is indeed true that there is no known cure for HPV. However, warts and precancerous lesions can be easily treated when detected. Recurrence of anal warts is not a given, and some patients might find recurrence getting less frequent and eventually stopping with time. 

Myth #4 – Condoms use during sex will prevent HPV transmission

Unfortunately, that is not the case. Condom use will prevent transmission of pathogens such as HIV and syphilis that are spread through bodily fluids. They are not so effective against other pathogens such as herpes or HPV as they are spread through skin-to-skin contact. This is because condoms do not cover the entire external genitalia.

Nonetheless, condom use can still lower the risk of HPV transmission and other STDs. They still play an important role in sexual health and STDs prevention strategies. 

Diagnosis of anal warts

Diagnosis of anal warts is normally done at the doctor’s office clinically through a thorough history and physical examination. The majority of anal warts do not require a biopsy for diagnosis.

HPV screening for anal warts is not routinely recommended. This is because all commercial laboratories will only test for high-risk HPV types and not low-risk HPV types that causes anal warts.

Treatment

Anal warts treatment depends on the size, number, site as well as patient’s preference.

Home treatment with preparations such as Imiquimod cream or Podofilox solution are available. However, they are limited in utility due to the locations of the warts which might not be easily reached by the patient. 

Cryosurgery is the use of extremely low temperature through liquid nitrogen to destroy the abnormal anal wart cells. It can be done as an office procedure but will require multiple cycles for treatment depending on the size of the warts.

Radiofrequency ablation is a procedure in which heat, which is generated through an electric current, is used to destroy the abnormal anal wart cells. It can also be done as an office procedure. An injectable pain-killer is commonly given before the procedure to numb the area and commonly a single session will be sufficient for anal warts removal.

Finally, if the anal warts are too large or too extensive, surgical excision under general anasthesia might be considered by a surgeon. 

Prevention 

By observing safe sexual practices such as use of condoms during sex and limiting the number of sex partners, patients can reduce their chance of contracting HPV.

A vaccine (Gardasil 9) is available for males and females to prevent ano-genital warts but it will not treat existing HPV or ano-genital warts. This vaccine can prevent most cases of genital warts in persons who have not yet been exposed to wart-causing types of HPV.

Next read: WHY IS MY SEMEN GREEN OR YELLOW?

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Common Causes Of Bumps & White Spots On Penis & Foreskin

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This situation may be familiar to many men: while taking a shower one day, you happen to notice some white spots on your foreskin. You do a double take as you lean down to inspect your manhood. What could it be? How long have they been there? The questions are aplenty as you instinctively reach for your smartphone to begin a Google search.

There are many conditions that can cause white spots to develop on the penis and foreskin. Some men may be born with them, while others may develop them as a result of poor hygiene practices or sexually transmitted infections (STIs). It is important to know what the white spots are due to, as not all conditions require treatment. Listed below are some common causes of white spots on the foreskin and penis.

Pearly Penile Papules

Pearly penile papules (PPP) are small, dome-shaped or projection-like bumps that are located just below the head of the penis, usually arranged in a neat row. They can be white, flesh-coloured, yellow or translucent in colour. They do not cause any pain or itch. PPP is considered as a normal variant of the male penile anatomy, and are harmless bumps. It is not cancerous and there is no cancer risk. It is not a sexually transmitted infection and is not contagious. It is common and can occur in up to 38% of young men up to age 25.

PPP can be left alone and does not require treatment. However, for men who find them unsightly, they can be removed. Treatment options include laser therapy, cryotherapy and electrosurgery. 

READ: What are Pearly Penile Papules?

PPP

Fordyce Spots

Also known as Fordyce glands, these are harmless, small white or yellow bumps that are found on the foreskin. They are basically enlarged sebaceous glands, and can occur alone or in clusters. They do not cause any pain or itch. Fordyce spots can also commonly occur on the edges of your lips or on the inside of your cheeks.

Just like PPP, Fordyce spots are not cancerous and infectious, and also does not require treatment. Similarly, they can be removed if men find them unsightly. Treatment options include topical retinoid cream, oral isotretinoin, laser therapy and electrosurgery. 

Tyson’s Glands

Also known as preputial glands, Tyson’s glands are modified sebaceous glands that are found on the inner surface of the foreskin. They occur in pairs and are located on either side of the frenulum. These glands are also present on the hood of the clitoris in females. Tyson’s glands are normal structures and do not require treatment.  

Skin Tags

Skin tags are small, soft, flesh-coloured growths on the skin. They usually have a stalk and hang off the skin, and can vary in size from a few millimetres up to several centimetres. They tend not to grow on the penis itself, but rather, around the groin and scrotum. They often grow in areas where the skin folds and rubs against itself, and as such they are often also found on the neck, armpits, eyelids and under the breast. They affect men and women equally. Obesity, diabetes and pregnancy can increase the chances of occurrence.

