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ZIKA IS AN STD!! – Battling the STD Stigma

The Zika virus gained notoriety in Brazil when it was blamed for causing a spate of birth defects known as microcephaly. Babies born with microcephaly had abnormally small heads and often also suffered concurrent problems with brain development. Some children born to Zika infected mothers had normal sized heads but their heads would fail to develop normally. These are obviously horrible consequences for both the mother and child. 


Zika is a virus that is spread by mosquitoes very much like Dengue. However, it was soon discovered that Zika was also sexually transmitted. And that consistent and correct use of condoms protected pregnant women from the Zika virus and consequently their unborn children to the devastating effects of Congenital Zika Syndrome.  

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But wait a minute? Does that mean Zika is an STD? Technically it seems to fit. STD is an acronym for Sexually Transmitted Disease. Zika is a disease that is sexually transmitted. But it is predominantly transmitted via the bite from an infected mosquito. So is it an STD? If Zika is an STD then is raises other uncomfortable questions like: if a person catches chickenpox from his/her partner because they had sex, is chickenpox then an STD too? Or even the common Flu, which is spread as an airborne virus, can also easily be caught via sexual intercourse. So the common Flu is an STD!


I’ve had this discussion many times with my patients when they have been diagnosed with an infection and they ask me “is it an STD?” Sometimes, this is rather easy to answer. If they have, for example, an infection of Gonorrhoea of the penis, one can be confident to say that they caught it from a sexual contact. But at times, things get murky. A good example is an infection with Ureaplasma Urealyticum. We know this tiny bacteria can be sexually transmitted. We also know that it can seem to appear out of nowhere in mutually monogamous couples. We also know that it can be just a commensal and not a disease causing pathogen. So when a patient with an infection of his urinary tract caused by Ureaplasma asks me “is this an STD?” I am unable to give a direct black and white answer. 


The same goes for what I would describe as the most feared STD by many, and that is HIV. For a fact, the commonest way that HIV is transmitted is via sexual contact. However, we also know for a fact that HIV can be transmitted by sharing needles, contaminated surgical instruments, transfusion of contaminated blood and transplant of contaminated organs. Albeit the last 2 hardly happens anymore due to increased awareness, better infection screening protocols and technology advancement. But let’s be honest, if and when we find out someone is infected with HIV, getting injured by surgical instruments is not likely the first reason to pop into our heads.


And therein lies the issue. Answering the question “is this an STD?” does not in any way contribute to the clinical management of the disease except perhaps for contact tracing. For partner protection, the same advice will be given if the disease can be transmitted sexually regardless of whether or not it is called an “STD”. The issue, I believe, is stigma. To be labelled as having an “STD” is to be labelled as a moral or sexual deviant. But should this really be the case? Infections are caused by microorganisms invading our bodies and using our resources to make more of themselves. Drawing on resources around them to reproduce is hardcoded into the genetic material of all living things, humans being the best and worst examples. Microorganisms do not care how they are transmitted or where they infect as long as the environment they are in supports their reproduction. Microorganisms do not care about our textbooks and whether or not we call them STDs.


Consequently, some infections although predominantly transmitted by sex, can also be transmitted by other means. And some that can easily be caught via sex, are for some reason not given the label “STD”. I do hope we can eventually drop this label and treat infections for what they are – infections. Treat the patient, prevent reinfection, protect partners. Labels are useless. 

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


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Rectal Douching and Associated Infection Risks

Similar to vaginal douching, rectal douching or anal douching is not something that many people talk about it polite circles. It is commonly practiced by Men-Who-Have-Sex-With-Men (MSM) who receive anal sex. Let’s face it, generally we don’t want our loved ones to have to deal with our faeces while having anal sex. However there is a growing concern about the practice of performing anal douching and its associated risk of STI including HIV infection.
Other Read: Anal Pap Smear for Anal Cancer.
 

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A recently published systematic review (essentially this means that the study involves gathering all published studies on a subject and compiling the findings together) in the journal Sexually Transmitted Infections (May 2019), there is evidence to suggest that anal douching can potentially increase the risk of STI and HIV infection among MSM. In the systematic review, it included a total of 28 studies looking at anal douching and the risk of STI/ HIV in MSM population around the world (46% from US, 35% from Europe and the rest from South America, Asia and Africa). 
Also Read: STD Risk From Receptive Unprotected Anal Sex In Men
 


The findings show that men who perform anal douching compared to those who don’t have a 2.8 times higher risk of HIV and close to 2.5 times higher risk of any other types of STIs (Hepatitis B, Hepatitis C, chlamydia, gonorrhoea, syphilis and HPV). With respect to specific STIs, the study found that anal douching increases the risk of chlamydia and gonorrhoea by up to 3.25 times and 3.29 times for Hepatitis B Virus and Hepatitis C Virus.
It is theorised that possible reasons for the association of anal douching with increased risk of STIs and HIV may be due to:

  1. Water and/ or soap causes the delicate lining of the rectum and intestines to become damaged.
  2. Removal of normal flora (bacteria that normally is found in the rectum) due to the action of flushing
  3. Risk of transmission of STIs and HIV through the sharing of douching devices much sharing of needles for IVDU. 

 


The authors also noted that further studies will be needed to further elucidate this association between anal douching and STIs and HIV infection.
Speak to your doctor if you have any questions regarding the associated infection risks from rectal douching or anal douching.
 


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Chancroid Symptoms & Treatment

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


Trichomoniasis in Men and Women – Sexually Transmitted Infection

What is Trichomoniasis?

