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TL;DR
By screening together, couples can confirm whether any undetected STD infections are present and get treated in time.
It can be embarrassing to notice abnormal vaginal symptoms following intimacy with partner. It can be even more awkward when your partner(s) feedback that he/ they are experiencing unusual genital symptoms following intercourse.
If this has happened to you, you may wish to continue reading this article.
In this article we strive to address the main concern on whether the recurring genital infection is a sign of the opposite partner(s) having STDs.
The human body is densely covered by billions of microorganisms. The skin, the gut, even the genital has their own distinct and unique microflora ecosystem.
The external male genitalia are exposed to the external environment. In uncircumscribed male, the microflora of the penis and urethra can be more diversified and potentially harbor anaerobic bacteria.
The male genital microbiome can be shaped by the opposite partner's genital microbiome due to transmissibility during coitus.
In those who has sexual contact with female partner(s) with bacterial vaginosis (BV), they have the propensity to house anaerobic bacteria over the penile folds.
Male genital microbiome that harbors more bad anaerobic bacteria can result in persistent inflammation over the penile region, leading to susceptibility of contracting STDs such as HIV, Herpes Simplex Virus (HSV), Human Papilloma Virus (HPV), Chlamydia trachomatis, Neisseria Gonorrheaand etc.
Untreated male with STD can result in displacement and disruption of the normal male genital microbiome, resulting in a more diversified pathogenic microorganism environment. One can be either completely 'fine' and asymptomatic or clinically manifest as discomfort over the urethral region, abnormal urinary symptoms, lower pelvic pain or even testicular discomfort.
The female genital microbiome is an ecosystem that maintains its equilibrium with constant low pH, homogenously dense amount of Lactobacillus spp. This ensures the sterility of the vaginal canal and serves as a protective layer against infections.
Following hormonal fluctuation, immune system changes, external stress, infections, medications, even sexual intercourse, the natural genital flora microbiome can be disrupted, resulting in a more heterogenous bacteria community and depletion of healthy lactobacillus spp, in the vagina and a higher risk of contracting infections.
The male genital microbiome environment can influence the female counterpart via:
Due to pH changes during sexual intercourse, the female microenvironment can become more alkaline (baseline normal pH tends to be acidic in nature!), resulting in depletion of healthy lactobacillus spp and diversification of the female microflora with anaerobic flora such as Ureaplasma spp, Mycoplasma spp, Candida spp, Gardnerella vaginalisand etc.
Male penile microflora can act as a blanket for various bad anaerobic bacteria and during sexual contact, the penile flora can be exchanged and passed onto the female vagina, resulting in growth of the bad bacteria in the female vaginal canal.
Abnormal female vaginal microflora with the loss of natural vaginal microflora physical barrier increases susceptibility of various STD infections. It is known that women with untreated bacterial vaginosis are at higher risk of contracting STDs.
In the event of having an undiagnosed and untreated STD in men, this can further complicate the female genital microflora.The male semen with STDs can be pro-inflammatory to begin with. This triggers inflammation in the vaginal mucosa during sexual intercourse, leading to symptoms of acute vaginitis such as burning, pain, itching, abnormal discharge of the vagina.
As mentioned in the above discussion, even if the opposite partner(s) are well and asymptomatic, having insidious untreated STDs can cause inflammatory response in the other couple during sexual contact resulting in vaginal infection. If the underlying infection(s) between the couple is not identified and treated, vaginal infection is likely to recur.
Having said that, recurrence of vaginal infection can occur non-STD related in view of influence and effect of the male genital microbiome de-stabilizing the female vaginal microflora as discussed on the above.
Regardless of whether either sides of the couples experiencing symptoms, proactive STD screening is the only way of identifying any hidden infection(s).
Couple screening allows:
You can reach out to your trusted healthcare providers and consider book in an appointment with your partner(s). It is worth discussing your concerns and your partner(s) concerns with your doctor during consultation. Your doctor can guide you on the relevant screening tests for both you and your partner(s) depending on your history, symptoms, and concerns.
Screening tests can involve blood tests, urine tests, vaginal and cervical swab tests (in female only).
Your healthcare provider should run through the tests results. If there is infection(s) identified, your doctor can prescribe you and your partner(s) (if need) medication to eradicate or alleviate the condition. Advice on lifestyle, healthy safe sex is often discussed to prevent re-infection or recurrence of symptoms.
It is good practice and advisable for you to let your partner know your health status and encourage your opposite partner(s) to get medically checked (even if the person is asymptomatic). This is imperative to break the infectious vicious cycle between couples, preventing repeated transmissibility during sexual intercourse.
If both sides are not treated properly, there is a chance that the infection(s) can re-infect each other again, resulting in recurring abnormal genital symptoms. Long term untreated genital infection, can result in health complications such as pelvic inflammatory disease, chronic pelvic pain, prostatitis, infertility, poor sperm quality or even miscarriage.
Don't ignore recurring symptoms—it's crucial to understand the cause of persistent vaginal infections, which may be linked to STDs. For a confidential consultation and comprehensive testing, reach out to our specialists today. Contact us now!
References:
Contracting HIV remains one of the biggest fears in most of us due to the incurable state of the condition and associated disease stigma. HIV infection is still a global public health concern, with ongoing transmission and infectivity worldwide. Hitherto, HIV have claimed approximately 44.1 million lives, based on the World Health Organization (WHO).
There is no cure for HIV infection. Once a person contracted HIV, they will have the infection for life. HIV infection can be contracted through unprotected sexual intercourse, body fluid, mother-to-child vertical transmission, needle sharing/ needle stick injuries or (rarely) blood transfusion with a HIV-infected person.
Despite being incurable in disease nature, we can prevent HIV. PEP medication is the next best chance to halt acquisition of HIV following exposure to the infection. PEP, when given promptly can be life-saving.
The risk of contracting HIV following unprotected intercourse with a person with HIV infection is estimated by below:
| Type of Intercourse | Risk |
| Receptive vaginal sex (Receiver) | 1 in 1000 |
| Insertive vaginal sex (Giver) | 1 in 1219 |
| Receptive anal sex (Receiver) | 1 in 90 |
| Insertive anal sex (Giver) | 1 in 666 |
The risk of HIV infection in oral sex is low with limited statistic estimation of the risk, though there are documented reports of HIV infection cases acquired through oral intercourse. The risk of oral sex increases if there is a history of ejaculation in a receptive oral intercourse person.
Other risk factors of acquiring HIV when exposed to a HIV person include:
As everyone's encounter risk may differ, you may wish to discuss with your trusted healthcare provider for further evaluation of your risk of exposure to HIV and/ or other STDs.
HIV PEP is the short form of post-exposure prophylaxis. 'Prophylaxis' means 'prevention' or 'containment' of further spread of disease. In the context of possible HIV infection, PEP medication is used to prevent the acquisition of HIV infection following a possible exposure.
HIV PEP should be started within the first 72 hours after possible exposure to HIV. The earlier one starts PEP, the better effect it is as every hour makes a difference.
Although HIV PEP is effective in reducing the risk to HIV, it should be used in emergency situation (after an accidental exposure occurred) and not meant to be used in those who may have frequent HIV exposure.
One should consider PEP if they do not have baseline HIV infection (or who is not aware of his/her HIV status), and in the last 72 hours have:
If you are concerned of possible exposure to HIV, do not hesitate to reach out to your healthcare provider for PEP without any delay.
When a person is exposed to HIV virus through the skin or mucous membrane, a type of body's immune cells known as macrophages attempt to engulf and contain the virus. As the immune cells circulate along the lymphatic drains and lymphatic nodes of the body, the HIV viruses will circulate, replicate and expand to the surrounding lymph nodes within 2-3 days after exposure. This is the critical moment that appropriate medical intervention can halt the progression of HIV. Within the next 3-5 days, the virus will be disseminated to other parts of the body causing permanent infection, establishing an irreversible HIV status.
Administrating PEP medication into the body as soon as possible, or at least within the first 72 hours (3 days) timeframe has been shown to be effective in curbing further HIV replication and establishment in the body, hence effectively reduces a person's risk of contracting HIV infection.
This is why starting on PEP is time-sensitive, and every hour counts.
Your Healthcare provider will obtain a medical history involving
Depending on individual history, your doctor may follow up with physical examination of the genital region and other parts of the body to evaluate for any symptoms or signs of HIV and STD infections.
In some, your doctor may offer baseline blood tests, rapid STD tests to evaluate your medical situation.
Your doctor will then discuss with you on your individual risk of HIV exposure and if needed/ appropriate, offer PEP medication to you.
Generally, there is no major preparation required before your PEP consultation appointment.
Any recent blood tests including liver and kidney functions, HIV tests/ STD tests can be useful for your doctor to evaluate further your suitability of PEP medications. If you are on long term medications or supplements, you can bring along the name of the drugs to share with your doctor.
Although there are medical advancement in the management of long term HIV infection, HIV remains one of the infectious diseases that is still incurable. Once a person is infected with HIV, one can develop multiple health complications and succumb to end-stage AIDS disease.
To make things worse, the status of HIV is associated with detrimental social implications. HIV may affect relationships as it can be passed to spouses and posed a danger during pregnancy to the newborn.
The fear of HIV discrimination and long-term health sequelae, social impact and moral conscience can may result in mental stress, breakdown and anxiety to a person who may have contracted HIV.
PEP is the only chance in the first 72 hours to 'make things right', reduce risk of contracting HIV and potentially save a person's life.
