Bagaimana jangkitan HPV dan masalah kesihatan yang disebabkan olehnya boleh dicegah?

Apakah itu human papillomavirus (HPV)?

HPV adalah virus yang boleh menyebabkan penyakit kelamin (sexually transmitted disease, STD) dan adalah penyakit STD yang paling kerap berlaku di dunia. Jangkitan HPV dianggarkan berlaku di kalangan sekurang-kurangnya 80 peratus wanita dan lelaki yang telah bermula hubungan seks.  

Apakah gejala atau simptom jangkitan HPV?

Kebanyakan orang yang dijangkiti HPV tidak mempunyai apa-apa gejala kerana sistem ketahanan (imun) badan dapat menyingkirkan virus HPV sebelum apa-apa gejala berlaku.

Walaubagaimanapun, bagi individu yang mempunyai simptom, ketuat (genital warts) boleh dilihat di kawasan alat kelamin. Ketuat juga boleh dilihat di kulit (non genital warts) kerana HPV disebarkan antara kulit. Ketuat kebanyakkanya disebabkan oleh HPV jenis 6 dan 11. HPV jenis berisiko tinggi (high risk strains) boleh menyebabkan penyakit barah di cervix, dubur (anus), vulva dan faraj, zakar dan juga dalam mulut dan tekak (oropharyngeal).  

Bagi penyakit barah cervix peringkat awal, simptom-simptom adalah lelehan faraj berdarah di luar masa haid, selepas menopaus atau selepas hubungan seks. Lelehan faraj yang mungkin berbau juga adalah antara simptom barah cervix.

Bagaimana seseorang boleh dijangkiti HPV?

HPV adalah virus yang boleh dijangkiti melalui sentuhan kulit, melalui hubungan seks (sama ada melalui vagina, oral, zakar atau lubang dubur) atau melalui sentuhan kawasan genital (alat kelamin). Individu tidak boleh dijangkiti HPV melalui sentuhan objek contohnya tempat duduk tandas. 

Disebabkan virus ini boleh dijangkiti melalui hubungan seks, jika individu mempunyai beberapa pasangan seksual, risikonya ditingkatkan. Tambahan pula, kondom hanya memberi perlindungan yang tidak sepenuhnya. Pengisapan rokok juga boleh meningkatkan risiko jangkitan HPV sebanyak 4 kali ganda, bersama juga jika individu mengambil ubat yang melemahkan sistem imun atau mempunyai penyakit yang melemahkan sistem imun. 

Apakah komplikasi penyakit jangkitan HPV?

Seperti dijelaskan di atas, HPV boleh menyebabkan penyakit barah di cervix, vulva, faraj, zakar atau lubang dubur. Ia juga boleh menyebabkan barah tekak, lidah dan tonsil. 

Jenis HPV yang menyebabkan penyakit ketuat tidak sama dengan jenis HPV yang menyebabkan barah. Penyakit barah yang disebabkan oleh HPV selalunya mengambil jangka beberapa tahun untuk berlaku.

Bagaimana jangkitan HPV dan masalah kesihatan yang disebabkan olehnya boleh dicegah? Apakah rawatan penyakit jangkitan HPV?

Vaksin terhadap HPV adalah sangat digalakkan. Vaksin HPV adalah selamat dan berkesan. Keberkesanan vaksin ini adalah setinggi 97% di kalangan individu yang tidak pernah dijangkiti HPV. Vaksin juga bermanfaat jika penerima sudah dijangkiti HPV. 

Jika individu menghidap barah yang disebabkan oleh HPV, rawatan yang diberikan termasuk pembedahan, kemoterapi dan radioterapi.

STDs: Apakah Simtom HIV Dan STD?


Doktor yang boleh berbahasa melayu


Dr. Taufiq at DTAP Clinic @ Somerset

1 Grange Rd,
#10-08 Orchard Building,
Singapore 239693

Telepon: +65 6262 0762

Dr. Ezlyn at DTAP Clinic @ DUO Galleria

7 Fraser St,
#B3-18 DUO Galleria (Bugis MRT), 
Singapore 189356

Telepon: +65 6976 5023

Chlamydia Conjunctivitis

Chlamydia is a sexually transmitted infection (STI) caused by the bacterium Chlamydia Trachomatis. It is one of the most common STIs worldwide, and likewise here in Singapore. According to the latest statistics provided by the Department of STI Control (DSC) Clinic, there were officially 2,719 newly diagnosed cases of Chlamydia reported in 2018.