Trichomoniasis (also known as “trich”)  is a very common sexually transmitted infection caused by a parasite (a single-celled protozoan organism) called Trichomonas vaginalis. The US Centers for Diseases Control (CDC) estimates that about 3.7million people in the US have this infection.
Both men and women can be infected with trichomoniasis, although it is more common amongst women.

Only 1/3 of infected individuals actually develop symptoms and asymptomatic individuals can still transmit the infection to their sexual partners.

How is Trichomoniasis Transmitted?

Trichomoniasis is transmitted through sexual intercourse. The parasite commonly resides in the urethra in men (the urine tract), and the lower genital tract (including the urethra, vaginal canal and cervix) in women. Transmission occurs with genital to genital sexual contact. Sex toys may potentially be a mode of transmission if shared. The transmission does not occur through oral intercourse.
DidYouKnow:
Chlamydia, Gonorrhea, and Trichomoniasis are all common sexually transmitted diseases (STDs) that can cause infections in the genitals, rectum and throat. These diseases are easily spread by having vaginal, anal, or oral sex with someone who is infected with the disease. See: Gonorrhea Symptoms 

What are the Symptoms of Trichomoniasis?

In men, the symptoms of trichomoniasis may include:

  • Discomfort, itching or an irritation along the urine tract
  • Dysuria (pain) or discomfort when passing urine
  • Penile discharge
  • Discomfort or pain during or after ejaculation

In women, the symptoms of trichomoniasis may include:

Again, it is crucial to remember that less than half of infected individuals develop symptoms. As with many other STDs, feeling well does not rule out the possibility of trichomoniasis.


Learn More about Other STDs & Other STD Symptoms


What are the Possible Complications of Trichomoniasis?

Trichomoniasis infection in women has been shown to increase the risk of acquiring as well as transmitting HIV to partners.
In pregnancy, trichomoniasis increases the risk of preterm labour in pregnancy (going into early labour before the baby is due) and of the infant being of low birth weight.

Sexually Transmitted Infections – Video

How is Trichomoniasis Diagnosed?

In women, trichomoniasis can be diagnosed with a vaginal swab test or a urine test. In men, testing can be done with a urine sample, semen sample or urethral swab. Trichomoniasis is more easily diagnosed in women than in men. See: STD Screening
Test methods that involve nucleic acid amplification testing (NAAT) are highly accurate, while other methods like a culture (waiting for the parasite to grow on a culture medium) may potentially yield false negatives.

How is Trichomoniasis Treated?

Trichomoniasis is treated with oral antibiotics – either metronidazole or tinidazole. Both sexual partners should be treated so as to minimise the risk of the infection recurring.

How Can I Reduce My Risk of Getting Trichomoniasis?

Observing safe sexual practices can help reduce your risk of trichomoniasis – this includes the proper and regular use of condoms, reducing your number of sexual partners as well as ensuring both you and your partner get tested regularly for STDs, regardless of whether you have symptoms or not.
If you would like to find out more about Trichomoniasis Testing and Treatment, come down to any of our clinics for a consultation.
Also see: std test singapore

Mycoplasma Genitalium (MG) – STD Screening, Testing & Treatment

Mycoplasma Genitalium (MG) is a type of bacteria that can be sexually transmitted: what it is and why you should be concerned.

  • Women tend to experience vaginal itching, burning on urinationpain during intercourse & etc.
  • Men, on the other hand, may experience urethral discharge, burning on urination, pain or swelling of the testicles & etc.

 

Mycoplasma Genitalium (MG): What It Is & Why You Should Be Concerned.

What is Mycoplasma Genitalium (MG)?

You may have heard of sexually transmitted infections (STIs) like Chlamydia or Syphilis or the feared HIV. But Mycoplasma genitalium (M.gen) may be unfamiliar to most of you, even if you are fairly conscientious in looking after your own sexual health. This is partly because of difficulty in testing for the infection. Up until recently; testing for M.gen was not available in Singapore.
Furthermore, a good proportion of people infected with M.gen may feel completely fine but are still able to spread the infection. So if you’ve done a full STI screen and think you are completely safe because it came back clear, think again- there might just be something else you need to be concerned about.
Mycoplasma genitalium is a tiny, slow-growing bacterium which was first identified in the 1980s. Testing for M.gen has traditionally been very difficult because of the nature of the bacteria. The M.gen bacterium also does not have a cell wall, which means certain classes of antibiotics which are commonly used are unfortunately ineffective against the bacteria. This, coupled with recent increasing antibiotic resistance, makes treatment of M.gen potentially challenging as well.
It is only in more recent years that it is now being recognised as a significant and increasingly more common STI which can cause symptoms in both males and females with potentially more serious consequences.
To put things in perspective as to exactly how prevalent M.gen is, the Centers for Diseases Control (CDC) data indicates that it is more common than Gonorrhea, coming in a close second to Chlamydia.

How is Mycoplasma Genitalium Transmitted?

Mycoplasma genitalium infects the cells in the genital and urinary tracts and can be transmitted through sexual contact including vaginal intercourse, anal intercourse and oral intercourse.

What are the symptoms of Mycoplasma Genitalium?