If you’ve had a possible HIV exposure, timely action is crucial. At DB Clinic, our team provides confidential consultations to help you understand HIV PEP in Singapore and discuss the options available.
References:
Our human body is covered with billions of micro-organisms. From the skin, nose, mouth, intestine, to the genital areas, we are covered with bacteria colonies which play pivotal impact on our overall health. It is increasingly known that a healthy microbiome over our genital region protects one against various infectious diseases including STDs.
In this article, we want to explore further the relationship of genital microbiome and fertility, potential long term effect of genital microbiome in conception- both naturally and in assisted reproductive treatments.
A healthy vagina is predominantly covered with Lactobacilli spp bacteria. Lactobacilli spp produces lactic acid in the vaginal canal, keeping the pH in an acidic level, preventing bad bacteria, fungus or even viruses from thriving.
The healthy Lactobacilli spp vaginal flora serve functions as:
The vaginal ecosystem can turn into a hostile environment with depletion of healthy Lactobacilli spp, making the pH of the vaginal canal higher and conducive for pathogens to grow. In an abnormal vaginal canal, the bacteria colonies are more diversified with the presence of bacterial-vaginosis-related bacteria (Gardnerella vaginalis), and fungus (Candida spp).
The alteration of the vaginal flora also leads to the loss of innate vaginal mucosal barrier, resulting in an unstable vagina susceptible to external insults such as infection and inflammation.
A diversified vaginal bacteria flora also predisposes one to form biofilm- which is a layer of diversified micro-organism colony that is resistant towards treatment and difficult to eradicate them.
Vaginal microbiome can change due to
Changes of estrogen and progesterone levels can be associated with changes in the vaginal microbiome.
| Hormonal Phase | Vagina flora | Health Impact |
| Follicular phase | Lactobacillus levels getting more
Overall flora getting stable |
Generally feeling well, minimal vaginal discharge |
| Ovulation phase | Lactobacillus levels high
Stable flora |
Reproductive environment is suitable for fertilization, ideal for sperm movement and survival |
| Luteal Phase | Lactobacillus starts to deplete
Flora becomes more diversified |
Noticeable heavier vaginal discharge, Susceptible to infection and inflammation |
| Menstruation | Lactobacillus depletedMore alkaline pH
Flora diversified |
Susceptible to infection and inflammation |
Unhealthy lifestyle such as chronic stress, smoking, poor dietary intake, certain intense exercises such as biking/ cycling, tight clothing can result in vaginal microbiome disruption. Also, medications such as antibiotics can also inadvertently disrupt the healthy vaginal flora by stripping off the good lactobacillus bacteria as well.
Untreated STDs are known to cause persistent inflammation in the lower genital tract, resulting in disruption and displacement of the normal healthy vaginal flora. Overtime, one can develop permanent scarring of the reproductive organs.
Frequent unprotected intercourse, different and multiple sexual partner(s) tend to diversify the vaginal microbiome. This is due to changes of the microbiome pH, leading to depletion of healthy lactobacillus and increase the overgrowth of bad bacteria. Without the innate vaginal mucosal barrier protection, one is also susceptible to various STDs.
The uterus is long believed to be a sterile, internal part of the human body. Increasing evidence has shown that the uterus has its own micro-ecosystem, and this is not a carry-over ecosystem from the vaginal microbiome.
Similar to vagina microenvironment, lactobacilli spp can be found in abundance in the uterus healthy lining. Contrary to vagina flora, the uterus normal flora also consists of non-lactobacilli bacteria such as bacteroides spp, pseudomonas spp, acinetobacter spp and etc.
The uterus microbiome is now proven to play a vital role in the outcome of fertility. When there is a dysregulation of the ecosystem, the uterus has a significant reduction in number of lactobacilli spp and increase growth of bacterial-vaginosis-related bacteria. Overtime, the uterus mucosal lining that serves as a protective barrier can be impaired with increased risk of inflammation and infection.
A uterus with predominant lactobacilli spp has a higher success chance in natural conception and assisted reproductive treatments. Those with unhealthy uterus microbiome is associated with poorer reproductive outcome, higher risk of infertility, embryo implantation failure, miscarriages and other obstetric complications.
Vaginal flora disruption is associated with poorer reproductive outcome.
In early part of fertilization or conception, the vaginal microbiome plays a vital role in sustaining the sperm and facilitating the sperm to reach the egg. In a less conducive vaginal microbiome, the sperm is unable to move and swim in the vaginal tract and it may also unable to survive long enough in the woman's genital tract due to an abnormal vaginal environment that is hostile, inflammatory and present of pathogens.
To further insult to the reproductive process, due to susceptibility and increase risk of infection in an abnormal vaginal microbiome, one can have irreversible genital tract/ tube scarring and damage, leading to difficult fertilization of the sperm and egg.
Surfacing medical evidence shows that the imbalance of vaginal flora is associated with pregnancy complications such as recurring miscarriages, failure of implantation, pre-termed labor, low birth rate and etc. In those seeking assisted reproductive treatments/ IVF, an abnormal vaginal micro-environment has lower success rate, with more risk of failure in embryo transfer and implantation.
One may be hesitant to see or discuss such concerns with your healthcare providers. The medical checkup is usually less apprehensive than we thought. Vaginal checkup with vaginal tests and STD tests can be performed at clinic settings. A sterile speculum device is carefully inserted into the vagina to open up the vagina canal. This is followed by a gentle swab test over the vaginal and cervical walls.
Over the years, reliable vaginal smear tests, cultures and PCR tests allow patients and health care physicians to determine accurately any underlying vaginal pathogens. Do consider exploring your vaginal health with your healthcare providers.
The vaginal microbiome plays an important role in fertility and overall reproductive health. If you would like to discuss this further, consultations are available at DB Clinic to help you discuss your concerns and possible care options.
References:
The scientific understanding of HPV infections acquired through sexual contact is a key medical breakthrough, allowing effective preventative and treatment measures against HPV infection and HPV-related cancers. On the flip side, this groundbreaking information also brings in its wake a stigma that is tagged along with the disease.
In this article, we would like to navigate along the unspoken stigma that makes us uncomfortable, the repercussions of this subtle stigma, and what we can do about it.
Stigma is a Greek word. Among the old Greeks, stigma is a ‘brand’ or ‘tattoo’ carved out with sharp instruments to permanently mark those who are ‘criminals’, ‘ousted group’. Stigma differentiates those who are considered socially ‘normal’ and acceptable vs those who are ‘abnormal’.
It is commonly believed that HPV infections such as genital warts, cervical abnormalities and cervical cancers only occur in those with high risk sexual behavior.
It is commonly believed that ‘healthy’, ‘normal’, ‘monogamous’ couples should not have HPV infection.
HPV-related discussion, sexual health education remains taboo in current society.
Debunk:
Commonly having physical symptoms such as genital warts, HPV infections, cervical abnormalities can come in shock to most patients.
Contracting HPV infection can often lead to a lot of negative labelling.
Debunk:
With the presence of physical HPV symptoms such as genital warts, or diagnosed with HPV-related illnesses such as cervical abnormalities, patients commonly experience low self -esteemed and self-conscious about the disease. One may feel upset, angry as to why such ‘disastrous’ infection befalls one, angry at the partner for passing the disease. Feeling of embarrassment, shame, self-blame, isolation is common when experiencing stigma. This leads to change of behavior, avoidance of socializing, internalizing and fear of others knowing about one's health conditions.
Combination of community belief, subtle judgement and discrimination against promiscuity, incomplete sexual education, inaccessibility towards the right knowledge and information, personal fear and stigma can eventually take a toll on our mental health. Chronic significant stigma against HPV infections can lead to a tumultuous mental stress and predispose one towards mood disorders such as anxiety and depression.
Progression of HPV-related medical complications
Due to stigma, one may turn a blind eye towards his or her health condition, decline to seek medical assistance. While HPV infection generally is benign, certain high-risk HPV strains can result on HPV-related cancers- such as cervical cancer, throat cancer, even skin cancers (vulva cancers, penile cancers or anal cancers). Furthermore, physical presence of HPV infection such as genital warts can be unsightly in appearance, and they can grow into a huge cluster of abnormal 'skin/ flesh'.
Delaying medical evaluation will lead to delay in diagnosis and treatment of HPV-related illness. It is worth noting that HPV infection, including HPV-related cancers, are one of the most preventable cancers if managed promptly.
Because of the silent stigmatization against HPV, society may not be equipped with sexual health clinics or relevant medical services. Accessibility to the right health channel when need arises for HPV-related illness may be hampered. One is likely to be poorly informed of HPV conditions, uncertain where to seek medical help, or even feel too embarrassed to engage medical care.
Long term society pressure and stigma against HPV-related conditions, low esteem, fear and isolation can alter a person's social pattern, causing strain to relationship with others. Also, due to communication barriers secondary to stigmatization, one may not be able to inform their sexual partner(s) of potential risk of spread and transmission of HPV infection between sexual couples. Diagnosis and treatment of HPV-related condition are also delayed as a result of poor communication.
Commonly one may find HPV vaccination as a preventative measure against HPV infection unnecessary as the vaccine is only targeted towards high-risk sexual behavior populations. One may also be defensive and hesitant for HPV checkup, HPV testing or even STD testing in view of the stigma associated with the tests. Such testing may imply engaging in immoral behaviors and abnormal HPV test results will then confirm their promiscuous acts.