It is well known that Chlamydia affects the genito-urinary system, with the typical symptoms being painful urination, increased urinary frequency or urgency, penile or vaginal discharge, testicular pain or swelling in men, and painful sex or bleeding after sex in women. You may also be aware that Chlamydia can sometimes be completely asymptomatic. However, what most people may not know is that Chlamydia can affect other parts of the body as well, namely the eyes, rectum, throat and joints.

In this article, we will focus on Chlamydia eye infection, also known as Chlamydia Conjunctivitis. You can read more about Chlamydia as an overall topic in a previous article:


What is Chlamydia Conjunctivitis?

Conjunctivitis is inflammation or infection of the conjunctiva, a clear membrane that covers the white part of the eye and lines the inside of the eyelids. The conjunctiva helps to lubricate the eye by producing mucus and tears, and prevents the entry of microbes into the eye. The various causes of conjunctivitis include viral or bacterial infections, allergies, chemical irritation and foreign objects. Therefore Chlamydia Conjunctivitis refers to conjunctivitis resulting from a Chlamydia infection.

How does Chlamydia Conjunctivitis occur?

Chlamydia Conjunctivitis is directly spread from the bacteria entering the eyes. This usually happens from touching or rubbing your eyes after touching your genitals (if you have Chlamydia) or those of an infected partner. It is also possible to get infected from sharing towels, eye makeup or cosmetics that contain the bacteria.

Signs and symptoms

Chlamydia Conjunctivitis can present acutely, but more commonly patients have mild symptoms for weeks to months. The majority of cases affect only one eye, and vision is usually unaffected.

Signs and symptoms include:

  • Red, itchy, swollen or scratchy eyes
  • Mucous, sticky discharge
  • Tearing
  • Photophobia (sensitivity to light)
  • Swollen eyelids
  • Crusting and sticking of eyelids
  • Foreign body sensation
  • Enlarged lymph nodes behind the ears

How to tell the difference between Chlamydia Conjunctivitis and other forms of conjunctivitis?

As Chlamydia Conjunctivitis presents very similarly to viral and other bacterial conjunctivitis, it is not possible to tell the difference based on eye signs and symptoms alone. For this reason, many patients may have been previously treated, or self-medicated, with various types of eye drops without symptomatic relief. A diagnosis of Chlamydia Conjunctivitis is usually suspected if close questioning reveals genito-urinary symptoms, or if the sexual partners of these patients have similar eye symptoms.

Who is at risk?

Chlamydia can affect anyone who is sexually active, both males and females alike, regardless of sexual preference or orientation. Young people may be at higher risk for various reasons, including practices like inconsistent condom usage.

Diagnosis

Chlamydia Conjunctivitis is usually diagnosed based on history and examination of the eye. If necessary, a swab test of the conjunctiva can be performed. Your doctor may advise you to test for other STIs as well.

STD Screening Singapore | Rapid STD Test for Chlamydia and Gonorrhoea PCR

Treatment for Chlamydia Conjunctivitis

If left untreated, Chlamydia Conjunctivitis resolves spontaneously in 6 to 18 months, but most individuals would seek treatment due to the severity of the symptoms. Chlamydia Conjunctivitis is treated with topical antibiotics such as tetracycline, erythromycin and fluoroquinolones, but due to the high probability of concomitant genital tract infection, oral antibiotic therapy is recommended. Sexual partners of the patients should be contacted, evaluated and treated.

Prevention

  • Wash your hands regularly, avoid touching or rubbing your eyes unless your hands are clean
  • Do not share eye makeup or cosmetics with anyone
  • Refrain from sharing towels, washcloths, pillows, or sheets with anyone. If one of your eyes is affected but not the other, use a separate towel for each eye
  • Observe safe sexual practices including consistent and correct usage of condoms, reducing your number of partners or being in a mutually monogamous relationship where you are aware of your partner’s sexual health status
  • Regular STI screening helps you remain aware of your own sexual health status

Neonatal Chlamydia Conjunctivitis

Although relatively harmless in adults, Chlamydia Conjunctivitis can have severe health consequences in children. Infection is acquired from an infected mother during vaginal delivery, from exposure to the bacteria in the birth canal. Chlamydia Trachomatis is responsible for up to 40% of conjunctivitis in neonates. If left untreated, neonatal conjunctivitis can cause blindness.

