Posts

Sexual Health Advice for Traveller

Passport, Phone, Plane tickets and….. PrEP!

Planning your next trip – for business or pleasure, or both? Apart from the usual, do you make plans for your own sexual health?

What? Why?
Whether you’re straight, gay, lesbian, bisexual, transgender or just curious and questioning, lots of people have casual sex when they travel, so you’re not alone.
However, lots of research and experience show that the risk of developing a sexually transmitted infection (STI) – like HIV, syphilis or others – is increased when you travel. 1
This could be due to increased risk-taking behaviour when we travel abroad. The reasons may include increased freedom, alcohol and drug use, loneliness, peer pressure or a general sexual lifestyle when you’re abroad.2
Of course, there are those who travel abroad specifically for sex, in what some call “Sex Tourism”, which is the intention of travel overseas to purchase sex. This usually involves travelling to neighbouring countries to purchase sex from commercial sex workers.
Whatever your reasons for travel, if you’re unprepared for sex you may be putting yourself at risk and participate in behaviours that you wouldn’t consider at home.3
 

So how? Top tips for your Sexual Health Risk Reduction  (T.R.A.V.E.L)

T for Testing & treatment of STIs

  • Please get tested prior to travel as blisters, ulcers, bumps provide an entry point for STIs into the body. Having an STI increases the risk of HIV transmission by 10 fold!
  • Periodic STD Screening & Anonymous HIV Testing can keep your status in check
  • Don’t assume your partner is STD-free because s/he doesn’t mention it and, STDs are often asymptomatic. Talk openly with him or her about your STD and HIV status and date of the last testing3

R for Rubbers & Lube

  • Unprotected (without a condom) sex with a new/casual partner carries a risk of contracting STIs or blood-borne viruses.
  • Stock up on condoms and lube, keep them in a cool place, practice using them and get confident in talking about using them before you go.

A for Alcohol & Drug Use

  • Be careful when having sex after alcohol use. With alcohol or other drugs, one is more likely to take risks: not using a condom, having sex with someone you normally wouldn’t have sex with. We encourage condoms to be used for all forms of sexual activity especially with new/casual partners.

*Note: We do not support illicit drug use and urge our readers to abide by the host country’s drug laws. Singapore has strict anti-drug laws. Any citizen or permanent resident found to have abused controlled drugs overseas will be treated as if he or she had abused drugs in Singapore. Furthermore,  possession, consumption, manufacturing, import, export, or trafficking of controlled drugs in any amount are illegal.

V for Vaccinations

  • Discuss with our DTAP team the risk of infections, STIs and Blood Borne Viruses and any vaccines that are available (plan ahead as some vaccinations may take up to 6 months for full immunity). The vaccines that we recommend are the HPV (human papillomavirus) vaccine, also known as Gardasil 9, Hepatitis A and Hepatitis B vaccination.

E for Education

  • Empower yourself with information where sex may be available, at your travel destination.4
  • Ensure you are vaccinated against Hepatitis B, carry and use kite-marked condoms, consider taking oral HIV PrEP (Pre-exposure Prophylaxis) prior.

L for Living and travelling with HIV

 
Get tested after you return and last but not least, consider PrEP before you travel!  Learn more about Travelling with HIV PrEP (Pre-Exposure Prophylaxis)

Safe Trip and Have Fun!
This article was written by Dr Tan & Partners, in collaboration with Oogachaga.


References

  1. Vivancos R, Abubakar I, Hunter PR. Foreign travel, casual sex, and sexually transmitted infections: systematic review and meta-analysis. International Journal of Infectious Diseases. 2010;14(10):e842–51.
  2. Svensson P.,et al. A meta-analysis and systematic literature review of factors associated with sexual risk-taking during international travel. Travel Medicine and Infectious Disease. 2018; Jul – Aug;24:65-88
  3. https://wwwnc.cdc.gov/travel/page/std
  4. https://www.fitfortravel.nhs.uk/advice/general-travel-health-advice/sexual-health-risks
  5. Riddell Jt, Amico KR, Mayer KH. HIV Preexposure Prophylaxis: A Review. Jama. 2018;319(12):1261-8.
  6. WHO Guidelines Approved by the Guidelines Review Committee. Guideline on When to Start Antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV. Geneva: World Health Organization Copyright (c) World Health Organization 2015.; 2015.
  7. Elsesser SA, Oldenburg CE, Biello KB, Mimiaga MJ, Safren SA, Egan JE, et al. Seasons of Risk: Anticipated Behavior on Vacation and Interest in Episodic Antiretroviral Pre-exposure Prophylaxis (PrEP) Among a Large National Sample of U.S. Men Who have Sex with Men (MSM). AIDS and behavior. 2016;20(7):1400-7.
  8. Brett-Major DM, Scott PT, Crowell TA, Polyak CS, Modjarrad K, Robb ML, et al. Are you PEPped and PrEPped for travel? Risk mitigation of HIV infection for travelers. Tropical diseases, travel medicine and vaccines. 2016;2:25
  9. Hampel B, Reinacher M, Fehr JS, HIV pre-exposure prophylaxis (PrEP): Is it time to rethink HIV prevention in travelers?, Travel Medicine and Infectious Disease (2018), doi: 10.1016/j.tmaid.2018.06.008
  10. https://www.iwantprepnow.co.uk/how-to-take-prep/

