U=U: Science, Not Stigma

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Sexual transmission of HIV can be stopped. While there are many barriers to ultimately reaching this goal, one of the most exciting and recently validated concepts resulting from large-scale studies is that of U=U, or Undetectable = Untransmissible.

U=U means that people living with HIV (PLHIV) with a suppressed/undetectable viral load have effectively no risk of transmitting the virus to their sexual partners. The landmark trial of HPTN 052, and subsequent PARTNER, and Opposites Attract studies showed that no linked HIV transmissions were detected between thousands of serodiscordant couples (where one partner is known HIV-positive and one is HIV-negative) as long as the viral load remained undetectable throughout the relationship. This was demonstrated for both heterosexual and homosexual couples, and the greater acceptance of the science has potentially vast implications for personal and public health, social and behavioural norms, and even legal matters.

In order for someone living with HIV to reach undetectable viral load, they will need to be on daily antiretroviral therapy (ART) for at least 3-6 months, and must continue on the medication to maintain viral suppression. Treatment as Prevention (TasP) has been strongly advocated for many years now by HIV specialists and other healthcare providers, but the science and messaging has finally caught up. And for PLHIV, growing awareness and acceptance of U=U will hopefully serve to reduce stigma and discrimination, as well as improve compliance to treatment and follow up.

In 2014, UNAIDS launched the 90-90-90 program which aims to diagnose 90% of all HIV-positive individuals, provide antiretroviral therapy to 90% of the people diagnosed and achieve viral suppression for 90% of those treated by 2020. Current estimates from the Ministry of Health are that only 72% of people living with HIV in Singapore know their status, out of which 89% are on treatment, with the proportion of people on treatment who had achieved viral suppression fairly high at 94%. While the latter two figures are encouraging, more needs to be done to improve HIV testing and diagnosis. Local data shows that only 23% of HIV cases are currently being detected via voluntary screening, while 41% of HIV cases are diagnosed in a late stage.

With over 6,000 people in Singapore currently diagnosed as living with HIV, this means that close to 2,500 are estimated to have the infection without knowing their status. With U=U being a reality, getting at-risk individuals tested and on treatment as early as possible is essential in our fight against HIV. For those who already know their HIV-positive status, there is now additional cause to adhere to ART, as doing so will protect potential future partners from potential transmission.

While U=U is great news overall, there are certain caveats we must remember. For U=U to be considered effective, PLHIV must have an undetectable viral load for a duration of at least 6 months on follow up. Furthermore, studies which have shown that over a quarter of HIV-positive gay and bisexual men in a serodiscordant relationship did not have an accurate understanding of their current viral load, with around 20% of men who believed they were undetectable actually having a detectable viral load. As such, regular condom use and testing is still strongly recommended, as is the wider uptake of Pre-Exposure Prophylaxis (PrEP). It’s also important to note that U=U only applies to HIV infection, so precautions should still be taken against other more common sexually transmitted infections (STIs) such as chlamydia, gonorrhea, and syphilis.

U=U is a simple but important message based on a foundation of scientific evidence. The campaign makes a strong case for adherence to treatment and follow up, and allows PLHIV and the community to understand that they can live long, healthy lives, have children, and enjoy relationships without having to fear passing the infection to others. It will hopefully bring us a few steps closer to achieving the UNAIDS’ 90-90-90 target and help to reduce the stigma still faced by many living with HIV today.

Dr. Jonathan Ti is a GP at DTAP @ Robertson clinic. He has a special interest in sexual health and HIV, and is a co-author of the Community Blueprint to End HIV-transmission and AIDS in Singapore by 2030, and part of the National PrEP Taskforce.

 
 
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Oral Gonorrhea / Throat Gonorrhea – What do you need to know

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What is Gonorrhea?

Gonorrhea is a sexually transmitted disease (STD) that is caused by a bacterium known as Neisseria gonorrhoeae. It thrives in warm and moist areas like the genital tracts, mouth and anus.

Gonorrhoea is a common STD in Singapore. MOH reports an incidence rate of 33.4 per 100,000 population in 2016.

What are the symptoms of Gonorrhea infection?

In men, up to 60% of patients with urogenital Gonorrhea might not have any symptoms (asymptomatic). Symptoms of urogenital Gonorrhea in male may include:

  • Discomfort, itchy along the urinary tract
  • Painful urination
  • Penile discharge
  • Testicular Pain (Epididymitis)

In women, up to 70% of patients with urogenital Gonorrhea might not have any symptoms (asymptomatic).