The symptoms usually develop within 1 day to 2 weeks after birth and typically include redness of the conjunctiva, eyelid swelling, and mucous discharge. At least half of neonates with Chlamydia Conjunctivitis also have the bacteria present in the nasopharynx, and some go on to develop Chlamydia pneumonia. Therefore, oral antibiotic therapy is the treatment of choice in neonatal Chlamydia Conjunctivitis as it can also target concomitant nasopharyngeal infection.

The condition can be prevented by undergoing prompt screening and treatment if a genital infection is suspected during pregnancy. Deliveries should be conducted under hygienic conditions taking all aseptic measures. The newborn baby’s closed lids should be thoroughly cleansed and dried.

Next Read: Common STD Incubation Periods

Pain During Ejaculation

What does it feel like?

Pain during ejaculation is also known as dysejaculation, odynorgasmia, post orgasmic pain, dysorgasmia or orgasmalgia. This can range from mild discomfort to severe pain and can occur during or after ejaculation. The usual sites of pain are the penis (along the shaft or at the tip), scrotum, perineal or perianal area.

The pain can last anywhere from a few minutes up to 24 hours. Dysejaculation can be associated with other sexual dysfunctions. It can significantly impair a person’s quality of life and sex life through reduction of the individual’s self-esteem and sexual desire.

Several studies demonstrated its prevalence between 1–10% in the general population, but this may be underreported due as the discomfort may be transient and mild for some people.The prevalence may increase to 30–75% among men who suffer from chronic prostatitis or chronic pelvic pain syndrome. It is also seen in other conditions mentioned below.

Causes 

There are a variety of conditions that can result in painful ejaculations, but it can also be an idiopathic problem with no identifiable cause. Sexually transmitted infections, calculi or stones in the seminal vesicles, damage to the pelvic nerves, inflammation of prostate, prostate cancer, benign prostatic hyperplasia, prostate surgery, pelvic radiation, a previous history of hernia repair or rectal intercourse and certain medications such as antidepressants have all been associated with dysorgamia. 

Psychological issues may also be the cause of painful ejaculations, especially if the patient does not experience this problem during masturbation. Other rarer causes include heavy metal or mercury toxicity or ciguatera toxin fish poisoning.
Also read: 7 Common Causes For Painful Ejaculation

Evaluation

Just with all types of sexual problems, the doctor will start with a thorough medical and sexual history. A history regarding sexually transmitted diseases, relationship issues, psychological or psychiatric issues and drug intake will be taken. The doctor will also be keen to assess any urinary symptoms, prostatic diseases, familial prostate cancer, previous surgical procedures (e.g., hernia repair or prostatectomy) and previous history of radiotherapy. 

Your doctor may do a prostate exam to look for any pain, swelling or nodules which may indicate a prostate pathology. A neurological and musculoskeletal examination may detect a nervous system pathology.

Investigations your doctor might do include a urine or semen culture looking for any infections, especially with sexually transmitted infections. Blood tests for prostate specific antigen (PSA) levels may be raised if it is a prostate issue. Ultrasound scans may also be ordered. No obvious pathology is detected in a significant number of patients. 

Treatment options

Treatment of painful ejaculation should be directed at managing the underlying cause if there is one. 

If an infection is detected, antibiotics will be given. Urological procedures may be done for prostate growth or cancers. If drugs are a suspected cause, changing the medications or stopping it can be considered. Your doctor may prescribe medical treatment such as muscle relaxants, α-blockers, anti-inflammatory agents, certain types of antidepressants and neuropathic pain medications to alleviate the symptoms. Psychotherapy or relationship counselling should be conducted for patients with an underlying psychological issue. Behavioural therapies and pelvic floor exercises have also shown to be helpful. Extracorporeal shockwave therapy (ESWT) can be done for pelvic pain and dysorgasmia which can also alleviate the pain.

If you do experience pain during ejaculation, it is important to seek medical attention and treatment to rule out serious causes and before this issue impairs your sexual function and quality of life. 

Next read: Dysuria (Painful Urination)

Also on this site: hiv test, pep hiv, std test singapore


Dysuria (Painful Urination)

What is Dysuria (Painful Urination)?

Dysuria is the sensation of pain, burning, or discomfort on urination. The pain may be in the lower part of the abdomen, along the length of the penis in males or at the urethral opening in females. It is a symptom which can be due to many different conditions. 


Causes of Dysuria (Painful Urination)

The most common cause of acute dysuria is infection, especially cystitis (infection of the bladder). Other infectious causes include urethritis (infection of the urinary tube) and vaginitis (infection of the vaginal canal). Infections of the prostate may also cause dysuria. These can be due to sexually transmitted infections (STI) or non-STI infections. 