M.gen can affect both males and females. Both males and females may often be asymptomatic/feel completely well, but can continue to spread the infection to their sexual partners. M.gen is thus a silent but dangerous STI.
In males who do develop symptoms, it can cause urethritis, which manifests dysuria (painful or uncomfortable urination), which may be associated with penile discharge. These symptoms are non-specific and similar to urethritis caused by other STDs like Chlamydia. As of now, M.gen is not yet well linked to more serious symptoms like pain or swelling of the testicles or epididymis (a gland near the testicles), but it is important to remember that data on M.gen is still lacking right now. Learn more about STD Risk From Receptive Anal Sex in Men

10 Causes Of Penile Pain – Ouch! Pain In The Penis

In females, it can cause cervicitis, inflammation of the cervix, resulting in abnormal vaginal discharge, painful intercourse, or bleeding after intercourse (post-coital bleeding) or spotting when one is not having one’s menses (intermenstrual bleeding). If the infection spreads to deeper organs like the uterus and fallopian tubes or ovaries, a condition known as pelvic inflammatory disease (PID) with potentially devastating long-term complications like infertility, one may also experience pelvic pain.

Common STD Symtopms in Women

Anal intercourse can result in M.gen in the rectum and anal canal, but this is generally asymptomatic in another word, does not display symptoms.

Can Mycoplasma Genitalium cause serious infections?

M.gen may very well be one of the next major STIs that the world needs to worry about. While there is a paucity of existing data, emerging research links M.gen to more serious infections with long term health consequences.
There is data to suggest that M.gen can cause Pelvic Inflammatory Disease (PID) in females- the bacterium was detected in women suffering from PID more frequently. Women with tubal factor infertility (infertility due to scarring of the fallopian tubes) were also found to have antibodies to M.gen, suggesting the bacterium could again be responsible or linked to increased risk of infertility. Learn more about Women’s Fertility Screening 
Some studies have also shown that in pregnant women, M.gen is associated with increased risk of pre-term delivery.
It is still uncertain as to whether M.gen can cause infertility in males, but it is important to note that there have been cases where M.gen was detected in men with epididymitis (inflammation of the epididymis).
All in all, we currently still lack robust data about M.gen and the consequences of infection, but overall data does suggest that there may be more to worry about than previously thought.

How is Mycoplasma Genitalium diagnosed?

M.gen was classically known to be notoriously difficult to diagnose because of difficulty in getting the bacterium to grow in laboratory conditions. Testing is done by nucleic acid amplification testing (NAAT) and is not as widely available as testing for other more well-known STIs is.
Until recently, testing for M.gen was not available in Singapore. But you will be glad to know that at DTAP clinic, we now offer testing for M.genitalium.
For males, testing is done using a urine sample. A high vaginal or endocervical swab is performed in females.
If you are a male who is troubled by persistent or recurrent symptoms of urethritis despite antibiotic treatment, and your urine STI screen is persistently “clear” of infection, this is a diagnostic test you should consider.
M.gen is an established cause of urethritis in males. If you may have potentially been exposed to M.gen from a sexual partner, you may also wish to consider getting tested, particularly in light of the above potential complications.
Diagnosis of M.gen is particularly important because of potential antibiotic resistance amongst various M.gen strains. This means that treatment of M.gen may not be so straightforward.

We provide Comprehensive STD screening for Men & Women in all our clinics.

 

Can Mycoplasma genitalium infection be treated?

M.gen is inherently resistant to some classes of antibiotics and there are concerns about increasing antibiotic resistance. It is therefore important that you are treated properly with the correct antibiotic and for an appropriate duration – this makes testing and treatment more crucial than ever.
As always, safe sexual practices including using barrier protection, reducing your number of sexual partners and knowing your partners’ infection status remains crucial in keeping yourself safe and healthy.
If you would like to find out more about Mycoplasma Genitalium testing and treatment, come down to any of our clinics for a consultation.


Other Reads:

  1. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  2. Is HPV Vaccine Necessary for Males?
  3. Weak Erection? Erectile Dysfunction? How to Improve Erection with Pills
  4. 11 Causes of Penile Itching & Pubic Itch
  5. HPV Infection & HPV Vaccination for Men who have sex with Men
  6. STD Risk for Receptive Unprotected Anal Sex in Men
  7. Is HPV Vaccine Necessary for Males?
  8. Low HIV Risk Doesn’t Mean No HIV Risk
  9. HIV PrEP for Travel – How You Need to Know
  10. An Overview on STD from an STD Doctor
  11. Everything You Need to Know about Herpes Simplex Virus
  12. How Do I Treat Oral Herpes (Cold Sores)
  13. Syphilis Symptoms – Painless Sore & Ulcers
  14. HIV Symptoms – What You Need to Know
  15. Sex During Period (Sex & Menstruation) What To Know
  16. 10 Common HIV Related to Opportunistic Infections

Perianal Warts (Peri-Anal Warts) & Anal Warts Removal

Perianal Warts (aka Peri-Anal Warts, Condyloma Acuminata) are flesh coloured, cauliflower-like growths in and around the anus that is caused by HPV (Human Papilloma Virus).

How Do I Know I Have Perianal Warts?

One of the first occurrences where people note this is new bleeding from the rectum, especially after wiping with toilet paper. Of course, there are many other causes of rectal bleeding, the most common being piles and the most deadly being some form of rectal cancer.
The other way people notice this is when their partner sees it and tells them about it. One would be able to feel the growth with your fingers and also see them with a mirror.

These perianal warts are painless and itchless.

How Can I Catch Perianal Warts?

These cauliflower-like perianal warts are caused by the virus HPV. This is spread through unprotected anal intercourse with a partner who has HPV.
Most often, HPV is symptomless and you can catch HPV from your partner even if he seems completely well.