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

An Overview of Gonorrhoea Symptoms

Gonorrhoea symptoms in Men & Women can include discharge, painful urination and itch. Some people who are infected may not display any signs or symptoms.

What is the Cause of Gonorrhea?

Gonorrhoea is one of the most common Sexually Transmitted Infection (STI) in women.  It can cause infections in the vagina, rectum, and throat.
Gonorrhoea is known to be easily transmittable via both penetrative and oral sex. It can infect the reproductive system and less commonly, the throat or eyes. A maternal to child transmission is also possible here.
Similar to Gonorrhoea, Chlamydia is a common sexually transmitted disease caused by bacteria called Chlamydia trachomatis. Gonorrhoea is caused by the bacterium Neisseria gonorrhoeae.

In women, gonorrhoea affects the cervix and its functions 90% of the time.

via GIPHY

What are the risk factors for contracting Gonorrhea?

  • Multiple sexual partners
  • New sexual partner
  • Unprotected sex
  • Men that have sex with Men (MSM)
  • A sexual partner who has an STI
  • Having concurrent STI

What are the Gonorrhoea Symptoms:

Gonorrhoea can be a silent infection in most of the population. Often time, women and men with Gonorrhea will not display any signs and symptoms.
Gonorrhoea Symptoms & Chlamydia Symptoms can be overlaping.

The Symptoms of gonorrhoea can differ between men and women.

via GIPHY

Gonorrhoea Symptoms in women:

Gonorrhoea Symptoms in Men

  • Penile discharge – colour may vary from white, yellow, green, or occasionally blood-tinged
  • Pain when passing urine
  • Pain in the testicles – rare

Read more about what are the other causes of penile infection & foreskin infection
Depending on the nature of the sexual activity and the severity of the infection, both men and women may experience pain, itchiness or discharge from the anus. They may also have pain, swelling, irritation, or discharge from the eye or both eyes (otherwise diagnosed as conjunctivitis).

How to Treat Gonorrhoea?

As with most bacterial infections, gonorrhoea is treated with antibiotics. The first choice is a wide spectrum antibiotic. It is, however, proving to be getting more resistant to antibiotics.
Gonorrhoea is also challenging to treat because most people who have this STI also have concurrent sexually transmitted illnesses like chlamydia.

via GIPHY
Also, like with any other sexually transmitted illness, treatment must be extended to all partners, and once treatment is completed, routine testing is highly recommended in view of relapse due to the increasing resistant nature of the gonorrhoea bacteria.
Abstinence is recommended during treatment.

What are the Complications of Gonorrhoea

Rarely, untreated gonorrhoea can spread throughout the body giving rise to skin pustules, infection of the joints (fingers, ankles, knees, and toes), brain or heart valves.

Complications of Gonorrhea in Men

More commonly, in men, infections of the epididymis, prostate and urethra are noted. Gonorrhoea can cause subfertility in some patients.

Complications of Gonorrhea in Women

In women, similar to other sexually transmitted diseases, untreated gonorrhoea may cause pelvic inflammatory disease (via an ascending infection involving the uterus, fallopian tubes, and ovaries) in up to 20% of patients. With inflammation, scarring and/or multiple infections, issues of subfertility and extra-uterine pregnancy will arise.
More annoyingly is the chronic, relapsing pelvic pain. This pain is characteristically stubborn and may require multiple analgesic medications in some women.
Read more about Herpes: Everything You Need to Know!