Symptoms of urogenital gonorrhea in female may include:

  • Vaginal itch, discharge or bleeding
  • Painful urination
  • Abdominal/Pelvic Pain
  • Pain during sexual intercourse

What are the complications of Gonorrhea infection?

Untreated Gonorrhea infections for females can lead to Pelvic Inflammatory Disease with abdominal pain and abnormal vaginal bleeding. It can cause infertility if the sexual organs are scarred by the infection. Gonorrhea can also lead to multiple complications during pregnancy for the infected mother and can even be passed on to her baby.

For men, untreated Gonorrhea infection can result in scarring of the urinary tract and urinary obstruction. Testicular/Epididymal infection can also cause infertility if left untreated.

What is Oral/Throat Gonorrhea and how is it transmitted?

Oral/Throat Gonorrhea is the infection of the pharynx by the same bacterium and it is commonly transmitted through oral sex. It is an oral STD.

How common is Oral/Throat Gonorrhea and what are the symptoms?

A recent study in 2016 has estimated the prevalence of throat Gonorrhea infection to be as high as 30% for straight woman, 15.5% for straight men and 17% for homosexual men.

The most common presentation of throat Gonorrhea is a sore throat. Some patients may have swollen neck lymph nodes. However, the majority of patients do not present with any symptoms at all.

Oral ulcers are not a presentation of throat Gonorrhea. If oral/peri-oral ulcers are present, other STDs such as Herpes and Syphilis need to be considered.

I do not practice oral sex. Why should I be screened for Throat Gonorrhea?

Throat Gonorrhea transmission can occur even in the absence of reported oral sex.

Even though the majority of throat gonorrhea are asymptomatic, in 0.5% to 3% of infected patients the bacterium can penetrate the mucosae and enter the bloodstream, leading to a widespread infection. This blood-borne invasion (Disseminated Gonococcal Infection) can lead to to a variety of dangerous conditions including:

  • Multiple joint inflammation
  • Tendon Sheath inflammation
  • Skin dermatitis
  • Joint Infections

Hence, even in the absence of oral sex or symptoms, patients with new or multiple sex partners or a sex partner with a diagnosed STD should go for STD screening.

How is Gonorrhea screening performed?

Gonorrhea Testing. NAAT (Nucleic Acid Amplification Test) is routinely performed to detect N.gonorrhoeae. The doctor will swab the suspected area of infection (throat/anus/vagina) or request a urine sample for diagnosis of gonorrhea infection. It has been shown to be superior to traditional methods of culturing the bacteria with far more rapid results.

How is Gonorrhea treated and how can I prevent Gonorrhea infection?

Gonorrhea is treated with a single antibiotic injection and a course of oral antibiotics.

Gonorrhea transmission can be prevented by observing safe sexual practices. This includes the use of barrier protections like condoms or dental dams, cutting down the number of sexual partners as well as ensuring regular STD screening for both the patient and their sexual partners.

Next read: WHAT IS ANTIBIOTIC RESISTANT GONORRHEA OR SUPER GONORRHEA?

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What is Antibiotic Resistant Gonorrhea or Super Gonorrhea?

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Gonorrhea is a sexually-transmitted infection caused by the bacteria called Neisseria gonorrhoeae. 

Antibiotic-resistant Gonorrhea refers to strains of Gonorrhea that are not killed by antibiotics that were previously effective in killing off these bacteria. 

In the 1980s, penicillins and tetracyclines could kill off Gonorrhea. By the 1990s, these drugs were no longer effective and Fluoroquinolones were recommended as the first line treatment. By the 2000s, Fluoroquinolones resistance was commonplace and only one group of antibiotics remains as an effective treatment for Gonorrhea – Cephalosporins. By now, certain strains of Gonorrhea that are resistant to cephalosporins have already been detected and that is worrisome because if these medications become useless, we might face a situation where we cannot clear gonorrhea from a person’s body. 

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What drugs are super gonorrhea resistant to?

Super Gonorrhea is the colloquial term for strains of Gonorrhea that are extensively drug-resistant, with high-level resistance to the current recommended treatment for gonorrhea (ceftriaxone and azithromycin) including resistance to penicillin, sulphonamides, tetracycline, fluoroquinolones, macrolides.

