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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.
References:
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.
References:
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.
References:
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.
References:
Over the years, there has been evidence of the development of antibiotic-resistant STDs. This is rather alarming, as the cases of STDs are not reducing at any rate. In fact, it is continuously on the rise. A healthy genital microbiome is our first line defense against external pathogens, including STDs.
There are clinical studies showing the good bacteria that constitutes the healthy genital microenvironment have an immune mechanism, and may provide protection against STDs. Treatment targeting the genital microbiome may potentially reduce the risk of acquiring STDs.
In this article, we would wish to enlighten the readers on the female and male microenvironment, the importance of maintaining a good baseline genital health and reducing one’s risk against STDs.
The vaginal environment is mainly covered with healthy anaerobic bacteria — lactobacillus spp. In an equilibrium, the lactobacillus spp keeps the vagina sterile, lubricated, and able to clear off common pathogens.
Unfortunately, this healthy state is easily tempered with the depletion of healthy lactobacillus spp and overgrowth of bad anaerobic bacteria. One of the commonly heard pathogenic vaginal bacteria is gardnerella vaginalis which plays a vital role in a recurring female vaginal infection known as bacterial vaginosis (BV).
BV is known to be associated with poor quality of life due to the uncomfortable symptoms of BV, and association with poor reproductive outcome such as preterm labour and low birth weight of infants. Furthermore, the persistence presence of bad anaerobic bacteria predisposes one towards contracting STDs and spreading STDs to others.
The actual mechanism of the destabilisation of the vagina flora remains unknown.
Factors that can shift the microflora to bad anaerobic bacteria rather than lactobacillus spp include:
Intriguingly, the male genital region is less discussed. In comparison to the female genital anatomy, the male genitalia are ‘externally’ seen. Yet, the male genital also has its own healthy microflora.
The penis is mainly covered with similar bacteria seen on our normal skin such as Corynebacterium spp and staphylococcus spp. Occasionally, bad anaerobic bacteria (that can be associated in BV in females) can be found in the male genital region as well.
As predicted and logically, men with female partners with BV infection tend to have genital microenvironments that have more bad anaerobic bacteria, such as gardnerella vaginalis, while men with female partners without BV are likely to carry normal skin bacterias such as, Lactobacillus spp, Corynebacterium spp and staphylococcus spp on the penis.
The male foreskin can also affect the microbiome in the penis. As the foreskin provides a physical layer, it can also house many bad anaerobic bacteria. In a circumcised man, as the penis is exposed, the quantity of bad anaerobic bacteria is lesser, with predominantly skin bacteria found on the penis surface. It is known that circumcised men have lower risk of acquiring HIV, herpes infection, HPV infection and lower risk to trigger BV in their female partners.
The actual mechanism of how the female genital microbiome can protect one against STDs has been a common clinical research topic though there remain gaps in the knowledge.
The healthy vaginal lactobacillus spp provides a more acidic sterile environment that prevents pathogens from replicating as they thrive better in alkaline environments. Additionally, the lactobacillus spp can protect women from STDs by:
In males, the role of genital microbiome against STDs are not as straightforward. Nonetheless, there are medical studies that show susceptibility of contracting HIV with higher numbers of bad anaerobic bacteria in the male genital region.
Bad anaerobic bacteria can be pro-inflammatory and they can create an environment that is easily succumbed to external pathogens. Men with skin flora bacteria predominant over the genitalia and less anaerobic bacteria may have lower risk of contracting STDs and triggering BV in their female partners.
You may have higher risk of STDs if
As a female, the general risk of contracting STDs is higher than males due to:
You may have higher risk of STDs if
Although STDs can be associated with abnormal genital symptoms, very often, STDs can be insidious without any tell-tale signs. You are advised to seek medical advice with your doctor if you are concerned of possible exposure to STDs and contracting the infections from your partner(s). STDs do not resolve on their own and will require the right medication and right dose to clear off the infection(s).
References:
This is a possible scenario that can be seen when a couple undergoes STD screening tests together and notice their results are “not the same”. Often, such medical results can create disharmony and distress between couples.
What does it mean when a couple’s STD results are different, and how can we proceed with such results?
