Swallowing Semen: What You Should Know

What is semen made of?

Semen consists of several fluids which are produced by various glands. Actual sperm cells make up only a very tiny portion of semen volume. The bulk of semen is made up of prostatic fluid, secreted from the prostate gland, seminal fluid which contains fructose, proteins and fatty acids and bulbourethral fluid from the bulbourethral glands. Semen contains protein and a multitude of other components such as fructose, citric acid, zinc, cholesterol etc. 

What is the usual color and consistency of semen?

Normal semen may have an off-white or slightly yellow tint. It is usually jelly-like in consistency, but may be slightly clumpy or more liquid in nature. But semen with a pronounced yellow or green colour may indicate an infection and a visit to your doctor is warranted. If there is blood in your semen (red or brown) please see a doctor as well.

Is semen safe to ingest?

All the components in semen are fully edible and digestible, so semen is generally safe to ingest. However, swallowing semen could prove dangerous if you suffer from a rare allergy to semen (known as “human seminal plasma hypersensitivity”), in which case you could develop a bad or potentially even life-threatening reaction. 

What happens if you swallow semen?

Swallowed semen is digested by the digestive enzymes in your gastrointestinal tract, the same as any other food which you ingest. Contrary to some urban myths, there is no risk of pregnancy from swallowing semen. 

What does semen smell or taste like?

Semen has been said to normally smell like ammonia, bleach, or chlorine due to the alkaline nature of semen. Semen can taste mildly sweet, salty or bitter. But the smell and taste can differ from person to person, and even from week to week, depending on your hydration status, hygiene, health and your recent food consumption.

However, if the semen smells or tastes abnormally strong, and is associated with discomfort on ejaculation or other urinary symptoms, it could be a sign of an infection, please see a doctor then.

Is it true that semen has dietary health benefits?

While semen does have a high percentage of protein for its weight, it is likely that you have to consume a large quantity in order for it to have dietary health benefits.

Semen also contains other components like sugar, sodium, citrate, zinc, chloride, calcium, lactic acid, magnesium, potassium and urea, but due to the small volume of semen, the dietary health benefits are likely insignificant.

Semen as a mood booster?

While there are no studies that can definitively make the link between ingesting semen and better mood, it is known that semen does contain trace amounts of endorphins, estrone, prolactin, oxytocin, thyrotropin-releasing hormone and serotonin, which can potentially affect your mood.

Rather than looking at semen as a mood booster, it is known that engaging in sexual activity in general is linked to a decrease in depression.

Will swallowing semen make you gain weight?

The amount of calories in semen is likely to be insignificant – containing less than 10 calories.

Does swallowing increase your risk of an STI?

When it comes to the risk of contracting STIs, it doesn’t matter whether you spit or swallow. Exposure to body fluids like pre-ejaculate fluid, semen, vaginal fluids or skin lesions like genital ulcers places one at risk of contracting STIs. This risk is further amplified if you have poor oral hygiene or wounds like cuts or ulcers in your mouth. 

What are the common STIs that can be transmitted through oral sex?

STIs can be transmitted through skin-to-skin contact, which includes oral-to-genital contact, or through contact with infected mucosa membranes and body fluids. Here are some of the common STIs which one may be at risk of contracting through oral sex.

Chlamydia and Gonorrhea are two common bacterial infections that can be transmitted through oral. Someone with throat Chlamydia or Gonorrhea may experience a sore throat but some individuals may have no symptoms at all and can continue to spread this infection to sexual partners. 

Syphilis can be transmitted during oral through contact with infected ulcers and if left untreated, can potentially affect multiple organs in the body including the brain and eyes.

Herpes (caused by the herpes simplex virus) can be transmitted either from an infected genital ulcer or oral cold sore or by skin-to-skin contact in an infected but asymptomatic individual. Genital herpes causes painful blisters and ulcers in the genital region. 

Human Papilloma Virus (HPV) can be transmitted as well. Some strains of HPV cause genital warts, while others increase the risk of various cancers such as cervical cancer, oral cancer or penile cancers.  

Many people tend to worry about HIV but the risk of HIV transmission through oral sex is actually extremely low, although unique circumstances like the presence or wounds or blood may increase this. 

Is it possible to be allergic to semen?

Yes. Semen allergy or seminal plasma hypersensitivity is a rare allergic reaction to proteins found in a man’s semen. While it usually affects the person exposed to it, it can also been shown to affect the person producing it.

Some common symptoms of sperm allergy are redness, swelling, pain, itching, and a burning sensation in the vaginal area. Symptoms usually start about 10-30 minutes after contact with semen. They may not be confined to the vaginal area; they can occur in any area that has contact with semen, including the skin and the mouth. Symptoms can last for a few hours or a few days.