Non-infectious causes can include a foreign body in the urinary tract, certain medication use, urinary tube anatomic abnormalities, trauma, and bladder pain syndrome. Certain autoimmune and psychogenic conditions can cause dysuria as well. 

Dysuria may be accompanied by other symptoms including urinary frequency and urgency, vaginal or penile discharge, pain during sexual intercourse, foul-smelling or blood stained urine, fever and swollen groin lymph nodes.  


Evaluation

The doctor will usually start off with taking a history and performing a physical examination. Crucially, the doctor will also order up some urine tests to be done. These tests can usually tell us the exact organism that is causing the infection. Depending on what the doctor might suspect, other investigations such as radiological investigations (x-rays, ultrasounds or CT scans) and blood tests may be done. If necessary, a urologist may do a scope of the bladder (cystoscopy) as well.


Treatment for Painful Urination

Most of the time, the reason is usually due to a bacterial infection of the urinary tract. For bacterial infections, antibiotics are given to kill off the infection. The type and duration of antibiotics depends on the type of bacteria. Antibiotics in the form of an injection may be given as well. 

If the cause of dysuria is due to a STI, it is imperative that we ensure the bacteria is eliminated completely, and that your sexual partners are tested and treated as well. It is also recommended to screen for other STIs. 

Other symptomatic treatment for dysuria can include medications to ease the discomfort on urination or the other symptoms like urinary frequency and urgency. While these medications do not clear the bacteria by itself, when used in conjunction with the antibiotics, they can provide much needed relief for symptoms that can otherwise be very uncomfortable.

If you do experience dysuria, do not hesitate and seek medical attention and treatment early.

Next read: Vaginal Piercings

Also on this site: hiv test, pep hiv, std test singapore


Vaginal Piercings

Female Genital Piercings

What are some different types of genital piercings in females?

Curious about genital piercings?

While the location may seem unusual to some, people still do opt for genital piercings either to enhance sexual pleasure or for ornamental purposes. 

“Vaginal” or “clitoral” piercings are actually misnomers; piercings are most commonly located around the clitoral hood or labia (majora/minora).

  1. Vertical clitoral hood (VCH) – a vertical piercing done through the skin above the glans of the clitoris and rests on top of the glans. This is often done to enhance sexual pleasure for the female as the piercing jewellery places pressure on the clitoris during sexual activity 
  2. Horizontal clitoral hood (HCH) – a horizontal piercing done through the skin above the glans of the clitoris. This is usually more ornamental as it does not come into contact with the clitoris and thus does not provide any sexual stimulation
  3. Triangle – a horizontal piercing that is done through the skin beneath the base of the clitoral hood and rests under the clitoral shaft 
  4. Princess Diana – similar to a VCH but it is done to one side rather than in the centre of the clitoral hood 
  5. Clitoral piercing – actual piercing of the clitoris itself is not so common as it comes with risks of pain and nerve damage 
  6. Labial piercings – either the labia majora or labia minora can be pierced
  7. Fourchette piercing – a vertical piercing through the skin of the perineum (between the vaginal entrance and the anus) 
  8. Christina – a surface piercing through the mons pubis and is purely decorative 

Do they provide any sexual benefits for both partners?

Not all female genital piercings help with sexual pleasure but for those which do (e.g. the VCH, triangle), the female will enjoy more physical stimulation from the piercing than her male partner will. Piercings such as the VCH or triangle, which place pressure on or come into contact with the clitoris, contribute to clitoral stimulation during foreplay or intercourse, increasing sexual pleasure for the woman. 

Fourchette piercings may be felt by your male partner during penetrative vaginal intercourse. 

What are the risks that come with female genital piercings?

The usual risks associated with any piercings apply, such as the risk of blood borne infections if correct sterile standards are not observed, as well as risk of piercing infection which could potentially lead to scarring. Botched piercings where the clitoris is pierced instead of the clitoral hood alone can cause significant pain and nerve damage. 

During the healing process, the piercing is essentially an open wound and you would be at increased risk of sexually transmitted diseases (STDs) so using condoms during this period is important. 

Are female genital piercings painful?

Female genital piercings are not quite as painful as one would imagine. While the perceived pain level is bound to differ between individuals depending on your pain threshold, it is generally accepted that the pain level is similar to piercings elsewhere. This is because the piercing is actually done through the skin (e.g. the clitoral hood rather than the clitoris itself).