Understanding the possibilities of a different STD results in comparison to your partner(s) is key to determine the next course of actions. Here we list down some of the common causes of discordance STD results.
This is unfortunately the commonest cause of discordance STD results. Commonly the tests results are different between the couple due to an increased risk of exposure to the infection in a couple or another, leading to the results differences.
This is a dicey situation where, arguably, it may mean that there is an 'unfaithful' polygamy going around, someone cheated in the relationship — which is possible. However, it is worth to note that STD infection can live in the body for years unless it is effectively treated with the right medication. Hence, discrepancies in results experienced by couples may merely mean that their partner may have had a 'past' rather than being 'unfaithful' in his or her current relationship.
One may not necessarily acquire STDs from intercourse with a person with STD, though the risk of contracting STDs is higher in those with a positive contact history. Some people can become infected and naturally clear off the infection due to better general immunity. One may have received treatment from another health condition (tooth infection/surgery etc) and inadvertently treated the STDs without realising it. In such scenarios, screening tests on the couples may result in different results.
While this is a possibility, generally, laboratory errors are not common as accredited and regulated medical laboratory has to undergo very stringent laboratory processing to ensure delivering accurate and quality results as this can affect the treatment plan of a patient . In Singapore, the medical laboratories need to be licensed, accredited and regulated by the Ministry of Health (MOH).
If you do get different STD results from your partner, here are some things you can do:
Having an open conversation without being judgmental and accusative is key in dealing with the situation of unexplained STD results. It is useful to always use logical approach than emotional impulsive approach in dealing with such results. It is worth finding proper time and space to discuss such results with your partner(s), rather than over text message or phone call leading to further misunderstanding and communication breakdown.
Exploring partner(s) current and previous sexual relationship can be useful in correlating the results and the past history of exposure. Rather than blaming, focusing on solution-based approach, consider to treat any infection(s) if need to avoid further co-spread of disease to one another.
If there remain unexplained answers to the differences in STD tests, you are advised to consult your physician/ clinic who offered the screening tests. Sometimes, bringing your partner along for the consultation may be useful to 'clear the air' on the spot.
Getting the right medical information regarding STDs is very important in correlating the clinical history and the tests results. This is advisable rather than doing self-research and over-reading on online platforms, causing unnecessary distress and alarm.
It is always important to correlate the test results and a person's clinical pictures. In this instance, you will require the expertise of your kind trusted healthcare providers. While most of the STD results, we can interpret ourselves based on 'normal' or 'abnormal' or 'reactive' or 'non-reactive', some of the STD results may not be as simple as a 'yes' and 'no' answer. Having a discrepancy results in comparison to your partner's results may be due to a previously treated or exposed infection.
In view of the possibilities of a false negative results as the tests may be done within the window period of the STD infection, one may consider repeat the tests again at a later date. It is prudent to check with your healthcare providers on the sensitivity and the time frame required for a particular test to ensure the results are reflecting a true clinical picture.
Different laboratories may offer different test kits with different sensitivity and window period. Some of the newer generation tests may be able to pick up an infection much earlier from the time of exposure.
While convenience is key, self-performing testing runs a risk of false results due to multiple reasons explained above. One may opt to head down to a physical clinic for proper consultation, evaluation, and appropriate sample test collection (if need) by your health providers. Currently, in Singapore there are a number of convenient, discreet, fuss-free clinics that can offer such services. Getting tested by your physician reduce the risk of inaccurate results due to sampling error.
Furthermore, your physician may be able to guide you on what are the relevant infectious tests to address your individual concerns, as STD tests are not merely just ‘HIV testing’.
Some may consider regular 3-6 monthly sexual health screening tests. Such practices are good as this will:
This article strives to facilitate patients who have results that differ from their sexual partner and are struggling to make sense of the results. We hope the article is able to help one way or another! Take care!
References:
Genital herpes infections are one of the most commonly known STDs. Hitherto, there is no cure for the disease — it is a lifelong viral infection.