What causes super gonorrhea? 

Super Gonorrhea is a problem that we have created. 

The unrestricted access, inappropriate selection and overuse of antibiotics over many decades has allowed the strains of gonorrhea to genetically mutate in such a way that they are no longer affected by these antibiotics. Extra genital infections in the rectum and throat may also play an important role in the development of resistant strains as gonorrhea can interact and exchange genetic material with other co-infections in these places.

How common is Super Gonorrhea?

Super Gonorrhea has been reported by several countries including France, Japan, Spain, the UK and Australia. The American CDC has not received any reports of verified clinical treatment failures to any cephalosporin in the United States to date. 

How does Gonorrhea spread?

Gonorrhea can be spread through sexual contact with the penis, vagina, mouth, or anus of an infected partner. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Even if you have had gonorrhea in the past and was treated, you can still get reinfected again if you are exposed to it again. 

What are the symptoms of super gonorrhea?

The symptoms of super gonorrhea are the same as regular gonorrhea. Gonorrhea can infect different areas of the body. Most symptoms present within 1-2 weeks after exposure.

In males, the most commonly infected site is the genitourinary system. It can present with symptoms such as pain on passing urine, penile discharge, swelling at the tip of the penis and scrotal pain and swelling.

In females, the most commonly infected site is also the genitourinary system and and present with symptoms such as vaginal discharge, pain on passing urine, intermenstrual bleeding, painful intercourse, and mild lower abdominal pain

Gonorrhea can also infect other areas of the body such as the rectum, causing rectal pain, itching, discharge, or tenesmus. If gonorrhea infects the throat, you can get a persistent sore throat. Gonorrhea can also infect the eyes, causing conjunctivitis which may present with eye pain, discharge, and redness. If gonorrhea spreads by blood to the rest of the body including the brain, heart, bone, joints, skin and liver, this is termed Disseminated gonococcal infection (DGI). While rare, DGI can be deadly and have long term complications. 

Does Gonorrhea always have symptoms?

Gonorrhea can have little to no symptoms at all in some people. That is the reason why it is so important to screen for STIs with every sexual encounter. 

A study has reported that more than 80% of people (both males and females) with Gonorrhea can have no symptoms. Do not wait for symptoms to appear before you screen for STIs. Do it regularly with every new sexual encounter. 

Also read: Rapid STD Test for Chlamydia and Gonorrhoea PCR

What are other STDs that do not display symptoms and have serious complications if left untreated?

All STIs can have no symptoms at all. Because people do not experience any symptoms, they think that they do not have an STI and thus the spread of STIs continues. Other STIs we regularly test for include other urinary STIs such as Chlamydia, Ureaplasma urealyticum, Mycoplasma hominis and Trichomonas. What we can test for in the blood are STIs such as HIV, Syphilis, Herpes and Hepatitis B and C.

What happens if gonorrhea is treated effectively?

If gonorrhea is treated effectively (with the proper antibiotics), your symptoms should clear up, and subsequent follow up tests to test for clearance should come back as negative for gonorrhea.

What are the complications of Gonorrhea?

In females, untreated gonorrhea may lead to pelvic inflammatory disease (PID). This is an infection of the fallopian tubes, uterus, and cervix. If left untreated, PID may cause permanent damage to the reproductive tract, which may lead to infertility. It may also lead to long-term pelvic pain.

Males with untreated gonorrhea may develop a condition called epididymitis. This condition is characterized by inflammation of the tubes near the testicles that carry semen. It can also lead to infertility. 

DGI is another complication of gonorrhea as well. 

What happens if you have drug resistant gonorrhea? Can I get rid of Antibiotic Resistant Gonorrhea?

If you have drug resistant gonorrhea, your doctor may opt to treat you with antibiotics that hopefully are effective against this strain of gonorrhea. Antibiotic sensitivity testing for that strain should be done. If it is truly multi-drug resistant, a referral to an infectious diseases specialist is appropriate, and they may have to treat you with antibiotics that are reserved for the worst kinds of infections. 

How do you reduce your risk of contracting these STIs?

Abstinence is the only way to reduce your risk to zero.

If you are sexually active, use barrier protection such as condoms, the right way. You can also speak to your partner to get tested for STIs before engaging in sexual activity.  A mutually monogamous relationship also carries a lower risk of STIs than having multiple sexual partners.