During the healing period, using condoms is a must as contact with your partner’s body fluids (genital fluids or saliva) places you at great risk of infection. 

How long does it take for the piercing wound to heal?

Healing time for female genital piercings generally ranges between weeks to months. VCH, HCH and Princess Diana piercings heal between 4-8 weeks, while triangle piercings may take 3-4 months. Christina piercings take upward of 6 months for healing. 

Will the piercing hole close if I remove the piercing jewellery?

Fresh genital piercings close extremely quickly once you remove the piercing jewellery. For healed piercings, the duration they remain open can vary and depends on how long or well healed the piercings have been for. It is generally accepted that even well healed piercings may close within days. 

Also read: Penile Piercings

Also on this site: hiv test, pep hiv, std test singapore


Common STD Incubation Periods

STD Incubation Period. The incubation period for the various STIs (Sexually Transmitted Infections) is a common question asked by patients in our clinics. It refers to the time between acquiring the infection and the presentation of symptoms. This is different from the window period, which refers to the period after infection in which no current available tests are sensitive enough to detect the infection. The window period for the various STIs depends on which tests are used. 

As different STIs have different incubation periods, it is not easy to answer the question when symptoms will appear after a particular risky exposure. I will list below the common STIs tested for, their incubation and window period as well as possible initial presentation. 


The following are the Common STDs and their incubating periods:

#1 STD Incubation Period – Human Immunodeficiency Virus (HIV)

Early HIV infection refers to approximately 6 months after initial acquisition. It is estimated that 10 to 60 percent of all early HIV infections are asymptomatic, or without any symptoms. For early symptomatic HIV infection, the usual incubation period is around 2 to 4 weeks, although incubation periods as long as 10 months have been observed.

Acute symptomatic HIV infection present with a collection of signs and symptoms known as Acute Retroviral Syndrome (ARS). The most common findings for ARS are fever, sore throat, rash, swollen lymph nodes, body aches and pains. However, all these symptoms are not specific to acute HIV infection, hence please do not panic if you observe these symptoms after a risky encounter. See your doctor for further advice and testing

The Window period for HIV testing depends on the test that is conducted. The initially 10 days after exposure is known as the eclipse period, for which there are no tests that can pick up any infection. The earliest tests that can be done with conclusive results are the HIV ProViral DNA test or the HIV RNA PCR test, which can pick up possible acute infections 10 days after exposure.

4th Generation HIV tests will be conclusive around 28 days after exposure, while 3rd Generation HIV tests will be conclusive around 90 days after exposure. 

Anonymous HIV Testing is available at our Robertson Walk Branch. HIV Test results in 20 mins.


#2 STD Incubation Period – Syphilis

Approximately 50% of patients diagnosed with syphilis do not have any symptoms. This is because syphilis has 3 stages of infection: Primary, Secondary and Tertiary Syphilis and Primary and Secondary syphilis might have symptoms that are so mild that they are ignored by the patient.

Primary syphilis presents with a painless ulcer on the genitalia, known as a chancre. The incubation period for a chancre appears to range from 3 to 90 days, with an average of around 21 days. The chancre will heal within 3 to 6 weeks even without treatment. Within weeks to a few months after the chancre appears, around 25 percent of untreated individuals will develop Secondary Syphilis.

Secondary Syphilis can present with a widespread rash, ulcers, patchy hair loss, swollen lymph nodes, weight loss and fatigue. The infection subsequently goes into a latent phase lasting for years for which there are no signs or symptoms. This is the reason why the majority of syphilis picked up on routine screening are asymptomatic.

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. 

The window period for syphilis testing depends on the stage of syphilis infection. The blood tests (FTA-ABS and TPPA) will be positive around 1 to 2 weeks after chancre formation. 


#3 STD Incubation Period – Hepatitis B and C

The majority of hepatitis B and C infection are asymptomatic. It has been estimated that around 30 percent of acute hepatitis B infection and less than 25 percent of acute hepatitis C infection are symptomatic. Symptoms of acute infection tend to be very mild and may include the following: Fever, Fatigue, Nausea/vomiting, Dark Urine, Pale stools and abdominal pain. 

The incubation for acute hepatitis B infection is estimated to be around 1 month to 4 month, while the incubation period for acute hepatitis C infection is estimated to be from 2 weeks to 3 months.