If I Have Perianal Warts Can I Pass It To My Partner?

Yes the virus which causes perianal warts – HPV, can be passed on to your partner during unprotected anal intercourse.
In the situation, you do not have noticeable perianal warts but your partner develops penile warts after anal intercourse with you, you should also have yourself check for perianal warts and HPV.
Also, you can learn more about symptoms of other STD one can contract from Anal sex

How Do I Check For Perianal Warts?

During a physical examination, what you will tend to notice is “cauliflower-like” growths around the anus. These are usually flesh coloured or a slightly lighter or darker shade.
Other growths that may appear around the anus would be skin tags which can mimic perianal warts to the untrained eye, or even on rare occasions, ulcers which may be red flags of non-benign growths.
The best advice we can offer is to see our doctors to determine whether you truly have Perianal Warts or another condition. We may then take a sample of the growth and send it to the laboratory for confirmation.
All our clinics in Singapore provide Rapid HPV Testing (Next Day Results)
You can learn more about

How is Perianal Warts Treated?

We have covered in this article “How to Get Rid of Genital Warts” some of the commonly used treatments for Perianal warts. We will summarize them here again for your perusal.
The 3 main modalities we use are Creams and lotions, Freezing the wart or “Laser” electrocautery of the wart.

1. Creams and Lotions

Aldara Cream (Imiquimod) is effective for Perianal Warts. The cream is applied 3-4x a week nightly and left for 8 hours overnight. This warts treatment process is repeated for about 6 weeks to get full eradication of the wart. If too much of the cream is applied, some may experience redness and burning of the area as well.
Of course, there is also a small percentage who do not see full resolution and may need other treatments. If too much cream is applied it can cause redness and even blistering of the surrounding skin.

2. Freezing

With a special device that controls the release of liquid nitrogen, we can also freeze the wart. Most people see a resolution after 2-3 freezing treatments over a month. This process is usually painless and no anaesthesia is needed prior.

3. “Laser” Electrocautery

This is usually done in 1 sitting and is enough to eradicate the wart. However, this process often stings and would require some form of anaesthetic to numb the pain prior.

How Can I Protect Myself From Perianal Warts?

One of the best ways to protect yourself is to use a condom if you are intending to have anal sex. This however only confers a rough 30% protection against HPV infection.
There are more than 100 strains of HPV viruses out there, 4 of them are the main high-risk ones causing cervical cancer, anal cancer, throat cancer and penile cancer.
There are new vaccinations available which protect you against these 4 high-risk strains and 5 other low-risk strains which are wart causing. You can read more about Gardasil 9 (HPV vaccination).
Recently the FDA (food drug administration of the USA) announced that Gardasil 9 should be expanded to include Men and Women from 27-45 years of age, thereby providing greater protection against HPV and the risks of those above-mentioned cancers or warts.
You can speak to our doctors to find out more about this HPV vaccination.

Are There Any Other Diseases Associated with Perianal Warts?

Yes as described above there are risks of getting anal cancer, throat cancer, cervical cancer (women) and penile cancer from HPV.

Are There Other STDs Associated with Perianal Warts?

Perianal warts are known to be associated with Rectal Gonorrhoea, HIV, Syphilis and Hepatitis B
If you are interested in HPV Treatment or Anal Warts Removal and Rapid STD Screening for other HPV Strain & other STDs, you can visit any of our clinics.
You can call us or email us for an appointment at hello@dtapclinic.com.
Take Care!


For more information on other STDS.

  1. An Overview of STD by an STD Doctor
  2. Is HPV Vaccine Necessary for Males?
  3. Mycoplasma Genitalium Testing & Treatment
  4. 11 Causes of Penile Itching & Pubic Itch
  5. Sexual Health Advice for Travellers 
  6. HIV & STD in the Singapore Commercial Sex Scene 
  7. What is HIV / AIDS Signs and Symptoms
  8. Ouch! 10 Causes of Penile Pain (Pain in the Penis)
  9. 7 FAQs on HIV PrEP (Pre Exposure Prophylaxis)
  10. HPV Infection & HPV Vaccination For Men Who Have Sex With Men
  11. A Guide to HIV Prevention Pills – (HIV PEP & HIV PrEP)
  12. Do I Have HIV Rash? Or Are They From Other STD-Related Rashes
  13. What Are The Causes of Abnormal Penile Discharge
  14. HIV Window Period – Timelines For Accurate HIV Testing
  15. Herpes Simplex Virus – Everything You Need to Know
  16. The Causes of Genital Blister, Genital Ulcer & Genital Sore

Genital Blisters, Genital Warts and Genital Ulcers – Causes & Treatments

Genital blisters, genital warts, genital ulcers – more common than you think but invariably exceedingly distressing for the person suffering from them. Today we talk a little about the various causes for the above genital skin conditions.
Genital lumps, bumps and sores can be an alarming phenomenon for anyone. One day you notice a tiny little bump, or perhaps several bumps.
Now you’re not sure when they appeared – was your skin normal last week, or did you just never notice the bumps for a good duration? Or perhaps you notice what you thought was a little pimple or an ingrown hair follicle which happens from time to time because you shave. But now it’s burst, leaving a painful raw ulcer.

What are the Causes of Genital Blisters, Genital Warts and Genital Ulcers?

1) What are the Causes of Genital Blisters?

