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Chlamydia Conjunctivitis

Chlamydia is a sexually transmitted infection (STI) caused by the bacterium Chlamydia Trachomatis. It is one of the most common STIs worldwide, and likewise here in Singapore. According to the latest statistics provided by the Department of STI Control (DSC) Clinic, there were officially 2,719 newly diagnosed cases of Chlamydia reported in 2018.

It is well known that Chlamydia affects the genito-urinary system, with the typical symptoms being painful urination, increased urinary frequency or urgency, penile or vaginal discharge, testicular pain or swelling in men, and painful sex or bleeding after sex in women. You may also be aware that Chlamydia can sometimes be completely asymptomatic. However, what most people may not know is that Chlamydia can affect other parts of the body as well, namely the eyes, rectum, throat and joints.

In this article, we will focus on Chlamydia eye infection, also known as Chlamydia Conjunctivitis. You can read more about Chlamydia as an overall topic in a previous article:


What is Chlamydia Conjunctivitis?

Conjunctivitis is inflammation or infection of the conjunctiva, a clear membrane that covers the white part of the eye and lines the inside of the eyelids. The conjunctiva helps to lubricate the eye by producing mucus and tears, and prevents the entry of microbes into the eye. The various causes of conjunctivitis include viral or bacterial infections, allergies, chemical irritation and foreign objects. Therefore Chlamydia Conjunctivitis refers to conjunctivitis resulting from a Chlamydia infection.

How does Chlamydia Conjunctivitis occur?

Chlamydia Conjunctivitis is directly spread from the bacteria entering the eyes. This usually happens from touching or rubbing your eyes after touching your genitals (if you have Chlamydia) or those of an infected partner. It is also possible to get infected from sharing towels, eye makeup or cosmetics that contain the bacteria.

Signs and symptoms

Chlamydia Conjunctivitis can present acutely, but more commonly patients have mild symptoms for weeks to months. The majority of cases affect only one eye, and vision is usually unaffected.

Signs and symptoms include:

  • Red, itchy, swollen or scratchy eyes
  • Mucous, sticky discharge
  • Tearing
  • Photophobia (sensitivity to light)
  • Swollen eyelids
  • Crusting and sticking of eyelids
  • Foreign body sensation
  • Enlarged lymph nodes behind the ears

How to tell the difference between Chlamydia Conjunctivitis and other forms of conjunctivitis?

As Chlamydia Conjunctivitis presents very similarly to viral and other bacterial conjunctivitis, it is not possible to tell the difference based on eye signs and symptoms alone. For this reason, many patients may have been previously treated, or self-medicated, with various types of eye drops without symptomatic relief. A diagnosis of Chlamydia Conjunctivitis is usually suspected if close questioning reveals genito-urinary symptoms, or if the sexual partners of these patients have similar eye symptoms.

Who is at risk?

Chlamydia can affect anyone who is sexually active, both males and females alike, regardless of sexual preference or orientation. Young people may be at higher risk for various reasons, including practices like inconsistent condom usage.

Diagnosis

Chlamydia Conjunctivitis is usually diagnosed based on history and examination of the eye. If necessary, a swab test of the conjunctiva can be performed. Your doctor may advise you to test for other STIs as well.

STD Screening Singapore | Rapid STD Test for Chlamydia and Gonorrhoea PCR

Treatment for Chlamydia Conjunctivitis

If left untreated, Chlamydia Conjunctivitis resolves spontaneously in 6 to 18 months, but most individuals would seek treatment due to the severity of the symptoms. Chlamydia Conjunctivitis is treated with topical antibiotics such as tetracycline, erythromycin and fluoroquinolones, but due to the high probability of concomitant genital tract infection, oral antibiotic therapy is recommended. Sexual partners of the patients should be contacted, evaluated and treated.