This allergy is rare. However, if you do experience such symptoms, speak to your doctor about it.

This article is written by: Dr Grace Huang & Dr Chester Lan

Also on this site: STD check, HIV Clinic Singapore

7 Things You Need To Know About Anal Cancer In Men

Anal cancer is a rare disease and the understanding of its natural history is evolving. While it is the 26th most common cancer in the USA annually, the incidence rate is increasing at 2% per year over the past decade. Further underpinning its importance in recent times is that it is also one of the cancers that has devastatingly poor outcomes in the late stage while being relatively easy to detect and treat in the early stages.


What is Anal Cancer?

Anal cancer like all cancers start when the cells lose the ability to maintain their original form. Precancerous changes such as aberrant growth soon occurs as these cells no longer serve their original function and a tumor develops. 

The anal canal is a 4 cm structure that continues from the rectum. Embryologically, this canal develops from 2 distinct stem cells that originate from different parts of the body. As the embryo develops into a fetus, these 2 stems cells develop into either Squamous Cells (outside of canal) or Columnar Cells (inside of anal canal). These 2 cells meet and develop into the anal canal. This is important because the junction at which these 2 cells converge while forming your anal canal all those years ago is also the most susceptible site for developing anal cancer. 


Although not entirely analogous, anal cancer shares many similarities with cervical cancer in women. Both cancers occur most frequently at the junction where 2 normally distinct cells meet and majority of both tumors are found to be co-infected with Human Papilloma Virus (HPV) sub-type 16.

Men who have sex with Men (MSM) and immuncompromised patients (transplant, cancer patients and HIV patients) are more prone to this cancer. Compared to the general population, MSM with no HIV have 2 times the risk of developing anal cancer, MSM with HIV have up to 25 times the risk while transplant patients have 5 times the risk and a patient with previous colon cancer has 20 times the risk. Other risk factors include previous ano-genital warts, previous STD infection and high risk sexual activity.

Anal Cancer In The Early Stages

In its early stages, anal cancer does not produce any symptoms. The early signs of of developing anal cancer is pre-cancerous cell changes. This is detected by direct visualization and sampling of the area. The core principle of screening for anal cancer is hence looking for these pre-cancerous changes. This can be done through a variety of methods depending on the expertise available, each method has different levels of specificity in detecting anal cancer. 

Anal Pap Smear & HPV Testing

Currently, the Anal PAP smear and HPV testing is considered to be the most practical means of screening for anal cancer. This involves a swab inserted into the anal canal and cells from the area are sampled and looked under a microscope for any pre-cancerous changes, further processing of the sample via HPV DNA PCR is also used to detect any presence of HPV in these cells. Once the patients with potential risk of developing anal cancers are pick out with this screening, a further diagnostic test is required. The current diagnostic standard is High Resolution Anoscopy where a high magnification scope is used to examine the tissue. Different reagents are also used to differentiate normal tissue from pre-cancerous tissue. 

There are no established guidelines for how frequent screening should be carried out but current expert opinions recommend every 1 – 2 years for MSM with HIV and 2 – 3 years for MSM without HIV. 

Treatment of Anal Cancer

Treatment of anal cancer can be considered in 2 categories – Pre-cancerous treatment and Cancer treatment. Precancerous changes, once detected by screening and diagnosed with Anoscopy can be treated with either Topical Therapy such to eradicate the precancerous tissues. Local Ablative Therapy that involves Radiofrequency Ablation can also be used to destroy the any precancerous tissue. Cancer treatment for pre-cancerous changes that have progressed to cancer, on the other hand requires surgery.

In both situations, close monitoring post treatment is essential as the recurrence rates are significant especially in high grade pre-cancerous changes. 

Preventing pre-cancerous changes is essential to the approach of reducing anal cancer rates. HPV vaccination is shown to reduce pre-cancerous changes with a recent study showing 75% reduction in both Low and High grade changes in MSM population. There is also data suggesting that vaccination after precancerous changes have been detected is also able to reduce the rate of recurrence by approximately 20%.

In summary, anal cancer is disease in which majority of the tumors are driven by the HPV virus and in which pre-cancerous changes in the patients can accurately predict the chances of developing cancer especially in high risk populations. This makes screening and detection of early disease together with vaccination essential to reducing the rates of anal cancer.

Next read: PENILE CANCER – 7 THINGS YOU NEED TO KNOW!

Anal Douching – 7 Things You Need to Know!

Anal douching is the act of cleansing the anal canal and can be done in a variety of ways with a range of products. Many use anal douching to prepare for receptive anal intercourse, however, while it does help with cleaning the area, it is not strictly necessary for anal intercourse.