Skin tags are benign tumours of the skin and do not require treatment. Occasionally, they may fall off on their own. People often wish to get them removed for aesthetic reasons, or if the skin tags are large and get in the way. Treatment options include cryosurgery, electrosurgery, ligation and excision.  

READ: Skin

Balanitis

Balanitis is inflammation of the foreskin and head of the penis. Spots can appear on the penile head or foreskin, and can be white or reddish. Other symptoms include redness, pain, itching, discharge, swelling and difficulty with retraction of the foreskin, and sometimes pain when passing urine. 

Balanitis can affect as many as 1 in 10 males, and can occur at any age. It is more likely to occur in uncircumcised men. The most common cause of Balanitis is a bacteria or fungal infection, or a combination of both. This can result from inadequate personal hygiene and/or phimosis (tight foreskin). There are non-infectious causes for balanitis as well. Risk factors for recurrent balanitis include diabetes, HIV and other sexually transmitted infections. 

To investigate balanitis, your doctor may perform swab tests to identify the responsible organism. Treatment involves topical and/or oral anti-fungal and antibiotics. The long term solution to balanitis is a circumcision.

READ: Causes, symptoms and treatment of Balanitis.

Balanitis

Pimples

Pimples develop as a result of the pores of our skin being blocked by dead skin cells, sebum and other debris. The sebaceous gland continues to produce sebum and build up under the blockage, allowing bacteria to grow in the area, resulting in inflammation, infection and pain. They can occur anywhere on the body, including the penis.

Pimples can be left alone and usually resolve on their own without treatment. It is important to resist the urge to pop the pimples as this may lead to superimposed infection, scarring and hyperpigmentation. However, they may end up self erupting and discharge small amounts of pus. Treatments for pimples include topical over-the-counter creams such as benzoyl peroxide, antibiotic creams and, if more severe, oral antibiotics.

READ: Skin

Folliculitis

Folliculitis is an inflammation or infection of the hair follicles. It can occur anywhere on the body, including the penis, where it is frequently seen at the shaft or base of the penis, or the pubic area. Folliculitis tends to result from shaving, waxing or chafing of the hair follicles. The damage to the hair follicles allows bacteria to enter. Sometimes, ingrown hairs can also occur from hair removal treatments, eventually leading to folliculitis as well. Folliculitis can be painful and/or itchy. Treatment options include topical and/or oral antibiotics. 

READ: Common causes of penile itching and pubic itching

Genital Warts

Genital warts are caused by the Human Papillomavirus (HPV). HPV is the most common sexually transmitted infection and can be spread via vaginal, oral or anal sex. They appear as flesh-coloured growths over the genitals that can cluster and resemble a cauliflower. Most of the time they do not have any symptoms but can sometimes itch. Bleeding can also occur during sexual intercourse. 

READ: Causes, symptoms and treatment for Genital Warts
READ: How to get rid of Genital Warts

Left alone, the warts can remain the same or increase in size and number. They will disappear once the body has shed the virus completely, typically over a course of 1 to 2 years. Treatment options include topical medications such as imiquimod, cryotherapy and electrosurgery. Vaccines are available to help prevent HPV infection, consider getting a HPV vaccination. 

READ: HPV Vaccination For Men
READ: Rapid HPV Testing

Genital-Blisters-Genital-Warts-and-Genital-Ulcers-Causes-Treatments

Genital Herpes

Genital herpes is caused by the Herpes Simplex Virus (HSV) and is a sexually transmitted infection. Itching of the penis is usually the first symptom, and can occur in other areas such as the scrotum, groin, buttocks and anus. Shortly after, tiny clusters of painful blisters develop, which can then rupture and form shallow ulcers with crusts. Other symptoms include painful urination, enlarged groin lymph nodes, fever and body aches. The virus can lie dormant in the body for years without causing any symptoms, therefore some people may not even be aware that they are infected. 

Genital herpes can be diagnosed via swab testing of the lesions. When there are no symptoms, no treatment is required. Flares can be treated with oral and topical antiviral medications. There is unfortunately no cure for genital herpes, as the virus will permanently remain in the body.

READ: Rapid Herpes Testing

Herpes-Simplex-Virus

Molluscum Contagiosum

This is a benign infection of the skin caused by the Molluscum Contagiosum virus, resulting in painless, small, shiny pearl-shaped lesions. They can happen anywhere on the body as a result of physical contact, but when they occur on the genital area, it is usually as a result of sexual contact. The virus is thus spread via sexual contact, or even to another part of the person’s own body, from scratching the lesions and touching another part of the body. They can appear alone, or in clusters. They usually do not cause any symptoms, but can sometimes itch. 