Understanding The Impact of Silent Stigma On Medical management of HPV infection
Addressing the challenges pertaining to HPV stigmatization allows better control of HPV-related conditions, reduces impediments to healthcare accessibilities, provides equal healthcare HPV resources to everyone, and reduces risk of HPV-related complications and cancers.
| HPV management | Silent HPV Stigma and Human Behavior |
| Prevention
(HPV vaccination) |
Due to social belief that HPV vaccination is for unmarried person, or those with multiple sexual partners, one may felt HPV vaccination is not required if they are married/ in a monogamous relationship.
Parents who are decision makers for their adolescents, may be hesitant to allow their children for HPV vaccination due to misconception and social belief that HPV only affects those who are sexually active, and their children are not the targeted population. |
| Screening and Diagnosis
(Medical checkup, HPV testing, Pap smear) |
The idea of being tested HPV positive or abnormal HPV tests reflecting a person having STD, will deter many from considering HPV screening or medical checkup.
Seeing healthcare providers physically will require sharing of one's sexual history and tests results. Again, one may have fear of being judged for seeking medical checkup. |
| Treatment
(Medical and Surgical treatment) |
Hesitancy to treatment of HPV can be related to resistance of acceptance of diagnosis given the stigmatization of HPV. |
Stigma against HPV, interestingly, does not just affect patients and family. Silent HPV stigmatization can be also seen among health care workers due to incomplete understanding of the HPV disease. This further impedes patients and public receiving prompt and correct education and medical intervention against HPV disease and progression.
As a person:
As a society:
Our belief, society norms, and culture can affect a persons' attitude and behavior, there after as a rippling effect, influencing people around us.
By reinforcing the right attitude, mindset, debunking HPV myths at personal and societal level, we can strive towards managing HPV associated stigmas, thereafter empower one against HPV-related medical conditions.
I would like to end the article with a few key points of HPV that we commonly have misconceptions about:
If you’re concerned about HPV or genital warts, know that you don’t have to face it alone. DB Clinic provides confidential consultations to help you better understand your options and next steps. Take the first step towards clarity and care—book an appointment here.
References:
It can be very disconcerting to know that the STD infections remain there or recur following treatment. This is not an uncommon scenario seen in STD consultation clinics, with one becoming a frequent outpatient attendee for recurring STD-related symptoms. Such vicious cycle can incur both emotional and financial burden to affected patients.
In this article, we wish to explore the causes of un-resolving STDs and possible ways to mitigate the situation, minimizing risk of recurrence of STDs.
This is one of the most common causes of recurring STDs. Despite receiving the right dose and right type of medication for the infection, the infection did not clear off. One may notice recurrence of symptoms, or their test results repeatedly showing a particular STD.
Reinfection occurs when the 'circle of disease' is not broken. STDs, as we know, are infections that are transmitted among couples sexually. If one has been treated, yet other partner(s) are not treated, inevitably, the treated person can be re-infected following intercourse with the untreated person(s).
Over the years, antibiotic resistance is progressively becoming a global concern. Due to repeated use of antibiotics, unnecessary treatment, blind treatment, bacteria are increasingly outwitting medication, they become more resilient towards medication.
Recent years of super gonorrhea incidence confirmed the rising resistance against antibiotics, leading to certain strong gonorrhea infection able to escape and survive conventional antibiotic treatment.
In the case of Mycoplasma genetalium infection, current guideline advised for 2 types of antibiotics to reduce the buildup of antibiotic resistance and better efficacy. Having said that, even with 2 antibiotics treatment regimen, some patients may require repeated rounds of antibiotic courses to successfully eradicate the infection.
Medication (pills) for STD infections can come in the form of tablets (like a normal paracetamol shape), or capsule (typical antibiotic medication-rectangular in shape with 2 tone color coding). The coated capsules are to ensure the medication reaches the gut/intestinal passage before dissolved by gut enzymes into the circulation. One of the common mistake that one does is to break the capsules and place them directly onto the mouth- this causes poor and inadequate absorption of medication.
Also certain supplements such as calcium supplement may interact and reduce absorption of STD medications.
Concurrent gastrointestinal conditions such as gastroenteritis, nausea, vomiting can result in poor absorption of STD medications as well leading to failure of treatment.
STDs will require specific antibiotics or antivirals- the right medication and the right dose. Commonly we may think any antibiotics or medication prescribed by doctors will treat STDs simultaneously. (Such in the case of flu medication does not clear off STDs!)
Poor compliant of medications whereby one forgets to consume their medications, or lost the pills can result in failure of treatment and persistent STD.
While bacteria STDs are treatable, viral STDs such as HIV infection and Herpes Simplex Virus are not curable. Although there are effective medications to manage the infections, there remain no cure. Once a person has contracted these disease, they become life-long infected and have the ability to transmit to others.
One may notice STDs symptoms may recur or flare during time of weakening immune system. This is often seen in viral STDs such as recurring herpes outbreaks or recurring HPV infection due to a poor immune system. One with concurrent medical conditions such as diabetes, chronic smoking, cancer, autoimmune conditions or those with long term immunosuppressive medications are particularly predispose to recurring of viral STDs.
Certain bacteria STDs, the bacteria acquire survival strategies to escape a person's immune system and antibiotics. Research has postulated STDs such as Chlamydia trachomatis may be able to alter its metabolism to persist and survive through antibiotics treatment, leading to failure of treatment and persistence in the body, making one chronically infectious.
Syphilis is another bacteria STD that can turn chronic. Following primary or secondary phase of syphilis one can progress to latent phase where the affected person can have no symptoms yet infectious to others.
STDs that are treatable should be nipped in the bud. Ensure obtaining the right dosed medication from your trusted physicians, follow through and complete the medication offered. It is worth checking with your physician the lead time from completion of antibiotics until the time it is safe to resume intercourse lifestyle.
It is key to have an open and honest communication with your sexual partner(s) and encourage them to get screened and treated for infection if required. This will break the vicious cycle of STDs repeatedly passing back-and-forth between partner(s).
In view of most STDs are asymptomatic and some STDs have long incubation period even up to months or years, one should consider regular STD checking to detect infections early and receive treatment without delay.
Avoid blind treatment, presumptive treatment to reduce development of antibiotic resistance.
It is important to discuss with your trusted physicians on what STD tests to consider, as everyone's exposure risk may differ. Merely doing a basic urine test or HIV test may not be sufficient to detect more insidious STDs that one may be exposed to.
If there is oral or anal intercourse involved, tissue samples from the mouth and anus may be required for STD testing. This is imperative to pick up and treat extra-sites STDs to break the vicious cycle of repeated transmission to sexual partner(s).
One should consider immunisation against certain STDs such as Hepatitis B, HPV. There are clinically-proven effective vaccines with minimal side effects to protect one against Hepatitis B or HPV infections. In the case of recurring herpes breakouts, long term suppressive medications may be offered to manage the symptoms.
Using barrier protection (condom) the right way is effective in preventing STDs. Consider limiting the number of sexual partner(s) and avoiding high-risk behaviors such as multiple sex partner(s), sex with alcohol and drugs.
While resurfacing of STDs can be terrifying and concerning, many of the STDs are treatable or manageable with current medical advancement. One should not hesitate to seek advice from their trusted healthcare providers on the best ways to protect self and others, reduce risk of exposure and recurrence of STDs.
If you’re experiencing recurring or persistent STD symptoms, it’s important not to ignore them. At Dr Ben Medical, we provide discreet consultations and evidence-based treatments tailored to your needs. Book an appointment today to take the first step toward better sexual health.
References:
Health screening tests are becoming a routine and norm as part of medical checkups in Singapore. These medical checkups are aim to screen for asymptomatic medical diseases, allowing early intervention, prompt treatment and better long-term health outcome.
While we are fairly open for general health screening, we tend to be hesitant towards STD screening. Why so? And why is STD testing important? Should STD testing be as important as general health screening?
Do read on this article.
Common reasons that one thinks twice about getting tested for STDs:
STD testing stigma comes from our society and cultural beliefs.
This stereotyping often deters most of us from even considering STD testing.
While we discriminate against STDs and even screening for STDs, STD infections are quite the opposite. It can potentially affect anyone who is sexually active regardless of background and occupation.
Most STDs have no symptoms. Screening is the only way to detect silent STD infection.
Infections such as HIV, syphilis, Chlamydia trachomatis, Neisseria gonorrhea can stay indolent in our body, without causing clear physical symptoms for a long period of time. It is important to note that even without symptoms, with the presence of underlying STD infection(s), one can insidiously develop health complications such as chronic inflammation of the reproductive organs, or deterioration in general immune system following progression of infection (in the case of HIV). It is only via screening that we can detect the infection(s) early, promptly control and treat the condition, to reduce further health destruction or transmission of STDs to others.
Untreated STDs can progress to irreversible health complications such as chronic pain from pelvic inflammatory and scarring disease, testicular and prostate inflammation, infertility in both men and women. In certain STDs such as HPV infections, one may even develop cancer unknowingly. It is imperative to note that many STDs are curable if picked up early and medically treated without delay.
STDs, as the name suggested, can be passed on sexually to partner(s). If one is unaware of their own infection(s), not tested and not treated, one can spread sexual viruses and bacterias to their love ones inadvertently. With proper treatment and management of STD conditions, one can protect their love ones, lowers the risk of passing infection(s)to their partner(s).
During pregnancy, untreated STDs increase risk of pregnancy complications and stillbirth. STDs can also affect the newborn- causing birth defects, blindness, deafness, nerve damage, lung infections, rashes, learning delay and disability. Some of the blood-borne STDs such as HIV, hepatitis B infection may carry long term health complications in the child.
