DTAP Clinic Receives Sensitivity Training for Working with LGBT+ Patients

Singapore, date – Regional GP+ group DTAP Clinic recently attended its first sensitivity training on working with LGBT+ patients. The online training workshop was conducted by Oogachaga and the T Project, attended by more than 60 doctors, nurses and support staff from Singapore and Malaysia. The responses from the workshop participants were positive and encouraging. 

The training focused on debunking common myths and assumptions as well as teaching good communication techniques for medical professionals in clinical and support scenarios when treating and consulting for LGBT+ patients. Response from the workshop participants was positive and encouraging. 

Better doctor-patient communication with the LGBT+ community

Mr. Leow Yangfa, a registered social worker and executive director of Oogachaga kicked off the training with the first session addressing various commonly held misconceptions and misheld beliefs regarding LGB individuals. He shared with DTAP Clinic’s professionals Oogachaga’s professional expertise and experience when working with Singapore’s LGBTQ+ community. The group commended DTAP Clinic as a valued and important private healthcare provider for many LGBTQ+ individuals, couples and families in the community.

“All our DTAP Clinics have always been committed to providing a safe space for everyone, regardless of race, religion, gender or orientation. Our ethos is to comfort, reassure and treat every patient with a uniformly high standard of care. We are extremely happy to have undergone this training with Oogachaga and the T Project. All of us learned a great deal and truly enjoyed the course”. 

Facts and Bad Assumptions

The second part of the training was conducted by Mr Keeshan Menon, a registered social worker with post-graduate credentials in social work and psychology, and Ms. June Chua, founder of the T Project. Their talk provided key insights into the concept of the continuum of sexuality and the pitfalls of making assumptions. The session was enlivened with positive engagement with questions from the audience and answers from panel. 

“I found this course really useful. Now I understand how certain things I may unintentionally say can be misunderstood by patients. I am more aware on how best to talk to patients and colleagues,” said Joel Wong, a staff from DTAP Clinic.

Aside from empowering all DTAP Clinic staff with the skills to put LGBT+ patients at ease, the course also helped with DTAP Clinics’ internal engagement and communication. The staff and doctors felt more confident and aware of using socially accepted terms and vocabulary when communicating with each other with regards to patient care, avoiding pitfalls when communicating with colleagues, especially with DTAP’s stand on equal opportunity employment. 

About DTAP clinic

Established in 2005, DTAP (Dr. Tan & Partners) clinics, a pioneer of GP plus, or “General Practice with Special Interest” model in Singapore, provides holistic and comprehensive medical care for everyone. We provide basic GP services with a key focus in HIV & STD testing and management, Men’s Health (Andrology), Women’s Health and Chronic Disease Management services. Our clinics are located in Singapore & Malaysia.

10 Things about HPV (Video)

HPV stands for human papillomavirus. HPV is usually harmless and goes away by itself, but some types can lead to cancer or genital warts.

 Here are 10 things about HPV.

1. HPV is incredibly common.

and It is estimated that 8 out of 10 people will get HPV at some point in their lifetime


2. Next… How is HPV spread?

HPV is one of the most common STI and is spread through genital or skin-to-skin contact. The virus can be spread even when no symptoms are evident.


3. The third point is that HPV doesn’t necessarily stay with you forever.

Patients commonly assume that HPV is a lifelong infection that will stay with them always. Most HPV infections clear up on their own and do not cause any problems. However, overtime persistent infection by certain HPV types can cause cancer and other diseases such as warts.


4. There are many strains of the virus.

HPV is not just one virus, but consists of over hundreds straina . Each virus is labeled with a number to distinguish it from the others, and different viruses can target different areas of the body, causing differentdiseases in humans.

HPV is most commonly associated with a risk for certain cancers, including cervical cancer, or oral cancers which involves, the base of the tongue or tonsils. 


5. Next in Cervical cancer

HPV causes more than 99% of cervical cancer cases and Approximately 400 new cervical cancer cases are diagnosed annually in Singapore.  

Cervical cancer ranks* as the 8th leading cause of female cancer in Singapore.


6. In Detection of HPV

A pap smear test is a cervical cancer screening tool that is commonly use to detect cervical cancer or pre-cancerous changes in the cervix.

A more sensitive test like the HPV DNA test can be used to detect certain high risk strains of HPV that can lead to cervical cancer


7. HPV in Men

Men can get HPV and pass it to their partners. HPV has been shown to increase the risk of anal cancer, penile cancer , oral and throat cancers in men.


8. There Is Also a Vaccine that Can Protect You

The HPV vaccine has been shown to be highly effective in protecting people against cervical cancer and warts..

Individuals already infected with HPV should still get vaccinated because the vaccine may protect against additional strains of hpv. However, for maximum benefit, vaccination should occur before an individual becomes exposed to the virus.

Thus it is recommended for preteens to get the vaccine at an early age.