Left alone, the lesions will eventually disappear once the body has shed the virus completely, typically over a course of several months to a year. Treatment options include topical medications such as salicylic acid, cryotherapy, laser therapy and curettage.

READ: Everything you need to know about Molluscum Contagiosum

Molluscum-Contagiosum-Water-Warts

In conclusion, do not panic if you notice white spots on your penis, as not all white spots require treatment.  Speak to your doctor for advice on white spots or bumps and request for an examination. 

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Condyloma Lata vs Condyloma Acuminata

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Condyloma

Condyloma refers to wart-like skin growths – usually in the genital, anal, or oral regions but occasionally found in other areas of the body – that are caused by a sexually transmitted infection. The most common type is known as genital warts and is termed condyloma acuminata.

These are caused by an infection with Human Papilloma Virus (HPV), the same group of viruses that can lead to cervical cancer as well as other oral and anogenital cancers. The prevalence of genital warts in the general population is estimated to be around 3-5%, making it the most common STD globally. See: 

Read: Rapid HPV Testing (Next Day Results)
Read: Anal Pap Smear

Condyloma Acuminata On The Penis

When condyloma acuminata are detected, we must always look for and differentiate these lesions from condyloma lata, which are caused by secondary syphilis infection. These two types of condyloma can appear extremely similar and are easily mistaken for the other.

They may also both be present as a co-infection, seeing as they share common risk factors. It is essential that syphilis infection is considered and tested for when condyloma lesions are found, so that rapid diagnosis, treatment, and partner tracing can be performed. 

Condyloma lata

Condyloma lata of secondary syphilis tend to be slightly larger and more moist than common genital warts, and may even ulcerate in later stages. They are usually found in the anogenital or oral regions, but can also be found sometimes on the palms or soles of the feet. Other signs of syphilis may be a diffuse body rash or a classic painless sore or chancre (seen in earlier stages of primary syphilis).

Both types of condyloma are mainly transmitted through penetrative anal or vaginal sex, as well as oral sex (fellatio and cunnilungus). However, as they can be spread with direct contact with mucosa and/or broken skin, there have even been cases of transmission through mutual masturbation.

If you or your partner noticed any suspicious skin lesions, please visit our doctors for a full consultation and assessment. 

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Also STD & HIV Related Read:

Common Causes of Penile Itching and Pubic Itching

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A myriad of conditions can cause a man to have penile itching or pubic itching. The excruciating urge to scratch and relieve that itch at such an inconvenient part of the body can be a major source of embarrassment to some. When severe, it can result in extreme discomfort in the day, and disrupt one’s sleep at night.

 

Here are some of the causes of Penile Itching and Pubic Itching:

 

6 Common Causes of Penile Itch:

 

1. Balanitis

Balanitis is a common infection of the foreskin and head of the penis. It is caused by bacteria or fungus, or a combination of both.

Symptoms include redness, swelling, discomfort, penile itching, and sometimes pain when passing urine.
(See: Penile Infection, Infection of the Penis)

When fungal infection (candidiasis) is present, a whitish cottage cheese-like discharge can be found under the foreskin. Balanitis is often hygiene related, but can also be caused by STDs. It is more likely to occur in uncircumcised males.  Watch: What are the causes of Foreskin Infection (Balanitis)

2. Genital Herpes

Genital herpes is caused by the Herpes Simplex Virus (HSV). Itching of the penis (penile itching) is usually the first symptom and can occur in other areas such as the scrotum, groin, buttocks and anus.

Shortly after, tiny clusters of fluid-filled blisters or ulcers can develop and these are usually painful. Other symptoms include painful urination, enlarged groin lymph nodes, fever and body aches. The virus can lie dormant in the body for years without causing any symptoms, therefore some people may not even be aware that they are infected.

Read: Genital Blister, Genital Ulcers & Genital Warts & Causes of Oral Herpes (Cold Sore)

 

3. Genital Warts

Genital warts are caused by the Human Papillomavirus (HPV), a sexually transmitted disease. They appear as flesh-coloured growths that can cluster and resemble a cauliflower. Most of the time they do not have any symptoms but can sometimes itch. Bleeding can also occur during sexual intercourse.

Read: Genital Warts Treatment

 

4. Contact Dermatitis

Contact dermatitis is a skin reaction to contact with an irritant. This can happen anywhere on the body, including the penis. When this happens, it is usually caused by latex condom usage. The skin of the penis can turn red and itchy.