Genital blisters are small, fluid-filled bumps and can occur anywhere over the genital region.

a) Genital Herpes

One of the classic causes of genital blisters is genital Herpes, caused by the Herpes Simplex Virus.
Here’s a video about Herpes

Genital herpes has Several Stages:
Stage 1: Prodrome – the skin appears normal but you may feel an unusual sensation like a tingling or itching. This indicates that the virus is active and heralds an impending outbreak
Stage 2: Redness – you may notice some nonspecific red spots which may be uncomfortable or slightly painful.
Stage 3: Blisters – this is usually when people realise something is not right, Initially, these may resemble tiny pimples. They then grow in size and become fluid-filled and painful.
Stage 4: Ulcers – the blisters burst, leaving shallow, painful ulcers
Stage 5: Scabbing or crusting – a scab or crust forms over the ulcer, which eventually heals
Also, check out What is Oral Herpes & Cold Sore

b) Balanitis

In males, balanitis may sometimes present with tiny blisters. The term “balanitis” is a descriptive term which means inflammation of the head of the penis and foreskin. This usually manifests as skin redness, with some tiny blisters or whitish bumps, as well as possible itching/pain or discomfort.
There can be multiple causes of balanitis. The skin on the penis is no different from skin elsewhere on your body and redness, discomfort and irritation can be caused by many factors:

  • Infections such as fungal skin infections
  • Skin irritation caused by external factors like soaps (irritant or contact dermatitis)
  • Mechanical trauma in the form of excessive friction e.g. masturbation or sexual intercourse with insufficient lubrication
  • Poor hygiene
  • Sensitive skin e.g. in people prone to eczema or dry skin

Depending on the possible underlying trigger or cause, various topical creams may be useful. In some cases, skin swab tests or urine tests may be useful in checking for underlying infections.
Read more about What is a Penile Infection?

2) What are the Causes of Genital Warts?

a) Human Papilloma Virus

This is THE cause of genital warts. Genital warts are skin coloured, fleshy bumps which may occur singly or in clusters around the genital and anal region. They can range from tiny firm bumps to larger, irregular shaped bumps which are classically described as “cauliflower-like” in appearance.
The Human Papilloma Virus (HPV) is a sexually transmitted viral infection. There are many strains of HPV and they are transmitted through sexual contact. Some strains are responsible for genital warts, while other “high risk” strains can lead to an increased risk of cancers such as cervical, oral and anal cancers.
If you have warts, it effectively means you have been infected by at least one strain of HPV. If you are female and you are not already doing your regular PAP smear for cervical cancer, you should do a PAP smear with high risk HPV testing because an individual may have not just one but several strains of HPV. You can read more about PAP smears and cervical cancer screening.
There are various methods available for the treatment of genital warts, ranging from topical medications to freezing or cryosurgery electrosurgery. But one must be prepared that warts can unfortunately recur as the treatment for warts addresses the effects of a HPV infection but does not clear the virus from your body.
The best defence we have against genital warts is the HPV vaccine – Gardasil 9, which provides immunity against certain wart causing strains of HPV.

3) What are the Causes of Genital Ulcers?

When people think of genital ulcers, often the first few causes that spring to mind may be herpes or syphilis. However, genital ulcers can be due to other infections as well as rarer, non-infective causes such as autoimmune diseases.
This is why various tests are useful in differentiating the causes of genital ulcers. The treatment of choice varies drastically depending on what the underlying cause is.
Caused by Sexually transmitted infections (STIs)

  • Herpes Simplex Virus (Common)
  • Syphilis (Common)
  • Chancroid (Rare)
  • LGV (Rare)
  • Donovanosis (Rare)

Non-infective causes

  • Behcet’s (Autoimmune)
  • Crohn’s disease (Autoimmune)
  • Fixed drug eruption (rare causes)
  • Skin Cancer (rare causes)

a) Herpes Simplex Virus

(Painful shallow ulcers and blisters)

As mentioned earlier, both genital blisters and ulcers are different stages of a herpetic flare. A genital skin swab test for the presence of HSV DNA is helpful in confirming HSV as the cause of genital ulcers.

b) Syphilis

(Painless ulcers)

Syphilis can cause ulcers both during its primary and secondary stages.  A chancre, a painless round ulcer, occurs in primary syphilis, while in secondary syphilis, multiple painless ulcers may occur as well. One of the defining traits of a syphilitic ulcer is its painlessness.
These ulcers may be accompanied by other symptoms such as a rash elsewhere on the body.

C) Chancroid

(Multiple painful deep ulcers and swollen groin lymph nodes)

Chancroid is a painful ulcer which is frequently associated with enlarged and painful inguinal (groin) lymph nodes. These are located along your underwear line and may be felt as tender swollen lumps. There are usually several or multiple deep and painful ulcers.
This is caused by a bacterium called Hemophilus ducreyi, which is transmitted through sexual contact. Painful lymph nodes and negative test results for both Herpes and syphilis support this diagnosis. The good news is that antibiotic treatment can clear this up.

Lymphogranuloma venereum (LGV)

Small ulcer, swollen groin lymph nodes, possible rectal pain

Lymphogranuloma venereum (LGV) is an uncommon cause of genital ulcers. It is caused by the bacterium called Chlamydia trachomatis (serovars L1-3). This Chlamydia is different from the “subtype” of Chlamydia trachomat is that causes the common STD you are thinking about. A Rapid Chlamydia & Gonorrhoea PCR test will be about to detect the infection.
The ulcer it causes tends to be small and often goes unnoticed. The lymph node swelling is dramatic and painful and may even discharge pus.
If this was acquired through anal intercourse, inflammation of the anal and rectal canal (known as “proctitis”) can occur, causing rectal pain, bleeding and discharge and diarrhoea.