Genital herpes is caused by herpes simplex virus (HSV). Both type 1 and type 2 of HSV can cause genital herpes. It is known that one may present with a chronic recurring flare up of herpes ulcers after contracting HSV infection. Active HSV infection with ulcers can be transmissible to sexual partners. To make things worse, HSV infection can also be transmitted from a person to another person even when one is asymptomatic due to the continuous shredding of the virus.
In this article we want to understand the pattern of shredding of HSV virus, hence correlating to one’s clinical presentation, and the relevance of episodic versus suppressive antiviral treatment.
The recurrence of HSV-1 genital herpes flare up tends to be lesser in comparison to HSV-2 genital herpes. Shedding occur commonly after infection but decreases rapidly from 12% at 2 months to 7% at 11 months post acquisition of HSV-1. The shedding of HSV-1 virus reduces quickly throughout the first year of infection, leading to the risk of asymptomatic disease transmission to sexual partner lower after the first year. Shedding of HSV-1 genital herpes in comparison to HSV-1 oral herpes is higher. Long term shedding of HSV-1 is less common, though it is not completely impossible.
Nearly all patients with known first episode HSV-2 genital herpes will have recurring episodes of genital herpes. Viral shedding in HSV-2 genital herpes is higher than HSV-1 genital herpes, hence HSV-2 genital herpes is associated with higher frequency of recurrence. Even in a person without active genital symptoms in long run, intermittent viral shedding still occurs in HSV-2 person.
The classical clinical presentation of genital herpes is recurring blisters or punched-out ulcers over the genital region. Having said that, often, in clinical practice, visual diagnosis can be difficult or even absent in many infected patients during the time of clinical assessment.
When the genital ulcers are present, the diagnosis of genital herpes and herpes subtypes can be confirmed with further tests.
When there is absence of genital ulcers, HSV serology antibody blood tests can be used to guide the diagnosis of HSV subtypes of genital herpes.
The evidence-based benefits of considering long term suppressive treatment for herpes infection:
In episodic antiviral treatment, one can start antiviral medication when they notice the first signs of herpes disease such as tingling, itching over the site of herpes outbreak. Early episodic antiviral can reduce the time of the recovery and reduce viral shedding hence reduce transmission to others.
In those patients who have frequent genital herpes outbreaks despite episodic antiviral treatment, long term suppressive antiviral therapy can be recommended. In HSV-2 genital herpes, chronic suppressive therapy is recommended in comparison to episodic therapy as most patients with HSV-2 genital herpes invariably has higher frequency of recurrence and have chronic intermittent shedding of the virus. Chronic suppressive treatment is also beneficial to patients with genital herpes and has a weaker immune system (concurrent HIV, cancer etc). While chronic suppressive antiviral treatment can be beneficial to frequent outbreak in patients with HSV-1 genital ulcers, as the recurrence rate is lower than HSV-2 genital ulcers, some patients may only require episodic treatment.
Your decision on antiviral treatment option can be discussed with your doctor. Aside from understanding your herpes disease progression, It is worth discussing you and your sexual partner(s) concerns and expectations with your doctor before deciding on which treatment to opt for.
When a person is having genital herpes with clinical presentations of ulcers and blisters, these open erosions and wounds can be channel for a partner’s genital or body fluid to enter the body. Hence, if the partner has other STDs, the person with active genital herpes has a higher risk of contracting other STDs as well.
Clinical statistics have shown HSV-2 genital herpes increases twice to thrice risk of a person acquiring HIV infection. If you are exposed to possible sexually transmitted disease, do reach out to your trusted healthcare staff for further medical screening and early treatment if required.
Genital herpes brought in its wake overwhelming emotions of shame, fear, anger, distress and helplessness. Most patients do go through all these phases following diagnosis of herpes.
In an attempt to understand further on the medical condition, patients commonly rampaged through multiple channels such as chatgroup, chatGPT, internet sources and etc. These further muddle one’s disease understanding and create more fear and anxiety.
One should be reassured that the overwhelming emotions are normal human reaction following diagnosis of the condition. It is imperative to understand that genital herpes is a medical condition that is controllable with effective treatment. Proper health education on genital herpes is very important for the patient in managing the disease and reducing the risk to transmitting the disease to their partner(s).
