ESWT Treatment For Elbow Pain

Watch as Dr Edwin Ong, Resident Doctor, Dr Tan & Partners (DTAP clinic) talks about ESWT, Extracorporeal Shock Wave Therapy,  as an effective treatment for elbow pain. Shock Wave therapy is a safe, quick and non-invasive treatment using energy from sound waves to activate the self healing properties of the body and accelerate the recovery process.

Common causes of Elbow Pain:

Tennis elbow, or lateral epicondylitis, is a painful condition which affects the tendons that attach to the outside of the elbow.

Golfer’s elbow, or medial epicondylitis, is a similar condition affecting the inside of the elbow instead. Tennis elbow is much more common than golfer’s elbow. Despite their names, these injuries can occur in people who overuse their wrists and arms through repeated motions and do not affect just tennis players and golfers only.


Shockwave Therapy: 

  1. Firstly, through a process known as cavitation, Shock Wave therapy stimulates the production of fibroblasts and tenocytes. These are the cells responsible for the healing of connective tissues such as tendons. The end result is tissue regeneration.
  2. Secondly, the Shock Waves stimulate microscopic circulation and therefore metabolism within the treatment area, which promotes healing and the breakdown of calcification deposits, also known as spurs.
  3. Lastly, Shock Wave therapy diminishes pain by over-stimulation of the nerves that send pain signals to the brain.

To conduct the treatment for elbow pain, we place the treatment probe over the affected area and deliver the required number of shocks. The treatment for elbow pain is tolerable. Most patients will need about 2 to 3 sessions each 2 weeks apart. If you are suffering from elbow pain and require treatment for elbow pain, speak to your Doctor and ask if Shock Wave therapy is right for you.

Please call or visit our Siglap Branch or drop us an email at hello@dtapclinic.com for an appointment.

Condyloma Lata vs Condyloma Acuminata

Condyloma

Condyloma refers to wart-like skin growths – usually in the genital, anal, or oral regions but occasionally found in other areas of the body – that are caused by a sexually transmitted infection. The most common type is known as genital warts and is termed condyloma acuminata.

These are caused by an infection with Human Papilloma Virus (HPV), the same group of viruses that can lead to cervical cancer as well as other oral and anogenital cancers. The prevalence of genital warts in the general population is estimated to be around 3-5%, making it the most common STD globally. See: 

Read: Rapid HPV Testing (Next Day Results)
Read:
Anal Pap Smear


Condyloma Acuminata On The Penis

When condyloma acuminata are detected, we must always look for and differentiate these lesions from condyloma lata, which are caused by secondary syphilis infection. These two types of condyloma can appear extremely similar and are easily mistaken for the other.

They may also both be present as a co-infection, seeing as they share common risk factors. It is essential that syphilis infection is considered and tested for when condyloma lesions are found, so that rapid diagnosis, treatment, and partner tracing can be performed. 

Condyloma lata

Condyloma lata of secondary syphilis tend to be slightly larger and more moist than common genital warts, and may even ulcerate in later stages. They are usually found in the anogenital or oral regions, but can also be found sometimes on the palms or soles of the feet. Other signs of syphilis may be a diffuse body rash or a classic painless sore or chancre (seen in earlier stages of primary syphilis).

Both types of condyloma are mainly transmitted through penetrative anal or vaginal sex, as well as oral sex (fellatio and cunnilungus). However, as they can be spread with direct contact with mucosa and/or broken skin, there have even been cases of transmission through mutual masturbation.

If you or your partner noticed any suspicious skin lesions, please visit our doctors for a full consultation and assessment. 

Find a Doctor | Make an appointment 


Also STD & HIV Related Read:

Cleaning Of Ear Wax

Cleaning Of Ear Wax

Ok! We all know that ear digging feels Super “Shiok“!

Did you know that our ear canal is a self-cleaning organ, and dead skin, hair & earwax are constantly moving out from our ear canal?

The common use of cotton buds for cleaning ear wax tends to push wax deeper into the ear canal. This may lead to a complete obstruction in some patients.


What is Ear Wax (Cerumen)?

Ear Wax, also known as cerumen, functions as a natural barrier preventing physical damage to the external ear canal from water, insects, trauma, infection and other foreign bodies. It is composed of secretion from sebaceous and ceruminous glands in the ear canal and admixed with sloughed skin, normal skin flora, water and the occasional depilated hair.

Fun fact of the day:

The uppermost of the skin (skin epithelium) moves from the inner to the external part of the ear and serves to remove excess wax from the ear canal.

The concern arises when this innate system is hampered or insufficient.

Read: 5 Objects Found In the Ear Where they Should Not Belong!


What are the Causes for Earwax to Buildup?

1.) Obstruction/ Narrowing of the ear canal

  • Ear canal disease is one of the causes of the impedance of clearance of wax. Ear canal disease can be secondary to bone damage such as osteoma (benign bone growth); or skin conditions including infection of the external ear canal and eczema.
  • Ear canal that is tortuously narrowed either due to normal anatomical variations or repetitive injury and infections of the soft tissue ear canal has a higher risk of Ear Wax impaction.

2.) Ineffective ear-wax migration

  • The glands lining the ear canal shrinks as we progress with age. This produces more solid, less fluid-consisted wax. The wax clearance mechanism becomes inefficient.
  • The common use of cotton-tipped applicators (eg Cotton buds) tends to push wax deeper into the ear canal, this may lead to a complete obstruction in some patients.
  • Prolonged use of earplugs, hearing aids and swim moulds can potentially obstruct ear canal and contribute to the accumulation of ear wax.

3.) Excessive ear wax

  • Excess ear wax can occur as a result of injury to the ear canal or water retention.

Read: What are the causes of Swimming’s Ear Infection (Outer Ear Infection) 


Are There Any Symptoms?

Most people are asymptomatic (no symptoms displayed) despite the accumulation of wax in the ear.

In some, symptoms surface when wax becomes hardened and hard to remove.

Patients may experience ear painfeeling of pressure in the earhearing lossitchdizziness or ringing sound in the ear.


Who Will Benefit from Ear Wax Removal?