Sometimes the skin can break causing serious discharge, and bacterial infection can occur. Mild cases can be treated with a corticosteroid cream. Non-latex condoms can be used if you have a latex allergy.

 

5. Urethritis

One of the causes of penile itching is Urethritis. Urethritis refers to inflammation of the urethra, the tube that carries urine from the bladder to outside the body. This condition most often causes pain or itching in the penis, which worsens when passing urine.

Other symptoms include urethral discharge, urinary frequency or urgency, difficulty urinating, and blood in the semen. Urethritis is most commonly caused by a bacterial infection and can be sexually transmitted. See other STD Symptoms 

 

6. Psoriasis

Psoriasis on elbows.

Genital psoriasis often occurs alongside psoriasis of the skin. Skin cells develop at an extremely fast rate, resulting in the accumulation of skin cells on the skin surface, building up into itchy, red plaques of scaly skin. See Psoriasis Treatment

5 Common Causes of Pubic Itch

 

1. Jock Itch

Also known as tinea cruris, jock itch is a fungal infection of the skin in the genital area, groin and buttocks. The rash is usually itchy, red, scaly and ring-shaped. It tends to occur in people who sweat a lot and/or are overweight.

 

2. Pubic Lice

More commonly known as crabs, these are tiny parasitic insects that attach to the hair and skin in the pubic region. Pubic lice can be easily spread via sexual contact or other forms of close contact, and can spread to other body areas with coarse hair such as beards, armpits and chest hair. It is also possible for pubic lice to spread by using an infected person’s clothes, towels, or bed.

 

3. Folliculitis

This is a condition in which hair follicles become inflamed and is usually caused by bacterial or fungal infection, or inflammation from ingrown hair. Initially, the affected hair follicles may have small red bumps or white-headed pimples, but can swell and become painful and subsequently develop into crusty sores.

 

4. Contact Dermatitis

As mentioned earlier, this condition can also occur in the pubic area.

 

5. Molluscum Contagiosum (mo-LUS-kum kun-tay-jee-OH-sum)

Molluscum Contagiousum is a benign viral infection of the skin and is caused by the molluscum contagiosum virus, resulting in painless, small, shiny pearl-shaped lesions. They can happen anywhere on the body as a result of contact, but when they occur in the genital area, it is usually as a result of sexual contact. They can appear alone or in clusters. They usually do not cause any symptoms, but can sometimes itch.

If you need to speak to our doctors, please visit our clinics.  Alternatively, you can email us hello@dtapclinic.com.sg or call us for an appointment.
Take Care.

Other Read:

Bumps on Vaginal Area – Vaginal Lumps & Vaginal Bumps

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Lumps and bumps over the external genitalia (the vulva) or vagina are a fairly common concern that ladies may have. These can be normal or benign, or due to infections, sexually transmitted diseases, and less commonly, due to cancers (malignancy).

Here are some of the Causes of Vaginal Lumps & Bumps:

1) Benign bumps

Causes of benign bumps in the genital region include vestibular papillomatosis, Fordyce spots, ingrown hairs and folliculitis, various cysts (sebaceous cysts, Bartholin cysts).

Vestibular papillomatosis

This is a variation of normal anatomy. Vestibular papillomatosis appears as multiple, symmetrical, tiny bumps or finger-like projections over the labia minora and vestibule (vaginal opening). This can often be mistaken for warts and may thus be an undue cause for worry but there are features which help differentiate it from warts. No treatment is required for vestibular papillomatosis. It is harmless and it is NOT due to infection and cannot be spread to your sexual partners.

Fordyce spots

These are due to enlarged oil glands, which appear as tiny (1-3mm) whitish or yellowish bumps over the labia minora. These can also occur in other parts of the body, for instance around the edges of the lips or on the penis in men. They are completely harmless and painless and are part of normal anatomy. There is no need for any treatment or worry.

Folliculitis and ingrown hairs

Ingrown hairs may manifest as bumps, particularly in someone who shaves. Both ingrown hairs, as well as hair follicles, can get infected (known as folliculitis), resulting in small, red, tender bumps. Usually, topical creams will suffice for treatment.  Good hygiene, particularly relating to hair removal, is helpful in reducing the risk of folliculitis.

Cysts

Cysts are small round bumps that can be felt underneath the skin. These may arise from structures in the skin layer itself e.g. sebaceous cysts, or from glands which are found in the genital region near the labia minora (Bartholin’s glands).

Sebaceous Cysts

Sebaceous cysts are the result of oil glands which get blocked. They are painless unless they become infected. Most of the time, they can be left alone—but in the event of infection or if they become too large, incision and drainage or removal may be necessary.