Prevention

  • Wash your hands regularly, avoid touching or rubbing your eyes unless your hands are clean
  • Do not share eye makeup or cosmetics with anyone
  • Refrain from sharing towels, washcloths, pillows, or sheets with anyone. If one of your eyes is affected but not the other, use a separate towel for each eye
  • Observe safe sexual practices including consistent and correct usage of condoms, reducing your number of partners or being in a mutually monogamous relationship where you are aware of your partner’s sexual health status
  • Regular STI screening helps you remain aware of your own sexual health status

Neonatal Chlamydia Conjunctivitis

Although relatively harmless in adults, Chlamydia Conjunctivitis can have severe health consequences in children. Infection is acquired from an infected mother during vaginal delivery, from exposure to the bacteria in the birth canal. Chlamydia Trachomatis is responsible for up to 40% of conjunctivitis in neonates. If left untreated, neonatal conjunctivitis can cause blindness.

The symptoms usually develop within 1 day to 2 weeks after birth and typically include redness of the conjunctiva, eyelid swelling, and mucous discharge. At least half of neonates with Chlamydia Conjunctivitis also have the bacteria present in the nasopharynx, and some go on to develop Chlamydia pneumonia. Therefore, oral antibiotic therapy is the treatment of choice in neonatal Chlamydia Conjunctivitis as it can also target concomitant nasopharyngeal infection.

The condition can be prevented by undergoing prompt screening and treatment if a genital infection is suspected during pregnancy. Deliveries should be conducted under hygienic conditions taking all aseptic measures. The newborn baby’s closed lids should be thoroughly cleansed and dried.

Next Read: Common STD Incubation Periods

Can I get an STD from a hand job?

This is a very common question that I get from patients who come to see me. Some are worried about contracting STDs when giving or receiving hand jobs or masturbation from another person. Generally speaking, there is very little risk of contracting STDs from a hand job.

Even though it is low risk, it is still not zero risk. Let me share with you some points about hand jobs and STDs.


You getting the hand job VS when you’re giving the hand job

Generally hand jobs have very low risk of transmission of STDs. However, if you give the hand job, you are at lower risk of getting an STD as compared to when receiving one. Why is that? STDs tend to affect genitals more than our hands. So if you are at the receiving end, it is your genitals that are at risk. If you are giving the hand job, it is less likely for you to get STDs unless you touch your own genitals after giving the hand job.


Type of STDs that might be transmitted through a hand job

Not all STDs are transmissible via handjobs. It is usually the ones that are passed on through skin to skin contact that are transmissible.

These include: 

  • Herpes Simplex Virus (HSV) Type 1 and 2. This usually causes painful sores or vesicles around the lips or genital areas. There is no cure for the virus but you can take antiviral medication when the symptoms appear to reduce the duration and severity of the symptoms.
  • Human Papilloma Virus (HPV): This virus usually causes genital warts. Warts are flesh coloured growths on the skin. There is also no treatment to treat the virus but there are different types of treatment available to remove the warts when they appear.
  • Molluscum Contagiosum: This is causes by a virus that lives on the skin. It can also be spread via skin to skin contact. It appears as small firm bumps on the skin which are generally harmless and painless. They usually go away on its own or you can get it removed by a doctor through freezing or laser removal.

How can you prevent it? What is considered “safe sex”?

As how we advise for all STDs, abstinence is best. 

Avoid multiple partners. Keeping to one partner minimizes the risk of STDs.

Avoid high risk exposure from sex workers or those who work in massage parlours. These workers have high exposure to several people a day so you will be at higher risk.

Condoms: Condoms may provide some protection. However do take note that areas not covered by the condom is still at risk of STDs.


Get tested to be sure!

If you’re ever in doubt, or unsure of your risks and or symptoms, do seek medical advice. The doctor will be able to advise if you need to get tested or get treated.


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

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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An overview of STD's from an STD Doctor

Sexually transmitted infections or diseases (STI’s/STD’s) are infections which are commonly spread through sexual contact, including vaginal, anal, and oral sex.

Some can even be spread just through direct skin-to-skin contact!

No one really talks about it, but sexually transmitted infections are very common, especially among young people – or rather, anyone who is sexually active is at risk!

Common Sexually Transmitted Diseases (STDs)

Chlamydia, Gonorrhea, Herpes Simplex Virus (HSV) and Human Papilloma Virus (HPV) are some of the most common STI’s we encounter in the clinic.
Syphilis and HIV are less commonly seen, but of course, pose a risk of serious and even potentially life-threatening complications if left undiagnosed or untreated.