In the recent years, medical research highlights the association of STD infections and poorer quality sperm and ovum, can play a role in long-term epigenetics of the future infant even if conception is successful. Hence, STD testing is encouraged for everyone, including couples who are in the midst of conceiving.
Certain STD conditions such as HPV infections, Herpes, HIV infection, Hepatitis infections can be life-long (though there are effective medications in the pipeline to control and manage the symptoms, minimizing the spread of infection to partners). As these medical infections are asymptomatic, STD screening allows couple to understand their sexual medical health background better, giving ample opportunities for inform consent and decisions before proceeding into the next stage of sexual relationship. This will also be preparing couples on possible consequences and understand the best way to reduce risk of transmission of disease among each other.
Living in fear, not knowing one's own health status, especially after sexual intercourse with others can place a toll on a person's mental health. This stress is further amplified with the associated stigma against STDs and incurability of certain STD infections. STD testing proactively relieves a person's anxiety and mental stress and encourages one take charge and be responsible to own health.
In Dr Ben Medical Clinic, we offer a wide range of patient-centered STD testing, allowing you to undergo STD checkups in a safe environment. Do reach out to us via call/ whatsapp/ email!
References:
Vulvovaginal candidiasis (VVC) or colloquially known as vaginal yeast infection is a common fungal infection of the female lower reproductive tract infection. Recurring vulvovaginal candidiasis (RVVC) occurs when the vaginal yeast infection occurs 4 times or more per year. Vaginal yeast infection tends to present with abnormal vaginal symptoms such as itching and burning, abnormal vaginal discharge, pain, redness and irritation over the genital region.
Vaginal yeast infection is caused by a type of fungus known as Candida albicans. Less commonly, the condition can also be affected by other fungal strains such as Candida glabrata, Candida tropicalis, Candida krusei, Candida parapsilosisand etc.
Intriguingly, Candida albicans can behave as commensal or healthy fungal colony. It also be found in the mucosal layer (inner skin layer) of the mouth, genital, or even the intestinal tract in 30-70% of healthy people without causing any harm.
Question: When does Candida spp (yeast) start becoming pathogenic and opportunistic- causing infection? Why does one have a tendency of recurrence?
By grasping the reasons behind these key questions, only can we delve deep into the root and manage the condition effectively.
Understanding the vaginal natural barrier, the repercussion of weakened vaginal defense and presence of fungus cells
The vaginal mucosal epithelium is the first line defense against external pathogens including fungus such as Candida spp. A healthy vagina has an abundant good flora Lactobacillus spp. These bacteria keep the vaginal environment constantly in a low acidic pH, making the vagina hostile for micro-organism including bacteria and fungus to thrive. These healthy bacteria will also compete with Candida spp and preventing Candida spp from adhering onto the vaginal cells.
Interestingly, the vaginal layer produces a mucus natural barrier lining to prevent external micro-organism (including Candida spp) from sticking and invading the vaginal cell layer. The vaginal epithelial layer also undergoes regular shedding, removing any unwanted micro-organism that is adhered to the external layer, keeping the vagina microenvironment sterile.
The natural vaginal barrier can be disrupted leading to disequilibrium of the vaginal microbiome and a depletion of Lactobacillus spp. With the protective bacteria and vaginal layer compromised, the vagina becomes susceptible towards various opportunistic micro-organism, allowing various bacteria, fungus, parasites to thrive, invade and infect the vaginal canal.
Up to 70% of healthy women without any vaginal symptoms may have Candida spp in the vaginal canal. Nonetheless, the weakening of the vaginal local defense mechanism coupled with excessive growth of Candida spp increases the ‘virulence ability’ of the fungus. (Virulence ability: the ability to invade and attack surrounding cells.) At one point, when the ‘virulence ability’ of the fungus surpasses the limit of the vaginal mucosal barrier, the vaginal epithelium breaks down, triggering a cascade of local vaginal inflammation.
Furthermore, when there is an impaired vaginal mucosal lining the Candida spp cells are able to adhere to the vaginal cells, forming hyphae (finger projections) that facilitate the fungal cells to invade the vaginal cells. This, again, results in further inflammation of the vagina linings.
The body mounts an inflammation response against pathogenic Candida spp in an attempt to clear the infection off ineffectively. An uncontrolled, persistent local vaginal inflammation leads to clinical symptoms of vaginal discomfort, pain, itching, swelling and abnormal discharge.
This can be due to lifestyle habits such as chemical douching, external medications (antibiotics, hormonal contraceptive medications), frequent sexual intercourse, leading to disruption of the healthy vaginal flora and overgrowth of yeast cells, resulting in recurring yeast infection.
One with underlying medical conditions such as HIV, diabetes, autoimmune conditions with compromised baseline immunity are more predisposed to having recurring vaginal yeast infection. Lifestyle such as high stress environment, excessive alcohol drinking and high glycemic index diet can increase a person's risk of developing recurring vaginal yeast infection.
Simultaneous vaginal infection by bacteria such as Gardnerella spp (in the case of bacterial vaginosis), mycoplasma spp, and STDs bacteria (Chlamydia trachomatis, Neisseria gonorrhe, Trichomoniasis etc) is a common reason for vaginal yeast infection to relapse. A diversified vaginal microbiome with less healthy Lactobacillus spp has a weaker natural vaginal layer barrier, predisposing a person's risk to yeast cells colonization and invasion.
One may notice that yeast cells may be present during the luteal phase of menstrual cycle (the week just before menstruation). Certain ladies may also notice more vaginal yeast symptoms during their pregnancy. This is due to hormonal changes during the menstrual cycle or pregnancy, resulting in changes in the vaginal bacteria flora composition, and susceptibility to yeast infection.
A large majority of women with abnormal vaginal symptoms including vaginal discharge symptoms tend to self-diagnosed and treat themselves with over-the-counter medications. Unfortunately, studies have shown that only 11% of these women correctly diagnosed their condition. This frequently results in wasting time and money (on ineffective treatment) and delaying recovering from infection.
It is imperative to seek advice from your healthcare providers if you have frequent, recurring abnormal vaginal symptoms. This is to ensure your symptoms are ‘truly’ due to yeast infection rather than other vaginal infective causes.
Your doctor will obtain a relevant clinical history and offer physical examination of the external genital and vaginal region. In recurring conditions, your doctor may offer vaginal swab tests to obtain a vaginal fluid sample to evaluate for yeast infection or other concurrent bacterial infection. This is paramount in ensuring the right and appropriate treatment is given subsequently.
Recurring vaginal yeast infection requires longer duration of treatment as short-term antifungal medication may be insufficient to manage the condition.
If you’re experiencing recurring vaginal yeast infections, professional care can make a real difference. Our doctors at Dr. Ben Medical Clinic are here to help you find relief and long-term solutions. Book a consultation today to take the first step towards better comfort and health."
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Mold allergy is one of the most common airborne allergies seen in Singapore due to its humid tropical weather. Intriguingly, some who suffer from mold allergy may have concurrent food allergies as well. In this article we strive to discuss on mold allergies, the cross-linkage with certain food proteins, and what we can do to mitigate both fungus and food allergies.
Fungi thrive well in environment which is warm, moist and high in humidity- such as tropical, heavy rainfall weather. Inhalant fungi are one of the most common causes of allergy seen in tropical country. Fungal spores can be found both indoor and outdoor, commonly on walls, ceilings, air conditioners, plants, vegetation and even soil. Common fungi that are associated with allergic diseases include Alternaria alternata, Aspergillus fumigatus, Cladosporium herbarum, Penicillium spp, Candida spp and etc.
Airborne fungi can cause adverse health reactions via
In the case of allergy, repeated exposure to fungi through inhalation or even direct skin contact can result in sensitization of the body’s immune system and presentation of allergy conditions such as respiratory allergic conditions (rhinitis/sinus disorders, allergic asthma, allergic bronchopulmonary aspergillosis), skin allergic disorders (hives, atopic dermatitis).
The proteins found in the fungal spores and hyphae contribute to allergic reactions.
One can be exposed to fungal spores and hyphae via breathing, eating, or even direct touching.
Following exposure to the fungal allergen protein, the body immune cells will become sensitized, and they will develop immunoglobulin E (IgE) antibodies and a cascade of immune cell response, resulting in a pro-inflammatory state that is seen as allergy symptoms clinically.
Some fungi are edible and have great health benefits. They are rich with micronutrients, have anti-microbial properties to our human body and do not contain cholesterol. These edible fungi include mushroom, agaric, Tuckahoe root, Cordiceps sinensis, mycotoxin etc.
Fungus-food allergy syndrome (FFAS) is a unique allergic condition whereby the body’s immune system mistakenly recognized the similarity of proteins in both fungus and food as allergens and mounts an inflammatory allergic response following consumption of certain edible fungi. The cross-reactive nature of symptoms between airborne fungi and food fungi are due to the similar protein structure found among these 2 fungi.
The affected person has to be firstly exposed and sensitized towards fungi protein allergen (commonly via inhalation), then with secondary exposure to similar fungi protein allergen (via consuming food fungi) leading to FFAS.
The symptoms of FFAS can range from non-specific gut symptoms to full-blown allergy reaction.
| FFAS Symptoms | |
| Oral/ Mouth | Itchy and swelling of lip/ tongue/ mouth/ throat |
| Gut/Intestine | BloatednessAbdominal crampsNausea and vomitingDiarrhea |
| Skin | Itchy whealsRed eczematous rash |
| Respiratory | Snuffly nose, watery eyesCoughShortness of breathwheezing |
| GeneralizedIn such situation (anaphylaxis) one should seek medical attention immediately as it can be fatal if there is any delay in treatment. | Feeling of impending loomDizzy and faintyDifficulty breathingTightening of airwayFacial swellingWidespread rash throughout the body |
Macro-fungus such as mushroom can trigger FFAS.