Recently the US Food and Drug Administration expanded its approval of the HPV vaccine to include men and women up to 45 years old As an effort to protect more people from several types of cancer caused by HPV.


9. After HPV Vaccination…

Women should continue to get regular Pap screenings because the vaccine though reduces risk of cervical cancer, does not protect against all HPV types.


10. To Sum Up HPV

The best thing you can do is stay proactive and look after your well-being.

“HPV is something both women and men should be aware and well-informed about, protecting yourself and your loved ones,”

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CD4 Count VS Viral Load – What do you need to know?

The Immune system is made up of a large network of cells that work together to combat infections. Helper T Lymphocytes are a particular type of immune cell that expresses a molecule called the Cluster Determinant 4 (CD4). Helper T lymphocytes are hence commonly known as CD4 cells. The Human Immunodeficiency Virus (HIV) selectively targets CD 4 cells and uses them as hosts for viral replication. As the virus replicates, it destroys its host cell as it releases new copies of the virus. Therefore, as the viral load (which is a measure of the amount of virus present in the body) increases and the host CD 4 cells will decrease. 

HIV Pro Viral DNA Test

HIV Infection

During the early stages of a HIV infection, viral replication occurs at a very fast rate at the expense of CD 4 host cells. A vicious cycle occurs, wherein an increase in HIV viral load attracts more CD4 cells which get infected and become hosts to further increase the viral load. Within the first few weeks of a HIV infection, the CD 4 count falls precipitously. Such a sharp fall in CD4 cells is the hallmark of a HIV infection. 

Upon diagnosis of HIV, it is crucial that the patient’s CD 4 and viral load are measured. The CD 4 count allows the medical team to determine the state of the immune system and plan the appropriate treatment. If the CD 4 count is below 200 units, the diagnosis of Acquired Immunodeficiency Syndrome (AIDS) is established. AIDS is a serious complication of HIV infection and can be fatal, therefore, if the patient is diagnosed with AIDS he/she requires immediate medical attention in a hospital.The viral load will give an indication of how fast the virus is replicating. Current medication used to treat HIV infection targets different parts of  viral replication and interfere in the process of new viruses being produced. Therefore, a fall in viral load after commencing medication is an indicator that the medication is working. 

People Living With HIV

For People Living with HIV (PLHIV), the main goal of therapy is to increase CD4 cell numbers and decrease the viral load to an undetectable level. Monitoring these 2 parameters will guide the treatment regime. In general viral load is measured 2 weeks after starting medications for HIV, then at 4 to 8 week intervals. The expected fall in viral load should be to approximately < 500 copies/ml by week 8 – 16 and < 50 copies /ml by week 16- 24. CD 4 recovery is slower, the first CD4 test is done 3 months after commencing treatment and every 6 months after. In general, a CD 4 count > 300 cell/uL with a low viral load is a good level to ensure that PLHIV does not encounter any opportunistic infections.

Also read: U=U: Science, Not Stigma

CD 4 and Viral load measurements are essential parameters in guiding the medical therapy for PLHIV. Regular check of these parameters ensure that PLHIV are able to maintain an active lifestyle and avoid any infections that may occur due to a lowered immunity.

HIV Screening Singapore


Detox Teas – Do They Work?

Detox teas are a controversial topic. For thousands of years, humans have been trying to rid their bodies of what they believe are toxins. Some historic “detox” practices include bloodletting, enemas, sweat lodges or saunas, fasting, and drinking herbal preparations. Some of these practices were even accepted as medical treatments before the advent of modern medicine. In the age of social media, you might have seen celebrities or even your friends posing with a pack of detox-tea on Facebook or on Instagram.

Detox teas are usually a mixture of tea leaves and other natural ingredients like berries, fruits, spices, herbs and roots.


Do detox teas actually help to detox the body?

Tea is generally considered healthy. Multiple studies over the years have shown an association with tea and health benefits including cardiovascular health, blood pressure regulation, mood regulation, mental performance and maintenance of weight and energy levels too. Tea contains tea flavonoids, polyphenols, in particular catechins and epicatechins and antioxidants which health benefits are still being studied and validated. Whether or not teas slapped with a detox label does what it actually says – remove toxins – is still very debatable. 

The additional natural ingredients may also have health benefits. Many ingredients of traditional medicine are currently being investigated scientifically, and some of them have been shown to have health benefits. 


Real weight loss or just a loss in water weight? 

Most of these detox teas do contain tea leaves, and tea does have caffeine. Caffeine is known to be a stimulant which can raise your metabolism. Caffeine can also act to suppress your appetite. Through such a mechanism, you might enter a caloric deficit by burning more calories, and eating less. This kind of weight loss is true weight loss. 

However, certain detox teas do contain supplements which act like laxatives, or medical laxatives itself. The effect of these laxatives are claimed as colon cleansing, which is often recommended as part of a detox plan. Such laxatives can cause cramping, bloating, nausea and vomiting. Dehydration and electrolyte loss can also be a concern. Such a weight loss is mainly water weight loss, and is not healthy, nor sustainable. 