If you are sexually active with multiple sexual partners, get yourself tested regularly and treated. The presence of one STI can increase your risk of contracting another one more easily. Most STIs can easily be detected through swabs, urine or blood tests at your doctors. These are rather pain free and minimally invasive, so there should be no fear to get tested!

There are some STIs that are preventable through vaccinations. Vaccines are available against certain strains of HPV that may cause warts, cervical, anal and penile cancer. Effective vaccines against Hepatitis B are available as well.

Also read: What is HPV (Human Papilloma Virus)?

How do I find out if I have been infected with Super Gonorrhea?

Gonorrhea is often diagnosed using a PCR test. This test can give results very fast and determine if a person is infected with Gonorrhea or not. However, this test cannot differentiate between regular Gonorrhea and Super Gonorrhea.

For that, a test called Gonorrhea Culture and Sensitivity has to be conducted. This test takes a longer time as the Gonorrhea bacteria has to be grown on a plate and tested against various antibiotics. This test is also less sensitive as for various reasons, sometimes the Gonorrhea bacteria cannot grow.

Also read: What Is Rapid Chlamydia & Gonorrhea PCR STD Testing?

If you think you may have been exposed to Super Gonorrhea, you have to see your Doctor immediately. DTAP clinics focus on STD screening and STD treatment. We offer rapid PCR testing for Gonorrhea (next day results) as well as culture tests to detect multi-drug resistant (Super) Gonorrhea. 

Speak to your doctor if you have any questions regarding Gonorrhea or other STDs.

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性传播感染 (STDs)

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大家好，今天黄医生想谈的是性传播感染也有些人称之为性病。

性传播感染是由病毒，细菌和其他微生物引起的，如果你与携带这些感染的人发生性关系，你可以捕获它们。

性病症状可分为泌尿系统症状，皮肤症状和一般症状，可在性生活后3天开始出现，也可能需要数周至数月。有些人受到感染但从未出现任何症状。

性病治疗取决于您所拥有的性传播感染的类型。一些可以通过抗生素治疗，一些如疱疹和艾滋病毒是必须管理的终身感染。人类乳頭瘤狀病毒 (HPV) 和肝炎等性传播疾病可通过疫苗预防

请记住，只要你发生性行为，你就可以患有性病。如果不及时治疗，大多数性传播感染会导致严重的并发症。

如有必要，请去看医生进行定期筛查和治疗。和他谈谈接种肝炎和HPV疫苗。

如果您怀疑自己有任何高风险的艾滋病毒感染，请告诉我们的医生。

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艾滋病 (HIV) 的症状与治疗方法

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大家好，今天黄医生谈谈艾滋病感染的症状。

HIV症状取决于个体和疾病阶段。

在最初感染后的前2-4周内，患者可能会出现流感样症状， 他们称之为“有史以来最严重的流感”。

这被称为急性逆转录病毒综合征。症状包括发烧，腺体肿胀，喉咙痛，皮疹，疲劳，身体疼痛和头痛。

艾滋病毒症状可持续数天至数周。请记住，这些症状可见于其他常见疾病，您不应仅仅因为体验过它而认为您患有艾滋病毒。还要注意许多早期HIV感染者没有症状。

在HIV感染的早期阶段之后，该疾病进入临床潜伏期，其中病毒在体内发展，但没有看到症状。如果您正在接受艾滋病治疗，那么病毒通常会受到控制，您可能会遇到可能持续数十年的无症状期。如果您感染了艾滋病病毒并且没有接受治疗，那么它将进展为艾滋病。您可能会出现严重的症状，包括体重迅速减轻，反复发烧，大量盗汗，极度疲倦，腺体肿胀，腹泻，口腔溃疡，肺部感染和神经系统疾病。

即使您遇到上述症状，除非您接受检测，否则无法确认HIV。

如果你担心自己有可能跟性(爱)产生接触或正在经历类似状况，请到我们的诊所进行相关咨询和诊测。

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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:

Everything You Need to Know About Molluscum Contagiosum

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What is molluscum contagiosum?

Molluscum contagiosum is a fairly common skin infection or condition caused by a virus called Molluscum contagiosum, a type of poxvirus. It manifests as raised, pearly, flesh or skin coloured bumps which may sometimes have a central dimple (known as “central umbilication”).  

How does molluscum contagiosum spread?

