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Itchy Testicles – Is it a sign of STDs?

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

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

  1. Chafing

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

  1. Jock Itch

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

  1. Contact Dermatitis

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

  1. Lichen Simplex Chronicus

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

  1. Psoriasis

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

  1. Pubic Lice

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

  1. Scabies

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

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

Parasitic STIs – Scabies

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Scabies are one of the more uncommon STIs (Sexually Transmitted Infections) present in Singapore. As it is rarely seen in a clinic setting and the signs are often unremarkable, it can be easily missed by both patient and the doctor. So what exactly is scabies? We will talk about it in a little more detail and how it is relevant to you and your sexual health.

Scabies – The hidden itch

Scabies are not an infection, but an infestation of microscopic mites, Sarcoptes scabiei. These tiny eight-legged creatures live within the human skin. After mating, female mites will burrow through the epidermis causing skin damage and lay eggs within the burrows. Larvae, after hatching, will grow and continue the whole lifecycle. 

Signs and Symptoms

These burrowing caused by the mites do not actually cause pain, but the allergic reaction to the mites, faeces and eggs leads to an intense itching that is typically worse at night. The itching starts 3 to 6 weeks after initial infestation. 

The typical physical finding is a extremely itchy pimple-like rash in areas such as:

  • Between fingers
  • Armpits
  • Wrist
  • Elbow
  • Genitalia
  • Waist
  • Buttocks

The back and the head are typically spared, except in very young infants.

Another more serious variant is Norwegian Scabies. This happens in patients with compromised immune systems, for example patients with HIV, lymphoms or long term steroid use. The mites will form deep, scaly rashes which are highly infectious.

How does one get it?

Scabies can be spread through direct and prolonged skin to skin contact, for example between family members or sexual partners. Casual contact is highly unlikely to spread scabies. 

Scabies can also be spread through indirect contact. As the scabies mites can survive up to 36 hours off a host, they can be indirectly transmitted through sharing clothes, bedding, towels with an infected individual. 

To prevent scabies, avoid skin to skin contact with infected individuals and do not share clothes and bedding. Condoms are NOT useful in preventing transmission as scabies spread through direct contact and not through body fluids and secretions.

Treatment options

Thankfully, scabies can be treated. A topical preparation known as Permethrin can be applied as a single dose to the whole skin from scalp to toe. Commonly, a single application is sufficient for eradication of scabies. An antiparasitic agent known as Ivermectin can also be given orally for eradication with good effect. To prevent re-infection, all contaminated clothing and bedding should be thoroughly laundered with hot water.

In conclusion, if you find mysterious pimple-like rashes which are intensely itchy after an exposure, see your doctor for further advice! 

Next read: CRABS STDS – PUBIC LICE

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What is Antibiotic Resistant Gonorrhea or Super Gonorrhea?

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Gonorrhea is a sexually-transmitted infection caused by the bacteria called Neisseria gonorrhoeae. 

Antibiotic-resistant Gonorrhea refers to strains of Gonorrhea that are not killed by antibiotics that were previously effective in killing off these bacteria. 

In the 1980s, penicillins and tetracyclines could kill off Gonorrhea. By the 1990s, these drugs were no longer effective and Fluoroquinolones were recommended as the first line treatment. By the 2000s, Fluoroquinolones resistance was commonplace and only one group of antibiotics remains as an effective treatment for Gonorrhea – Cephalosporins. By now, certain strains of Gonorrhea that are resistant to cephalosporins have already been detected and that is worrisome because if these medications become useless, we might face a situation where we cannot clear gonorrhea from a person’s body. 

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What drugs are super gonorrhea resistant to?

Super Gonorrhea is the colloquial term for strains of Gonorrhea that are extensively drug-resistant, with high-level resistance to the current recommended treatment for gonorrhea (ceftriaxone and azithromycin) including resistance to penicillin, sulphonamides, tetracycline, fluoroquinolones, macrolides.

What causes super gonorrhea? 

Super Gonorrhea is a problem that we have created. 

The unrestricted access, inappropriate selection and overuse of antibiotics over many decades has allowed the strains of gonorrhea to genetically mutate in such a way that they are no longer affected by these antibiotics. Extra genital infections in the rectum and throat may also play an important role in the development of resistant strains as gonorrhea can interact and exchange genetic material with other co-infections in these places.

How common is Super Gonorrhea?

Super Gonorrhea has been reported by several countries including France, Japan, Spain, the UK and Australia. The American CDC has not received any reports of verified clinical treatment failures to any cephalosporin in the United States to date. 

How does Gonorrhea spread?

Gonorrhea can be spread through sexual contact with the penis, vagina, mouth, or anus of an infected partner. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Even if you have had gonorrhea in the past and was treated, you can still get reinfected again if you are exposed to it again. 

What are the symptoms of super gonorrhea?

