Posts

Crabs STDs – Pubic Lice

Pediculosis pubis also known as the Crab Louse is a common insect infestation of the human genital area. As the infestation becomes more profound, it can also extend into other parts of the body including the eyelids. 

The louse is approximately 1 cm in size, which makes it visible to the naked eye. It has 6 legs, 4 of which have prominent pincer-like claws – much like a crab, which it uses to attach to its host. The louse feeds off its host by biting and drawing blood from the area. The lifespan of the louse is between 3 – 4 weeks, during which time, the female louse can lay as many as 80 eggs or nits. 

How do you get them?

Sexual transmission is the most common mode of transmission of the louse. Once the area has become infested with the louse, the patient will soon experience itchiness in the area. Prolonged infestation generally results in bluish bite marks in the skin. The louse requires a warm area and blood to thrive, hence they do not remain on inorganic surfaces such as tabletops and toilet seats for long. This means you do not usually get an infestation by touching such areas. 

The most at risk population are teenagers and young adults. 

How to get rid of Crabs STDs (Pubic Lice)?

The current treatment for Pediculosis pubis infestation is by topical treatment to the affected area. The aim of these treatments are to eradicate both the adult louse and nits. Although cure rates are high, it generally takes a few sessions of topical treatments to achieve complete eradication.

How to avoid getting Crabs STDs (Pubic Lice)?

The best way to prevent yourself from getting an infestation is to avoid contact with the louse. If you find out that your partner has an infestation, ensure that you clear the environment of any adult louse and eggs. Wash all fabrics such as curtains, bedding, towels and clothes with a hot cycle and a strong disinfectant. In the event you do find that you have an infestation see your doctor immediately so that treatment can be started early.

Next read: PARASITIC STIS – SCABIES

Join our channel on Telegram – https://t.me/dtapclinic or follow us on Twitter https://twitter.com/dtapclinic for more health updates or the latest medical news!

crabs stds

Also on this site: hiv screening

Common Medical Conditions That Are Asymptomatic

Signs and Symptoms are technical terms to describe the extent of disease in a patient. A sign is an effect of the disease that can be observed by another person or elicited through certain manoeuvres while a symptom is an effect that is experienced only by the patient. 

What does being asymptomatic mean?

Being “asymptomatic” is when the patient does have the disease but does not experience any effects of the disease. In this article, we will be discussing 5 diseases where patients are usually asymptomatic in the early stages of the disease but as the disease progresses, it adds an increased burden on the body leading to more pronounced signs and symptoms.

The 5 diseases were selected because while there is no way for patients to know if they have the disease early on due to the lack of symptoms these diseases can be easily detected during health screening with your General Practitioner. Therefore, we hope to highlight the importance of your health screening in allowing your doctor to detect these diseases early and prevent the disease from progressing to a more severe state.

So just before you brush off that health screening appointment because “I feel OK” , have a read to see the benefits or early detection and treatment.


5 Diseases where patients are asymptomatic

Human Immunodeficiency Virus (HIV)

What it is?

HIV infection is a disease in which the virus attacks specific cells (CD4) in the immune system and uses the cells to create more copies of the virus, killing the host cells in the process. In the early stages of HIV, the rate of CD 4 cell production can still cope with the loss from the viral infection, therefore patients are mostly asymptomatic.

Over time as the virus replication picks up pace, the CD 4 cell numbers dwindle and the immune system becomes less effective in responding to environmental insults such as bacterial or fungal infections. Major risk factors for HIV infection include, IV drug use, unprotected casual sex and anal intercourse.

How do you test for it?

Point of Care testing can be done at most clinics in Singapore, this involves taking a sample of blood from a finger prick and placing it into a test kit. Currently, the earliest you can be tested for HIV is 30 days after infection. Early treatment of HIV prevents the virus from replicating and thus prevents the disease from worsening and progressing to Acquired Immunodeficiency Syndrome (AIDS).
HIV Testing Singapore
Anonymous HIV Testing Singapore

Chlamydia

What it is?

Chlamydia is a common bacterial infection in both Men and Women. Infection is usually found in the genital tract but also in the rectum, throat and even eyes. Up to 70% of women and 50% of men are asymptomatic. Left untreated, the bacteria can replicate further to eventually lead to an inflammatory state in the pelvis. This results in severe discomfort and particularly in women the risk of infertility is especially raised if chlamydia is untreated.

How do you test for it?