Donovanosis

Shallow beefy looking ulcers

This is again a rare cause of genital ulcers in the developed world. It is caused by a bacterium called Klebsiella granulomatis and causes shallow ulcers which may bleed easily. This is usually diagnosed with a punch biopsy, which is when a sample of skin tissue is removed for evaluation in the lab.

Other rare causes:

Autoimmune or inflammatory causes, skin cancers, drug reactions

“Autoimmune” diseases occur when your body’s immune system has a tendency to attack itself and one of the many manifestations can be genital ulcers. These are rare and treatment is by a specialist doctor. These ulcers will go away only with good control of the underlying disease.
Sometimes, a bad reaction to a certain medication may cause a persistent, painful ulcer.
Very rarely, genital ulcers may be due to cancer.

All in All

The good news is that most of the above mentioned causes for genital blisters, warts and ulcers can be treated. But an even better step would be to protect yourself from even developing these – safe sexual practices (using barrier protection, doing your regular sexual health screening, and getting the HPV vaccine) are your best bet against these.
Take Care!


  1. HPV Infection & HPV Vaccination for Men who have sex with Men
  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. How Late Can a Period Be (Delayed Menstrual Cycle)
  4. What are the Causes of Abnormal Penile Discharge?
  5. STD Risk for Receptive Unprotected Anal Sex in Men
  6. Low HIV Risk Doesn’t Mean No HIV Risk
  7. HIV PrEP for Travel – How You Need to Know
  8. An Overview on STD from an STD Doctor
  9. Everything You Need to Know About Herpes Simplex Virus
  10. How Do I Treat Oral Herpes (Cold Sores)
  11. Syphilis Symptoms – Painless Sore & Ulcers
  12. HIV Symptoms – What You Need to Know
  13. 10 Common HIV related to Opportunistic Infections

Syphilis Symptoms & Treatment (Painless STD Sores and Rashes)

What is syphilis?

Syphilis is a sexually transmitted infection (STD) with many different manifestations and potentially serious complications. It is caused by a bacteria called “Treponema pallidum”.
In the past, before the advent of antibiotics, syphilis was considered a dangerous illness with long-term, devastating consequences which could even affect the brain and nerves.
Thankfully, with the development of penicillin antibiotics and lab tests to detect syphilis infection early, modern medicine is now well equipped to diagnose, treat and cure syphilis well before complications can set in.

Syphilis – Still a Real and Relevant Infection Today

As of recent years though, there has been a rise in syphilis cases amongst both heterosexuals as well as homosexual couples, as reported by the Centers for Diseases Control (CDC), a reminder that syphilis remains a very real infection concern that any sexually active individual should be aware of.
Syphilis is transmitted by direct contact with a syphilis sore, which is a painless ulcer known as a “chancre”. These chancres can occur both in the mouth/oral cavity or in the genital region and the rectum. Sexual contact in the form or oral, vaginal or anal intercourse can all spread syphilis. If a pregnant mother has syphilis, she can also transmit it to her unborn child.

What are the symptoms and different stages of syphilis?

Reading about syphilis can be confusing because it is an infection with different stages and a multitude of varied symptoms.
But to simplify things, there are three stages of syphilis: primary, secondary and tertiary.

Primary Syphilis Symptoms

(usually begins a few weeks up to 3 months from infection)

a.) Syphilis Symptoms: Chancres
  • Painless, round ulcer
  • usually single – occurring at the site where the infection enters the body which is usually in the genital, anal or oral region
  • lasts between 3 – 8 weeks

Note that chancres will heal by themselves and disappearance of the chancre does not mean the infection is gone!

Secondary syphilis

(months or more after initial infection)

b.) Syphilis Symptoms: Rashes
  • Syphilis is known in the medical world as “the Great Mimicker” – so keep in mind that the rash it causes may look very different from what you see in photos!
  • The classic rash is a brownish rash over the palms and soles but syphilis can also cause a rash anywhere over the body
  • May range from very faint rashes to obvious reddish patches
  • Generally not itchy
  • Can occur anytime from when the initial chancre is healing to weeks after
  • May come and go
c.) Snail track ulcers
  • Raw reddish ulcers in the mouth and genital region
d.) Condylomata Lata
  • Raised, greyish patches that occur in moist regions of the body like the groin, armpits
e.) Nonspecific symptoms
  • Fever
  • Enlarged lymph nodes
  • A sore throat

Tertiary syphilis

(occurs decades after initial infection)

  • Tertiary syphilis is now fairly rare as most cases are detected and treated before they progress to this. Symptoms depend on the organs affected by syphilis

NOTES:
Someone with syphilis can also feel entirely well and not have any symptoms- this is known as latent syphilis. If the infection was acquired within the last year, it is considered early latent syphilis, but if it occurred more than a year ago, then it is considered late latent syphilis.
Syphilis can affect the eyes and nerves during any stage of infection. This can result in a variety of symptoms including vision problems, abnormal body movements and even early dementia or memory problems.

What Does a Syphilis Test Do

Who should test for syphilis and what tests are done to diagnose syphilis?

You should test for syphilis…

  • If you have had sexual contact with someone with known syphilis
  • If you have symptoms suspicious for syphilis
  • As part of your regular STD screening if you have an active sex life and have had partners whose infection status you are unsure of

Diagnosis of a syphilis infection is done through a blood test which looks for antibodies to syphilis. Syphilis blood tests can be a little complex and your doctor will be able to explain more to you about the interpretation of results and what to look out for.

