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

What is Gonorrhea?

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

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

What are the symptoms of Gonorrhea infection?

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

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

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

Symptoms of urogenital gonorrhea in female may include:

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

What are the complications of Gonorrhea infection?

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

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

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

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

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

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

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

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

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

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

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

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

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

How is Gonorrhea screening performed?

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

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

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

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

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


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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


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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)