1.) Symptomatic patients

Patient with symptoms arising from wax accumulation who underwent wax removal experienced IMPROVED symptoms.

2.) Patients with an inability to express symptoms

This category of patients includes young children and patients with cognitive impairment. Ear Wax removal is advisable in these instances as its benefits in relation to hearing improvement has been well-evidenced.

3.) Asymptomatic patients

However, patients without symptoms are not advised to undergo routine Ear Wax removal as the Ear Wax mostly clears without intervention. Also, Ear Wax can serve as a protective layer.

Pearls of wisdom:

  • Consider consulting a doctor if you experience symptoms indicating excess wax such as troubled hearing, earache, ear block sensation or tinnitus.
  • Avoid attempts to remove Ear Wax using cotton bud sticks as this pushes the Ear Wax deeper into the canal leading causing further obstruction.
  • Excess ear wax can be managed by Ear Waxolytic ear drops, irrigation or manual extraction. A doctor will be able to advise on the appropriate method based on a patient’s medical history, expectation and preference.

What are the Ear Wax Removal Options?

1.) Cleaning Ear Wax by Cerumenolytic agents

Safe option in patients without infective, eardrum perforation, ear surgical histories. Unlike, other methods of ear wax removal, this is a convenient and effective option.

Patients who opt for this choice of treatment should follow-up with a doctor for examination as prolonged retention of cerumenolytic drops behind the Ear Wax can lead to irritation of the skin lining of the ear canal.

However, some patients have reported transient hearing loss, dizziness, ear pain, and external ear canal infection. It is advisable to use cerumenolytics not more than 3-5 times a day for this reason.

2.) Cleaning Ear Wax by Irrigation

Ear irrigation is one of the most widely used methods to remove Ear Wax. This involves using flushing of water to remove the build-up of ear wax. Under the gentle force of water, the ear wax is dislodged and flushed out from the ear. This procedure is not advisable for patients who have a history of the hole in the eardrum or ear infection.

A common side effect of ear irrigation is the retention of water behind any wax that was not completely removed. As a result, this might result in an infection of the ear canal. Irrigation may also lead to perforation of the eardrum, hearing loss, ear pain, giddiness and tinnitus.

3.) Manual Removal of Ear Wax

The procedure needs to be performed by an experienced clinician with appropriate equipment. Manual removal requires sufficient visualization with an otoscope or a binocular microscope.

Instruments used include curettes, forceps, hooks, suction. It is a preferred option for patients with perforation eardrum or patients at high risk of sustaining an ear infection.

Manual removal procedures are most effective for removing Ear Wax in the ear canal.

The method can be associated with ear pain, bleeding, laceration and perforation of the eardrum.

4.) Ear Toilet (Aural Toilet)

Toilet?! It is not as unglamorous as it sounds. Ear Toilet is an ear cleaning procedure using “micro-suction” or “mini-vacuum” tube to remove earwax in a safe manner.

With direct visualisation through a binocular microscope, this enables our doctors to clean the ear canal with greater precision and reduced patient discomfort.

This method allows 2-handed working which further minimizes the risks of human error.

5.) Ear Candling

This involves lighting one end of a hollow candle and putting the other end in the earEar candling is not FDA recommended for ear wax removal, as it is not safe and can cause injuries or burns.


If you are experiencing an Ear Infection or Excessive ear wax build up in your ears, it is highly recommended to visit a doctor at as soon as possible.

Our clinic provides Treatment for Ear Infection & Ear Toilet (Ear Wax Removal Singapore), you can email us at hello@dtapclinic.com or call us at +65 6962 7144.

ESWT Treatment For Shoulder Pain

Watch as Dr Edwin Ong, Resident Doctor, Dr Tan & Partners (DTAP clinic) talks about ESWT, Extracorporeal Shock Wave Therapy,  as an effective treatment for shoulder pain.
Shock Wave therapy is a safe, quick and non-invasive treatment using energy from sound waves to activate the self healing properties of the body and accelerate the recovery process.
It does so in a number of ways: 

  1. Firstly, through a process known as cavitation, Shock Wave therapy stimulates the production of fibroblasts and tenocytes. These are the cells responsible for the healing of connective tissues such as tendons. The end result is tissue regeneration.
  2. Secondly, the Shock Waves stimulate microscopic circulation and therefore metabolism within the treatment area, which promotes healing and the breakdown of calcification deposits, also known as spurs.
  3. Lastly, Shock Wave therapy diminishes pain by over-stimulation of the nerves that send pain signals to the brain.

Shoulder Pain

It works for a variety of causes of shoulder pain including rotator cuff tendinitis and frozen shoulder.

Rotator cuff injury

Repetitive overhead arm movements, heavy lifting or other forms of trauma can strain the rotator cuff tendons and lead to tendinitis. Tendinitis can also develop due to chronic degeneration. The pain is felt mainly when raising the arm outwards and upwards from the body. When tendinitis is present, there is an increased risk of a rotator cuff tear occurring. The tear can be partial or complete and results in weakness when trying to raise the arm.

Frozen shoulder

Also known as adhesive capsulitis, this is a condition in which the movement of the shoulder becomes severely restricted due to the growth of abnormal bands of tissue (called adhesions) between joint surfaces and a lack of synovial fluid to lubricate the joint. Frozen shoulder commonly occurs between the ages of 40 to 60 and can occur after a rotator cuff impingement, a tendon tear, or even minor injury. The problem usually resolves on its own, but this can take up to three years.
To conduct the treatment for shoulder pain, we place the treatment probe over the affected area and deliver the required number of shocks. The treatment for shoulder pain is tolerable. Most patients will need about 2 to 3 sessions each 2 weeks apart.
If you are suffering from shoulder pain and requires tratment for shoulder pain, speak to your Doctor and ask if Shock Wave therapy is right for you.
Please call or visit our Siglap Branch or drop us an email at hello@dtapclinic.com for an appointment.