What Treatment is Available for Syphilis?

Syphilis infections are treated with penicillin which is administered as an injection. The dosage or number of injections required depends on the stage of the infection.
In unfortunate cases where the infection fails to clear up with initial treatment (which is known as treatment failure), then additional antibiotics may be required for a longer duration of time.
In order to determine if treatment is successful, as well as to monitor for recurrence of the syphilis infection, regular blood tests at intervals of a few months may be required. Until one is clear of syphilis, it is best to abstain from the sexual activity so as to minimise the risk of transmitting the infection to others.
Syphilis remains a problem in the present day, but while it is a potentially serious infection, the good news is that with early diagnosis, the frightening complications that occur with untreated syphilis can very easily be prevented.

Take Care!

Other Interesting Reads:

  1. An Overview of STD – From an STD Doctor
  2. Weak Erection? Erectile Dysfunction? How to Improve Erection with Pills
  3. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  4. What are the Causes of Abnormal Penile Discharge?
  5. What are the Symptoms of HIV Infection and AIDS?
  6. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  7. 11 Causes of Dyspareunia (Pain During Intercourse)
  8. What is HPV Vaccination (Gardasil 9)
  9. 10 Causes of abnormal Vaginal Lumps and Bumps
  10. An Overview of Gonorrhoea
  11. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  12. Syphilis Symptoms (Painless STD Sores & STD Rashes) 

What is the Treatment for Cold Sores? What Causes Cold Sores?

What exactly is a cold sore?
You have probably heard of cold sores or even have had one at some point in your life. But perhaps you’re not entirely sure of what it is caused by and what else you may need to be concerned about.
A cold sore is a small, painful, fluid-filled blister that most commonly occurs near the mouth or on the face, although it may infrequently appear elsewhere on the body. Cold sores tend to occur in clusters.  The appearance of a cold sore is sometimes preceded by an unusual tingling or itching sensation over the same area.
The blisters then form and eventually burst, leaving shallow ulcers/open sores which scab over, forming a crusty lesion. They may come and go, with each flare lasting up to a few weeks.

What Causes Cold Sores?


Cold sores are caused by the Herpes Simplex Virus

There are two types of Herpes Simplex Viruses (HSV) – Type 1 and Type 2.
Cold sores are caused by the Herpes Simplex Virus (Type 1), and genital sores are caused by the Herpes Simplex Virus (Type 2).

Herpes Simplex Viruses (Type 1)

HSV-1 usually causes cold sores, while HSV-2 tends to be responsible for genital sores. HSV-1 is extremely common in the general population, with the World Health Organisation (WHO) estimating 3.7 billion people under the age of 50 have HSV-1 globally.
Herpes Simplex Viruses (HSV) is transmitted through body secretions.
HSV-1 can be transmitted through saliva via kissing, or sharing of utensils (oral-to-oral transmission), but oral-to-genital secretion can also occur through oral intercourse. This means that someone with cold sores can transmit HSV-1 to their partner’s genitals, resulting in genital sores. An STD Screening can screen for both herpes simplex viruses.
Individuals with HSV are most contagious when they have cold sores, but can still be infectious even when they have no sores or blisters.
Here’s a video about Herpes

Unfortunately, HSV infections are lifelong – meaning there is no cure for HSV and once infected a person carries the virus for life.
This is the reason why cold sores can flare up from time to time. There are certain triggers that can set off an outbreak of cold sores- for instance, environmental factors such as sunlight and cold temperatures, or anything which weakens your immune system, such as an illness, or medications which suppress your immunity.

What is the Treatment for Cold Sores?

Antivirals can help clear up and keep cold sores away.
While there is no cure for HSV, the good news is that anti-viral medications (treatment for cold sores) are extremely effective in suppressing the virus and can be used to treat an outbreak of cold sores, and even prevent or minimise future outbreaks.
Some people may not be significantly bothered by their cold sores, which flare up only occasionally and go away by themselves. However, if you are troubled by your symptoms and worried about transmission of the virus to people around you during a flare, anti-virals such as acyclovir or valacyclovir are available as both oral tablets and topical creams.
Sometimes, just the topical cream (treatment for cold sores) may be enough to address your cold sores but if they fail to respond or if your flare is particularly bad, your doctor may prescribe a short course of tablets on top of the cream.
If you are someone who experiences frequent and painful outbreaks of cold sores, or if you are concerned about transmitting the virus to your loved ones, then suppressive anti-viral therapy may be a good option for you. This is when you take the anti-viral medication on a daily basis in order to achieve continued suppression of the virus just like HIV treatment. This not only stops flares from occurring but also reduces your infectivity and the risk of transmitting HSV to others.
Now that you know a little more about, the cause of and, the treatment for cold sores, hopefully, this has helped you realise that you do not need to live with intermittent painful outbreaks. There are treatment options available in our clinics, so if this is an issue which has been troubling you, then it’s time to make that a thing of the past.
Take Care!

Other Interesting Reads:

  1. An Overview of STD – From an STD Doctor
  2. What are the Symptoms of HIV Infection and AIDS?
  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. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  7. 11 Causes of Dyspareunia (Pain During Intercourse)
  8. 10 Common HIV-related Opportunistic Infections
  9. What is HPV Vaccination (Gardasil 9)
  10. 10 Causes of abnormal Vaginal Lumps and Bumps
  11. An Overview of Gonorrhoea
  12. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  13. How Do I Get an Anonymous HIV Testing?
  14. Syphilis Symptoms (Painless STD Sores & STD Rashes) 

Why Do I Have Abnormal Vaginal Discharge?