The anal canal is situated just beyond the rectum, its surface is lined by mucosa layer that amongst other functions, prevents the entry of infective agents such as bacteria into the underlying tissue. Another important structure of the anal canal are the anal sphincters, these muscles line both sides of the canal and maintain fecal continence (keeping your poop in).Tears in the mucosa layers can become infected very quickly, as these wounds further develop into abscesses, they ulcerate through the deeper layers of the anal canal and if the sphincters are damaged, can result in fecal incontinence. 

Overzealous cleansing – too hard or with harsh chemicals results in the mucosal lining of the anal canal to dry out. Dry tissue is “friable” meaning it breaks apart easily thus pre-disposing the anal canal to infection. Therefore, much like how scrubbing your hands with steel wool can give you blisters, anal douching is not entirely bad but must be done in a measured and safe way.

Is douching necessary for Anal intercourse?

No. Clearing your bowels before anal intercourse is useful in keeping your sheets clean and because most bowel movements are able to clear the rectum (the body’s poop storage pouch), gentle cleaning of the external anal canal will suffice in most cases. 


Are laxatives recommended when preparing for anal sex?

Not generally. Laxatives are designed to clear the entire colon which is approximately 1.5 m long. Generally, anal intercourse involves the anal canal (~4cm) and rectum (~15cm), which works out to approximately 20 cm of length or 10 inches (the law of averages would suggest that it enough space for most anal intercourse). A downside of using laxatives is that it can dehydrate you because it pulls water from your body into the colon to give “soften” the contents of the colon. 


Enemas for anal douching?

Enemas for emptying out the rectum and anal canal. It can be seen as a more focused means of cleaning out the area compared to Laxatives. There are however several concerns with enemas.

Firstly the solution used in the enemas can change the chemical balance in that area of your body. This can dry out the mucosa and predispose to damage. The tip of the enema should be soft and insert gently, this will prevent inadvertently tearing the mucosa with the tip of the enema. And lastly, do not share your enemas, studies have found that sharing enemas is a risk factor for the transmission of Sexually Transmitted Infections.


Is using water the best option to clean out your anus?

Yes. Water is generally pH neutral and is not as caustic to the mucosa as some of the chemicals in enemas. Again be careful when inserting anything into your anal canal!


Does over-douching cause you to poop?

Depending on how you do it but generally no. Douching itself is different from laxatives in that it only clears the poop in your anal canal and rectum. 


How long should anal cleansing take?

Anal cleansing should take about 5 – 10 minutes. Again, like washing your hands, overzealous washing can damage the tissue and make it friable. A good bowel moment and gentle washing if the area with water should suffice in getting the area clean.


Does anal douching increase the risk of HIV/ STDs?

Potentially. As mentioned, sharing enemas is a risk factor for contracting STDs even after washing the tip. Because most STDs infect by entering the body through a break in the mucosa, any damage to that layer either by overzealous washing changing the chemical balance of the tissue making friable or mechanical damage with a pointed enema tip create entry points for infective agents that cause STDs to enter the area. To further minimize the transmission of STDs during Anal Intercourse it is hence best to wear a condom.

Also read: Vaginal Douching


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Pride Month

When COVID-19 started hitting China back in Jan 2020 and in subsequent weeks, Wuhan one of the hardest-hit city in China began a lockdown that lasted for 2 months or so, few in the rest of the world stopped to think that in the following months to come, various countries would be implementing some version of the lockdown seen in Wuhan. 

As more and more countries started to close their borders and implement movement restrictions and social distancing measures in order to control the spread of the pandemic, people around the world started to realise how much as humans we value the physical interaction we have with each other. From shaking hands of friends and co-workers to holding hands of our loved ones or visiting our elderly parents and grandparents to meeting friends for a meal, we suddenly found ourselves living in an artificial bubble where all such interactions we took for granted have all but vanished in a span of days or weeks.

Singapore is no exception. Towards the end of March 2020, the government announced that Singapore would be placed in Circuit breaker mode which initially was supposed to last for a month but has since been extended to 1st Jun 2020. In a matter of days, all forms of social interaction outside an individual’s household would come to an abrupt halt. As the circuit breaker progress through time, reports from media started highlighting vulnerable groups in society which were originally marginalized under normal circumstances and made even more vulnerable with the circuit breaker rules.

Plight of groups of the homeless, jobless, foreign workers and the elderly were talked about much in the media. This pandemic has brought to surface the many groups of vulnerable populations in any society and has raised the indignation of many. As Pride month approaches, perhaps let us think about another group of vulnerable populations in the world – the LGBT+ community. The LGBT+ community around the world still faces various forms of discrimination – legal, religious, societal and in some cases their own family.

