Sexually Transmitted Infections

Background Information 
Sexually transmitted diseases are those diseases which are transmitted through sexual intercourse with an infected partner. Sexual intercourse includes oral sex as well as anogenital sex. It may also include those that are transmitted through close contacts (skin to skin) eg scabies, pubic lice, warts, etc. Some of the STDs are also transmitted via other routes eg, mother to child, intravenous via contaminated needle-sharing (HIV, syphilis, Hepatitis B) and very rarely through contaminated blood and blood product transfusion or organ transplantation / grafts.

Epidemiology 
As at the end of 2012, the top 5 STDs in Singapore are:

  • Chlamydia
  • Syphilis
  • Gonorrhoea
  • Genital Warts
  • Genital Herpes

These findings represent only the notified cases, which is just the tip of the iceberg, as many patients seek treatment in private clinics and are not always notified.

Clinical
Symptoms of STD can include:

  • Genital discharge (vagina in females, urethra in males)
  • Dysuria (pain when passing urine)
  • Genital ulcers or sores
  • Groin lymph node swelling
  • Genital blisters/rash/growths
  • Fever, rash, lymph node swelling and joint pains (eg. secondary syphilis, disseminated gonorrhoea)
  • Pelvic pain in females (Pelvic inflammatory disease)
  • Testicular swelling/prostate inflammation (Orchitis/ prostatitis in males)

The incubation period which is the time between infection and the first symptoms can vary from 2 days to many weeks depending on the type of infection. Not every STD can be diagnosed by a blood test. Usually, STDs like HIV, hepatitis B and syphilis are best diagnosed by blood tests. Those that present with a genital pain or discharge are best diagnosed by culture of the discharge, taking an endocervical swab (female) or urethral swab (male). Some blood tests for antibodies can tell you if you have been infected before but cannot be used to diagnose acute infection. Prevention is available for certain STDs eg Hepatitis B can be effectively prevented by immunisation, HPV (Human Papilloma Virus) by HPV vaccination. For the other STDs, the only absolute prevention is abstinence. The use of a condom gives close to 100% protection provided it is used correctly.

Treatment 
STDs are treated according to the type of infection, for example:

  • Syphilis is usually treated with penicillin injections
  • Gonorrhoea is usually treated with intramuscular injection and sometimes pills
  • Genital herpes is treated with anti-viral drugs eg. Valtrex
  • Genital warts can be treated with creams, surgery, electrocautery, liquid nitrogen or lasers
  • Chlamydia is usually treated with either Azithromycin or Doxycycline

In the treatment of STDs, partner screening and treatment is very important. Sometimes, we have to do a test of cure before they can resume normal sexual activities.

Points to Note:

Some myths fallacies associated with STDs include:

  • STDs can be transmitted by toilet seats, sharing food and handshakes.
    Fact: STDs can only be transmitted by sexual contact
  • STDs can be inherited from your parents and may affect all future generations.
    Fact: STDs are not genetically passed down from generation to generation. However, an infected mother who is not treated can infect her newborne via placental route or during birth/delivery
  • People can only get one STD at a time.
    Fact: Since STDs are transmitted by the same route, it is not uncommon to get more than one STD at a time
  • STDs once notified will cast a black mark on you.
    Fact: STDs are notified only for reason of statistics, occasionally, it is for contact tracing especially when it involves commercial sex workers. This is to prevent further transmission to other clients.

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