Food that has fermented fungi can also cause FFAS in affected individuals.
Food such as blue cheese, fermented soybeans, miso, tempeh and shoyu contains fermented fungi. Alcohol drink such as beer, cider, wine requires fermented yeast for drink brewing. Cured sausages or dry Catalonian sausage contains fermented fungus as well.
Interestingly, although spinach or kiwifruits are not a type of fungus, airborne fungus can elicit an allergic response in susceptible individuals who consume these citrus fruits or vegetables.
Certain allergic symptoms may improve with ‘heated or cooked’ edible fungus- such as in the case of baked bread, heated alcohol drink due to inactivation and denaturizing of the allergen proteins under high heat. With the allergen proteins broken down, the immune system will not be triggered even though one is 'exposed' to the culprit food.
A good clinical history with known airborne fungi allergy and subsequent inducible allergic symptoms following certain food consumption is suggestive of fungus and food allergy. Nonetheless, a good history is always challenging and often much confusing in real life.
Allergy tests in Singapore can guide both affective individuals and physicians in narrowing down or ruling out the possibility of fungus and food allergy:
Allergen specific immunotherapy (AIT) can be used to re-educate and de-sensitize those with airborne fungi allergy. The concept of immunotherapy revolves around repeatedly re-challenging the immune system with daily exposure to the triggering allergen, in hope of down-regulating the immune response and resolution of allergic symptoms.
Current medical evidence remains sparse though there are potential benefits for AIT treatment in FFAS. While current AIT treatment is focusing on air-borne related allergies rather than food allergy per se, interestingly, by managing the airborne allergies, one may notice improved tolerance towards edible fungus.
If you’re experiencing persistent symptoms that may be linked to a fungal infection or food allergy, it’s best to seek professional advice. Our specialists can help identify the cause and guide you towards effective allergy treatment options. Book a consultation today to get started.
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Mixed vaginitis should be considered as a differential diagnosis when a person has intermittent, recurring abnormal vaginal symptoms. It is a medical condition that is commonly under-diagnosed. Both patients and attending physicians may encounter frequent flare up of abnormal vaginal symptoms, inability to clear of the symptoms with standard 'quick', 'over-the-counter' medications. The condition can lead to patient's frustration with repeated futile clinic visits and rising medical costs due to inadequate treatment of the condition.
Mixed vaginitis occurs when there is more than one pathogen affecting the lower genital tract, leading to persistent abnormal vaginal infective symptoms. Hitherto, there are over 20 types of lower genital infective pathogens including various bacteria, fungus, mycoplasma, viruses, or protozoa that can result in un-resolving vaginal inflammation.
The aim of this article is to create awareness of this medical condition, encouraging one to consider laboratory testing to evaluate this condition as a differential and receive appropriate treatment without further delay, thereafter reducing the long term morbidities from the disease itself.
| Non-STDs | STDs |
| Candida spp Gardnerella vaginalis Ureaplasma spp | Chlamydia trachomatis Neisseria gonorrhea Trichomonas vaginalis Mycoplasma genitalium Herpes Simplex Virus (HSV) Human Papilloma Virus (HPV) |
The healthy vagina is covered with dense lactobacillus spp bacteria. Via releasing lactic acid, the lactobacillus spp is able to keep the vagina in a low pH environment, preventing growth of pathogens on the vagina surface lining.
Due to changes in a person’s immune system, hormonal levels, lifestyle habits, intercourse patterns, or infections, this intact vaginal microenvironment can change. There can be depletion of healthy lactobacillus spp and a shift of the vaginal linings in housing more diversified microbiomes.
In mixed vaginitis, the vaginal microbiome has a mixed floral, allowing the microbiome to escape a person’s own immune response, resistant to antibiotics, making vaginal infection difficult to be eradicated.
Furthermore, certain pathogenic bacteria such as Staphylococcus aureus can ‘piggyback’ yeasts (Candida albicans), resulting in persistent inflammation of the vagina.
Interestingly, pathogenic bacteria such as Streptococcus agalactiae when present in the vagina, can weaken the vaginal mucosal lining immune system, leading to susceptibility of colonization of fungus such as Candida albicans.
To make things worse, with a weakened general vaginal mucosal immune system, lack of healthy lactobacillus, and pH imbalance, the vaginal mucosal becomes a perfect ground for thriving of external STD pathogens such as chlamydia, gonorrhea, herpes, HPV and etc.
It is worth to note that the symptoms that one experiences in mixed vaginitis may have its limitation in determining the cause of the disease inflammation. This is because the symptoms are quite 'generalized' and non-specific.
Patients tend to present with a constellation of vaginal discomfort symptoms such as
It can be challenging to attempt to tease out your symptoms on your own. You are advised to consult your healthcare providers for further evaluation of your symptoms.
While a vaginitis (inflammation of the vagina) can be diagnosed via clinical symptoms of vaginal discomfort and abnormal discharge, diagnosing mixed vaginitis may require a more in-depth medical checkup involving vaginal swab tests. Microscopy smear tests, culture tests, and PCR tests of the vaginal fluid sample can be useful in evaluating the presence of different pathogens in mixed vaginitis, ensuring appropriate targeted treatment to be given.
You are advised to consult your doctor on your concerning symptoms. If there is suspicion of mixed vaginitis, your doctor may advise for further vaginal tests to evaluate further your condition.
The treatment goal for mixed vaginitis involve resolving vaginal symptoms, eradicating culprit infections/pathogens and rebuilding a robust healthy vaginal flora.
When mixed vaginitis is left untreated, the persistent presence of various pathogenic biofilms in the vagina can carry potential health risk factors:
One may notice persistent and recurring vaginal discomfort, abnormal discharge symptoms, foul-smelling discharge causing psychological stress, poor quality of life, affecting sexual wellbeing. Complete recovery becomes harder with persistent infection, leading to requiring repeated course of medical treatment.
Persistent vaginal infection can spread towards adjacent genital or urinary organ leading to a condition known as pelvic inflammatory disease. In pelvic inflammatory disease, one can experience systemic unwell symptoms such as fever, lower pelvic pain, discomfort. If this is left unattended, it can lead to scarring of the reproductive organs and can even cause irreversible damage of the genital structure resulting in infertility.
Weakening and disruption of the normal vaginal floral/ mucosal lining increases the susceptibility of getting infected with STDs. Studies have shown bacterial vaginosis infection when left untreated increases the risk of HIV and other form of STD infections.
Vaginitis such as bacterial vaginosis is associated with pregnancy complications such as miscarriage, pre-termed labour, infant with low birth weight and post pregnancy infection.
Untreated mixed vaginitis and pelvic inflammatory disease can increase risk of ectopic pregnancy.
Despite the effectiveness of antimicrobial treatment in managing and treating the causative pathogens, long term recovery can be hindered by recurring infections. While STD causative pathogens upon treatment would not recur (unless there is re-infection), pathogens that are non-STD related can recur due to underlying insufficient healthy vaginal flora. As mentioned above, the key management of mixed vaginitis involve eradicating the pathogens and overtime recovering back to healthy lactobacillus-baseline of the disturbed vaginal flora.
If you’re experiencing persistent vaginal discharge or discomfort, it’s important not to ignore the signs. Our experienced doctors at Dr. Ben Medical Clinic can provide a proper diagnosis and guide you toward the right treatment. Book a confidential consultation today to get the care you need.
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With recent repeated highlights and adverts by MOH and AFA (Action for AIDS) on the importance of HIV testing, one cannot help but wonder is HIV the only STDs that one should be concerned of? If I am HIV negative, am I also safe from the rest of the STDs?
Unfortunately, that might not be the case. There are also other types of STD pathogens that can commonly infect a person during sexual intercourse.
In this article, we would like to explore the term’ full STD testing’. Is it really necessary?
You should consider a full STD testing if you have
A thorough STD tests covers a broad range of different pathogens that can be transmitted during unprotected sex- be it oral, vaginal or anal intercourse. The objective of a comprehensive STD panel is to pick up infection(s) early and allow timely treatment.
A general comprehensive STD panel usually consists of HIV, syphilis, Chlamydia trachomatis, Neisseria gonorrhoea, herpes simplex virus and hepatitis viral screening. But if we delve further into the literature of STDs, one may notice the list of pathogens transmitted via sex can be even longer and concerning. A person’s exposure to STD may differ from another. One may also have symptom presentation suggestive of certain infections. Hence, it can be particularly useful to discuss with your healthcare provider before running a STD test.
A comprehensive STD testing usually involves blood tests (to screen for blood-borne related diseases), urine test, and genital swab test involving various sites including the vagina (female), urethra, anal or throat regions.
A good STD testing also involve getting guidance from your doctor on which tests to consider. While one may think they are perfectly well, sometimes medical history or physical examination by your doctor may prove otherwise. This may determine the focus of your STD testing.
Over the recent years, there are more available self-testing options. Some STD kits can be obtained online, or some healthcare places offer self-testing options- providing kits, swabs for one to be tested at one’s convenience.