How to Perform Testicular Self Exam

There are doctors that recommend all men examine their testicles monthly after puberty, but because testicular self-exams have not been studied enough to know if they reduce the death rates from testicular cancer, no clear guidelines exist on whether or not they should be recommended to everyone.
Each man has to decide for himself if he wants to examine himself. This might be more important if you have any of the risk factors listed above. Seek medical attention immediately if you do find a lump. Your doctor will advise as appropriate.
Testicular cancer is comparatively rare when putting side by side with other cancers, but testicular cancer is the most common cancer in males between the ages of 15 and 35.

How to Perform Testicular Self-exam

Step 1: Clean up, Warm-up


(Testicular Self-exam)
The testicles are easiest to examine when the skin of the scrotum is relaxed. The skin is usually relaxed when you are relaxed, or after a warm shower or bath.

Step 2: Roll it Gently between Your Fingers


(Testicular Self-exam)
You can examine yourself lying down or standing up. Most doctors will examine your standing up.
Hold your penis away. Hold your testicle one at a time between your thumb and fingers. Roll it gently between your fingers.

Step 3: Feel for any Lumps, Bumps or Fluid


(Testicular Self-exam)
Check for any lumps, bumps or unusual features. If you do examine your testicles regularly, you will eventually know what is normal for you and what is different.

Step 4: Feel for any change in the Size, Shape, or Consistency


(Testicular Self-exam)
Feel for any change in the size, shape, or consistency of your testicles. Seek medical attention if you notice any difference.

What is normal

  • One testis may be slightly larger than the other
  • One side may hang lower than the other
  • Part of the testicle is known as the epididymis where sperm are stored. This may be felt as a bump at the posterior upper or posterior middle aspect of the testicles
  • Above the testicles you may feel a cord-like structure – this is the spermatic cord where sperm is carried.

What is abnormal

  • Abnormally large testes compared to the other side
  • A hard lump
  • Fluid around the testicle
  • Dilated veins above the testicles which may feel like worms
  • Tender lumps

Not all the above abnormalities are related to cancer. But if you do find such abnormalities, please visit your doctor for a consultation. One of the easiest ways to characterize a lump is with an ultrasound, which is completely painless.

Speak to our doctors for more information or professional advice on testicular cancer at our Men’s Health Clinic.

Happy Movember everyone!

Movember (Moustache + November)

Movember (Moustache + November) is a global movement by the Movember Foundation which puts the spotlight on men’s health, especially prostate cancer, testicular cancer, mental health and suicide prevention.
The Movember Foundation recognized that males of all ages may hide their pains and suffering and ultimately result in greater problems, including an untimely demise. Unlike females, males are unlikely to share their deeply personal pains and suffering with others, including loved ones or professionals. This is why it is important for fellow males to stand up for each other, and lift them up from the fog of suffering and silence.

Cancer and Suicide – Not a pretty picture

Prostate Cancer

Prostate cancer now makes up one in seven cancers in Singapore males and is the third most common cancer now. In the five years from 2011 to 2015, almost 20% of those diagnosed with prostate cancer died. What is worse is that prostate cancer in the early stages has no symptoms at all. The earlier the cancer is diagnosed, the more likely the treatment will be successful for patients and help them remain in remission.

Testicular Cancer

While testicular cancer only accounts for 1 to 2% of all cancers in males, it is the most common cancer in young males between ages 20 to 40 – at the prime of their lives. Like prostate cancer, the earlier testicular cancer is diagnosed, the more likely that a cure is achievable.
See:  How to Perform Testicular Self-Exam

Suicide Prevention

More than 70% of all suicides in Singapore for 2018 were males. This is not unique to Singapore. In Australia, males accounted for 75% of suicides. The number of male suicides in Singapore is twice that of women and the majority were aged 65 years old and above.
It is generally believed that many factors contributed to these statistics. Societal pressures for males to “Man Up” means that males may feel isolated and have nowhere to turn to for help.
In addition, many males may feel that if they seek the help they will lose status or identity and they fear that they may lose independence, competence, control, and autonomy, all of which are perceived norms expected of males.

Mental Health

Finally, a previous study by Oogachaga (a non-profit community-based organisation that works with LGBTQ individuals) in Singapore showed that 3 in 5 LGBT individuals who participated in the survey reported facing some form of discrimination as a result of their sexual orientation. This may be part of the reason why in 2015 a study in CDC found gay and bisexual youths in the U.S. are 4 times more likely to have attempted suicide than their straight peers.

What can you do?

Now, anyone, especially males, can step forward and support your buddies and families by:

  1. Growing a moustache or beard for the month of November.
  2. Pledge to walk 60 km for the month of November – for the 60 men that are lost every hour globally due to suicides.
  3. Spend time with your buddies – be it having a night out or playing a favourite sport or whatever activity you enjoy doing together.

For the whole month of November, Dr. Tan & Partners (DTAP) is proud to support the Movember 2019 initiative with a supportive and friendly environment throughout all its clinics for men of all ages to seek help for all men’s health issues.
Dr. Julian Ng

Dr Julian Ng has 10 years of medical practice experience. He currently serves as the Chief Medical Officer of the DTAP Group of clinics in Singapore, Malaysia and Vietnam. He is also a member of the Singapore Men’s Health Society. His special interests are in the field Andrology, especially sexual health. He is currently practising at Dr Tan and Partners (DTAP) clinic at Novena Medical Centre.

Everything You Need to Know About Molluscum Contagiosum

What is molluscum contagiosum?

Molluscum contagiosum is a fairly common skin infection or condition caused by a virus called Molluscum contagiosum, a type of poxvirus. It manifests as raised, pearly, flesh or skin coloured bumps which may sometimes have a central dimple (known as “central umbilication”).  

How does molluscum contagiosum spread?

Molluscum contagiosum is spread through skin contact with the virus. 
This can occur if you come into direct contact with someone else’s molluscum lesions, be it through sexual contact, or during contact sports like wrestling.
Unfortunately, the virus can survive on surfaces outside the body and can remain on infected surfaces like clothing, towels, gym equipment etc. Someone else who then comes into contact with these surfaces can get infected. 
In someone who is already infected, scratching or touching the lesions and then touching other parts of their body can result in the virus spreading. Shaving over infected skin can also spread the virus and worsen the infection. 
Once lesions resolve, an infected individual is no longer contagious. 

Who is affected by molluscum contagiosum?