Medical counselling may be useful in coping and coming to terms with the diagnosis of herpes. Importantly, do reach out to your doctor to obtain the right information and debunk myths about herpes infection.
References:
A noticeable lump over the groin is usually a symptom that most people will be concerned of. The left and right groins are the area just above the top of the legs, with creases noted over the area that the legs join the rest of the body. The groins house numerous lymphatic nodes and they are generally not palpable. There are also inguinal canals on both groins to allow internal visceral tissues such as ligament to pass through the abdomen to the genital region.
The two most common causes of lumps in the groin are swollen lymph nodes and hernia. Other causes of groin lumps include underlying dermatological condition, cancer, blood vessels disorder such as aneurysm.
In this article we explore the common causes of palpable lumps over the groin, highlight the differentials of possible STD infections and common non-STD causes of groin lump and the importance of reaching out to your health care providers for evaluation.
Both our groins are full of lymphatic nodes and drainage. These are network vessels and circulations that collects lymph fluid (made up of white cells) to clear and fight against any external pathogens or infections. Occasionally, when the body or immune system is filtering and fighting against external pathogens, the lymph nodes nearby to the source of infection will be swollen and tender. The presentation of lumpy painful lymph nodes over the groin can be the first sign of the body trying to inform us that the body is having a brewing infection including STDs. STDs that can cause both local genital symptoms or general symptoms, such as:
STDs that can be associated with lymph node swelling include:
The important caveat here, although STDs can present with abnormal additional genito-urinary symptoms, having no symptoms does not rule out STDs. The only way to confirm or rule out presence or absence of STDs is via testings.
One can still have STDs, and remain indolent and asymptomatic or present with just a lymph node lump felt over the groin.
Do consider reaching out to your health care providers if you have palpable lymph nodes over the groin and have potential exposure to STDs. Once the underlying infection or STDs are managed, the groin lymph node will eventually subside.
Skin STDs are usually due to direct skin-to-skin contact from the affected external party (partners) leading to direct inoculation and acquisition of the pathogens. This can lead to clinical presentation of unusual ‘lumps’ or ‘bumps’ over the genital or groin area.
| Skin STDs | Presentations |
| Human Papillomavirus (HPV) | Warts |
| Pox Virus | Molluscum Contagiosum lesions |
| Herpes Simplex Virus | Painful punch-out blisters and erosions |
| Syphilis | Painless ulcer (Chancre) |
| Scabies/ Lice | Itchy red eczema-like patch/areas, Possible moving mites |
| Monkey Pox | Unusual, never seen-before: Painful, deep-seated ulcers with a ‘dot’ on the top of the lesions |
As STDs has potential to spread to other sexual partner(s) and can be associated with long term comorbidities such as infertility, one should seek medical assistance for further evaluation and early treatment of STD groin lumps.
Not all lumps in groin are sexually related and sexually transmissible. Lumps in groin can be due to common skin conditions such as a cyst or a boil or an inflamed hair follicle in the case of folliculitis. Medical treatment may be required if the lump(s) causes inconveniences, pain, irritation, is infected or purely treated for aesthetic reasons.
Lumps in the groin can also be a hernia. Hernia is the medical condition that occurs when the internal organs or body viscera are protruded through a weaken abdomen or groin. When hernia occurs, it can present as a lump seen over the groin. Hernias are usually painless and can be reduced/ tucked back into the body by lying down, changing body position. Nonetheless, it can get trapped and remained externally as a ‘lump’, causing pain, strangulation of the internal organs or even necrosis of the organs and may require surgery in severe cases.
Blood vessel structural causes such as aneurysm can present as a lump over the groin. When there is weakness on the blood vessel (artery) wall, the wall may bulge-out and present as a lump in the groin. The lump can be noticeable ‘pulsating’ when one place the finger over it. This can cause pain, bleeding or even can be dangerous.
Less commonly, yet imperative not to miss, lumps in groin can be due to underlying cancer, blood malignancies such as leukemia and lymphoma. One may have other constitutional symptoms such as weight loss, feeling poorly, fever and etc. You should always get your ‘lump’ checked with your healthcare providers.