Is self-testing better than physician testing? Both have their advantages and disadvantages.
| STD tests | Advantages | Disadvantages |
| Self-Testing | - Convenient - Can be done at own private time and space - Discreet - No need to disclose history to anyone - Can be Cheaper - Encourage more people to test regularly | - Test kits may not work - Test kits can be mere marketing gimmicks - Test kits may not be FDA/ HSA approved. - Test kits can give false positive or false negative results - Test may be done at the wrong time after exposure (too early to test) - Nobody to interpret and navigate the test results and treatment |
| Physician Testing | - Test will be done safely and appropriately with the correct method - Test will be done at the right timeline after exposure - Physician is able to advise on which tests to consider based on the exposure risk and symptoms - Physician is able to follow through the results and treatment. | - Involve physical trip to see your doctor - Disclose personal sexual and social history to doctor - Can be more costly |
Consider both the pros and cons above and decide what is best for yourself!
Unsure if an HIV test is enough? Get clarity and peace of mind with a full STD screening at Dr Ben Medical. Book a private consultation today.
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Atopic dermatitis tends to be the first step in the subsequent development of allergic conditions such as allergic rhinitis and allergic asthma- this is known as the 'Atopic March'. Managing atopic dermatitis is key in halting and managing the later atopic conditions. Atopic dermatitis can be associated with allergy triggers, including airborne and food protein allergens. One of the key common airborne allergens triggering atopic dermatitis is house dust mites.
One with atopic dermatitis has baseline leaky or ineffective skin layer barrier, leading to susceptibility of airborne proteins, allergens, bacteria, and irritants to enter the skin layer and interact with immune cells in the body. Over time and with repeated exposure of the allergens to the internal immune cells, one can be sensitised towards the protein triggers and progressively develop an inflammatory allergic response in the form of atopic dermatitis.
Singapore is a tropical country known for its high humidity and density of house dust mites. We would like to share further insights on the role of house dust mites as a key airborne allergen in atopic dermatitis.
Atopic dermatitis is one of the most common recurring inflammatory skin conditions that is seen, affecting up to 20% of the paediatric group and about 8% of the adults globally. While allergy or predisposition to allergy (also known as atopy) can also affect the respiratory system, causing allergic rhinitis, asthma, skin presentation remains one of the key concerns that affects a person's wellbeing and quality of life. Uncontrolled atopic dermatitis is associated with poorer quality of life, reduced work performance, increased absentees from work, and can even be associated with mood disorders such as anxiety and depression.
While the actual cause of atopic dermatitis can be multifaceted and remains much to be elucidated, able to identify common triggers of symptom exacerbation can potentially beneficial to overall management of the skin condition.
As its name suggests, our home environment contains various species of mites- hence the name house dust mites! House dust mites are commonly found in tropical and subtropical countries.
The mite species that are found ubiquitous in tropical/ locally consists of Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis. In farm, or storage places, other house dust mite species include Glycyphagus domesticus, Lepidoglyphus destructor, Tyrophagus putrescentior and Ascarus siro.
The dust mite’s life cycle starts from egg, turning into larva and adult over a course of 3 months. They are difficult to visualise with naked eyes as they are usually minute with a translucent body length of only 0.25-0.3mm. They thrive under humid weather, low (dimmed) light, feeds on skin scales, dander, food crumbs, fungus, yeast, bacteria and takes in the water vapour from the surrounding environment.
Dust mites themselves can trigger allergic response in human. Besides, their dead body and excrement (faeces/dropping) can also induce allergy.
Dust mite allergy can present itself as Respiratory allergic symptoms:
| Allergic Rhinitis | Snuffly watery nose, blocked nose, watery and itchy eyes, cough, hay fever |
| Allergic Asthma | Wheezing, shortness of breath, cough |
Skin allergic symptoms:
| Atopic dermatitis/Eczema | Itching, red inflamed skin patch |
| Hives | Itching, wheals that comes and goes |
House dust mites are known to play a role in atopic dermatitis. They are able to weaken and breakdown the skin barrier layer in people with atopic dermatitis. Following the disruption of the skin barrier, allergens (either from dust mite or even other protein particles) are able to enter the skin layer triggering a cascade of immune inflammatory response, leading to persistent inflammation of the skin- this manifests clinically as atopic dermatitis –with itch, discomfort, eczematous red broken patches of the affected skin.
House dust mite allergies are usually picked up from a strong history of exacerbation of allergic symptoms following exposure to dust mite environment. A history of other atopic diseases or family history of atopy also points towards atopic dermatitis and possible underlying airborne allergies, such as dust mite allergies.
The diagnosis can be safely confirmed with a skin prick test or laboratory RAST blood tests.
You may wish to speak to your health care provider if there is a concern of house dust mite allergy.
There are conflicting research study results, though some medical evidence has shown that children who grew up in environment that is less exposed to house dust mites are less likely to develop allergy against house dust mites. This suggested that measures to reduce or avoid dust mite particles can be beneficial in avoiding development of house dust mite allergy.
Lifestyle advice is mainly to reduce exposure to house dust mites:
Although lifestyle management of dust mite allergies potentially benefits the overall control of atopic dermatitis, it is often less practical in real life. The backbone management of atopic dermatitis still involves good skin care with regular moisturiser to maintain a good physical skin barrier and topical corticosteroid to control the surface skin inflammation. In more severe, uncontrolled atopic dermatitis conditions, one may consider second-line treatment such as phototherapy or immunosuppressant medications.
Immunotherapy against dust mite particles has been gaining popularity for the treatment of allergy in recent years. Allergen-specific immunotherapy is useful in the treatment and prevention of future sensitisation and progression of allergic respiratory disease (from allergic rhinitis to allergic asthma).
Studies have shown that when immunotherapy is used on those with respiratory allergy symptoms who also have concurrent atopic dermatitis, the skin condition may improve during the treatment, suggesting a possible benefit of immunotherapy in those with atopic dermatitis and dust mite allergies. While clinical data is not fully conclusive on its efficacy, immunotherapy can be considered for selective atopic dermatitis patients who are proven with house dust mite sensitisation and a history of exacerbation following exposure to dust mites.
Struggling with recurring eczema or allergy symptoms at home? Let Dr Ben Medical help you identify the triggers and find the right treatment approach for your skin. Book your consultation today.
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Sperm health is starting to gain awareness in couples who are in the midst of family planning. Gone were the days when conceiving was a pure woman’s problem. We now know that in one-third of infertility cases are due to the underlying male factor. Good healthy sperms are required to effectively fertilise the ovum.
In this article, we want to understand the importance of having healthy sperm, factors that affect sperm quality and ways to improve and maintain good healthy sperm.
Beyond the role of impregnating the ovum, the sperm has a longer-term impact on the pregnancy and health outcome of the future offspring. This is a medical topic that is gaining popularity in research and understanding in the recent years. The epigenetic inheritance can be transferred to the future generation based on the sperm that successfully fertilizes the egg. The paternal effect can be subtle, yet significant over the growing years of the offspring. Studies have shown that poorer quality sperm can be associated with low birth weight and potentially has an effect on the metabolic health of the baby, affecting the development and performance of his later life.
The sperm is produced by the male testicles. Once the sperm is produced, they will travel via the male reproductive tract, combined with semen fluid that is produced by the prostate glands and seminal vesicles. The sperm is then expelled/ ejaculated during orgasm.
The sperm production is healthy and efficient in fertilising the egg when
Sperm quality can be affected by underlying medical conditions. From a logical point of view, the production of a good sperm can be hindered if
The sperm quality also deteriorates with age, with lesser number of sperm produced as one ages, less ability of the sperm to move and swim.
In modern days, one of the common reasons for poor sperm quality is infection, in particular- sexually transmitted infections. This is a common and reversible (most of the times) cause of poor sperm quality. Following identification and treatment of the causative infections, the sperm quality improves. Nonetheless, if the infections have been chronic and in late stages with complications of scarring and inflammation of the reproductive organs (such as epididymitis/ testicle scarring/ tube blockages), one can have permanent poor sperm quality, or even reduced/ no sperm production.
Male performance conditions secondary to erectile dysfunction, retrograde ejaculatory disorder, pelvic/testicular surgery, spinal injury, and vein swelling of the testicles (varicocele) can affect the ability to produce good quality sperm.
Medical causes that can affect sperm production include poorly controlled diabetes, cancer treatment, endocrine disorders, brain surgery, and rare genetic conditions such as Klinefelter syndrome and cystic fibrosis.
| Factors | Sperm quality |
| Age | The older you are the quality, quantity, and movement ability of the sperms are poorer. Those who are over the age of 45 have less healthy sperms. |
| BMI | An overweight person tends to have poorer sperm quality. There are studies that show the sperm genetics of an overweight person can be passed on to the offspring, affecting the baby's weight and future health. |
| Smoking | Smoking affects a person's sperm and semen fluid production, resulting in lower sperm count and reduced semen fluid. |
| Alcohol | Excessive alcohol drinking can reduce the quality of sperm, reduce a person's testosterone level, affecting a person's sexual drive. |
| Occupation/ Environment | An environment such as hot spring/ onsen may affect the sperm quality. Work environments such as hot kitchen, exposure to chemicals such as pesticides, heavy metals, radiation can affect the sperm quality. |
| Medications | Medications such as steroids, testosterone hormonal replacement, cancer medication, radio/chemotherapy, recreational illicit drugs can be detrimental to sperm quality. |
| STDs | Untreated STDs such as herpes simplex virus, chlamydia, gonorrhea, trichomonas, mycoplasma genetalium, syphilis, and HPV infections can cause chronic inflammation of the male reproductive organs, leading to poor sperm quality and infertility. |
Often, one feels well and normal. A sign of poor sperm quality involves inability to impregnate after attempting for at least 6 to 12 months.
Other associated symptoms include
You are advised to reach out to your healthcare provider if there is concern of fertility and poor sperm quality for evaluation and early treatment.