Both children and adults alike can be infected by the virus. It is common amongst young children who may spread the virus through playing with each other. Lesions may occur anywhere – on the trunk, limbs, armpits, neck and possibly even face.
In adults, it is more commonly spread through sexual contact and may be considered an STD. The resultant lesions occur anywhere on the lower abdominal wall to the external genitalia and perineum. 
Individuals with weakened immune systems e.g. cancer patients or immunosuppressed patients, or individuals with skin conditions like eczema are at higher risk of being infected. 

What are the symptoms of molluscum contagiosum?

Molluscum contagiosum gives rise to shiny, pearly, skin coloured bumps which may range in number from few to many. These can occur anywhere on the body depending on where the virus inoculates the skin. These bumps are painless and can range in size from barely visible to several millimeters in size or larger. When lesions are larger, you may be able to notice a central dimple. 
In individuals with weakened immune system, lesions may be far more widespread e.g. >100 lesions.
Symptoms usually surface between 2 weeks to 2 months from initial infection, but can be delayed for up to half a year even. 

What are the complications of molluscum contagiosum?

Molluscum contagiosum is a benign and self-limiting condition. However, scratching lesions can result in scarring or secondary bacterial skin infections.

How is molluscum contagiosum diagnosed?

Molluscum contagiosum is diagnosed clinically i.e. by identification of the classic pearly skin bumps. If the lesions look atypical, a skin scraping of a bump may be useful – examination under a microscope will reveal “molluscum bodies” which confirms the diagnosis, but this is not routinely performed in most patients. 

How is molluscum contagiosum treated?

Treatment of molluscum contagiosum is not always necessary as the condition is self-limiting and lesions will eventually resolve by themselves without scarring. Most lesions will resolve within a year but can take longer than that. 
Treatment is recommended for:

  • Lesions around the genital or perianal region
  • If lesions are large 
  • In immunocompromised individuals with extensive lesions 

Various treatment methods available include:

  • Physical removal of lesions – with laser removal or cryotherapy (freezing with liquid nitrogen)
  • Topical creams or ointments e.g. podophyllotoxin application, imiquimod cream – but the efficacy of topical treatment may vary 
  • In immunocompromised individuals, usual treatment methods may fail and specific, special treatment (e.g. intralesional interferon) may be required 

How do I minimize my risk of getting molluscum contagiosum?

Good hygiene habits are crucial to minimize your risk of molluscum – regular hand washing, not sharing towels or sports equipment, wiping down equipment at the gym before usage, or covering equipment with your own towel rather than sitting or lying directly on it. Do not share razors or personal items. 
Avoid touching lesions if you are infected. Do not scratch, pick, or attempt to pop lesions. Shaving should also be avoided. Molluscum lesions should ideally be covered e.g. with a plaster to reduce the risk of transmission. 
Adults with lesions around their genital or perianal region should also avoid sexual contact until these have been treated. 
If you are concerned about any skin lumps or bumps and think you may have molluscum contagiosum, it is best to hold off attempting to treat it yourself (this may worsen the infection!) and see a doctor as soon as possible.
If you would like to find out more about molluscum contagiosum come down to any of our clinics for a consultation.

Pap smear – Mengapakah anda perlu ketahui ujian ini?

Apakah itu barah cervix, HPV dan apakah pemeriksaan yang disyorkan?

Apakah itu ujian Pap smear?

  • Pap smear (atau ujian Papanicolaou) adalah ujian yang dijalankan oleh doktor untuk mengesan tanda-tanda kanser (barah) cervix. Cervix adalah bahagian antara vagina dan rahim di dalam badan wanita (bahagian bawah rahim). 
  • Semasa ujian Pap smear, doktor tersebut akan memasuki sesuatu alat pemeriksaan bernama speculum yang digunakan untuk menolak tepi belah vagina. Setelah ditolak tepi, cervix dilihat dan sesuatu berus kecil digunakan untuk mengiris sel-sel di cervix secara perlahan-lahan. 
  • Individu yang menjalani ujian Pap smear mungkin akan merasa kurang selesa tetapi biasanya tidak merasa sakit. 
  • Setelah ujian lengkap, sampel akan dihantar ke makmal untuk diperiksa di bawah mikroskope. 

Siapakah sesuai untuk menjalani ujian Pap smear?

  • Semua wanita yang berumur 25 tahun dan ke atas yang sudah aktif secara seksual sepatutnya menjalani ujian Pap smear. 
  • Bagi mereka yang tidak pernah mempunyai keputusan Pap smear yang tidak normal, Pap smear perlu dijalankan sekurang-kurangnya setiap 3 tahun. 

Apakah yang perlu disediakan sebelum wanita menjalani ujian Pap smear?

  • Tidak ada apa-apa yang spesifik yang perlu disediakan sebelum ujian Pap smear.
  • Wanita yang dalam haid juga boleh menjalani ujian ini. Jika haid terlalu berlebihan, individu tersebut boleh menghubungi klinik tersebeut untuk menukar tarikh temujanji.

Apakah itu barah atau kanser cervix?

  • Barah atau kanser cervix adalah barah ke-enam paling kerap antara wanita di Singapore. Barah cervix terjadi apabila sel-sel yang normal bertukar kepada sel yang tidak normal yang tumbuh diluar kawalan. Kebanyakan wanita yang mempunyai kanser cervix yang dikesan semasa peringkat awal boleh dirawat dengan sepenuhnya.
  • Faktor risiko barah cervix yang paling penting adalah jangkitan human papilloma virus (HPV).
  • Simptom-simptom barah cervix termasuk lelehan berdarah dari vagina yang berlaku di antara waktu haid (bukan semasa haid), selepas hubungan seks atau selepas menopaus.
  • Penyakit barah ini terbelah kepada beberapa peringkat (awal ke peringkat akhir). Barah ini boleh dirawat dalam beberapa cara termasuk pembedahan. Pembedahan termasuk “radical hysterectomy” atau pengeluaran cervix, rahim dan bahagian atas vagina atau pembedahan pengeluaran semua atau sebahagian daripada cervix – pembedahan ini boleh dilakukan dalam keadaan tertentu sahaja. 
  • Rawatan lain termasuk radiasi dan kemoterapi. 