Although some groin lump are benign and self-resolving, you are encouraged to seek medical attention to evaluate unusual lump when you first notice it.
Red-flags of requiring medical attention without further delay include:
Your doctor will obtain a relevant medical history. In the context of concern of possible STDs infection, your doctor may acquire personal sexual history. Your doctor will then perform a physical examination by palpating the lump over the groin.
Investigations will also be carried out, such as:
Treatment of lump on the groin depends on the underlying cause.
It is important to pick up common reversible causes such as infection including STDs as the infections are usually treatable or manageable with the right antibiotics or antiviral medication. Delaying or ignoring the signs and symptoms may lead to future health complications such as scarring and infertility.
Operation may be required if there is concern of cysts, hernia, aneurysm or other structural causes. Chemo or radiotherapy may be required if there is concern of underlying malignancy/ blood disorders.
With the advancement of medical care in Singapore, HIV (human immunodeficiency virus) infection is no longer seen as a ‘death sentence’. Clinically effective treatment has shown that one with a HIV infection is able to have a near normal life expectancy as someone without HIV infection. The outlook of HIV infection has transformed from being a terminal illness to a chronic medical condition that is controllable.
To achieve this, those who are found to be HIV infected are advised to start on anti-retroviral medication as soon as possible to decelerate, control the progression of disease, and improve long term quality of life of an infected person.
Dermatological manifestation of HIV infection is unique at various stages of HIV. Understanding possible association of certain dermatological conditions can facilitate picking up undiagnosed HIV, hence allowing commencement of anti-retroviral medication without further delay.
In this article, we want to highlight the common skin diseases that can be associated with people living with HIV. We want to encourage public social awareness and we encourage those who are at risk to consider HIV testing.
During acute HIV infection, when the body sero-converts HIV virus, one can present with a body eruption. It can be a red rash over the body that is generalised yet faint, subtle in appearance, and it is very easily missed. One may present concurrently with fever, flu symptoms or even unexplained lymph nodes on the body.
Picking up HIV infection at this stage is very beneficial as this allows early treatment of HIV and reduce the chance of progressive transmission of disease. One should consider HIV testing if there is concern of exposure to HIV infection.
As its name suggests, HIV is an infection associated with progressive deficit of the host’s immune system, hence predisposing the infected person with various skin conditions, such as infections and even cancer.
Furthermore, anti-retroviral medication used for HIV management is commonly known to be associated with skin allergy and reactions.
One living with HIV infection are predispose to fungal infection due to the constant immunocompromised state of the condition. Commonly, thrush (candidiasis), skin (tinea infections) or nail fungal infection can occur any part of the body areas. The fungal infection tends to be more aggressive and resistant to treatment in comparison with those without fungal infection.
When the HIV infection progresses with dwindling of the immune system of the infected person, one can develop fungal opportunistic infections that involve uncommon widespread skin appearance, mucosal (oral/ genital involvement) or in severe cases even disseminate and affect the blood stream, internal organs such as the lungs, liver etc.
Living with HIV increases a person’s risk of developing skin-related cancers due to impairment of the immune system. Skin cancers such as melanoma, basal cell carcinomas or squamous cells carcinoma can occur more rapidly in patients with HIV. Skin related lymphomas, Kaposi sarcoma can be seen associated with HIV patients.
Certain skin presentations tend to occur in advanced or severe compromised immune system state in HIV or AIDS. Picking up these conditions should warrant a screening for HIV.
These are some of the skin conditions that are associated with severe HIV infections/AIDS and will require a trained health care worker or further biopsy skin tests to confirm the diagnosis. Nonetheless, if there is any doubt or concern of a person’s skin condition, it is always advisable to seek medical advice and if need, consider HIV testing.
Douching is the physical act of washing the internal vagina with water or ‘mixed liquid’. Feminine douche is commonly available over the counter. They are usually made up of mixed water and iodine, baking soda, vinegar, fragrant or other chemicals etc. Feminine douche are administered by squirting the douche mixture upwards through a bottle nozzle into the vagina to ‘clean’ the vagina.