Just as many of the heterosexual couples who under the current circumstances who are unable to meet physically with each other, the LGBT+ couples are also faced with the same scenario. While one may argue that couples both heterosexuals and LGBT+ can use technology such as Zoom/ Facebook messenger to “see” each other, it is a poor substitute for being able to hold the hands of your loved ones while walking down a street or hug each other for encouragement. How many times when we feel low have we wished for friends or family or loved ones to just hold our hands or to brush that one teardrop off our face. How many times during our moments of joy have we felt to hug our friends or family or loved ones to share in that moment of joy. The LGBT+ community is no different from any other human. They too long for those moments.

Similarly, like many heterosexual individuals who are searching for love and hope to share their lives with their loved ones, the LGBT+ community is of no exception. As humans, we hope that in our short time on this Earth, we can share our joys and tears with our loved ones. To be able to wake up in the morning and see the face of our loved ones sleeping soundly and safely, to prepare meals for our loved ones. Even with the most mundane activity like grocery shopping as long as we have our loved ones beside us, we would feel the bliss of the moment. This again is no different for the LGBT+ community.

When the time comes for heterosexual couples that they are ready to move on to the next stage of the relationship, they would propose and register to become lawfully wedded couple. Similarly, for the LGBT+ community when they found the one whom they want to share the rest of their lives together, they too hope to be able to register to become a lawfully wedded couple. It is not just a symbolic gesture but also has legal implications. For example, when medical decisions have to made because for whatever reason the other partner is unable to do so, because LGBT+ couples are not legally recognized as next of kin, many times they are not allowed to make decisions on behalf of their partner and the true wishes of the other partner is not being respected. It is a heart-wrenching experience faced by all involved.

For many of the LGBT+ community, they often are faced with the prospect of “coming out” to their family or friends. The numerous nights they toss and turn in bed trying to decide whether to “come out” to their family or friends. The umpteen times when they think they have decided to “come out” but yet at the last moment could not bring themselves to do so and then subsequently beating themselves over it later. This flip-flopping is not because they are ashamed of their gender identity but rather the fear of hurting their family or losing friendships. Let all of us as friends and family and as society in general remove that fear. No one (heterosexual or otherwise) should feel fearful when they need to tell their family or friends of some news of their lives. As family or friends, we are their safe harbour.

Some may think the fear is irrational as some family or friends may think they have not said or done anything that warrants that fear. However sometimes in our daily snippets of conversation, we have evidence and subtly expressed our discrimination or disapproval of the LGBT+ community. For example, some of us may have said in the moment of anger or jest the word fag just as we would say the F- word, it may not necessarily suggest that we are discriminating against the gay community but to the LGBT+ community is another stab in their heart.

In a YouTube video featuring a gay couple who have found love with each other but found themselves unable to be legally married because while one of the partners lives in a country that just passed a law to allow for LGBT+ marriage, it comes with a restriction that if one of the partners is not a citizen of that country and is not of a citizen of a country that legalized LGBT+ marriage then they still another not allowed to be married. One of the partners in the video asked poignantly, “All we want is to get married, is it that difficult?”

With talks of how this pandemic is going to change society even when the pandemic is over, I hope that part of that change will be a greater acceptance by society of the LGBT+ community where the LGBT+ community is finally able to be allowed to love without discrimination and be accepted as being part of society. The right to love and be loved should be unconditional.

Happy Pride Month
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. 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.

Penile Cancer – 7 Things You Need to Know!

The mere mention of penile cancer conjures up much fear and uncertainty among public imagination, especially among grown men. It is not a common cancer in Singapore, hence it is not well known to the public. We shall explore more details in this article about this little known cancer.

What exactly is penile cancer?

Penile Cancer happens when the normal cells of the skin and tissue of the penis turns malignant and grows beyond control, forming a tumour. Penile cancer may eventually spread to other parts of the body including other glands, lymph nodes or organs.

Penile cancer is typically a disease of older men, with most patients around the age of 60 when diagnosed. In developed countries like the USA, Europe, Singapore, penile cancer is rare, accounting for less than 1% of all cancers diagnosed. This is in contrast to less developed countries like South America, Parts of Africa and Asia where penile cancer can account for 10 to 20% of all cancers diagnosed.


Signs and Symptoms of penile cancer

The majority of penile cancers arise from the head of the penis or from the foreskin. The most common findings on examination is a painless lump or an ulcer. The symptoms may include bleeding, rash or balanitis. 30 to 60 percent of patients also have swollen lymph nodes in the groin as well. 


What is the cause of penile cancer?

The majority of penile cancers are squamous cell carcinoma (SCC) and its many variants. Other cancers which can affect the penis include basal cell carcinoma (BCC), Kaposi Sarcoma (KS), melanomas and other lymphomas.