 
Apakah itu human papillomavirus (HPV)?

  • HPV adalah virus yang boleh dijangkiti melalui sentuhan kulit, melalui hubungan seks (sama ada melalui vagina, oral 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. 

Adakah semua jenis atau strain HPV berbahaya?

  • Terdapat lebih daripada 100 strain atau jenis HPV tetapi kebanyakan jenis HPV tidak menyebabkan kanser. Lebih daripada 80% wanita akan terdedah kepada virus HPV dalam hidup mereka. Kebanyakannya, system imun badan akan menyingkirkan virus ini secara semula jadi sebelum virus ini menyebabkan penyakit teruk. Tetapi, peratusan kecil wanita akan menghidapi penyakit yang lebih serius seperti kanser. 
  • Terdapat jenis HPV yang berisiko rendah iaitu HPV jenis 6 dan 11 yang boleh menyebabkan penyakit ketuat kelamin (genital warts). Jenis berisiko rendah ini jarang sekali boleh menyebabkan kanser.
  • Antara jenis HPV yang berisiko tinggi adalah jenis 16 dan 18 yang boleh menyebabkan kanser cervix. Jenis 31, 33, 45, 52 dan 58 juga boleh menyebabkan kanser. 


Apakah ujian yang boleh dijalankan untuk mengesan HPV?

  • Ujian HPV boleh dilakukan pada masa yang sama dengan ujian Pap smear iaitu melalui pengunaan berus kecil yang digunakan untuk mengiris sel-sel di cervix secara perlahan-lahan. 
  • Di clinic Dr Tan & Partners, kita dilengkapi dengan mesin yang boleh mendapatkan keputusan HPV secara cepat iaitu melalui Rapid HPV test. Keputusannya boleh dihasilkan dalam masa 24 jam. 

Apakah cara yang boleh mengurangkan risiko seseorang dijangkiti HPV dan barah cervix yang disebabkan oleh HPV?

  • Vaksin adalah efektif untuk mengurangkan risiko ini dan boleh mengelakkan seseorang daripada dijangkiti 70-90% jenis HPV berisiko tinggi dan juga jenis HPV yang boleh menyebabkan penyakit genital warts. Vaksin tersebut dinamakan Gardasil 9.
  • Selepas individu menerima vaksin, individu tersebut masih lagi perlu menjalani ujian Pap smear sekurang-kurangnya setiap 3 tahun kerana vaksin tidak boleh mencegahkan seseorang daripada dijangkiti jenis HPV berisiko tinggi yang lain yang tidak dilindungi Gardasil 9. 

Siapakah sesuai untuk menerima Gardasil 9?

  • Vaksin Gardasil 9 diluluskan untuk diberi kepada perempuan yang berumur 9 tahun ke 26 tahun. Bagi mereka yang berumur lebih daripada 26 tahun, penerimaan Gardasil 9 boleh dibincangkan bersama doktor. 


Apakah beza Gardasil 9 dengan vaksin HPV yang lain? 

  • Terdapat vaksin yang lain yang dinamakan Gardasil dan Cervarix. Gardasil hanya boleh mencegah jangkitan HPV jenis 6, 11, 16 dan 18 sahaja (16 dan 18 adalah jenis HPV yang berisiko tinggi) dan Cervarix hanya mencegah jangkitan jenis 16 dan 18 sahaja. 
  • Gardasil 9 boleh mencegah jangkitan HPV jenis 6, 11, 16, 18 dan juga jenis 31, 33, 45, 52 dan 58 (31, 33, 45, 52 dan 58 juga boleh menyebabkan barah cervix).

____________________________________________________________________________
Jika anda mengalami simptom-simptom yang disebut di atas dan ingin berjumpa dengan doktor wanita, sila hubungi klinik kita di Dr. Tan & Partners cawangan:
Dr. Tan & Partners @ DUO Galleria



Nombor telefon +65 6976 5023
Dr. Tan & Partners @ Robertson
11 Unity St
#02-06/07 Robertson Walk
Singapore 237995
Nombor telefon +65 6238 7810
Klinik juga bersedia menerima pesakit tanpa membuat temu janji. 

Vaginitis – Penyakit Yang Anda Perlu Ketahui

Apakah itu vaginitis?

Vaginitis adalah penyakit faraj atau vagina yang kerap berlaku antara kaum wanita. Lazimnya, sebanyak 5-50% kes vaginitis dilaporkan merentasi Amerika Syarikat, Eropah dan Asia Tenggara.Terdapat kajian yang dijalankan yang menunjukkan bahawa faktor-faktor seperti umur, status perkahwinan dan tahap pendidikan mempengaruhi jangkitan vaginitis. Contohnya, wanita yang berumur antara 21 dan 35 tahun dan yang sudah berkahwin paling kerap dilaporkan dengan simptom-simptom di bahagian faraj. Tahap pendidikan rendah juga dikaitkan dengan jangkitan vaginitis yang lebih kerap berbanding dengan wanita-wanita yang menuntut di universiti atau kolej. 

Terdapat ramai wanita kurang pengetahuan mengenai vaginitis dan lebih-lebih lagi, tabu (taboo) masyarakat boleh menyekat wanita menampilkan diri ke hadapan dan menyuarakan isu-isu seperti ini. Sebab-sebab vaginitis boleh dibahagikan kepada dua kumpulan: penyakit berjangkit dan penyakit tidak berjangkit. 

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Apakah simptom-simptom vaginitis?

Simptom-simptom atau gejala vaginitis termasuk perubahan dalam kuantiti, warna atau bau lelehan faraj, rasa gatal, perlepasan lelehan pada bahagian faraj, faraj atau pembukaan faraj bengkak, lelehan faraj berdarah, rasa sakit atau pedih setelah hubungan seks atau kencing. 

Apakah penyakit berjangkit yang menyebabkan vaginitis?