How is Gonorrhea Test Performed?

In most cases, usually for men, a urine sample will be required for the test. However, for female patients, ideally, the doctor will need to take a sample from the cervix ( neck of the womb).
For this, patients will lie down on the examination couch with knees bent and a small plastic instrument called a speculum will be used to open the vagina, then a soft brush will be used to collect a sample from the cervix. This procedure is very quick and painless, with only some minimal
discomfort.
Depending on sexual history, gonorrhoea swab may also be taken from the throat and rectum, in both men and women.

Any preparation needed before the test?

Vaginal douching and rectal douches, as well as creams, should be avoided 1 day before the test.
For the urine test, it is best to not urinate at least 2 hours before the sample is taken.

How long will the results take?

The test is usually performed together with chlamydia screening and results will be ready by the NEXT DAY. This allows treatment to be given as soon as possible when needed.
We can provide Rapid Chlamydia and Gonorrhea STD Testing. STD Test result will be available the following day.
If you are interested in getting a Rapid STD Testing or treatment for gonorrhoea, please visit our clinics and speak to our male and female doctors.
That’s All Folks!


Other Interesting Reads:

  1. An Overview of STD – From an STD Doctor
  2. What are the Signs & Symptoms of HIV and AIDS?
  3. STD Symptoms
  4. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  5. Weak Erection? Erectile Dysfunction? Improv Erection with Pills
  6. 11 Causes of Dyspareunia (Pain During Intercourse)
  7. What are the Causes of Genital Ulcers, Genital Warts and Genital Blisters
  8. What is HPV Vaccination (Gardasil 9)
  9. How to Get Rid of Genital Warts?
  10. 10 Causes of abnormal Vaginal Lumps and Bumps
  11. HPV Infection & HPV Vaccination for Men who have sex with Men
  12. STD Risk for Receptive Unprotected Anal Sex in Men
  13. 7 FAQs HIV Preexposure prophylaxis (HIV PrEP)
  14. What is the Treatment for Cold Sores? What causes Cold Sores?
  15. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  16. Syphilis Symptoms (Painless STD Sores & STD Rashes) 


Genital Warts: The Cauliflower-Like Lumps on the Genitals

Genital warts are white or flesh-coloured, smooth, small bumps that can appear anywhere in the general area of the genitals. They can also grow larger and appear as fleshy, cauliflower-like lumps on the genitals. Neither of which are more dangerous than the other, it is merely a characteristic and the stage that the illness was noticed.
Genital warts is an STD symptom caused by the Human Papilloma Virus (HPV).

HPV can cause multiple illnesses in the body as there are multiple strains of the virus attributing to different diseases in humans. Out of the hundreds of known strains of HPV, about 30 strains of the virus cause diseases of the genital area. These include warts, or in more sinister cases, cancer of the anus, cervix, vagina, and penis. Read: Causes of Vaginal Lumps & Bumps & Perianal Warts (Peri-Anal Warts)

Most of the other strains have no known effect on humans.


How do I get infected by the Human Papilloma Virus (HPV)?

Human Papilloma Virus (HPV) is a contagious disease that is transmitted through genital skin contact or through direct contact with genital fluids of a person already infected with HPV.
For transmissible illness such as these, using barrier methods of protection for sexual intercourse such as condoms should be emphasised. However, condoms are not very effective against transmitting HPV just because the HPV virus does not require penetrative sex to transmit the virus.

It can also be transmitted from a mother to an unborn child if the mother has an active HPV infection during the course of the pregnancy.


How do I know I am infected with HPV? How can it be detected?

A majority of people infected with HPV do not realise they even have the virus as it does not present with any symptoms.

Some people will notice bumps or warts around the genital area, otherwise known as genital warts. These usually occur one to three months after initial infection with HPV.


The most sinister manifestation of the HPV disease is cervical cancer affecting women in their 30s or 40s. The simplest way to detect cervical cancer is by identifying if an individual is an active risk of getting the disease and doing regular PAP smears. MOH guidelines are also apparent on the timing and interval for PAP smears for women in the reproductive age group. Sometimes a biopsy of unhealthy cervical looking tissue may be needed.

For men-who-have-sex-with-men (MSM), it is recommended that they do an anal PAP smear to investigate for HPV.

We also provide Rapid HPV Testing (next day result) in all our clinics in Singapore.


How can HPV & Genital Warts be treated?

In most cases, the HPV infection is self-limiting therefore no treatment is deemed necessary.