Chalmydia Rapid testing can be carried out to detect the presence of Chalmydia within 24 hours. A sample is taken from the region, a vaginal swab for women and a urine sample for men, and a Polymerase Chain Reaction is used to detect any chlamydial genetic material. Treatment of chlamydia can be as simple as a single dose of antibiotics if detected at an early stage.
Rapid STD Testing Singapore

Chronic Illnesses

High cholesterol

What it is?

Cholesterol can be thought of in 2 forms, a high density form (HDL) and a low density form (LDL). HDL lowers the total cholesterol in the body while LDL increases it. An increase in cholesterol and triglycerides (both from fatty foods) results in plaques developing within your blood vessels (Atherosclerosis). As the plaques increase in size, blood flow to your vital organs like your heart and brain are compromised thus increases the risk of heart attacks and strokes.

How do you test for it?

A blood test usually done at your health screening enables your doctor to determine the cholesterol levels in your body. Not all elevated cholesterol has to be treated with  medications because changes in diet and lifestyle can also lower cholesterol in some cases. 

Hypertension

What it is?

Hypertension is when your blood pressure is persistently elevated, the normal blood pressure should be below 140 systolic and 90 diastolic. There are myriad of causes for elevated blood pressure including, high salt intake, stress or kidney disease.

However, many people have Essential hypertension, which is when the blood pressure is found to be elevated for no particular cause. Even though the cause may not be determined in most cases of hypertension, patients with an elevated blood pressure have a higher risk of strokes. This is because, the increased pressure in the blood adds additional strain to the blood vessels, eventually, the blood vessels become weaker and are more likely to break, resulting in a stroke.

How do you test for it?

The diagnosis of hypertension in an asymptomatic patient involves a Blood Pressure diary where the patient measures her blood pressure at the start and end of the day for 2 weeks. A persistently elevated blood pressure may prompt the doctor to start treatment, however there are also non-pharmacological means of lowering blood pressure.

Diabetes

What it is?

Diabetes, in particular Type 2 Diabetes, is a condition where the body is unable to regulate carbohydrate metabolism. This results in wide spread effects on the patient because sugar derived from carbohydrate metabolism is essential to many cellular activities in the body. Although patients are mostly asymptomatic in the early stages of the disease, patients can eventually have a variety of pathologies as the disease progresses such as loss of sensation in the hands and feet, poor wound healing, reduced immunity and even blindness.

How do you test for it?

Testing for diabetes also involves a blood test to measure the sugar levels in a fasting state to gauge the current level of sugar metabolism in your body and the Haemoglobin A1c (HbA1c) which is a gauge of the long term extent of sugar metabolism in your body. Depending on the extent of your disease, treatment of diabetes can range of lifestyle modification to injectable medications.


Having a disease in its early stages sometimes means that you still feel “fine” and not experience any symptoms. However, if left untreated, these diseases can progress and lead to severe complications in your health. Getting checked regularly is essential for detecting disease in the asymptomatic phase and treating it early. This prevents the disease from progressing to a more severe state and allows us to lead better, healthier lives. Speak to your doctor today!


Other Asymptomatic Medical Conditions:

Also on this site: Wart Removal Singapore, STD Check Singapore

Neurosyphillis

Syphilis is a Sexually Transmitted Infection (STI) caused by the bacteria Treponema Pallidum. It is a systemic infection with a multitude of signs and symptoms depending on the stage of the infection. As such, syphilis is also known as “the Great Imitator” because the clinical presentation may appear similar to many other diseases.

There are four stages of infection: 

  1. Primary syphilis – painless ulcer (or chancre) at the site of infection
  2. Secondary syphilis – manifestations that include, but are not limited to, skin rash, mucocutaneous lesions, and lymph node swelling
  3. Latent syphilis – this stage can last for a number of years with few or no symptoms
  4. Tertiary syphilis  – gummatous lesions (soft, non-cancerous growths), neurological problems, or cardiac symptoms

In this article, we will focus on neurosyphilis. You can learn more about syphilis as an overall topic in a previous article:



What is Neurosyphilis?

Neurosyphilis occurs when the infection reaches the central nervous system i.e. the brain or spinal cord. Neurosyphilis can occur at any stage of infection, but tends to occur in tertiary syphilis. Therefore, neurosyphilis can occur within a few months, but could also develop after 10 to 30 years, of a syphilis infection. 