Terdapat berbagai penyakit berjangkit yang boleh menyebabkan vaginitis. Kita lihat penyakit-penyakit ini dengan lebih terperenci seperti berikut: 

1. Bacterial Vaginosis

Penyakit Bacterial Vaginosis (BV) adalah penyakit yang disebabkan oleh bakteria-bakteria seperti Gardnerella vaginalis, spesies Prevotella, spesies Bacteroidies, Mycoplasma hominis, Ureaplasma urealyticum dan berbagai lagi. Penyakit ini boleh dijangkiti melalui hubungan seks.

Ia disebabkan oleh perubahan dalam flora faraj daripada Lactobacillus (yang semulajadi dalam faraj) kepada pelbagaian bakteria yang boleh menyebabkan peningkatan pH dalam faraj (pH yang normal adalah 4.5).

Apakah tanda dan simptom Bacterial Vaginosis?

Kebanyakan wanita (sebanyak 50-75%) dengan BV tidak menunjukkan simptom. Wanita yang mempunyai simptom biasanya melaporkan lelehan faraj berwarna putih atau kelabu yang berbau tidak normal. Baunya digambarkan sebagai bau hanyir. 

Bagaimana Bacterial Vaginosis dirawat?

BV boleh dirawat dengan antibiotik seperti metronidazole atau clindamycin. Metronidazole boleh diberi secara oral ataupun secara pessari (kemasukan ubat ke dalam faraj).

Apakah petua pencegahan Bacterial Vaginosis dan apakah akibat potensi jangkitan ini?

Disebabkan BV boleh dijangkiti melalui hubungan seks, mengelakkan hubungan seks boleh mencegah penyakit ini. Kontrasepsi (ubat yang mengelakkan wanita hamil) dan kondom juga boleh mengurangkan risiko jangkitan penyakit ini. Wanita juga boleh mencuba probiotik walaupun keberkesanan tidak terbukti atau jelas. 

Fakta penting yang anda perlu ketahui bagi mereka yang mempunyai jangkitan BV juga mempunyai peningkatan risiko untuk memperolehi jangkitan HIV, Herpes, Gonorrhoea dan Chlamydia. Pentingnya, BV boleh menyebabkan kelahiran pra-matang dalam kalangan wanita hamil.

2. Candida 

Candida adalah kulat yang kadang-kala hidup di dalam faraj tetapi tidak menyebabkan apa-apa simptom. Walaubagaimanapun, penyakit jangkitan Candida (juga dipanggil “vulvovaginal candidiasis”) berlaku jika wanita tersebut mempunyai simptom-simptom yang dijelaskan di bawah. 

Apakah simptom-simptom vulvovaginal candidiasis?

Simptom termasuk kegatalan (paling kerap) dan kepedihan. Wanita kadang-kala mempunyai lelehan faraj yang berwarna putih yang boleh menyerupai keju (cottage cheese atau curd) dan kemerahan kulit di pembukaan faraj (vulva) dan kemerahan mukosa faraj.

Apakah faktor risiko seseorang mengalami vulvovaginal candidiasis?

Penyakit ini kadang-kala berlaku tanpa apa-apa pencetus. Walau bagaimanapun, terdapat faktor-faktor yang boleh meningkatkan risiko jangkitan ini. Ini termasuk:

  • Penyakit kencing manis
  • Pengambilan antibiotik
  • Peningkatan tahap oestrogen yang boleh disebabkan oleh pengambilan ubat kontrasepsi, kehamilan, dan penggunaan ubat oestrogen
  • Keadaan sistem imun yang lemah (misalnya penyakit HIV atau penggunaan ubat yang boleh melemahkan sistem imun seperti steroid atau kemoterapi)
  • Walaupun penyakit ini bukan dikelaskan antara penyakit yang boleh dijangikiti melalui hubungan seks (sexually transmitted infection or disease atau STD/STI) secara ekslusif, risikonya meningkat jika wanita tersebut melakukan hubungan seks. 

Apakah ubat yang boleh merawat vulvovaginal candidiasis?

Ubat seperti fluconazole boleh digunakan untuk rawatan penyakit ini. 

Apakah petua pencegahan vulvovaginal candidiasis?

Tidak ada cara pencegahan yang spesifik yang boleh mencegah penyakit ini. Untuk mengurangkan risikonya, individu yang mengidap penyakit kencing manis perlu memastikan permakanan yang bergula dikawal rapi, mengelakkan pengambilan antibiotik jika tidak diperlukan dan mengelakkan hubungan seks dengan pelbagai pasangan. 

Walaupun tidak sepenuhnya terbukti, probiotik boleh dicuba untuk mengurangkan risiko penyakit ini.  

3. Chlamydia trachomatis

Chlamydia trachomatis adalah bakteria yang paling kerap menyebabkan penyakit yang melibatkan organ seksual. Hampir semua jangkitan bakteria ini adalah melalui hubungan seksual. Ia boleh berlaku di kalangan kaum wanita dan juga kaum lelaki. 

Apakah simptom-simptom jangkitan Chlamydia trachomatis?

Di kalangan wanita, simptom-simptom adalah seperti simptom vaginitis di atas – perubahan dalam lelehan faraj, kepedihan di faraj ataupun semasa kencing, lelehan darah walaupun bukan semasa haid, lelehan darah selepas hubungan seks. Jika bakteria ini menyebabkan jangkitan yang melibatkan organ yang lain di dalam system reproduksi wanita (cervix, tube fallopian, ovari), ia boleh menyebabkan penyakit keradangan pelvis (pelvic inflammatory disease) dan wanita tersebut mungkin akan mengadu kesakitan perut atau pelvis. Kebanyakan wanita yang mempunyai penyakit Chlamydia trachomatis tidak menunjukkan apa-apa simptom dan boleh menjangkiti pasangan mereka tanpa disedari. Bagi wanita yang hamil, kesulitan boleh berlaku seperti kehamilan ektopik (di mana janin berada di tempat selain daripada rahim) dan kelahiran pra-matang pada wanita hamil yang dijangkiti bakteria ini. 

Bagi kaum lelaki, simptom-simptom yang boleh berlaku adalah kesakitan ketika kencing, kesakitan ketika ejakulasi, kesakitan perut atau di kawasan lubang dubur. Kaum wanita dan lelaki juga boleh mengalami simptom kesakitan dan kemerahan mata dan juga sakit tekak.

