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Itchy Testicles – Is it a sign of STDs?

It is common to experience a need to itch every now and then, but if you feel the need to scratch all the time it’s probably time to seek some help. Inadvertently, there would be a concern of any possible sexually transmitted diseases (STD), but not all itches are sexually transmitted. – STD Screening in Singapore

Listed below are some of the more common causes of itchy testicles.


  1. Chafing

Chafing is an irritation of the skin caused by repetitive friction. This is typically caused by inappropriately sized clothing and is commonly experienced by guys doing biking or running. It can happen anywhere on the skin but vulnerable areas are the groin, thighs, underarms and even the nipples. Chafing is easy to prevent though, by wearing the right clothes and using some form of barrier cream/ointment like vaseline to protect vulnerable areas.

  1. Jock Itch

Jock Itch, also known as tinea cruris, this is a fairly common condition seen in gentlemen who exercise a lot or are involved in jobs involving heavy physical activity. This creates a warm, moist environment on the scrotum that is ideal for fungal growth. Common symptoms are an itchy and red rash on the scrotum that can be scaly in nature. Treatment is through the use of oral or topical antifungal medications. Jock Itch can be prevented by regular change of clothing after heavy exertion as well as use of antiperspirants.

  1. Contact Dermatitis

Contact dermatitis is a type of eczema triggered by contact with a particular substance. The skin can become red and cracked with blistering and sometimes can resemble jock itch. Common causes of contact dermatitis are new soaps and detergents, so if the new soap/detergent is causing itchy testicles, it might be a good idea to swab back.

  1. Lichen Simplex Chronicus

This is what happens when you leave an itch too long without seeing a doctor. After prolonged itchy, rubbing and scratching of the skin, the scrotum can become lichenified. Like lichen on the trees, the skin can become thick and scaly with accentuated skin fold lines. This is an extremely pruritic chronic itch, and the treatment is usually the use of a strong steroid cream to thin out the lichenified skin. 

  1. Psoriasis

Psoriasis is an unpleasant skin condition presenting as reddish rashes with silvery scaling over the whole body. It commonly involves the scrotum and it can be itchy as well. There are also other dermatological conditions which may look similar to psoriasis and can involve the scrotum as well. This is why it is important to see a doctor if there is an odd looking rash over the scrotum that does not go away on its own. 

  1. Pubic Lice

Also known as crabs, Pthirus pubis is a very small insect that parasites humans. Pubic Lice are commonly found attached to the hair in the pubic region but can also be found in other coarse hair elsewhere on the body, for example eyebrows or armpits. Other than the adult insects, eggs known as “nits” can also be found attached to the hair. Pubic lice is normally spread through sexual contact. It is however very easily treatable by over the counter anti-louse preparations. 

  1. Scabies

Sarcoptes scabiei are tiny eight legged mites that live within the human skin. Allergic reaction to the mites, eggs and faeces can lead to an intense itching that is worse at night. Symptoms are a pimple like rash over the scrotum that can be very itchy out of proportion to the rash. Scabies is spread through skin to skin contact and hence can be sexually transmitted. It’s treated with an anti-mite topical preparation known as permethrin. 


The astute reader might realise that not a lot of STDs are found on the above list. The truth is that the majority of STDs do not lead to testicular itching but rather other symptoms like ulcers or discharge. If itchy testicles are still a problem, it is still better to seek a doctor for a medical consultation.

Ureaplasma Symptoms

Signs & Symptoms of Ureaplasma

Ureaplasma are a group of tiny bacteria that can commonly be found in the urinary and genital tracts of men and women. The most clinically relevant type of Ureaplasma species is Ureaplasma Urealyticum, which can cause urethritis (inflammation of the urethra) in men, and bacterial vaginosis in women.

These infections may have few or no symptoms at all for many people, and may only get picked up on routine STD screening or when an individual presents with symptoms from another infection such as Chlamydia or Gonorrhea. For those who develop symptoms directly from a Ureaplasma infection, common presentations would be with pain or burning on passing urine, penile discharge or vaginal discharge, or pelvic/genital discomfort. As their name suggests, these bacteria also hydrolyse urea to produce ammonia, which can result in a strong or unpleasant odour as well.

How is Ureaplasma transmitted?

Ureaplasma is predominantly transmitted through sexual contact (vaginal, anal, and oral sex). However, it is not typically classified as an STD due to its relatively low degree of pathogenicity (ability to cause disease). Although many infections may be asymptomatic or have very mild symptoms, there are still risks for complications including pelvic inflammatory disease and epididymo-orchitis. Studies have also found associations with complications in pregnancy such as preterm labour, as well as infertility in both men and women. As Ureaplasma infection can cause inflammation of the mucous membrane, it can also increase the risk of transmission of other STDs and is commonly found to cause co-infections. 

Testing for Ureaplasma can be done with urine samples or swab tests, and would generally be detected through special cultures or through PCR testing. It would not be detected through a normal bacterial culture for non-STD infections. Treatment of Ureaplasma would generally be a course of oral antibiotics and of course, partner testing and treatment would be recommended as well. STD Testing in Singapore


Next read: 10 things you didn’t know about this STD: Mycoplasma Genitalium

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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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