Let’s talk a little about normal vaginal discharge first.

The vagina is a muscular passage which leads from the vaginal opening to the cervix, which is the entrance to the womb. There are naturally occurring “good” lactobacillus and other bacteria which are part of the normal vaginal flora. The walls of the vagina have glands which produce secretions for the cleansing of the vaginal canal. Normal vaginal discharge is a result of these secretions. It is usually clear or whitish and largely odourless and may change slightly throughout your menstrual cycle.
 

via GIPHY
 

How to identify abnormal vaginal discharge and what you should be worried about?

However, when you notice a major change from your usual vaginal discharge, this abnormal vaginal discharge may indicate that something is wrong.
Signs that your vaginal discharge may be abnormal include different coloured discharge – greenish, yellowish, greyish or even brownish discharge, the presence of a bad vaginal odour, changes in discharge consistency such as thicker, clumpy discharge or large amounts of watery discharge.
If this discharge is accompanied by abdominal pain, fever, or spotting/bleeding after sexual intercourse or bleeding when your period is not due yet, then these are all alarming features that should Fprompt you to consult a doctor.
Abnormal vaginal discharge is one of the most common female health problems and it should not be something you feel you have to suffer in silence about. Most ladies will experience this at some point in their life and while it can be an extremely distressing and uncomfortable problem, it is very treatable.
 
 

You probably have a vaginal infection.

The top cause of abnormal vaginal discharge is a vaginal infection, also known as vaginitis. Other rare causes of abnormal vaginal discharge include cervical abnormalities such as cervical cancer.
The next question, then, would be what sort of infections you have to worry about if you are experiencing abnormal vaginal discharge. These can broadly be divided into Sexually Transmitted Infections (STIs) and non-Sexually Transmitted Infections (STIs).
The most common causes of abnormal vaginal discharge are non-sexually transmitted infections- Bacterial Vaginosis and yeast infections. These all occur when there is disruption to the delicate balance of your healthy vaginal flora and can be triggered by a multitude of factors.
However, if you have had unprotected sexual intercourse, particularly if you are unsure of your partner’s infection status (whether this be a casual partner or a long-term partner), then your abnormal vaginal discharge may very well be due to a Sexually Transmitted Disease (STD) such as Chlamydia, Gonorrhoea, Trichomonas, and various types of Mycoplasma and Ureaplasma bacteria.
Regardless of the underlying cause of your abnormal vaginal discharge, proper evaluation is crucial as it allows you to receive the appropriate treatment, which is important not just in relieving your discomfort but also in preventing more serious, long-term complications (like Pelvic Inflammatory Disease) that can occur with certain infections.
 
 

Why does the abnormal vaginal discharge keep coming back?

This is a very common question and recurrent abnormal vaginal discharge can be an extremely frustrating and distressing issue.
Recurrent yeast infections and bacterial vaginosis tend to be responsible for the above phenomenon and can be triggered by a variety of factors which upset the balance of your vaginal flora.
 

1) Hormonal Fluctuations

  • For some ladies, they may find that the hormonal fluctuations during their peri-menstrual period (before or after menses), may cause them to be prone to recurrent yeast infections.
  • Pregnancy

 

2) Weakened Immune System

  • If you have diabetes or are undergoing any other sort of medical treatment that affects your immunity, you may be more prone to recurrent yeast infections.

 

3) Sexual Lifestyle

  • Sexual intercourse can trigger off bacterial vaginosis – in fact, the number of sexual partners which one has had is actually a risk factor for bacterial vaginosis, with every new partner that a lady has increased the risk of Bacterial Vaginosis infections.
  • Other habits like using spermicide may also kill off the good lactobacilli in the vagina and lead to increased susceptibility to infection

 

4) Medications

  • Being on the combined oral contraceptive pill does increase your risk of recurrent yeast infections
  • Antibiotic usage (for instance, taking something for a bacterial throat infection) can also (ironically) upset the delicate balance down there

 

5) Hygiene Habits

  • Use of vaginal douche washes or feminine washes with harsh chemicals can disrupt your natural vaginal balance and lead to increased yeast and BV infections
  • Tight underwear, pantyliners or menstrual pads which trap humidity and moisture may also place you at increased risk for a yeast infection

 
As can be seen, not all triggers may be entirely avoidable but good habits- like avoiding feminine douche washes, wearing breathable cotton underwear, minimising antibiotic use unless medically indicated, and using condoms- do play a part in helping you maintain a healthy vagina.
If you keep having abnormal vaginal discharge that comes back with a vengeance after the initial episode, do speak to your doctor about additional treatment that may be suitable for you.
 
Remember that you are not alone – abnormal vaginal discharge is common – and treatable!
Don’t let your discomfort about the topic keep you from treatment.
 
Take Care!

Other Interesting Reads:

    1. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
    2. 11 Causes of Dyspareunia (Pain During Intercourse)
    3. How Do I Get an Anonymous HIV Testing?
    4. What is HPV Vaccination (Gardasil 9)
    5. 10 Causes of abnormal Vaginal Lumps and Bumps
    6. An Overview of Gonorrhoea
    7. What is the Treatment for Cold Sores? What causes Cold Sores?