There are four different forms of neurosyphilis:

  1. Asymptomatic (most common form)
  2. Meningovascular
  3. General paresis (muscle weakness)
  4. Tabes dorsalis (slow degeneration of the neural tracts of the spinal cord)

Asymptomatic neurosyphilis occurs before symptomatic neurosyphilis. Early neurosyphilis affects the blood vessels and meninges (membranous coverings of the brain and spinal cord) whereas late neurosyphilis affects the brain and spinal cord itself.

Signs & Symptoms

Signs and symptoms vary widely depending on the form of neurosyphilis, including:

  • Stroke
  • Changes in personality
  • Dementia, mania, or paranoia 
  • Ataxia (loss of coordination of muscle movements, eg. leading to gait abnormality)
  • Ophthalmic symptoms (eg. blurred vision, reduced color perception)
  • Urinary symptoms (eg. bladder incontinence)
  • Headache
  • Giddiness
  • Hearing loss
  • Seizures 
  • Hyporeflexia 
  • Sensory impairment 

Risk Factors

The risk factors include: 

  • High risk sexual behaviour from unprotected sex and multiple sexual partners
  • Men who have sex with men
  • Recreational drug use

Diagnosis

Syphilis is diagnosed either via blood tests or direct visual inspection using dark field microscopy. In practice, blood tests are more commonly used as they are easier to perform.

To diagnose neurosyphilis specifically, cerebrospinal fluid (CSF), which is a fluid surrounding the brain and spinal cord, is obtained via lumbar puncture and the Venereal Disease Research Laboratory (VDRL) test is performed on the CSF. 

Other laboratory investigations that may be performed include: cerebral angiogram, computed tomography (CT) or magnetic resonance imaging (MRI) scan of the brain, brain stem or spinal cord.

Treatment

Syphilis is treated with intramuscular injection of the antibiotic benzathine benzylpenicillin. Early syphilis is treated with a single dose whereas late syphilis is treated with a once-weekly dose for 3 weeks. 

For neurosyphilis, however, the treatment course is different as penicillin penetrates the central nervous system poorly. Instead, the treatment requires intravenous penicillin every 4 hours for 10 to 14 days.

Generally, follow-up blood tests are performed at 3, 6, 12, 24, and 36 months to ensure the infection has fully resolved. Follow-up lumbar punctures for CSF analysis are performed every 6 months. 

Prevention

Neurosyphilis can be prevented with the following measures:

  • Safe sex practice, namely correct and consistent condom usage
  • Avoiding high risk sexual behaviour. Aside from abstaining from sexual contact, the surest way of avoiding STIs is to be in a mutually monogamous relationship with a partner who has been tested and is free of STIs
  • Regular STI screening and if syphilis has been detected, to receive early and prompt treatment
  • In the case of an individual diagnosed with a syphilis infection, prompt partner notification and treatment helps to reduce the risk of undetected syphilis

Join our channel on Telegram – https://t.me/dtapclinic or follow us on Twitter https://twitter.com/dtapclinic for more health updates or the latest medical news!

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

What is Gonorrhea?

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

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

What are the symptoms of Gonorrhea infection?

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

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

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

Symptoms of urogenital gonorrhea in female may include:

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

What are the complications of Gonorrhea infection?

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

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

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

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

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

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

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

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

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

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

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

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

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

How is Gonorrhea screening performed?

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

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

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

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

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


Find a doctor | Make an appointment

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

Mycoplasma Genitalium is a common STI (sexually transmitted infection). It can be transmitted by different forms of sexual contact including vaginal, anal and oral intercourse. The symptoms experienced can include painful urination, penile/vaginal discharge, and, specifically in women; pain during sex, bleeding after sex, inter-menstrual bleeding, and lower pelvic pains.

Mycoplasma Genitalium is not as well known as Chlamydia or Gonorrhoea. The key reason for this, is the difficulty in testing for the infection and also a lack of awareness about the condition.


Here are 10 interesting things that you didn’t know about Mycoplasma Genitalium

1. Mycoplasma Genitalium was first identified in the 1980s

The bacteria was first isolated in the urogenital tract of humans in 1981, and was recognised as a new species of Mycoplasma in 1983. As it is still relatively recent that Mycoplasma Genitalium was identified, there is lack of sufficient data and research, and perhaps more of the condition that we do not yet know about.


2. Mycoplasma Genitalium is one of the smallest free living microorganisms capable of self-replication

The Mycoplasma species are the smallest bacterial cells yet discovered, with sizes ranging from 0.2 to 0.7 micrometres. In fact, Mycoplasma Genitalium is too small to be visible under a light microscope, and the first detailed study of its structure was conducted under a transmission electron microscope (TEM). 