Here are just some of the signs and symptoms that may appear if you have a sexually transmitted infection:

Chlamydia and Gonorrhea

Did you know that up to 8% of sexually active females between the age of 16-40 will be carrying a chlamydia infection at any one time, and most will not have any symptoms at all!

Herpes Simplex Virus (HSV)

  • Fever and flu-like symptoms before the outbreak
  • Tingling, itching, or burning sensation where the blisters would appear
  • Swollen lymph nodes
  • Cold Sores
  • Crops of painful blisters/ulcers – these can vary in appearance and severity, and can be transmitted to any site of the body depending on exposure (e.g. mouth, hands, buttocks, eyes!)

It is estimated that 1 in 5 people in the US have genital herpes!

There is no way to fully eradicate the herpes virus once it has been contracted – it usually causes recurrent outbreaks of blisters, and can be transmitted even without visible ulcers.

Human Papilloma Virus (HPV)

  • Certain types of HPV can cause genital warts – may appear as a small bump, or cluster of bumps, flat lesions, or ‘cauliflower-like’ protrusions with a small stem; sometimes these may be itchy or bleed if scratched
  • Most types of HPV are actually asymptomatic (no signs or symptoms), but can instead increase the risk of oral and genital cancers – these can be detected on screening (especially recommended for women > 30 years old, to be done together with a pap smear)

The newest HPV vaccine is now available, and will protect against 9 strains of the virus!

The US FDA has also recently extended the recommended coverage to males and females from ages 9 to 45 years old.

Syphilis

Known as ‘The Great Pretender’ as symptoms can mimic other conditions, and can vary greatly between individuals and depending on the stage of infection

  • Primary stage: usually presents with a solitary ulcer known as a chancre at site of initial infection, which is often painless and can be easily missed; may have associated swelling of lymph nodes as well
  • Secondary stage: can happen weeks after primary chancre has appeared and even healed, and presents with skin rashes and/or lesions over mucous membranes – the STD rash can occur on any part of the body, but typically also appears with reddish-brown spots over the palms and soles of feet
  • Tertiary stage: can occur many years (even decades) after infection was first acquired, and can affect multiple organ systems including the brain, nerves, heart, eyes, blood vessels, bones and joints

Learn More about Syphilis Symptoms (Painless Sore & Rashes) 

Frequently Asked Questions (FAQs)

When should I see a doctor?

If you have any worrying symptoms or exposure risk, see a doctor immediately. However, it is important to remember that many people may not have any noticeable symptoms for any of these infections, or that symptoms may take a long time to develop (weeks to months), thereby increasing the risk of complications and also the risk of transmission to others. As such, it is recommended to perform regular STI screening at least once or twice a year for anyone who is sexually active even if there are no obvious symptoms. STD Testing may be done more frequently if there has been any potentially risky exposure. Risky exposures would include sex with someone who has had multiple sex partners, sex with commercial sex workers (CSW), or unprotected sex with a person of unknown status.

What is the ‘window period’ for testing?

The window period refers to the time period following exposure where it may be still too early to detect infection with full accuracy. Different infections will have different window periods for detection. For bacterial infections such as chlamydia and gonorrhoea, this period is fairly short, and most cases can be accurately detected 1-2 weeks post-exposure. However, for blood tests (e.g. HIV, syphilis) we usually recommend at least one-month post-exposure for accurate results. For concerns on specific infections, it is best to speak to the doctor who can advise you most clearly in person.

What will happen when I see the doctor?

Screening is a simple procedure and will include a thorough consultation with a doctor, physical examination if necessary, and either blood and/or urine or swab tests. You will need to find a doctor you can be comfortable speaking with about your risk and symptoms, as it will guide us to determine the most appropriate tests for you.

How soon can I get my results?

Most tests that we send to the lab will have a turnaround time of 3-5 working days. We also have Rapid STD Testing available in all our clinics for the “Big Four”: HIV and syphilis (results in 20 minutes), and chlamydia and gonorrhoea (next day results).
Earlier diagnosis means earlier and more effective treatment, reducing the risk of late-stage complications and also minimizing the risk of further transmission. 