Bagaimana penyakit Chlamydia trachomatis diuji?

Sampel kencing, lelehan faraj, lelehan zakar atau buntut dan juga tekak boleh diambil dan dihantar untuk ujian mengesan DNA bakteria Chlamydia trachomatis. Ujian untuk mengesan penyakit jangkitan STD yang lain juga perlu dilakukan kerana jangkitan satu bakteria boleh meningkatkan risiko jangkitan bakteria yang lain. 

Walaupun keputusan ujian yang dijelaskan di atas selalunya mengambil lebih kurang 1 minggu untuk di proses, di klinik Dr Tan & Partners, satu ujian berlainan yang dinamakan Rapid CGP (Chlamydia/Gonorrhoea panel) juga boleh dijalankan. Keputusannya boleh diterima dalam masa 1 hari. Ujian ini boleh menguji sampel kencing dan lelehan faraj sahaja.  

Apakah rawatan yang boleh didapati untuk jangkitan Chlamydia trachomatis?

Antibiotik seperti azithromycin atau doxycycline adalah berkesan untuk membasmi bakteria ini. Kebanyakan kes-kes di mana disyaki penyakit jangkitan STD, antibiotic untuk merawat jangkitan gonorrhoea juga diberi sebelum pengesahan bakteria dibuat kerana kadang-kala jangkitan Chlamydia trachomatis berlaku bersama jangkitan gonorrhoea. 

Apakah komplikasi penyakit Chlamydia trachomatis

Komplikasi penyakit ini jika tidak dirawat adalah penyakit keradangan pelvis (pelvic inflammatory disease) yang boleh menyebabkan kemandulan kepada kaum wanita, kehamilan ektopik atau kesakitan pelvis yang kronik. 

Apakah petua pencegahan Chlamydia trachomatis?

Hubungan seks perlu dielakkan untuk mencegah penyakit ini. Penggunaan kondom juga boleh mengurangkan risikonya. Adalah sangat penting jika seseorang dijangkiti penyakit Chlamydia trachomatis atau STD lain untuk menasihatkan pasangan individu tersebut menjalani ujian dan diberi rawatan secepat mungkin. Ini adalah untuk mencegah jangkitan tersebut berulang. 

4. Gonorrhoea

Seperti Chlamydia trachomatis, penyakit gonorrhoea (atau gonorrhea) juga dijangkiti melalui hubungan seksual oleh bakteria Neiserria gonorrhoea

Apakah simptom-simptom jangkitan gonorrhoea? 

Seperti penyakit jangkitan Chlamydia trachomatis, simptom-simptom yang boleh berlaku adalah perubahan pada lelehan faraj, selalunya lelehan akan berwarna kuning seperti nanah, kepedihan di bahagian faraj ataupun semasa kencing, lelehan darah walaupun bukan semasa haid dan lelehan darah selepas hubungan seks. Penyakit ini juga boleh menyebabkan pelvic inflammatory disease. Kaum lelaki juga boleh mengalami lelehan zakir yang menyerupai nanah, kesakitan semasa kencing atau semasa ejakulasi dan kesakitan di kawasan lubang dubur. Sakit tekak dan kesakitan dan kemerahan mata juga boleh berlaku dalam kalangan kaum wanita dan lelaki. Kadang-kala seseorang yang dijangkiti bakteria ini tidak menunjukkan apa-apa simptom. 

Penyakit gonorrhoea juga boleh menyebabkan sindrom yang bernama “disseminated gonorrhea infection” dimana penyakit ini boleh melibatkan bahagian badan lain seperti sendi dan jarang sekali tulang, injap jantung ataupun meningitis. 

Bagaimana penyakit gonorrhoea diuji?

Sama seperti Chlamydia trachomatis, sampel kencing, lelehan faraj, lelehan zakar atau dubur dan juga tekak boleh diambil dan dihantar untuk ujian mengesan DNA bakteria Neisseria gonorrhea. Ujian untuk mengesan penyakit jangkitan STD yang lain juga perlu dilakukan kerana jangkitan satu bakteria boleh meningkatkan risiko jangkitan bakteria yang lain. 

Walaupun keputusan ujian yang dijelaskan di atas selalunya mengambil lebih kurang 1 minggu untuk di proses, di klinik Dr Tan & Partners, satu ujian berlainan yang dinamakan Rapid CGP (Chlamydia/Gonorrhoea panel) juga boleh dijalankan. Keputusannya boleh diterima dalam masa 1 hari. Ujian ini boleh menguji sampel kencing dan lelehan faraj sahaja.  

Jika individu disyaki mengalami penyakit “disseminated gonorrhea”, individu tersebut dinasihatkan supaya mendapatkan rawatan di hospital. 

Apakah rawatan yang boleh didapati untuk penyakit gonorrhoea?

Antibiotik seperti ceftriaxone melalui suntikan ke dalam otot bersama dengan pengambilan ubat azithromycin atau doxycycline secara oral adalah berkesan untuk membasmikan bakteria ini. 

Apakah komplikasi penyakit gonorrhoea? 

Komplikasi penyakit ini jika tidak dirawat adalah penyakit keradangan pelvis (pelvic inflammatory disease) yang boleh menyebabkan kemandulan kepada kaum wanita, kehamilan ektopik atau kesakitan pelvis yang kronik.

Bayi yang dilahirkan oleh wanita yang menghidapi penyakit gonorrhoea boleh mengalami komplikasi mata yang boleh menyebabkan bayi itu buta. Kesulitan kepada bayi yang lain juga termasuk penyakit jangkitan yang serius seperti sepsis, meningitis atau penyakit sendi. 

Apakah petua pencegahan gonorrhoea?

Hubungan seks perlu dielakkan untuk mencegah penyakit ini. Penggunaan kondom juga boleh mengurangkan risikonya. Adalah sangat penting jika seseorang dijangkiti penyakit gonorrhoea atau STD lain untuk menasihatkan pasangan individu tersebut menjalani ujian dan diberi rawatan secepat mungkin. Ini adalah untuk mencegah jangkitan tersebut berulang. 