3. Mycoplasma Genitalium is one out of the 15 (known so far) named Mycoplasma species of the human origin

Hundreds of Mycoplasma species are known to infect animals and plants. Of these, about 15 are pathogenic in humans. Mycoplasma Genitalium was the 12th to be identified.

4. Mycoplasma Genitalium is more common than Gonorrhoea and is the second most prevalent STI after Chlamydia

Since its discovery around 30 years ago, Mycoplasma Genitalium is now recognized as an important cause of male urethritis. The US Centers for Disease Control and Prevention (CDC) states that it is more common than Gonorrhoea but less common than Chlamydia, and is responsible for approximately 15%–20% of non-gonococcal urethritis (NGU), 20%–25% of non-chlamydial NGU, and approximately 30% of persistent or recurrent urethritis.

5. It is possible to have Mycoplasma Genitalium and not know it, and there is a high chance that your partner is also infected

Infection with Mycoplasma Genitalium can cause the symptoms as mentioned earlier, but can also be asymptomatic. Studies have shown that in heterosexual couples where the male partner was tested positive, up to 30% of the female partners were positive for the bacteria. If the female was first tested positive, up to 50% of their male partners tested positive as well. In men who have sex with men, up to 40% of their partners tested positive for the bacteria in the rectum. This points to the fact that if a person is tested positive for the bacteria there is a good chance that their partner is also infected.

6. Mycoplasma Genitalium, like Chlamydia and Gonorrhoea, can lead to more serious complications with long term health consequences

Data suggests that Mycoplasma Genitalium can cause Pelvic Inflammatory Disease (PID) in females, as the bacteria is found in the cervix and/or endometrium of women with PID more often than in women without PID. Women with tubal factor infertility are more likely to have antibodies to Mycoplasma Genitalium than fertile women, suggesting that this organism might cause female infertility. Two studies have shown that infection with Mycoplasma Genitalium is associated with an increased risk of preterm delivery in pregnant women.

It remains unknown whether Mycoplasma Genitalium can cause male infertility. However, the organism has been detected in men with epididymitis in a limited number of cases.

7. Mycoplasma Genitalium is a slow growing bacteria; this leads to diagnostic challenges

Mycoplasma Genitalium is a fastidious, slow-growing organism. This makes detection and subsequent isolation of the bacteria extremely difficult. Culture can take up to 6 months, and only a few laboratories in the world are able to recover clinical isolates.

Therefore, the preferred method of testing is by Nucleic Acid Amplification Test (NAAT), typically using Polymerase Chain Reaction (PCR). NAAT detects genetic materials (DNA or RNA) rather than antigens or antibodies, and is highly accurate. Testing can be done on urine, urethral, vaginal, and cervical swabs and endometrial biopsy. However, to date there is no diagnostic test for Mycoplasma Genitalium that has been approved for use by the US Food and Drug Administration (FDA).

8. Mycoplasma Genitalium does not have a cell wall

The Mycoplasma Genitalium bacteria lacks a cell wall, which makes treatment of the infection more difficult as certain classes of antibiotics that work by targeting bacterial cell walls are ineffective against this organism.

9. You can get reinfected with Mycoplasma Genitalium even after you have been treated for it 

Much like many other STIs, it is possible to get reinfected with Mycoplasma Genitalium even after one has been successfully treated for it. Therefore, safe sexual practices including using barrier protection, reducing your number of sexual partners and knowing your partners’ infection status is important in keeping yourself safe and healthy.

10. It is possible for vertical transmission of Mycoplasma Genitalium to occur?

Although uncommon, it is possible for vertical transmission of Mycoplasma Genitalium from mother to baby to occur, as previously reported in one case. 

Next read: MYCOPLASMA GENITALIUM (MG) – STD SCREENING, TESTING & TREATMENT


Find a doctor | Make an appointment

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.  

Find a doctor | Make an appointment


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?

Speak to your doctor for more information or if you have any questions regarding Dengue Rapid Testing or other Dengue related topics: Dengue in the era of COVID, Dengue Fever Symptoms? Dengue Fever What You Need to Know, Why the recent resurgence in Dengue Fever?, ZIKA IS AN STD!! – Battling the STD Stigma


Find a doctor | Make an appointment

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.
 

Find a doctor | Make an appointment

 


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.
 


Find a doctor | Make an appointment

 
 

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