When you consult your healthcare provider on concern of sperm health, your doctor will obtain a relevant history including your sexual history/ ability to father a child in the past. This is mostly followed by a physical examination of the genital area to ensure no physical abnormalities. Semen analysis test can be offered to evaluate further the quality of the sperm.
Depending on individual medical history, sometimes your doctor may offer STD screening (in the form of blood tests and urine tests), hormonal blood tests, genetic testing or ultrasound of the testis and prostate to screen for reversible causes such as infection, hormonal imbalance or structural causes of the poor sperm quality.
Semen analysis is a laboratory evaluation test of the ejaculated semen sample that is produced by a man. The semen sample is analyzed under microscope and evaluated for its number of sperms that is contained, the shape (morphology) of the sperm and the movement of the sperms.
Taking care of a person's general wellbeing is vital in ensuring sperm are healthy. This is a common fact to most of us yet it is always taken for granted in our daily life until our health starts to show red signs.
Healthy living includes
Furthermore, to ensure the sperm production is not curtailed, maintaining a good environment for the male reproductive organs is vital. This includes pieces of advice such as
At Dr Ben Medical, we offer confidential and personalised assessments to help you gain clarity and take care of your reproductive well-being. Schedule a consultation at your convenience.
Human papillomavirus (HPV) is a common type of sexually transmitted disease (STD) that can be passed on through skin-to-skin exposure. One can be asymptomatic yet a carrier of HPV and transmit the disease to their sexual partner without realising.
There are over 150 subtypes of HPV viruses in the world. We can broadly classify HPV into 2 main groups:
The human immunodeficiency virus (HIV) diminishes the immune system by killing and destroying a type of immune cell known as CD4 T-lymphocytes. These cells are important to protect the body against various infections. Over time, with HIV infection progresses, there is progressive loss of CD4 cells, leading to a detrimental drop in general immune system, and increased risk of opportunistic infections (infections that do not occur in a healthy immune system). Over time, one can progress into an advanced stage of HIV infection known as AIDS- acquired immunodeficiency syndrome.
While currently there remains no cure to HIV infection, medical advancement is promising with effective antiretroviral therapy (ART) to control HIV. HIV medicine allows one with HIV to be able to enjoy a good quality of life and have a similar life span with those without HIV. With proper ART use, and if the HIV viral load is kept undetectable (the lowest possible level), the risk of HIV transmission can be reduced.
HPV infection is contracted through sexual intercourse, and as mentioned previously, one can be asymptomatic yet is a carrier of the virus, spreading to sexual partner(s). Worse still, HPV can live in the body for years without showing any abnormal symptoms.
HIV can lower a person’s immune system, increase the risk of infection with HPV and reduce the ability to clear off HPV infection, leading to a higher risk of developing HPV-related invasive cancer. There is also impaired immune response to HPV in those having HIV, and direct interaction between the 2 viruses.
Those with HIV have a higher risk of developing warts in the genital and oral areas.
Both female and male with HIV infection are at higher chance of contracting HPV-related cancers including cervical cancer (female only), 80-90% of anal cancer (female and male), oral cancer (female and male), vaginal/vulva cancer (female) and penile cancer (male).
In HIV positive female patients who have HPV co-infection, the risk of developing precancerous HPV infection, invasive cervical cancer is higher and faster.
HIV medication (ART) is clinically effective in maintaining good CD4+ count and immune system, lowers the risk of acquiring HPV, aids clearance of HPV, reduce risk of progression to precancerous or invasive state of HPV.
HPV testing is currently recommended for women as part of cervical cancer screening. The HPV test is able to detect high-risk types of HPV that can cause pre-cancerous or invasive cancerous changes of the cervix.
Unfortunately, in men, there is no FDA-approved or recommended HPV test available.
HPV vaccine can reduce a person’s risk of contracting HPV infection, minimising risk of developing warts, HPV related precancerous and cancer lesions.
While HPV vaccination is most useful when given to a person before becoming sexually active/ exposed to virus, it is still of benefit to be given to a person who is already sexually active/potentially exposed to the virus. Currently HPV covalent-9 vaccine is offered from the age 9 years old to 45 years old. Adult is recommended for 3 doses of the HPV covalent-9 vaccine over the course of 6 months.
Limiting the number of sexual partner(s) or avoiding partner(s) who has multiple partner(s) can reduce a person’s risk against HPV. While condom is not full proof either, using it correctly every time during intercourse can minimise the risk of STD, including HPV infections.
If you’re concerned about HIV or HPV, taking action early can make a difference. Talk to our doctors at Dr. Ben Medical Clinic to learn more about screening and preventive care. Contact us to book a consultation.
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Non-Gonococcal Urethritis (NGU) is a common syndrome seen in men. Often, NGU is assumed to be caused by underlying STDs and causing relationship disharmony between couples- especially when no final causative bacteria/virus can be ‘pinned down’ following elaborative STD testing.
In this article, we want to understand the term NGU and explore whether NGU can be non-STD related. So brace yourself and read on.
Non-Gonococcal Urethritis (NGU) or non-Specific urethritis (NSU) is a medical condition involving the inflammation of the urethra that is not caused by Neisseria gonorrhoeae bacteria. The urethra is the tube that connects the bladder to the external body, allowing the urine to be excreted out of the body system.
Although NGU can affect anyone, it is more common in male. In female sexual partner, one can be affected by similar infection yet one can be asymptomatic.
Approximately two-thirds of NGU cases are due to underlying STDs with chlamydia trachomatis and mycoplasma genetalium bacteria being the most common bacteria associated with STD-related NGU.
Unfortunately, one-third of NGU cases have to causative found following medical investigations and can be due to non-STD causes including irritation or contact chemicals to affected area.
One with NGU commonly presented with abnormal urinary symptoms such as
In more severe case, on may also experience
The symptoms of NGU are similar with symptoms with gonorrhea infection (yet, it is not due to gonorrhea, hence the name NGU!)
NGU is an umbrella term for medical condition related to the inflammation of the urethra. NGU can be broadly categorised into STD related (which is common) vs non-STD related.
This involves various bacteria and virus that can be contracted through intercourse to body fluid-mucous-blood transmission.
As mentioned, Chlamydia trachomatis, Mycoplasma genetalium comprises most of the cases of NGU.
Common pathogens responsible include
Men who has female sexual partner(s) with bacterial vaginosis (BV) have a higher risk of developing of NGU. Clinical studies have shown that bacterial vaginosis-related bacteria such as Gardnerella vaginalis, Prevotella spp, Ureaplasma urealyticum, Ureplasma parvum can trigger or cause NGU symptoms in men sexual partner. Viral shredding of herpes simplex virus (HSV-1 and HSV-2) can also trigger male NGU from sexual partner(s).
This highlights the importance of ensuring female sexual partner(s) taking care of their general health as well. Despite one may have minimal symptoms, or ‘discharge that is considered normal/monthly’, female partners may consider regular checkup and treatment to ensure healthy microflora. As a consequent, the occurrence and trigger of male NGU can be avoided.
Occurrence of NGU in men can also be associated with bacteria or viruses exposed following received oral intercourse. Chlamydial bacterial infection remains the most common culprit causing NGU cases.
Infections such as herpes simplex virus (HSV-1), adenovirus can be passed on through oral intercourse resulting in urethritis symptoms in men. Sometimes, oral sex can be associated with NGU inflammation without identifiable pathogens/bacteria.
If you suspect you have NGU/ NGU-related symptoms, do reach out to your healthcare providers as STD-related NGU is treatable with the right medication and right dose-duration of medication.
Your healthcare provider will usually obtain a sexual history and other relevant medical history of your symptoms. A physical examination involving genital examination is usually offered to examine for any rash, ulcers, lumps, lymph nodes and discharges. Depending on individual’s clinical suspicion, your doctor may offer urine test, swab test (penile if male or vaginal if female) or even blood tests to evaluate your condition and screen for NGU causes.
For STD-related NGU or infection-related NGU, your doctor may prescribe antibiotics to eradicate underlying infections (if any). One will require follow up review after treatment as occasionally some patients may require more than 1 course of medication treatment due to persistent symptoms.
If the underlying cause is related to STDs, your partner is advisable to get screened and treated if needed. You should abstain from any form of sexual intercourse until you have finished your antibiotics and your symptoms have resolved. This is imperative to break the vicious cycle of re-infections between sexual partner(s).
If you have symptoms or concerns about NGU, speak with our doctors at Dr. Ben Medical Clinic to discuss your options and get the support you need. Contact us to make an appointment.
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In this article, we’ll be exploring the implications of abnormal pap smear results and whether they warrant an STD test. Does an abnormal pap smear indicate the presence of an STD? Let’s find out.
Pap smear is a simple and safe bedside procedure performed by your doctor for cervical cancer screening. The idea of the procedure is to use a small sterile brush to obtain cervical cells and incorporate them into a liquid medium which will then be sent to the laboratory for microscopy examination. This is to screen for any abnormal cells on the cervix.
Pap smear test reports tend to be jargon to most laymen unless your doctor explains them to you in detail. We attempt to simplify and facilitate your understanding of your pap smear test results here:
The cervical cells obtained from the brush appear normal, and do not show pre-cancerous or cancerous findings.
The cervical cells on your pap smear are unusual but are not abnormal. This can be a mild change secondary to infection or hormonal changes. Your doctor will usually want you to follow up on the test or consider treating for any infection (if applicable).
The cervical cells obtained from the pap smear show low level or mild changes of cervical cells due to underlying HPV infection. Colposcopy is advised to investigate further and evaluate the extent of abnormalities of cervical cells.