Side effects or dangers of detox teas?

The detox teas that are conservative mixes of tea leaves and natural products are usually not more dangerous than regular teas. However some detox teas may include, in large amounts, natural products that have a prominent biological effect on our body. Some brands may also have additional chemical ingredients that could harm your health.

As mentioned above, diarrhea could be a side effect of these teas. These may be from the laxative effect of natural plant-based sennosides, or actual laxative medications. Excessive diarrhea can lead to dehydration and electrolyte loss, which may leave you lethargic and weak. Some compounds, including caffeine, are also diuretic, which can cause you to pass more urine than normal. Severe diarrhea and dehydration has led to death, so this is a side effect of concern. 

Appetite suppressants or stimulants like caffeine are commonly found in detox teas. Ingesting too many stimulants may leave you irritable, unfocused and jittery, similar to when you drink too much energy drinks. You may also suffer from insomnia if these teas are taken too late in the day. Illegal stimulants like ephedra and medications such as ephedrine have been found in detox teas. These may trigger heart attacks, strokes, seizures and cause even death, especially in people with pre-existing medical conditions. 

Diabetic medications that lower your blood sugar level have been found inside detox teas. People who are on detox teas may also be eating less, contributing to a lower blood sugar level. Such a situation can lead to hypoglycemia, where the sugar level in your blood is dangerously low. This can lead to sweating, confusion, shaking, loss of consciousness and even death.

Some of the herbs that are inside detox teas may have drug-drug interactions with the medications that people are currently taking, raising the levels of the medication in your body to toxic levels. Some herbs themselves if ingested in large enough quantities, may also put strain on your kidney and liver. This has the opposite of detoxing your body, poisoning your body instead. 


Are there any benefits to detox teas?

Not all detox teas are harmful. Tea itself does have health benefits. The other natural ingredients (in conservative amounts) may also serve to improve your health. But please use it with caution and moderation. These teas, if used, should be incorporated into a healthier lifestyle.


Is it healthy to consume detox teas long-term?

The manufacturers themselves do not recommend taking detox teas in the long run. If you do decide to try out a detox tea, stick to the recommended serving guide, and be vigilant about any side effects that may occur. If these side effects are causing you any discomfort, it is recommended that you stop. 


What are some recommendations for detoxing the body in place of consuming detox teas?

The human body is more than capable of clearing out waste products for the vast majority of us. This is what our bodies have evolved to do to keep us alive. Our kidneys, liver, cardiovascular system, gut and skin are all working hard every day to process all of the substances that we come in contact with, and they do a good job at it. The best thing to do is to not add additional burden to the body. 

The very fact that you are considering a detox tea means that you are willing to do something to change your lifestyle for the better. Use this motivation to kick start good habits. The detox tea can be the spearhead in the charge to a better you. 

Also read: Weight Loss Treatment

An overall healthy and balanced diet with whole grains, fish, fruits and vegetables, and less red and processed meat is a key component to a healthy life. Processed foods have been shown to be poor in nutrition, laden with salt and fat and contribute to obesity and cardiovascular disease. Unprocessed and minimally processed foods on the other hand are packed full of nutrition, keeps you full for longer and is essential for your bodily functions. Try and limit the frequency and amount of processed foods to a minimum.

Physical activity and exercise is just as important as the quantity and quality of food. The Health Promotion Board of Singapore recommends 150 minutes of moderate intensity, or 75 minutes of vigorous intensity physical activity a week. Health benefits of regular physical activity include a 20 – 50% reduced risk of premature death, incidence of coronary heart disease, type 2 diabetes, depression, stroke, high blood pressure, colon cancer and breast cancer, to name just a few. If you are just starting to get into more physical activity, it is always advisable to start slow and ramp up your physical activity slowly. This will help minimize musculoskeletal injuries. The lack of time should not be an excuse to pass on both healthier food options and exercise

It is also advisable to drink lots of water. Water makes up about 60% of our body weight and is essential for our survival. Water gets rid of wastes through urination, perspiration and bowel movements. It keeps your temperature normal, lubricates and cushions joints, protects organs and tissues and maintains the electrolyte balance in our body to name just a few. This is the form of detox that definitely has no opponents. 

Getting enough sleep every night is essential as sleep plays a vital role in good health and well-being throughout your life. Getting enough quality sleep at the right times can help protect your mental health, physical health and quality of life. Sleep is the time where the body and brain heals itself and recharges for the next day. Sleep deprivation has been shown to be associated with chronic diseases, decreased mental and physical performance and even reduced immune function. 

Just remember that there are no shortcuts to a healthy lifestyle. That however should not stop you from living the best life. 

Join our Telegram for medical news and health tips: https://t.me/dtapclinic

*Parts of this article were first published in CLEO.

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