Bartholin Cysts

Bartholin cysts are the result of Bartholin’s glands which are blocked. These cysts can enlarge, become infected and tender. They also have a tendency to recur and a minor surgery to remove them may be required.

2) Infections and Sexually Transmitted Diseases (STDs)

Warts

These are caused by certain strains (type 6, 11) of the Human Papilloma Virus (HPV). They appear as small skin-coloured bumps or irregular, cauliflower-like skin growths. They and can occur in isolation but are usually multiple. Genital warts usually appear anytime between weeks to 8 months (average 3 months) from the time of HPV infection and are highly infectious. The clinical course of warts can vary – in some individuals, genital warts may spontaneously resolve, while in others they may stay the same or increase in size and number.
The treatment of genital warts does not remove the underlying HPV infection and the only medication available against this is the HPV vaccine. The HPV vaccine protects against future infection but does not get rid of existing strains, so it is best to get vaccinated as soon as possible before one is exposed to more strains of HPV.
Read: Cervical Cancer, PAP SMEAR & HPV Vaccination – What you need to know

Molluscum contagiosum

This is skin infection caused by the Molluscum contagiosum virus which causes multiple small, pearly white or skin coloured bumps, sometimes with a central dimple (“central umbilication”). These are painless, non-itchy and can occur not just in the genital region but elsewhere on the body as well. The virus is spread through direct skin contact, or through contaminated clothing and towels. These lesions are harmless and will generally resolve within 6 months to a year (occasionally longer). Treatments available to address these bumps include topical medications like imiquimoid cream, freezing, and electrosurgery (laser).

Herpes

One of the stages of genital herpes is painful genital blisters – red bumps which eventually become fluid filled and later burst to form ulcers. Genital herpes is caused by the Herpes Simplex Virus which can be transmitted through secretions such as saliva or genital fluids. There is no cure for herpes, but antiviral medications are prescribed when an individual has a painful flare of blisters and ulcers.

Read: Genital Warts, Genital Blister & Genital Ulcer – Causes and Treatments
Read: Syphilis Symptoms – Painless Sores & Rashes

3) Malignancy

Vaginal cancer

Vulval or vaginal cancer are rare but serious causes of a vaginal lump or bump. These may be accompanied by other features such as persistent itching, pain, a persistent ulcer, and abnormal vaginal bleeding or discharge.

Melanoma

Vaginal melanoma (a type of cancer of the skin) can appear as a pigmented lump which may be associated with itching, bleeding and pain.

Malignancies tend to occur in older women but as their symptoms can be rather nonspecific, it is best to get any abnormal lump/bump checked.

If you wish to speak to female doctors if you have experienced the above signs and symptoms, call us or email us for an appointment at hello@dtapclinic.com.sg.

Take Care!

Other Reads:

  1. What Is the Cause & Treatment For Oral Herpes (Cold Sores)
  2. How Late Can a Period Be (Delayed Menstrual Cycle)
  3. 10 Causes of Abnormal Vaginal Lumps and Bumps
  4. 11 Causes of Dyspareunia (Pain During Intercourse)
  5. What You Need to Know about HPV Vaccination, Cervical Cancer & Pap Smear
  6. Why Do I Have Abnormal Vaginal Discharge
  7. What is HPV Vaccination – Gardasil 9
  8. Sex During Period (Sex & Menstruation) What To Know

 

STD Risk from Receptive Unprotected Anal Sex in Men

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Anal sex, not only consists of penile insertion into the anus (bottom) but also allowing your partner to use his mouth on the anus (analingus) or insertion of fingers and sex toys into the anus.
It is highly recommended to use condoms and lube during anal sex to reduce the risk of contracting a sexually transmitted disease (STD).

What is the STD that you can potentially get from anal sex for Men-Who-Have-Sex-With-Men (MSM)?

1. Chlamydia and Gonorrhea

The reason why we clumped them together in this article is that chlamydia gonorrhoea can present with similar symptoms and may present together in certain patients. These bacteria’s can present in a few ways:

Anal Discharge

Discharge is a term used when liquid is seen coming out of the anus. This is usually very minimal and patients usually notice a small number of stains on their underwear. In very rare situations, the volume may be high and appear yellow in colour. see more of Rectal Gonorrhea

Anal Discomfort

Patients usually present with mild discomfort in the anal region and some of them describe it as a feeling of constant urge to poo. It is never painful, and if patients present with severe pain, it is usually due to haemorrhoids or a tear at the opening of the anus.

Anal Bleeding

This is very rare. If patients present with bleeding, it is usually due to piles or a tear at the opening of the anus.