Molluscum contagiosum is spread through skin contact with the virus. 
This can occur if you come into direct contact with someone else’s molluscum lesions, be it through sexual contact, or during contact sports like wrestling.


Unfortunately, the virus can survive on surfaces outside the body and can remain on infected surfaces like clothing, towels, gym equipment etc. Someone else who then comes into contact with these surfaces can get infected. 


In someone who is already infected, scratching or touching the lesions and then touching other parts of their body can result in the virus spreading. Shaving over infected skin can also spread the virus and worsen the infection. 


Once lesions resolve, an infected individual is no longer contagious. 

Who is affected by molluscum contagiosum?

Both children and adults alike can be infected by the virus. It is common amongst young children who may spread the virus through playing with each other. Lesions may occur anywhere – on the trunk, limbs, armpits, neck and possibly even face.


In adults, it is more commonly spread through sexual contact and may be considered an STD. The resultant lesions occur anywhere on the lower abdominal wall to the external genitalia and perineum. 


Individuals with weakened immune systems e.g. cancer patients or immunosuppressed patients, or individuals with skin conditions like eczema are at higher risk of being infected. 

What are the symptoms of molluscum contagiosum?

Molluscum contagiosum gives rise to shiny, pearly, skin coloured bumps which may range in number from few to many. These can occur anywhere on the body depending on where the virus inoculates the skin. These bumps are painless and can range in size from barely visible to several millimeters in size or larger. When lesions are larger, you may be able to notice a central dimple. 


In individuals with weakened immune system, lesions may be far more widespread e.g. >100 lesions.


Symptoms usually surface between 2 weeks to 2 months from initial infection, but can be delayed for up to half a year even. 

What are the complications of molluscum contagiosum?

Molluscum contagiosum is a benign and self-limiting condition. However, scratching lesions can result in scarring or secondary bacterial skin infections.

How is molluscum contagiosum diagnosed?

Molluscum contagiosum is diagnosed clinically i.e. by identification of the classic pearly skin bumps. If the lesions look atypical, a skin scraping of a bump may be useful – examination under a microscope will reveal “molluscum bodies” which confirms the diagnosis, but this is not routinely performed in most patients. 

How is molluscum contagiosum treated?

Treatment of molluscum contagiosum is not always necessary as the condition is self-limiting and lesions will eventually resolve by themselves without scarring. Most lesions will resolve within a year but can take longer than that. 
Treatment is recommended for:

  • Lesions around the genital or perianal region
  • If lesions are large 
  • In immunocompromised individuals with extensive lesions 

Various treatment methods available include:

  • Physical removal of lesions – with laser removal or cryotherapy (freezing with liquid nitrogen)
  • Topical creams or ointments e.g. podophyllotoxin application, imiquimod cream – but the efficacy of topical treatment may vary 
  • In immunocompromised individuals, usual treatment methods may fail and specific, special treatment (e.g. intralesional interferon) may be required 

How do I minimize my risk of getting molluscum contagiosum?

Good hygiene habits are crucial to minimize your risk of molluscum – regular hand washing, not sharing towels or sports equipment, wiping down equipment at the gym before usage, or covering equipment with your own towel rather than sitting or lying directly on it. Do not share razors or personal items. 


Avoid touching lesions if you are infected. Do not scratch, pick, or attempt to pop lesions. Shaving should also be avoided. Molluscum lesions should ideally be covered e.g. with a plaster to reduce the risk of transmission. 


Adults with lesions around their genital or perianal region should also avoid sexual contact until these have been treated. 


If you are concerned about any skin lumps or bumps and think you may have molluscum contagiosum, it is best to hold off attempting to treat it yourself (this may worsen the infection!) and see a doctor as soon as possible.


If you would like to find out more about molluscum contagiosum come down to any of our clinics for a consultation.

A Case of HIV from Vampire Facial

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Our clinics recently diagnosed a case of HIV from a vampire facial.
A Vampire Facial is a type of cosmetic treatment that was made popular by celebrity Kim Kardashian.
The treatment involves taking the patient’s own blood and spinning it down until the cells separate out of the liquid portion (plasma). Small needles known as micro-needles are then used to make multiple small holes in the patient’s face. The plasma is then poured over the face so that it soaks into these holes.
Two cases of HIV infection from such treatments were reported earlier this year in Albuquerque, New Mexico in the US. https://www.medscape.com/viewarticle/912436
Vampire Facial treatment is NOT approved in Singapore.