Some ladies may have the habit of douching, in order to feel ‘cleaner and fresher’. One may douche in hope to take away unpleasant vaginal smell, leftover menstrual blood, or even hoping to prevent STDs and pregnancies after intercourse.
In this articles, we discuss about the cons of douching, and many reasons why you should avoid douching.
The healthy vaginal microenvironment is slightly acidic with abundant hydrogen peroxide (H202) producing lactobacilli. By constantly producing lactic acid to keep the vaginal pH less than 4.5, these ‘good’ lactobacilli bacteria avoid the growth of ‘bad’ bacteria and fungi. The lactobacilli also attached themselves to the surface lining of the vagina, competing with the ‘bad’ organism from adhering onto the vaginal wall, and secrete protective mucus and discharge for the vagina.
Douching can alter the microenvironment of the vagina which is made up good vaginal bacteria under an acidic environment. Healthy good vaginal bacteria protect the vagina from external insults such as infections. The act of douche can wipe out the good bacteria leading to overgrowth of bad bacteria and fungus leading to recurring vaginal infections.
Aside from removing the normal vaginal flora and causing overgrowth of ‘bad’ bacteria, douching can act as a ‘pressurised fluid transporter’, allowing external bacteria/viruses (pathogens) to ascend from the vagina to the cervix, uterus, fallopian tube, ovaries or even the abdominal cavity. This can eventually lead to pelvic inflammatory disease.
It is clinically documented that frequent douching is associated with bacteria vaginosis, recurring vaginal yeast infection, HIV and STDs infection, pelvic inflammatory disease, ectopic pregnancy, pre-termed labour and infertility.
Strangely but rightfully, the vagina cleans itself automatically. The vagina produces mucous accordingly to flush out the unwanted ‘bacteria’, menstrual blood, semen, or discharge and ensure the vaginal microenvironment and pH are maintained.
The external of the vagina can be rinsed with water and mild soap. If you have sensitive skin, chemical soap/bath may cause external vagina (vulva) irritation and dryness. Scented pads, tampons, sprays or powder should be avoided as these can cause vaginal irritation or even infection, in more severe cases.
No, douching before and after intercourse does not prevent STDs. On the contrary, douching can increase risk of contracting STDs including HIV as it washes away the ‘good’ bacteria in the vagina, leading to the vagina susceptible to external bacterial STDs and virus STDs.
Regular douching is associated with female related vaginal infection such as bacterial vaginosis and vaginal candidiasis (fungal infection). Those who douche weekly has a 5 times increase risk of developing bacterial vaginosis. Due to a significant reduction of H202 lactobacilli, the vagina environment is tempered with a hostile overgrowth of ‘bad’ bacteria such as Gardnerella spp, Mycoplasma hominis and etc.
Bacterial vaginosis though is not a STD, increases the risk of a women acquiring STDs, and frequently is associated with womb lining infection, pelvic inflammatory disease, pre-termed labour and low birth weight in babies.
It is a ‘chicken-and-egg’ situation whether women with abnormal vaginal symptoms engage in douching in hope to ease the symptoms, or women who engage in douching subsequently develop abnormal vaginal symptoms. Regardless of the chronological causative link, there is a strong association of douching and female-related vaginitis.
Douching is unlikely to resolve vaginitis and may exacerbate the symptoms further by ‘over-cleansing’ and causing greater susceptibility of contracting other infections. If you have abnormal vaginal symptoms, you are advised to see your female health care professional for further treatment and management of your condition.
With the act of douching, reducing the amount of ‘good’ vaginal bacteria, the vagina is even more susceptible to STDs such as Chlamydia trachomatis, Neisseria gonorrhea, Trichomoniasis and other bacterial STDs.
As mentioned above, as the act of douching provides a vacuum-transport-pathway for the untreated STD bacteria, one can be predisposed to ascending infection of the womb, fallopian tube, ovaries, leading to pelvic inflammatory disease, chronic pelvic scarring and infertility.