Lower Urinary Tract Symptoms

The insertive partner (or top) may present with a burning sensation when passing urine, urethral discharge, an increase in urinary frequency, waking up in the middle of the night to pass urine and the feeling of incomplete bladder emptying. However, keep in mind a large proportion of men may not show these symptoms.
It is best to get tested via anal swab or urine test for these bacteria if you have had an exposure as it can be easily treated with antibiotics.
Prostate infection and inflammation can be due to non-Sexually Transmitted infections & Sexually Transmitted Infections.
We provide Rapid Chlamydia & Gonorrhea PCR Screening (Next Day Results).

2. Human papillomavirus (HPV)

HPV is, in fact, one of the most common STD’s out there but is less well known. It is usually transmitted through skin to skin contact, through contact with infected mucous membranes or bodily fluids. In other words, condoms will not protect you from this virus. There are many different strains and can cause anal cancer and cauliflower-like growths in the anus and surrounding skin. It is recommended to see a doctor screen for anal warts, or other genital warts because some warts may be inside the anus and may not be visualised externally.
Warts can be treated and you should see a men’s health doctor if you have any suspicious lumps. It is highly recommended for men who engage in anal sex to get the HPV vaccine.
Rapid HPV Testing (Next Day Results) is available in our clinics.
Check out: How to Get Rid of Warts

Read: Is HPV Vaccine Necessary for Males?

3. Herpes

There are 2 kinds of herpes virus, HSV type 1 and HSV type 2. These viruses can be easily passed through skin to skin contact, which means condoms have a very limited to a negligible role in reducing the transmission. They usually present in the area of contact with multiple, small and painful ulcers or blisters within a week or sometime months after exposure. If there is any suspicion, the doctor will perform a dry swab to diagnose the lesion. Unfortunately, there is no cure but there is treatment available for flares.

4. Molluscum Contagiosum

Molluscum Contagiosum is caused by a virus call Poxvirus and presented with lesions that may appear anywhere on the body. The lesions are small, raised and usually white or flesh-coloured with a dimple or pit in the centre. The size can range from 2 to 5 mm in diameter and may be itchy or sore. This virus can be passed through skin to skin contact or thru contaminated materials such as clothing, towels, pool equipment or even toys. The good news is that these lesions usually do not cause long-term medical problems and can be easily treated. Water Wart Removal is available in our clinics.

5. Syphilis

Syphilis an STD which is transmitted thru any form of sexual contact. It is caused by a bacteria known as Treponema pallidum. This disease can present in many ways, from a single, big and painless ulcer in the area of sexual contact, to rashes around the body and palms. In certain cases, they can cause an infection in the brain and spinal cord. This symptom can present any time between 9 to 90 days after being infected. The good thing is this disease is usually curable with antibiotics.

6. HIV

The riskiest sexual behaviour for getting and transmitting HIV in men is anal sex. The receptive anal sex is much riskier as the bottom partner’s risk is 13 folds higher than the insertive partner. This virus can pass through blood, semen, pre-seminal fluid (Pre-cum) or rectal fluids.
This risk is higher when recreational drugs are used.
Condoms and HIV pre-exposure prophylaxis (PrEP), if used consistently can reduce the risk of getting HIV significantly. The condom reduces the risk of getting HIV by 63% for the insertive partner and 72% for the receptive partner if they engaged in anal sex with an HIV infected partner.
Yes. it is not 100%!!. PrEP can reduce the risk of getting HIV by more than 90%. If you think you have been potentially exposed to the virus and did not use a condom, you can see a doctor within 72 hours of the exposure to start the HIV post-exposure prophylaxis (PEP) treatment.
Also, a regular HIV Test is recommended if you are sexually active with unknown HIV status partners.
If you think you have had an exposure to HIV or any form of STD thru risky sexual activity, it is recommended you get tested and seek treatment early to reduce any untoward complications and risk of passing it to your partner.
Take Care!

Other Reads:

  1. The HIV Pro-Virus DNA Test can be done 10 days post exposure.
  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. What are the Causes of Abnormal Penile Discharge?
  4. HPV Infection & HPV Vaccination for Men who have sex with Men
  5. Low HIV Risk Doesn’t Mean No HIV Risk
  6. 7 FAQs HIV Preexposure prophylaxis (HIV PrEP)
  7. HIV PrEP for Travel – How You Need to Know
  8. An Overview on STD from an STD Doctor
  9. Everything You Need to Know about Herpes Simplex Virus
  10. How Do I Treat Oral Herpes (Cold Sores)
  11. Syphilis Symptoms – Painless Sore & Ulcers
  12. HIV Symptoms – What You Need to Know
  13. 10 Common HIV related Opportunistic Infections

 

HPV Infection & HPV Vaccination for Men who have sex with Men

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About 40 types of HPV are passed on through sexual contact. The virus can be spread through skin-to-skin contact that doesn’t involve penetrative sex. Condoms will not necessarily fully protect people from coming into contact with it. Also Read: Anal Pap smear for men

What you need to know about Gardasil 9 HPV Vaccine and HPV in Men who have sex with Men

 

What is Human papillomavirus (HPV)?