The symptoms of super gonorrhea are the same as regular gonorrhea. Gonorrhea can infect different areas of the body. Most symptoms present within 1-2 weeks after exposure.

In males, the most commonly infected site is the genitourinary system. It can present with symptoms such as pain on passing urine, penile discharge, swelling at the tip of the penis and scrotal pain and swelling.

In females, the most commonly infected site is also the genitourinary system and and present with symptoms such as vaginal discharge, pain on passing urine, intermenstrual bleeding, painful intercourse, and mild lower abdominal pain

Gonorrhea can also infect other areas of the body such as the rectum, causing rectal pain, itching, discharge, or tenesmus. If gonorrhea infects the throat, you can get a persistent sore throat. Gonorrhea can also infect the eyes, causing conjunctivitis which may present with eye pain, discharge, and redness. If gonorrhea spreads by blood to the rest of the body including the brain, heart, bone, joints, skin and liver, this is termed Disseminated gonococcal infection (DGI). While rare, DGI can be deadly and have long term complications. 

Does Gonorrhea always have symptoms?

Gonorrhea can have little to no symptoms at all in some people. That is the reason why it is so important to screen for STIs with every sexual encounter. 

A study has reported that more than 80% of people (both males and females) with Gonorrhea can have no symptoms. Do not wait for symptoms to appear before you screen for STIs. Do it regularly with every new sexual encounter. 

Also read: Rapid STD Test for Chlamydia and Gonorrhoea PCR

What are other STDs that do not display symptoms and have serious complications if left untreated?

All STIs can have no symptoms at all. Because people do not experience any symptoms, they think that they do not have an STI and thus the spread of STIs continues. Other STIs we regularly test for include other urinary STIs such as Chlamydia, Ureaplasma urealyticum, Mycoplasma hominis and Trichomonas. What we can test for in the blood are STIs such as HIV, Syphilis, Herpes and Hepatitis B and C.

What happens if gonorrhea is treated effectively?

If gonorrhea is treated effectively (with the proper antibiotics), your symptoms should clear up, and subsequent follow up tests to test for clearance should come back as negative for gonorrhea.

What are the complications of Gonorrhea?

In females, untreated gonorrhea may lead to pelvic inflammatory disease (PID). This is an infection of the fallopian tubes, uterus, and cervix. If left untreated, PID may cause permanent damage to the reproductive tract, which may lead to infertility. It may also lead to long-term pelvic pain.

Males with untreated gonorrhea may develop a condition called epididymitis. This condition is characterized by inflammation of the tubes near the testicles that carry semen. It can also lead to infertility. 

DGI is another complication of gonorrhea as well. 

What happens if you have drug resistant gonorrhea? Can I get rid of Antibiotic Resistant Gonorrhea?

If you have drug resistant gonorrhea, your doctor may opt to treat you with antibiotics that hopefully are effective against this strain of gonorrhea. Antibiotic sensitivity testing for that strain should be done. If it is truly multi-drug resistant, a referral to an infectious diseases specialist is appropriate, and they may have to treat you with antibiotics that are reserved for the worst kinds of infections. 

How do you reduce your risk of contracting these STIs?

Abstinence is the only way to reduce your risk to zero.

If you are sexually active, use barrier protection such as condoms, the right way. You can also speak to your partner to get tested for STIs before engaging in sexual activity.  A mutually monogamous relationship also carries a lower risk of STIs than having multiple sexual partners.

If you are sexually active with multiple sexual partners, get yourself tested regularly and treated. The presence of one STI can increase your risk of contracting another one more easily. Most STIs can easily be detected through swabs, urine or blood tests at your doctors. These are rather pain free and minimally invasive, so there should be no fear to get tested!

There are some STIs that are preventable through vaccinations. Vaccines are available against certain strains of HPV that may cause warts, cervical, anal and penile cancer. Effective vaccines against Hepatitis B are available as well.

Also read: What is HPV (Human Papilloma Virus)?

How do I find out if I have been infected with Super Gonorrhea?

Gonorrhea is often diagnosed using a PCR test. This test can give results very fast and determine if a person is infected with Gonorrhea or not. However, this test cannot differentiate between regular Gonorrhea and Super Gonorrhea.

For that, a test called Gonorrhea Culture and Sensitivity has to be conducted. This test takes a longer time as the Gonorrhea bacteria has to be grown on a plate and tested against various antibiotics. This test is also less sensitive as for various reasons, sometimes the Gonorrhea bacteria cannot grow.

Also read: What Is Rapid Chlamydia & Gonorrhea PCR STD Testing?

If you think you may have been exposed to Super Gonorrhea, you have to see your Doctor immediately. DTAP clinics focus on STD screening and STD treatment. We offer rapid PCR testing for Gonorrhea (next day results) as well as culture tests to detect multi-drug resistant (Super) Gonorrhea. 

Speak to your doctor if you have any questions regarding Gonorrhea or other STDs.

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