The window period for both hepatitis B and C testing for antibodies is on the average about a month. It will be much shorter if alternate tests such as the Hepatitis C RNA PCR test for Hepatitis B Viral Load are used instead.


#4 STD Incubation Period – Genital Herpes

Genital herpes is caused by both Herpes Simplex Virus 1 or 2 (HSV1/2). Genital herpes infections often do not have symptoms or mild symptoms that go unrecognized. It is estimated that one third of patients with new infections do not have symptoms. The initial presentation of symptoms range from severe with painful genitalia ulcers, painful urination, painful lymph node swellings and fever. However, patients also can have mild or no symptoms as well. The initial presentation does not depends on the type of virus (HSV1 vs HSV2)

The incubation period for genital herpes is around 4 days, with a range from 2 days to 12 days.

For asymptomatic infections, HSV 1/2 Antibodies will start appearing in the serum starting from 3 weeks and majority of patients would have antibodies by 16 weeks. The window period for testing for asymptomatic patients is hence from 3 weeks to 16 weeks. For patients with symptoms of the painful genital ulcers, the test of choice is Nucleic Acid Amplification Testing (NAAT) for which a swab of the ulcer is taken and tested for HSV DNA. There is no window period for NAAT.

Rapid Herpes Testing with Next Day Results is available in all DTAP Clinic in Singapore.


#5 STD Incubation Period – Gonorrhea

Gonorrhea causes different symptoms for men and women. For women, the cervix is the most common site of infection and the common symptoms are vaginal itch and discharge. Some women also have heavier periods or bleeding in-between periods. If the infection has ascended beyond the cervix into the uterus, this is a potentially more dangerous condition known as Pelvic Inflammatory Disease (PID) for which abdomen pain and fever are common symptoms. Up to 70 percent of patients with cervical gonorrhea infection are asymptomatic. 

For men, urethritis is the most common presentation of gonorrhea infections. It is characterised by purulent urethral discharge and painful urination. In contrast to infections in women, the majority of infections in men are symptomatic. 

In women, the incubation period for genital infection is around 10 days. In men, the incubation period for symptomatic infected men is around 2 to 5 days, with 90 percent of these individuals with symptoms of urethritis by 2 weeks.  

The gold standard for testing for gonorrhea infection is NAAT, a urine sample for men and a cervical swab for women. As NAAT is able to detect low numbers of organisms with good accuracy, there is no window period for NAAT testing.

Rapid Gonorrhea & Chlamydia Testing with Next Day Results is available in all DTAP Clinic in Singapore.


#6 STD Incubation Period – Chlamydia

Chlamydia causes similar symptoms as gonorrhea in both men and women. In women, the cervix is also the most common site of infection with a proportion of patients having a urethra infection as well. However the majority of infected women, around 85 percent of patients are asymptomatic with neither signs or symptoms.

Symptoms of chlamydia infection are similar to gonorrhea in men as well, with a clear to mucoid penile discharge and painful urination. The proportion of asymptomatic infection varies as well in men, ranging from 40 to 96 percent with no symptoms. 

The incubation period for symptomatic infection ranges from 5 to 14 days after exposure for both men and women.

The gold testing for testing for chlamydia infection is NAAT as well. There is no window period for NAAT testing.

Rapid Gonorrhea & Chlamydia Testing with Next Day Results is available in all DTAP Clinic in Singapore.


Asymptomatic/Mild Infections (%)Incubation PeriodSample TypesWindow Period
HIV10 to 602 to 4 weeksBloodProviral DNA : 10 days
RNA PCR : 12 days
4th Generation Ag/Ab :28 days
3rd Generation Ag : 90 days
Syphilis503 to 90 days
Average 21 days
BloodFTA-ABS : 1 to 2 weeks after chancre
Hepatitis BMajority Asymptomatic1 month to 4 monthBloodHbsAg : 1 month
Hepatitis CMajority Asymptomatic2 weeks to 3 monthBloodAnti-HCV Ab : 1 month
Herpes702 to 12 days
Average 4 days
Blood/
Swab
HSV 1/2 IgG : 3 to 16 weeks
HSV DNA PCR : No window period
GonorrheaWomen: 70
Men: Majority Symptomatic
Women:10 days
Men: 2 to 5 days
Swab/
Urine
Gonorrhea DNA PCR: No window period
ChlamydiaMajority Asymptomatic5 to 14 daysSwab/
Urine
Chlamydia DNA PCR: No window period

If you like to speak to our doctors on your STD concern, please visit any of our clinics in Singapore & Malaysia.