Who is at risk for penile cancer?

  • Patients with previous known medical condition of the penis. This would include warts, infections, previous injury, tears or strictures
  • Phimosis. Uncircumcised males sometimes have a thickening and scarring of the foreskin. This is a condition known as phimosis, which is a difficulty in retracting the foreskin over the head of the penis. 
  • Human Papillomavirus infection (HPV). HPV can be found in 30% to 50% of penile cancers.
  • Smoking and Tobacco Exposure
  • Human Immunodeficiency Virus (HIV) Infection
  • Patients with previous Ultraviolet treatment for psoriasis.

Who to prevent penile cancer?

  • Patients who have phimosis can consider getting a circumcision
  • Vaccination against HPV early can also be useful in preventing infection and possible penile/anal cancer. Screening for High Risk HPV through a swab can also be useful in patients who have risk factors.
  • Patients who are smokers should definitely stop smoking not only to prevent penile cancers but other forms of cancers as well.

What are the treatments for penile cancer?

Treatment of penile cancer depends on the type and staging of the cancer. If disease is limited, organ preserving treatment options include topical medications, lasers, radiation therapy or micrographic surgery. If the cancer is advanced and locally extensive, a partial or even full amputation of the penis might be required.


What are the complications of penile cancer?

After treatment, patients might be faced with complications depending on the kind of treatment. For organ preservation treatments, issues with cosmesis, erectile dysfunction and reduced sensation are common. For surgical treatments, for example a penile amputation, patients might require an external opening known as a urethrostomy for urination. Patients might also require a surgical reconstruction of the amputated organ for cosmetic issues.


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7 Different Types of Eczema

Eczema is an uncomfortable condition where parts of the skin become itchy, rough, inflamed, and in worst cases, ooze puss. Characterized by red patches and blisters, they are a great discomfort and are projected to plague a number of people in our population.

In this article, we will go over the various types of Eczema, their symptoms, and their causes in order to help you understand how to best prevent getting them. 


Different Types of Eczema


1. Stasis Dermatitis 

What is Stasis Dermatitis? 

Occurs usually in the lower leg, it is the formation of rough dry patches. It makes the leg feel heavy and inflamed. Stasis Dermatitis can also be known as Venous Dermatitis or Venous Eczema. 

What are the symptoms of Stasis Dermatitis? 

• Patches of skin colored yellow, red, or brown. 

• Bulging veins and swelling of the leg. 

• Itchiness and inflammation. 

• Sores that ooze. 

• Ulcers. 

What are the causes of Stasis Dermatitis? 

Usually found in individuals over 50 years of age or above, the condition is brought about by low circulation of blood to the leg. Usually due to high cholesterol or injury preventing proper blood flow. 

2. Nummular Eczema 

What is Nummular Eczema? 

Also known as Nummular Dermatitis or Discoid Eczema, these are characterized coin-shaped lesions that appear on the arm and legs that may or may not ooze puss or clear liquid. 

What are the symptoms of Nummular Eczema? 

• Circular lesions on the skin 

• Dry and itchy 

• Blisters that ooze liquid or puss 

What are the causes of Nummular Eczema?

There are no known definitive reasons why Nummular Eczema forms. It is thought that it is a congenital condition that forms when the individual is injured or experiences drastic changes in temperature. It may also be an allergic reaction to certain soaps or skin products. 

3. Neurodematitis 

What is Neurodematitis? 

Typically found on the neck, wrists, arms, legs and anal region, it is known for causing extreme itchiness that will worsen if scratched – creating an uncomfortable itch-scratch cycle. 

What are the symptoms of Neurodematitis? 

• Itchy Patches 

• Scaly textured skin 

• Patches that are rough and differently colored to the rest of the skin. 

What are the causes of Neurodematitis? 

A chronic skin condition, it is generally thought to form through bug bites or tight fitting clothes. There is, however, no objectively proven reason for their formation.

4. Hand Eczema 

What is Hand Eczema

Also known as hand dermatitis, it is blisters and red patches in the hands that are thought to be caused by allergic reaction or genetics. 

What are the symptoms of Hand Eczema? 

• Red Patches on the hands 

• Blistering 

• Dryness and flaking 

• Itchiness and pain 

What are the causes of Hand Eczema? 

Likely caused by allergic reaction to irritant substances. It is also known to come seasonally for those who possess it genetically. 


5. Dyshidrotic Eczema 

What is Dyshidrotic Eczema? 

Also known as Pompholyx, it is a form of dermatitis that forms on the tips of fingers, soles of feet, toes, and palms. Such a skin condition can sometimes be unresponsive to treatment and can cause much burden to both patient and doctor. 

What are the symptoms of Dyshidrotic Eczema? 