Unless an individual has issues with antibodies or a weak immune system in general, the body should be able to contain and eradicate the virus from the body in due time.
If an individual has an impaired immune system or a weak immune response, a lingering infection or a co-infection with another sexually transmitted illness can occur.

In cases of genital warts, the treatment options are largely dependent on the severity of the infection. The most common treatment options include creams and paint-on ointments. These induce a state of cell death so warts around the genital will eventually wither and fall off the skin.

Some patients may be offered cryotherapy where the wart is frozen then removed. The wart is frozen prior to that so that there will be no transmission of the wart after.
Apart from the above surgical options for wart removal also exist. This is where a surgeon uses electrocautery or a scalpel and surgically excise warts. See: Genital Warts Removal

Unfortunately, the majority of genital warts or other warts can recur very frequently and is rather common to have warts recur post removal. Sometimes, repeated treatments are required for complete remission, but patients should be aware of the recurrence rates in such an infection.


HPV and Cervical cancer

Some HPV viruses are known as high-risk viruses. This is particularly true in virus strains 16 and 18. This is because it induces changes in the cells in the cervix of a woman and causes cervical if not detected early.

It is in this light that it is recommended that all sexually active women are advised to go for regular PAP smear tests, screen for HPV infections and visit your doctor for HPV vaccination in Singapore.


HPV and PAP Smear

Pap smear is a relatively painless test that can be quickly done. It involves inserting a speculum into the vagina of the patient to allow for inspection then a tool is inserted to obtain scraping. The patient should go back to resume activities of daily living with no hindrance once after the procedure completed by our female doctor.
These scrapings and obtained cells are then examined under a microscope to look for abnormal cells.

We also provide Rapid HPV Testing & Pap Smear in all our clinics in Singapore.

https://www.youtube.com/watch?v=UTm6ShKZjO4

HPV and HPV Vaccination

Human Papilloma Virus (HPV) is a group of virus that can cause:

  • Vaginal Cancers
  • Vulvar Cancers
  • Anal Cancers
  • Penile Cancers
  • Oropharyngeal Cancers (cancers of the throat and tongue)
  • Genital warts or Papillomas

HPV vaccination is used to protect against HPV-related diseases and cancers.
To complete the HPV vaccination, 3 doses of injections will be given. The recommended HPV vaccine schedules are:
First dose: During your doctor visit.
Second dose: 1 – 2 months after the first dose
Third dose: 4-5 months after the second dose


Get More protection with New 9-valent HPV vaccine (Gardasil 9)

There are over a hundred strains of HPV and they are each given a designated number e.g. HPV 6 or HPV 16 or HPV52.
HPV strains that cause warts will NOT cause cancers and HPV strains that cause Cancer will NOT cause warts.

Compared to the older Gardasil, the new GARDASIL 9 offers a wider range of protection against HPV strains.
Both Gardasil and Gardasil 9 give you protection against the cancer-causing HPV 16 and 18 and the wart-causing HPV 6 and 11.
Gardasil 9 protects additional 5 other high-risk types: 31, 33, 45, 52 and 58.
Together these types cause about 90% of cervical cancers.

Another HPV vaccine Cervarix, on the other hand, protects only against the commonest cancer-causing HPV 16 and 18. There is no wart protection with Cervarix.
If you are interested in getting the HPV testing & PAP smear, genital warts treatment or HPV vaccine, please visit our STD clinics and speak to our male and female doctors.
If you or your partner are experiencing any possible signs or symptoms of infection, or have had any potential risk exposures, please see our STD doctors today.
Take Care. Be Safe!



Other Interesting Reads:

  1. An Overview of STD – From an STD Doctor
  2. Anal Pap Smear for Anal Cancer Screening
  3. HIV Rash: What You Need To Know
  4. Genital Blister, Genital Ulcers & Genital Warts – What You Need to Know
  5. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  6. 11 Causes of Dyspareunia (Pain During Intercourse)
  7. 10 Common HIV related to Opportunistic Infections
  8. What is HPV Vaccination (Gardasil 9)
  9. 10 Causes of abnormal Vaginal Lumps and Bumps
  10. An Overview of Gonorrhoea
  11. What is the Treatment for Cold Sores? What causes Cold Sores?
  12. Herpes: Everything You Need to Know!
  13. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  14. Syphilis Symptoms (Painless STD Sores & STD Rashes)