The Human Papilloma Virus (HPV) is not one virus, but a family of about 200 different strains that cause common warts, genital warts and some cancers.
Sexually active adults mostly acquire at least one variety of HPV and it’s a near-universal infection in people with HIV. Even people with a one-lifetime partner can get HPV if their partner has it.
About 40 types of HPV are passed on through sexual contact. The virus can be spread through skin-to-skin contact that doesn’t involve penetrative sex. Condoms will not necessarily fully protect people from coming into contact with it.
For most people, HPV will not cause any harm. Only some varieties of HPV can cause cancer and even if you do come in contact with these strains, the chances of developing cancer are very small.
However, some people do not clear the virus from their bodies, and this can cause:

  • Genital warts on the penis and anus. It is also possible to have these types of warts on the lips and in the mouth.
  • Cancer of the anus, penis and oropharynx (back of the throat, including the base of the tongue and tonsils).

Although some other strains of HPV are associated with cancers, two main strains of HPV – HPV 16 and HPV 18 – cause 70% of cervical cancers in women and over 80% of anal cancers worldwide.
It is estimated that HPV is responsible for about 5% of cancers worldwide. However, anal cancer is one of the most common cancers for people living with HIV.

Learn more about Rapid HPV Testing (Next Day Result)

HPV & Men Who Have Sex With Men (MSM)

Every year anal cancer is diagnosed in about two people per 100,000 in the general population.
Men who have sex with men are about 20 times more likely than heterosexual men to develop anal cancer, and men-who-have-sex-with-men who are living with HIV are even more likely (up to 100 times more than the general community).

What is the new Gardasil 9 (HPV Vaccine)?

GARDASIL 9 is a vaccine (injection/shot) given to individuals 9 through 26 years of age to help protect against diseases caused by some types of Human Papillomavirus (HPV).
In boys and men 9 through 26 years of age, GARDASIL 9 helps protect against:

  • Anal cancer
  • Precancerous anal lesions
  • Genital warts – Penile warts, Anal Warts and other areas

These diseases have many causes. Most of the time, these diseases are caused by nine types of HPV: HPV Types 6, 11, 16, 18, 31, 33, 45, 52, and 58. GARDASIL 9 protects against diseases caused by these nine types of HPV.

What is the difference between Gardasil and new Gardasil 9?

Gardasil only covers 4 strains of HPV: 6, 11, 16, 18.
Gardasil 9 covers that and 5 more strains, 31,33,45,52.

HPV-4 types
(6, 11,16,18)		 HPV-9 types
(6,11,16,18,31,33,45,52,58)
Cervical cancer cases 70% 90%
High-grade cervical lesions 50% 75-85%
Low-grade cervical lesions 30-35% 50-60%
HPV-related vulvar cancer cases 70-75% 85-90%
HPV-related vaginal cancer cases 65% 80-85%
HPV-related anal cancers 85-90% 90-95%
Genital wart cases 90% 90%

As you can see, Gardasil 9 has a broader HPV coverage compared to Gardasil.

Frequent Asked Questions (FAQs)

1.) Can I get Gardasil 9 if I am above 26 years old?

Gardasil 9 in Singapore is indicated for boys and men from ages 9 to 26. That does NOT mean that men above the age of 26 years cannot get the vaccine.
If you are above 26 years old, the best thing to do is to have a discussion with our doctor about the pros and cons of the vaccine then make a decision on whether or not you will benefit from it.

 

2.) Can I get Gardasil 9 even if I have had genital warts?

There are 200 different strains of HPV. Even if you have been infected with 1 strain, the vaccine can help protect you against other strains.
Also, there is data to show that people who have received treatment for HPV related cancers and had the HPV vaccine were less likely to get recurrences of their cancers.
So even if you have had or currently have genital warts, you should still have a frank conversation with our doctor about how Gardasil 9 can benefit you.

3.) Can I get Gardasil 9 even though I have already had the older version of Gardasil?

Yes, you certainly can. Scientific data has proven that it is absolutely safe to receive the full dose of Gardasil 9 even though you have already completed the vaccination using the older version of Gardasil.
If you have any concern about HPV infection treatment or you are interested in getting HPV vaccination, please contact us for more information.