• Blistering and scaliness 

• Clear, white, or yellow colored patches 

• Itchy and may exude clear liquid 

What are the causes of Dyshidrotic Eczema? 

It may be caused by stress, pollen, excessive sweating, and/or an allergic reaction to nickel in jewelry or other metals. 


6. Contact Dermatitis 

What is Contact Dermatitis

It is the red and itchy patches of skin caused by direct contact to substances which one is allergic to.

What are the symptoms of Contact Dermatitis?

• Red rashes 

• Bumps caused by severe scratching 

• Itchiness 

• Tenderness, swelling, or burning sensation of the skin. 

What are the causes of Contact Dermatitis? 

The likely culprits are cosmetic products, soaps, and/or cleaning chemicals that cause irritation and allergic reactions.


7. Atopic Dermatitis 

What is Atopic Dermatitis? 

Long lasting and tends to flare up in periodic time frames, it is characterized by red itchy patches and may be accompanied by fever or asthma. There is no known cure. 

What are the symptoms of Atopic Dermatitis? 

• Dry Skin 

• Red Patches or Bumps 

• Itchiness and swelling 

• May be crusty and leak 

What are the causes of Atopic Dermatitis? 

Perhaps caused by an allergic reaction to certain foods, it is likely a genetic condition spurned by a lack of moisture on the skin thus making it more prone to irritants. 

We provide testing, treatment and management for Eczema and other skin conditions at our Vitiligo, Psoriasis & Skin Clinic by DTAP Clinic

Speak to our doctors today!



Parasitic STIs – Scabies

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

Scabies – The hidden itch

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

Signs and Symptoms

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

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

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

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

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

How does one get it?

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

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

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

Treatment options

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

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

Next read: CRABS STDS – PUBIC LICE

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Neurosyphillis

Syphilis is a Sexually Transmitted Infection (STI) caused by the bacteria Treponema Pallidum. It is a systemic infection with a multitude of signs and symptoms depending on the stage of the infection. As such, syphilis is also known as “the Great Imitator” because the clinical presentation may appear similar to many other diseases.

There are four stages of infection: 

  1. Primary syphilis – painless ulcer (or chancre) at the site of infection
  2. Secondary syphilis – manifestations that include, but are not limited to, skin rash, mucocutaneous lesions, and lymph node swelling
  3. Latent syphilis – this stage can last for a number of years with few or no symptoms
  4. Tertiary syphilis  – gummatous lesions (soft, non-cancerous growths), neurological problems, or cardiac symptoms

In this article, we will focus on neurosyphilis. You can learn more about syphilis as an overall topic in a previous article:



What is Neurosyphilis?

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. 

There are four different forms of neurosyphilis:

  1. Asymptomatic (most common form)
  2. Meningovascular
  3. General paresis (muscle weakness)
  4. Tabes dorsalis (slow degeneration of the neural tracts of the spinal cord)

Asymptomatic neurosyphilis occurs before symptomatic neurosyphilis. Early neurosyphilis affects the blood vessels and meninges (membranous coverings of the brain and spinal cord) whereas late neurosyphilis affects the brain and spinal cord itself.

Signs & Symptoms

Signs and symptoms vary widely depending on the form of neurosyphilis, including:

  • Stroke
  • Changes in personality
  • Dementia, mania, or paranoia 
  • Ataxia (loss of coordination of muscle movements, eg. leading to gait abnormality)
  • Ophthalmic symptoms (eg. blurred vision, reduced color perception)
  • Urinary symptoms (eg. bladder incontinence)
  • Headache
  • Giddiness
  • Hearing loss
  • Seizures 
  • Hyporeflexia 
  • Sensory impairment 

Risk Factors

The risk factors include: 

  • High risk sexual behaviour from unprotected sex and multiple sexual partners
  • Men who have sex with men
  • Recreational drug use

Diagnosis

Syphilis is diagnosed either via blood tests or direct visual inspection using dark field microscopy. In practice, blood tests are more commonly used as they are easier to perform.

To diagnose neurosyphilis specifically, cerebrospinal fluid (CSF), which is a fluid surrounding the brain and spinal cord, is obtained via lumbar puncture and the Venereal Disease Research Laboratory (VDRL) test is performed on the CSF. 

Other laboratory investigations that may be performed include: cerebral angiogram, computed tomography (CT) or magnetic resonance imaging (MRI) scan of the brain, brain stem or spinal cord.

Treatment

Syphilis is treated with intramuscular injection of the antibiotic benzathine benzylpenicillin. Early syphilis is treated with a single dose whereas late syphilis is treated with a once-weekly dose for 3 weeks. 