You can also email us at hello@dtapclinic.com, or call any of our clinics for an appointment

Also on this site: HIV Screening, HIV Test Clinic Singapore, STD Clinic Singapore


Penile Discharge – Video

Penile discharge

Penile discharge is any substance (other than urine) that comes from the urinary tube, also known as the urethra.

Normal discharge includes pre-ejaculate, or pre-cum, and semen ejaculate. These are usually produced during sexual stimulation.

Abnormal discharge can range from clear to pus-like and usually produced in the presence of an infection. In males, the infection is usually due to a sexually transmitted infection.

This may be accompanied by symptoms such as pain on the passing of urine, ulcers, urinary frequency and urgency.

The most common 2 causatives STI organisms are Chlamydia and Gonorrhea, but there are a variety of other microorganisms that can cause similar symptoms. Read more: STD symtopms

Non-STI organisms that cause urinary tract infections can also present with discharge. These are usually accompanied by urinary frequency, urinary urgency and foul-smelling or cloudy urine.

Similar organisms may infect the prostate causing prostatitis which may present with discharge, fever, urinary symptoms, pelvic pain and even blood in the semen.

If there has been any instrumentation of the urethra, for example with a catheter or after a procedure at the urologist, a discharge may also be produced due to the trauma.

Balanitis

Balanitis is inflammation of the foreskin and head of the penis that can cause some discharge under the foreskin. It may present with a rash, itching or pain, a foul smell and ulcers. The inflammation may be due to infections or irritation. While it is not a true penile discharge as it does not come out of the urethra, it may be confused with true penile discharge by some people.

If you do not clean your foreskin and head of the penis regularly, a layer of dead cells and sebum may build up. This is known as smegma and may also be confused with true penile discharge. While this is not harmful, it is advised to wash this area properly so smegma does not build up as a dirty head of the penis predisposes you to balanitis.

If you do have any of the symptoms that we have mentioned, please visit us at DTAP clinic so we can evaluate your condition.

Dengue in the era of COVID

While the current COVID-19 pandemic continues to capture all our attention, an arguably more deadly disease which has always been endemic in Singapore continues to wreak its havoc. Often hiding behind the symptoms of COVID-19. This is dengue.

Dengue has been endemic in our shores for as long as our history. As recent as 2019, 15,998 cases of dengue were reported and a total of 20 people died from it. As frightening as these numbers may be, they pale in comparison to the situation developing this year. We are halfway through the year and already the National Environment agency has reported a cumulative total of 12,539 cases of dengue and 12 people have succumbed to the disease. 1,375 cases of dengue were reported in the week ending 20th June. That is almost 200 cases of dengue every single day. The most number of dengue cases ever reported in Singapore was 22,170 cases in 2013 and 2020 looks well placed to break this unenviable record. 


To make matters worse, as we enter the warmer months of the year, the breeding and maturation cycle of the Aedes mosquito accelerates. This means they will reproduce faster resulting in an increase in the number of insect vectors that transmit dengue. In addition, due to the shift in the strain the risk of dengue haemorrhagic fever, the deadly form of dengue, is higher as cross-immunity to different strains are only partial.

It is difficult for doctors to differentiate between the 2 diseases. Dengue and COVID-19 share many similar symptoms for example fever, muscle aches, cough, sore throat and running nose. Given the attention currently heaped on COVID-19, both the patient as well as the physician have to consciously maintain a high level of suspicion for dengue and not be swept up by the publicity.


“As long as it is not COVID” – is not OK. Furthermore, it is absolutely possible that a patient is suffering from both dengue and COVID-19 simultaneously making it even more challenging for a doctor to diagnose. As if all these were not bad enough, a final complication exists which is the blood tests for dengue are not always accurate. This was very well illustrated by a local case report of a patient who presented to his doctor with fever and muscle aches and subsequently tested positive on a dengue test. On further testing, the patient was eventually diagnosed with COVID-19 and it was discovered his initial dengue test was falsely positive. Other supporting blood tests like platelet counts and liver function tests can also show the same abnormalities in both patients who suffer from dengue and patients who suffer from COVID-19 so are also rather unhelpful.


Dengue is not spread from person to person like COVID-19. A mosquito stings a person with dengue and sucks the dengue parasite along with the blood from its victim into itself. Mosquitos do not fall sick from dengue. They fly along to another person and while stinging them, transmits the dengue virus. This means that while social distancing can protect us from COVID-19, it does nothing to protect us from dengue. Dengue can be spread as far as the mosquito can fly. 