What Can You Do to Protect Yourself?

Before undergoing a treatment, ensure that the establishment has all the proper local licenses required.
Ensure that the therapist conducting the treatment has all the training certifications required.
Do not undergo any treatments in non-medically licensed establishments that involves blood or body fluids.
For treatments that involve puncturing or breaking the skin, ensure that the instruments used are properly packaged and sterilized. 
Insist on seeing the operator open the sealed package in front of you.

If you feel you might have been exposed to an infection, see your local Doctor immediately for a discussion on HIV PEP and screening for other blood-borne infections like Hepatitis B and Hepatitis C.

Learn More about Other STDs & Other STD Symptoms

Chancroid Symptoms & Treatment

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What is Chancroid?

Chancroid is a sexually transmitted infection caused by the bacterium Haemophilus ducreyi. It is a highly contagious but curable disease. 
Chancroid was once highly prevalent worldwide, but thanks to increased social awareness leading to better sexual practices, along with improved diagnosis and treatment options, it is nowadays rarely seen in industrialized countries. However, it still occurs frequently in underdeveloped areas, including certain parts of Asia, Africa and the Caribbean. It is most prevalent in lower socioeconomic groups, and is associated with commercial sex workers.

Signs & Symptoms

Symptoms typically begin 4 to 10 days after sexual exposure. Patients usually develop a small, red pustule on the genitals that breaks down within a day or two to form a painful, soft ulcer with irregular borders.
About half of infected males develop a solitary ulcer whereas women usually develop 4 or more ulcers. In males, the ulcer can be located anywhere on the genitals, including the penis and scrotum. In females, the ulcers can occur on the labia, between the labia and anus, and along the inner thigh. 
Lymph node swelling in the groin may accompany shortly thereafter, and these may break through the skin and form large draining abscesses (collections of pus). These swollen lymph nodes and abscesses are referred to as buboes. With lymph node involvement, fever, chills and malaise (general feeling of illness) may also develop.
Other symptoms of Chancroid include rectal bleeding, pain with bowel movements, vaginal discharge, painful urination (women) and pain during sexual intercourse (women).

Is Chancroid associated with other subtypes of genital ulcer diseases that include other STDs, such as HSV-2, syphilis, and LGV?

Chancroid is one of the causes of genital ulcer diseases, which includes Herpes Simplex Virus (HSV) Type 2, Syphilis and Lymphogranuloma Venereum (LGV). There is no direct association, but any form of STD can increase your risk of contracting another STD, including Chancroid.
Genital ulcer diseases are concerning as their presence greatly increases the risk of HIV transmission, with a report from the World Health Organization (WHO) estimating that the presence of genital ulcer diseases increases the risk of HIV transmission by 10%-50% in women and 50%-300% in men.

How do I test for Chancroid?

Currently there is no laboratory test that is able to immediately confirm the diagnosis of Chancroid. Haemophilus ducreyi can be isolated on a special culture media, but this is not readily available in many centres. Moreover, this technique has a sensitivity of <80%.
Diagnosis therefore is made based on clinical judgement. According to the US Centres for Disease Control and Prevention (CDC), a probable diagnosis can be made if: 

  1. There is presence of one or more painful genital ulcers
  2. The presentation and appearance of the genital ulcers and, if present, enlarged groin lymph nodes are typical for Chancroid
  3. There is no evidence of syphilis infection on testing of the ulcer, or from blood test performed at least 7 days after onset of ulcers
  4. Swab testing of the ulcer for Herpes Simplex Virus is negative

What is the treatment for Chancroid?

Appropriate treatment of Chancroid cures the infection, reduces the complications, and prevents transmission. Treatment should be started as soon as a diagnosis of Chancroid is suspected due to the lack of appropriate fast and accurate laboratory testing.
The key treatment for Chancroid involves the use of antibiotics. Antibiotics may also help decrease the chance of scarring as the ulcer heals. Your doctor will choose the appropriate antibiotic for you. 
If buboes are present, they should be drained with either needle aspiration or surgery, in order to reduce swelling and pain. Sexual partners of patients with Chancroid should be informed to get examined and treated regardless of whether they have symptoms or not, if there was sexual contact within 10 days preceding the onset of symptoms.
If you would like to find out more about Chancroid, come down to any of our clinics for a consultation.
Stay safe, stay healthy.

Learn More about Other STDs & Other STD Symptoms