For neurosyphilis, however, the treatment course is different as penicillin penetrates the central nervous system poorly. Instead, the treatment requires intravenous penicillin every 4 hours for 10 to 14 days.

Generally, follow-up blood tests are performed at 3, 6, 12, 24, and 36 months to ensure the infection has fully resolved. Follow-up lumbar punctures for CSF analysis are performed every 6 months. 

Prevention

Neurosyphilis can be prevented with the following measures:

  • Safe sex practice, namely correct and consistent condom usage
  • Avoiding high risk sexual behaviour. Aside from abstaining from sexual contact, the surest way of avoiding STIs is to be in a mutually monogamous relationship with a partner who has been tested and is free of STIs
  • Regular STI screening and if syphilis has been detected, to receive early and prompt treatment
  • In the case of an individual diagnosed with a syphilis infection, prompt partner notification and treatment helps to reduce the risk of undetected syphilis

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“Cheap” Viagra

From time to time, there has been reports on the news about people suffering ill effects after taking unlicensed, unverified health products which claim to boost the “virility” and “sexual prowess” of men.

In fact, these illegal products often contain different pharmaceutical compounds. In 2008, 10 people died after taking them for sexual enhancement. Diabetes medications were found in these tablets, resulting in people experiencing low blood sugar, dizziness and fainting, cold sweats and eventually loss of consciousness. 

Furthermore because the compounds of the drug are unknown, many have also experienced side effects such as loss of hearing, strokes and extremely painful erections. Not the outcome one would be looking for when wanting to boost their own libido. In fact if left untreated, these painful erections caused by the engorgement of blood can lead to Permanent Impotence.

Image taken from Immigration & Checkpoints Authority Facebook.


These illegal products are often bought from street peddlers, online pharmacies or even from other countries with no prior Health Sciences Authority (HSA) Singapore approval. That being said, here are the top 5 reasons why “Cheap” Viagra may end up costing you so much more than just the money you think you might be saving.

1. You can get severe side effects from unknown doses or what is in the drug

The tablet may contain any combination of medicines to boost erections, other medications that may have adverse side effects such as the diabetes medications i described above. Ultimately leading to organ damage and eventually  death.

The main way medications boost erections are by enlarging the blood vessels in the penis, allowing more blood to flow in. If these engorgement of blood is not regulated and the blood flow is not reversed after a while, it can lead to priapism (engorgement of blood in the penis), painful erections and ultimately impotency. 

Without medical supervision, the penis may eventually have not enough new oxygen from new blood, and after a few hours, critical damage to the penis can start to occur. This is dangerous and is a medical emergency.

2. You could be paying for a dud

Don’t be fooled by catchy packaging names such as King Power, Black Gorilla, Tiger King. Many times, for the sake of selling the tablet, the peddler has no idea what goes into it.

You would be lucky to have avoided an adverse health event, and in this case, have completely no effect at all after taking the tablet. In fact, the scary thing is you might end up taking an additional one or two to get a better effect and end up overdosing on the toxic components of the tablet as well. 

3. You have no idea how these drugs are made

Because there is HSA approval of these illegal drugs, there is no guarantee they are made under the proper conditions. This means you might think you are buying a new Ferrari, but after getting the keys, you realize that either there is no engine or that they have given you a Toyota engine instead. Worse still, they could have given you a spoilt ferrari engine, and after driving for 5mins, the engine explodes and you get caught in the explosion.

4. You may not be getting to the root of your problem

You might also think that these sexual enhancement medications may address your poor erections, but instead there are other root causes or even more effective and safer treatments available that need to be addressed. Testosterone Deficiency Syndrome | Andropause

ESWT For Erectile Dysfunction

This is a novel mode of treatment for Erectile Dysfunction which uses low-intensity shock waves directly to penile tissues to help stimulate the growth of new blood vessels. It has been shown to be safe, painless, and effective for the treatment of vasculogenic Erectile Dysfunction (caused by blood vessel problems such as in people with diabetes and high blood pressure).

If you think you may have Erectile Dysfunction, the first step is to speak to your doctor. There are many safe and effective treatments now available for Erectile Dysfunction, but recommended treatments may vary depending on the underlying cause, age and comorbid conditions such as heart disease.

5. You might think it is very difficult to see a doctor and get real HSA approved medications

With DTAP Teleconsult, we are one call away from addressing your erection concerns in full privacy, medical supervision and support with 3 breezy steps. Furthermore, you do not even need to leave the comforts of your own home to receive the medications you require with DTAP Delivery. All within the same span of the day. This convenience and assurance should be no excuse for you to put your health and life at risk by taking “Cheap” Viagra.

With 15 years of caring, our doctors at DTAP clinic will support you through your men’s health journey professionally, discreetly, and effectively.