The COVID-19 pandemic has created an almost perfect storm for dengue to spread. Just like COVID-19, there is currently no effective way to cure dengue. And just like COVID-19 the solution to the pandemic is to stop its spread. To stop the spread of dengue, we need to stop mosquitoes from breeding. This is where we all have to play our part. As much as we would like to blame the empty construction yards, the reality is it is homes that form the bulk of mosquito breeding grounds. In a single dengue cluster in Singapore, 84% of homes were found to be breeding Aedes mosquitoes. It is up to every one of us to ensure that our homes as well as common areas do not serve as breeding grounds for mosquitoes.

Quote from NEA:

Homeowners and occupants are strongly urged to do their part and pay close attention to any mosquito breeding or adult mosquitoes present in their homes, take the necessary steps to prevent or remove them, and protect themselves from mosquitos’ bites.

These include:

  1. Regularly doing the Mozzie Wipeout and removing any stagnant water in homes;
     
    • Turn the pail
    • Tip the vase
    • Flip the flower pot plate
    • Loosen the hardened soil
    • Clear the roof gutter and drains within compounds, and place Bacillus thuringiensis israelensis (Bti) insecticide inside
  2. Spraying insecticide at dark corners of the home, for example under the sofa and bed, behind the curtains and in the toilets
  3.  Applying mosquito repellent to protect themselves from mosquito bites
  4. Using mosquito screens
  5. Using spatial mosquito repellent (e.g. mosquito coil) in well-ventilated areas of the home.

NEA has published two educational videos to guide residents on the spraying of aerosol insecticide at home , and what to do if one lives in a dengue cluster area or sees mosquitoes at home.

Rapid COVID-19 Testing is available.

Dengue Vaccination – Is it suitable for you?


Next read: FAQS ON THE NOVEL CORONAVIRUS (2019-NCOV)

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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


Penile Piercings

Common types of penile piercings.

Penile piercing is a general term and there are actually many different ways and styles a man can get a piercing on his manhood.

Apadravya: This is a piercing that passes through the glans vertically. It can go from top to bottom or vice versa.

Ampallang: This piercing goes through the glans horizontally. It can go from left to right or vice versa.

Deep shaft: This piercing goes through the penile shaft. It can be pierced like Apadravya or Ampallang and goes through the shaft.

Dydoe/king’s crown: This piercing passes through the ridge or corona of the glans and on to the head of the penis itself. It usually comes in pairs.

Foreskin: This piercing is done through the foreskin of an uncircumcised penis. It is equivalent to a clitoral hood piercing in females.

Frenum: Frenulum is the skin that attaches the foreskin to the head of the penis. A frenum piercing is one that goes through the frenulum horizontally.

Guiche (perineum): This piercing is on the perineum. Perineum is the area between the anus and the scrotum.

Hafada (scrotal): This is a surface piercing done anywhere on the scrotal skin. It does not penetrate deep into the scrotum.

Lorum: This piercing is done horizontally on the underside of the penis at its base.The position is where the scrotum meets the penis.

Magic cross: This piercing is basically an Ampallang and Apadryava combined together. Making it appear like a cross.

Prince Albert: This is one of the most popular penile piercings. It is a ring type of piercing that goes along the underside of the glans from the urethral opening to the part where the glans meet the shaft of the penis.

Pubic: consists of a piece of jewelry through any part of the area around the base of the penis

Reverse PA: the opposite of Prince Albert, with jewelry entering the urethra and exiting through the top of the shaft



Sexual benefits to penile piercings

  • Some men chose piercings to enhance sexual pleasure for him and or the partner. It can increase pleasure during masturbation or sexual intercourse
  • Depending on the type of piercing, some can stimulate the partner more than others. Especially during vaginal or anal intercourse.


Risks associated with penile piercings

  • Increased risk of UTI (Urinary tract infections)
  • Infection at piercing site.
  • Increased risk of STI
  • Injuring your partner’s genitals during intercourse.

Common signs & symptoms of STIs

Genital piercings are getting more exposure and interest nowadays. Before you decide to get one I suggest you make the necessary research before deciding. When choosing to pierce, I would suggest going to a reputable body piercing specialist. One who has experience and also maintains high standards of cleanliness and hygiene. I highly discourage you from doing it on your own. It’s definitely an acquired taste, so make sure you make the right decision.

Next read: Vaginal Piercings

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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

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crabs stds

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