Gardasil 9 vaccination is avilable in all our clinics in Malaysia and Singapore.
You can call any of our clinics or email us at hello@dtapclinic.com.sg for an appointment.

Take Care!

Other Reads:

  1. Low HIV Risk Doesn’t Mean No HIV Risk
  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. What are the Causes of Abnormal Penile Discharge?
  4. HIV PrEP for Travel – How You Need to Know
  5. An Overview on STD from an STD Doctor
  6. Everything You Need to Know about Herpes Simplex Virus
  7. How Do I Treat Oral Herpes (Cold Sores)
  8. Syphilis Symptoms – Painless Sore & Ulcers
  9. HIV Symptoms – What You Need to Know
  10. 10 Common HIV related Opportunistic Infections

Cervical Cancer, Pap Smear & HPV Vaccination – What You Need To Know

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What is Pap Smear?

Pap smear is a cervical cancer screening recommended every 3 years for all sexually active females starting from age 25 years old.

This is a quick, simple and painless procedure that can be done in the clinic and it only takes a few minutes.  A brush will be used to collect some cells from the neck of the womb (cervix) and it will be sent to the lab to identify any precancerous and cancerous cells.

Cervical Cancer

In Singapore, cervical cancer is the 3rd leading cause of cancer deaths in women age 15-44 years old.
Cervical cancer risk is increased with :

  1. Multiple sexual partners
  2. Human papillomavirus (HPV) infection
  3. Smoking
  4. Unprotected sex

What is Human papillomavirus (HPV)?

Human papillomavirus (HPV) is one of the commonest sexually transmitted infection. It can affect both men and women.
There are 2 types of HPV – the low risk and high-risk types.

  1. Low-risk HPV can cause genital warts in both female and males. These are flesh coloured growths on the genitals, and they are infectious.
  2. High-risk HPV plays a significant role in the increased risk of cancer, such as cancer of the cervix, vulva, and vagina in women as well as anal cancer in men who have sex with men (MSM)..

The American College Obstetrician and Gynaecologist (ACOG) strongly recommends co-testing using Pap smear and HPV DNA testing (high-risk HPV types) especially for women ages 30-65 years old.
Patients are advised to repeat these tests in 5 years if pap smear and HPV results are negative.
This allows patients to extend their screening interval.

However, for women who test positive for high-risk HPV types, this means their risk is increased and hence, may need to have Pap smear screening at a closer interval, i.e once a year and depending on the results of the pap smear, some may need a referral to a gynaecologist for early intervention.

Remember, women can have no symptoms with an abnormal pap smear and HPV infection. Hence, early detection and screening are crucial as early intervention can be life-saving. Symptoms such as bleeding and pain during sex (postcoital bleeding), bleeding in between periods, heavy vaginal bleeding, and bleeding after menopause are usually late signs of cervical cancer.

The good news is cervical cancer can be prevented through vaccination.

GARDASIL 9 is a vaccine that helps protect against Human Papillomavirus (HPV). Most people infected with HPV show no signs or symptoms, this means they can transmit the HPV virus to others without knowing it in any kind of sexual activity or skin to skin contact.

Gardasil 9 provides protection against 9 major strains of HPV, which includes HPV types 6,11,16,18,31,33,45, 52 and 58 which are responsible up to 90% of genital warts and cervical cancers or precancer changes.

The vaccine, however, does not treat the infection.

It can be given to both females and males from the age of 9 up to 45 years old.
From the age of 9-14 years, 2 doses 6 months apart is recommended while those age 15 onwards, 3 doses will be recommended according to the schedule of 0, 2 and 6 months.
The side effects post vaccination is usually mild and temporary including pain, swelling, bruising over injections site and very rarely may cause fever and nausea.
HPV vaccine reduces your risk significantly but it does not mean your risk becomes zero.

After the completion of HPV vaccination, all women who are sexually active and above the age of 25 should still undergo routine screening via pap smear.

If you are due for your routine PAP smear or if you have questions about cervical cancer screening & HPV vaccination and wish to find out more, please call or visit any of our clinics or drop us an email at hello@dtapclinic.com.sg
We have Female doctors at our Robertson Walk, & The DUO Galleria Branches Location. Call our clinic @ +65 6976 5023 

Take Care! 

Other Interesting Reads:

    1. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
    2. 11 Causes of Dyspareunia (Pain During Intercourse)
    3. What is HPV Vaccination (Gardasil 9)
    4. 10 Causes of abnormal Vaginal Lumps and Bumps
    5. An Overview of Gonorrhoea
    6. Herpes – What You Need to Know
    7. The Good Wrinkles, Bad Wrinkles & the Ugly Wrinkles