Phototherapy

What is Phototherapy?

Phototherapy is the treatment of skin diseases with light, commonly using ultraviolet (UV) light.  UV light is that invisible part of sunlight with wavelengths shorter than visible light. The history of phototherapy dates as far back as ancient Egypt, where natural light was used in combination with herbal extracts to treat skin diseases.

The UV spectrum is classified into 3 wavelength ranges – UVA, UVB and UVC – in descending order of wavelengths.  UVA and UVB are used in medical treatments. UVA penetrates deeper into the skin and is more often associated with skin aging.  It is the most abundant form of UV rays in sunlight that reaches the earth surface.  UVB is associated more with sunburns.

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How does Phototherapy work ?

Phototherapy has the effect of reducing skin inflammation and promoting growth of pigment cells in the skin.  Hence it is especially well suited for the treatment of vitiligo and inflammatory skin conditions like psoriasis and eczema. 


What skin diseases can Phototherapy treat ?

Skin conditions that have been effectively treated with phototherapy include:

  • Vitiligo
  • Psoriasis
  • Atopic dermatitis also commonly known as eczema
  • Nodular prurigo
  • Pityriasis rosea
  • Pityriasis lichenoides chronica
  • Lichen planus
  • Chronic spontaneous urticaria
  • Progressive macular hypomelanosis

How is treatment like ?

Phototherapy can be delivered either to the whole body or only to a certain part of the body.  The machines used are different in each case.

Whole body phototherapy is conducted in a stand-up position inside an enclosed treatment booth. The inner walls of the treatment booth are lined with UV lamps all around for a uniform whole body treatment.  This is the most common form of treatment and is suitable for skin diseases that involve a large proportion or span across different parts of the body.

Targeted phototherapy on the other hand, is delivered via a handheld UV lamp operated by a therapist. This form of phototherapy treats only the affected parts of the skin and spares normal skin from unnecessary UV radiation.  It is suitable for treatment of skin diseases affecting only a small part of the body.

In whole body phototherapy, the initial treatment time is brief, usually less than a minute.  This time will gradually increase in subsequent sessions as the skin becomes used to the effects of treatment such that a higher dose of UV light will be required to maintain effective treatment effects.

Treatment times for targeted phototherapy will depend on the amount of skin area to cover in one treatment session. Treatments are usually carried out 2 to 3 times per week for several weeks and sometimes several months in order to see significant improvement in the skin conditions treated.

The number of treatments needed to achieve satisfactory clearance of skin disease is variable and depends on several factors like the type of skin disease being treated, duration of disease, area of the body affected, sensitivity of the skin to UV therapy and others.  Consistently following a regular treatment schedule is usually key to successful therapy.

Once satisfactory clearance of disease has been achieved, maintenance phototherapy once a week or fortnight may be recommended to prevent relapse.

Phototherapy may sometimes be combined with certain oral medication and/or topical creams to enhance treatment effects and success.


Is Phototherapy safe ?

Phototherapy is generally a very safe method of treating skin diseases.  It is an externally applied treatment that does not harm the internal organs compared to certain oral medications that are used to treat skin diseases.

The actual treatment is generally painless.  The most common potential side effects are sunburn, redness of the skin, itchiness and dryness that are easily relieved with frequent application of a moisuriser. Very rarely, severe sunburn can develop that requires medicated creams for treatment.

A tan may also develop after prolonged phototherapy.

The eyes and skin of the male genital organs can be susceptible to damage from UV radiation.  Hence it is important to shield those areas during phototherapy with UV protective goggles and underwear.  Doing so can prevent such risks.

It is possible with any form of UV light that an increased incidence of skin cancer may occur later in some patients, usually only after many UV light treatments.  This risk is minimal in short-term therapy.  Studies to date have not shown association of narrowband UVB phototherapy with increased skin cancer.

Skin aging is another side effect of long-term therapy.


How do I know if I am suitable for Phototherapy ?

Your doctor will ask about your medical history and the medications that you are currently taking before advising if you are a suitable candidate for phototherapy.  Certain medical conditions such as systemic lupus erythematosus can be made worse by phototherapy and if you have such a medical condition, you may not be suitable for phototherapy.  Certain medicines can make you more sensitive to UV light or sunburn easily.  If the medicine that you are taking have this concern, then adjustment to dose or time of taking the medicine may have to be made before phototherapy.

Phototherapy is usually recommended as the next step in treatment if medicated creams are no longer working for your current skin condition.

Phototherapy is avaiable at our Vitiligo, Psoriasis & Skin Clinic, if you have any question or would like to find out more about phototherapy and how this safe and potentially beneficial treatment method can help manage your skin disease.

Next read: Vitiligo Causes, Signs & Symptoms

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