Learn More: What are the symptoms of HIV and AIDS?

Will my medical information be revealed to anyone else?

Your medical information is strictly private and confidential, and will not be shared with any other individual or organization. Only HIV infection is notifiable by law in Singapore – this means that if you did a lab-based HIV test and it came back positive for HIV, this result would have to be notified to the Ministry of Health.

However, our Robertson Walk Branch has been mandated to perform rapid HIV testing anonymously – this means that no matter the result, it will not be notified to the Ministry of Health. The Robertson Walk clinic is the only DTAP branch that can do HIV testing anonymously.

Can these infections be cured?

Many of these infections are treatable and can be fully cured/eradicated. Certain infections require longer courses of treatment and/or clearance testing to ensure they are cleared.
However, there are a few infections which can be treated with medications but may not be fully curable, such as herpes, hepatitis B, and HIV. Your doctor will advise you in more detail should your tests show any abnormal results. (see HIV Treatment)

If you or your partner are experiencing any possible signs or symptoms of infection, or have had any potential risk exposures, please see a doctor today.

Take Care. Be Safe!


Other Interesting Reads:

  1. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  2. World AIDS Day (2018) #KnowYourStatus – By Dr Tan Kok Kuan
  3. Weak Erection? Erectile Dysfunction? How to Improve Erection with Pills
  4. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  5. What are the Causes of Abnormal Penile Discharge?
  6. 4 Things You Need to Know About Penile Health
  7. Sexual Health Advice For Travellers 
  8. Mycoplasma Genitalium Testing & Treatment
  9. What are the Symptoms of HIV Infection and AIDS?
  10. Things You Need to Know about Travelling & HIV PrEP
  11. 11 Causes of Dyspareunia (Pain During Intercourse)
  12. What is HPV Vaccination (Gardasil 9)
  13. 10 Causes of abnormal Vaginal Lumps and Bumps
  14. An Overview of Gonorrhoea
  15. What is the Treatment for Cold Sores? What causes Cold Sores?
  16. Herpes: Everything You Need to Know!


We provide a discreet, comfortable and private environment for you to discuss your STD/HIV related medical matters.

What is Rapid Chlamydia & Gonorrhea PCR STD Testing?

Chlamydia and gonorrhoea are 2 common Sexually Transmitted Infections (STIs) which can infections in various parts of the body such as penis, vaginal, anus, throat and eyes.
Most commonly you will experience discharges from the penis/ vaginal or discomfort when passing urine.
However, the majority of men may not have any symptoms and for women, 50% may also not have symptoms.
The infection will stay in the body for a few weeks after the symptoms have been treated.
In rare instances, Gonorrhoea and Chlamydia can continue to cause damage to the body, specifically the urethra and testicles. Pain may also spread to the rectum. An overview of Gonorrhoea

At Dr Tan and Partners, we recognize that symptoms like abnormal vaginal discharges, penile discharge or discharge from the rectum can cause quite a bit of worry.
Thus, we have introduced a Rapid STD testing (next day results) that can detect these 2 infections within a day.
Which means that you can get the necessary treatment quickly as well.
All it requires is a urine sample or swab from the vaginal/ throat/ anal

This Rapid STD Testing detects for the presence of the DNA of the 2 organisms, making the test very sensitive

If you think you may have symptoms suggestive of chlamydia or gonorrhoea infection or if you think you may have been exposed and you are interested in an STD Screening, please visit a doctor for further evaluation.

Take Care!


Other Reads:

  1. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  2. Weak Erection? Erectile Dysfunction? How to Improve Erection with Pills
  3. HPV Infection & HPV Vaccination for Men who have sex with Men
  4. STD Risk for Receptive Unprotected Anal Sex in Men
  5. Low HIV Risk Doesn’t Mean No HIV Risk
  6. HIV PrEP for Travel – How You Need to Know
  7. An Overview on STD from an STD Doctor
  8. Everything You Need to Know about Herpes Simplex Virus
  9. How Do I Treat Oral Herpes (Cold Sores)
  10. Syphilis Symptoms – Painless Sore & Ulcers
  11. HIV Symptoms – What You Need to Know
  12. 10 Common HIV related Opportunistic Infections