5. Trichomoniasis

Penyakit trichomoniasis adalah disebabkan oleh protozoa yang dinamakan Trichomonas vaginalis dan hampir semua jangkitan berlaku melalui hubungan seksual. 

Apakah simptom-simptom jangkitan penyakit trichomoniasis? 

Sebanyak 70-85% individu yang dijangkiti penyakit ini tidak mempunyai simptom. Bagi kaum wanita, simptom-simptom seperti lelehan faraj cair yang boleh merupakan nanah yang berbau, kepedihan, kesakitan semasa kencing, kegatalan, kesakitan perut atau semasa hubungan seksual boleh berlaku. 

Bagaimana penyakit trichomoniasis diuji?

Sampel lelehan faraj diambil dan diuji untuk ujian yang melibatkan pengiktirafan protozoa Trichomonas vaginalis di bawah mikroskop dan juga pengesanan DNA (sama seperti Chlamydia trachomatis dan Neisseria gonorrhoea). 

Apakah rawatan yang boleh didapati untuk trichomoniasis?

Antibiotic metronidazole adalah berkesan untuk membasmi penyakit ini dan boleh diberi secara oral atau pessari. 

Apakah komplikasi penyakit trichomoniasis? 

Penyakit keradangan pelvis (pelvic inflammatory disease) boleh berlaku dan boleh menyebabkan wanita tersebut mandul atau mengalami kehamilan ektopik. Selain daripada itu, wanita juga boleh mengalami keadaan neoplasia cervix dimana sel-sel di cervix boleh berubah dan boleh mengakibatkan keadaan yang mendorong kepada kanser. Penyakit trichomonas juga boleh meningkatkan risiko kecenderungan jangkitan HIV. 

Bagi wanita yang hamil yang mengalami penyakit ini, kelahiran pra-matang atau penurunan berat badan bayi boleh berlaku. Bayi tersebut juga boleh mengalami demam, sesak nafas atau jangkitan kencing. 

Apakah petua pencegahan trichomoniasis?

Hubungan seks perlu dielakkan untuk mencegah penyakit ini. Penggunaan kondom juga boleh mengurangkan risikonya. Adalah sangat penting jika seseorang dijangkiti penyakit ini atau STD lain untuk menasihatkan pasangan individu tersebut diuji dan diberi rawatan secepat mungkin. Ini adalah untuk mencegah jangkitan tersebut diulang lagi sekali. 

Ujian penyembuhan atau “test of cure” perlu dijalankan 3-4 minggu selepas rawatan. Ini adalah kerana sebanyak 17% individu dilaporkan mendapat jangkitan yang berulang. 

6. Vaginitis yang disebabkan oleh virus 

Virus-virus seperti herpes simplex (HSV) dan human papilloma virus (HPV) boleh menyebabkan vaginitis. 

Apakah simptom-simptom atau tanda vaginitis virus?

Virus herpes simplex selalunya menyebabkan individu tersebut mengalami kesakitan dan semasa pemeriksaan,doktor luka atau ulser boleh dilihat di dalam faraj. Untuk mereka yang dijangkiti HPV, pertumbuhan yang dinamakan “wart” boleh berlaku di bahagian faraj, pembukaan faraj, lubang dubur dan juga di dalam mulut. Kedua-dua virus ini selalunya dijangkiti melalui hubungan seksual. 

Apakah rawatan yang boleh diberi untuk vaginitis virus?

Untuk HSV, rawatannya adalah pengambilan ubat secara oral iaitu valaciclovir atau acyclovir. Rawatan vaginitis HPV pula memerlukan pakar ginekologi untuk rawatan lebih khusus. 

Apakah sebab-sebab vaginitis yang tidak disebabkan oleh jangkitan bakteria, protozoa atau virus?

Terdapat pelbagai amalan individu yang boleh mengubahkan keseimbangan faraj. Pengekalan keseimbangan pH dalam faraj adalah penting untuk mencegah penyakit jangkitan seperti yang disebut di atas (bakteria, protozoa dan virus). Perubahan pH boleh meningkatkan risiko jangkitan. 

Amalan kebersihan seperti penggunaan sabun dan detergen yang mengandungi perfum, amalan “douching” atau mencuci faraj, kemasukan bahan spermicide (bahan yang menghapuskan sperm) dan spray faraj semua boleh menganggu penghasilan mukosa (lapisan) faraj yang boleh mengubahkan pH atau menyebabkan ulser dan kepedihan faraj. 

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Jika anda mengalami simptom-simptom yang disebut di atas dan ingin berjumpa dengan doktor wanita, sila hubungi klinik kita di Dr. Tan & Partners cawangan:

Dr. Tan & Partners @ DUO Galleria

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

Telepon +65 6976 5023

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#02-06/07 Robertson Walk

Singapore 237995

Nombor telefon +65 6238 7810

Klinik juga bersedia menerima pesakit tanpa membuat temu janji. 

A Case of HIV from Vampire Facial

Our clinics recently diagnosed a case of HIV from a vampire facial.
A Vampire Facial is a type of cosmetic treatment that was made popular by celebrity Kim Kardashian.
The treatment involves taking the patient’s own blood and spinning it down until the cells separate out of the liquid portion (plasma). Small needles known as micro-needles are then used to make multiple small holes in the patient’s face. The plasma is then poured over the face so that it soaks into these holes.
Two cases of HIV infection from such treatments were reported earlier this year in Albuquerque, New Mexico in the US. https://www.medscape.com/viewarticle/912436
Vampire Facial treatment is NOT approved in Singapore.

What Can You Do to Protect Yourself?

Before undergoing a treatment, ensure that the establishment has all the proper local licenses required.
Ensure that the therapist conducting the treatment has all the training certifications required.
Do not undergo any treatments in non-medically licensed establishments that involves blood or body fluids.
For treatments that involve puncturing or breaking the skin, ensure that the instruments used are properly packaged and sterilized. 
Insist on seeing the operator open the sealed package in front of you.

If you feel you might have been exposed to an infection, see your local Doctor immediately for a discussion on HIV PEP and screening for other blood-borne infections like Hepatitis B and Hepatitis C.


Learn More about Other STDs & Other STD Symptoms