The cervical cells obtained on your pap smear show pre-cancerous changes of the cervix. This is usually a finding secondary to underlying HPV infection and your doctor will advise you to evaluate further with colposcopy. You may require medical treatment to treat the condition and halt further progression of the HPV infection.
The cervical cells from the pap smear show cancer or severe pre-cancerous cells. You will be required to seek medical treatment from a gynaecologist without further delay.
Colposcopy is a medical procedure to examine the cervix in detail. The cervix is examined under a colposcope which is a microscope used to magnify the cervix and identify pre-cancerous or cancerous changes.
Acetic acid (vinegar) is applied to the cervix to highlight the HPV-affected area on the cervix to aid colposcopy examination. The cervical cells area that are of concern can be biopsied to obtain tissue samples for further confirmation of whether there are potential cancer/pre-cancerous cells.
The procedure is usually done by the gynaecologist. It is painless, though light bleeding (similar to the start of a period), and some people may experience menstrual cramps after the procedure.
Human papillomavirus (HPV) remains the predominant reason a person develops cervical cancer. HPV contributes to 99.7% of cervical cancers worldwide. While most HPV infections are temporary and most people are able to abort the infection spontaneously by their own general immune system. Unfortunately, some may have a persistent HPV infection over the cervix. Over time, the cells over the cervix can transform into abnormal cells and tissues and eventually turn into invasive cancer cells.
To prevent cervical cancer, it is imperative to pick up early and manage abnormal findings found on pap smear screening. HPV vaccination is usually encouraged in age-eligible patients if this has yet to be done at the time of abnormal pap smear results.
To mitigate the risk of persistent HPV infection and subsequent risk of cervical cancer, concurrent infective vaginal or cervical infections that can promote persistent HPV infection should be screened and treated if required.
Co-infection of bacterial STDs is associated with higher incidence of abnormal pap smear results. Untreated bacterial STDs infections can disrupt the vaginal and cervical innate barrier/ protective lining, leading to susceptibility to HPV infections.
During pap smear procedure, the cervical cells (from the neck of the womb-cervix) are obtained to evaluate for precancerous or cancer cells. The confusion here is when an STD test involves vaginal testing. STD tests that involve vaginal swab are obtaining the cells and tissues from the vagina (which is the external mucosal tunnel that connects the outside world to the cervix/uterus).
To evaluate vaginal infection from STD infections, the cells/tissues will be ‘cultured’ or processed through PCR testing. Pap smear sample, on the other hand, is reviewed under microscopy by the laboratory pathologist. It does not tell you specifically of any bacterial infection.
Hence, a normal pap smear test does not rule out STD infection. An abnormal pap smear test that suggests HPV infection suggests increased correlation with other bacterial STDs, hence suggesting further screening and evaluation.
Unfortunately, most of the time, patients with abnormal pap smear results do not exhibit abnormal symptoms until late stages of invasive cervical cancer. Hence, pap smear should be offered routinely as part of cervical cancer screening.
Similarly, one can be well without symptoms or minimal discomfort when having STD infection. Overt STD infection symptoms include lower pelvic pain, abnormal discharge, vaginal itching, painful urination, bleeding between period and after sexual contact.
If you are sexually active/ sexually active before, you should:
If you have an abnormal pap smear test result, it is important to discuss with your doctor on your results, and get your doctor to advise on follow up plans.
With an abnormal pap smear test results, it is worth to consider STD testing:
There are associations of untreated co-infected bacterial STDs and high risk of cervical abnormal cells/invasive cervical cancers.
Furthermore, bacterial STDs are treatable with the right antibiotics, right dose and duration. With eradication of the bacterial co-infection STDs, one can mitigate and lower the risk of persistent HPV infection and reduce the risk of cervical invasive cancers.
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Bacterial vaginosis (BV) is one of the most common causes of abnormal vaginal discharge seen in females who are sexually active. Generally, one notices unpleasant symptoms, such as vaginal odor, itching, watery discharge or pain. At least half to 2/3 of ladies with BV may not be aware of their conditions as they can have no symptoms at all.
BV is a condition due to overgrowth of pathogenic bacteria Gardnerella vaginalis and other anaerobic bacteria following the loss of good vaginal lactobacilli.
Aside from affecting a female’s quality of life, BV is known to increase risk of STDs, and can affect a person’s reproductive ability-causing spontaneous abortion, premature delivery, and more.
Although BV is not classified as an STD, it is associated with sexual activities and seen in women with higher frequency of sexual intercourse or those with more numbers of sexual partners. Other risk factors for BV include:
Herpes Simplex Virus (HSV) is a common STD seen globally. HSV type 2 is one of the most common causes of sexually related genital ulcers. While one can present HSV-2 with genital blisters, pain, itch and ulcers, one can also be asymptomatic yet shedding the virus continuously. In fact, more than 80% of people with HSV-2 are asymptomatic shedders of the virus.
In this article, we explore the association between these 2 conditions — BV and genital HSV-2. The article is written in hopes of increasing awareness for both conditions, and encouraging readers to consider getting screened and treated for both conditions.
Although both conditions do not pose an immediate health threat, they can have long term health implications if left alone and untreated.
The relationship between BV and HSV-2 is a unique one. Those with BV are more likely to contract HSV-2 from their partners than someone without BV. Those with HSV-2 infections have a higher risk of acquiring BV compared to people without HSV-2 infections.
By nature, the vagina is a sterile microenvironment on its own, housing millions of healthy lactobacillus, self-sustaining in flushing out bad bacteria/ particles and generating good bacteria to maintain the internal pH ecosystem. The actual mechanism of how the lactobacillus in the healthy vagina protects HSV-2 infection remains much to be discovered.
There are studies that suggest the presence of good lactobacillus such as lactobacillus salivarius, Lactobacillus plantarum or Lactobacillus brevis in cell cultures reduce HSV-2 viral replication up to more than 90% and reduce acquisition of HSV-2 infection, suggesting the protective role of these good lactobacillus.
In bacterial vaginosis, there is an alteration of the vaginal flora with depletion of the good lactobacillus, and an overgrowth of anaerobic bacteria, including Gardnerella vaginalis bacteria.
Such hostile vaginal microenvironments, without the protective effect from good lactobacillus, will increase the risk of contracting STDs, including HSV-2 infections. Additionally, the occurrence of bacterial vaginosis is associated with women with a greater number of sex partner(s) and higher frequency of sexual intercourse. These can also be independent risk factors of encountering STDs including HSV-2 infection.
It is postulated that genital HSV-2 infection or even asymptomatic constant HSV-2 viral shredding, can lead to activation of the immune system in the vaginal mucosal. This, in addition to natural occurrences, such as female hormonal fluctuations and normal changes in the vaginal microbiome, can lead to an increased occurrence of BV.
The other possible explanation is due to the thriving Gardnerella vaginalis bacteria on iron. This is based on the understanding that BV tends to occur more commonly peri-menstrual (before and after) timing due to availability of iron. In genital HSV-2 infection/ persistent viral shedding, this can create a microenvironment with iron allowing the overgrowth of Gardnerella vaginalis bacteria.
Interestingly, in a vicious cycle, with the increased risk of BV, the person with genital HSV-2 can transmit/ infect HSV-2 virus even more as untreated BV can increase further viral shedding of HSV-2.
There are increasing clinical studies showing that both genital HSV-2 infections and BV increase the risk of acquiring Human Immunodeficiency Virus (HIV) and transmitting HIV. Hence, it is worth considering screening for HIV in one who has HSV-2 and BV.
In a HIV positive person, due to a persistently compromised immune system, one is predisposed to contracting genital HSV-2 has a higher risk of genital HSV-2 flare ups (tends to be more severe), a higher risk of genital HSV-2 reactivation, and in a negative vicious way, increases susceptibility to developing BV and further HSV-2 viral shedding — the cycle never ends.
If one is concerned of contracting genital HSV-2 infection or BV infection, please do not hesitate to reach out to your doctor.
While history and physical examination can facilitate the right diagnosis, HSV-2 viral infection can be picked up with herpes simplex virus PCR test or herpes simplex virus antibody blood tests. In the case of BV, vaginal swab can be beneficial in nailing down the diagnosis and future treatment. Your doctor will need to understand your health condition and concerns before being able to guide you on the tests to proceed with.
If there is concern of exposure to HIV or other STDs, it is worthwhile to consider a screening test, as having one STD may heighten your chances of contracting a second, third or fourth.
STDs commonly can be asymptomatic and left untreated can cause health complications, as well as unknown social implications to our loved ones.
Genital HSV-2 infection is managed with antiviral medication (such as Acyclovir, Valocyclovir, Fanciclovir). However, as genital HSV-2 infection is associated with invariable recurring viral shedding, recurring flare up of genital HSV-2 is common. Hence, some patients may opt for a longer term of suppressive antiviral medication to reduce flare ups, viral shredding and risk of infecting their sexual partner(s).
BV can be treated with antibiotics in the form of oral tablets or vaginal pessaries. As one of the main causes of depletion of healthy vaginal lactobacillus, probiotics play a beneficial role in reducing the recurrence of BV.
Every patient can have different clinical presentations, concerns, and lifestyles. It is always important to consult your trusted physician to come up with an individual realistic treatment plan to manage both conditions above.
Currently, there are ongoing clinical research studies for the questions above, with potential results. Having said that, as we now know the nature of both genital HSV-2 and BV infections, it is worth managing both genital HSV-2 infection and BV concurrently.
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