It is understandable that some women douche following experiencing abnormal vaginal symptoms such as itching, abnormal discharge, pain or irritation, discomfort down below. Unfortunately douching does not resolve the symptoms, in fact it may even exacerbate the underlying problem. You should see your medical professional staff whom you are comfortable with to further evaluate your symptoms. STD tests may be offered accordingly to one’s exposure risk and symptoms. Only via testing, the right medication can be offered to treat and resolve the symptoms.
Interestingly the healthy acidic vaginal environment is able to partially inactivate viruses including HIV (human immunodeficiency virus). The vaginal flora changes when a personal douche the vagina, with an obliteration of acidic lactobacilli and vaginal protection layer, a rise of vaginal pH and production of inflammatory cells. These inevitably encourages the ‘bad’ bacteria such as bacterial vaginosis or external pathogens (STDs), HIV to thrive more easily.
No, douching does not prevent pregnancy. It is not medically proven to control and avoid unwanted pregnancies. While douching can wash away the semen in the vagina, the sperm inside the semen can travel quickly into the cervix, uterus, fallopian tube to fertilise the ‘egg’. Douching is unable to halt the progressive journey of the sperm.
If you are concerned of pregnancy after unprotected sex, you can consider emergency contraception to prevent becoming pregnant. You can consider long term contraception methods if you have recurring risk of unwanted pregnancy. You can understand more on various contraceptive options by consulting your health care provider.
One may consider douching out of ‘hygiene’ purpose, amelioration of vaginal odor, resolution of vaginal discomfort, avoidance of STDs or even pregnancy. Nonetheless, there is no clinical proof to support the use of douche for the above roles.
If there are abnormal vaginal symptoms and concerns of vaginal infections including STDs, douching will not help the underlying condition. One will need appropriate medical attention and treatment. In some cases, vaginal swab testing, urine test, blood tests, STD tests may be required to evaluate for the underlying vaginal infection.
Using douching as a mode of preventing pregnancy is ineffective and medical contraception is advised.
There is no sufficient medical data to prove the benefits of douching and good evidence to show that douching can be detrimental to health. It is hence, advisable to avoid douching.
References:
Women who are with a child, or are breastfeeding are not protected against acquiring sexually transmitted diseases (STDs). While most STDs are treatable, some of the STDs can be transmitted vertically from the pregnant mother to the unborn child or during breastfeeding. If a baby has STD, it can harm the baby’s health and long term development.
Most STDs are without any tell-tale signs or symptoms. Both yourself or your partner can have STDs without knowing. The only way to determine a person’s status is through STD testing.
Majority of antenatal follow up do involve sexual health checkup. Nonetheless, it is still paramount to consider STD screening before pregnant or during pregnancy/ breastfeeding if you are concerned of possible exposure to STD infections.
Both women who are not pregnant and women who are pregnant can develop similar health complications from untreated STDs. However, in one who is pregnant, persistent STDs can be detrimental to the unborn child’s wellbeing.
STDs in pregnancy can be associated with:
Mother who is pregnant or lactating can acquire STDs through vaginal, oral or anal intercourse. In some STDs, the infections can also be passed on via skin-to-skin contact of the genital region.
STDs that can be passed on to babies during pregnancy include:
STDs that can be passed on to babies during breastfeeding include:
The unborn child can be infected with STDs when he is in the placenta of the pregnant mother. Infections such as HIV and syphilis can pass through the placenta during pregnancy and infect the baby.
STDs such as chlamydia, gonorrhea, genital herpes or genital warts, can be transmitted to the baby during delivery when the baby passed through the birth canal. HIV is also able to infect a baby during delivery.
Babies who acquired STDs via vertical transmission from pregnant mother can be associated with serious long term health complications such as:
In some of the STD conditions, breastfeeding may be possible. You are advised to speak to your healthcare professionals if you are lactating and you are having STDs.
| STDs | Should I still breastfeed? |
| HIV | You should not breastfeed as the virus can be passed on through breastmilk to your infant. |
| Syphilis | Breastfeeding is okay as long as there is no active syphilis lesions on the breasts/nipple/areola and the infant or breast pump equipment is not in contact with the affected area. |
| Chlamydia | Can breastfeed |
| Gonorrhea | Can breastfeed |
| Trichomoniasis | Can breastfeed. You may discuss with your doctor on timing of breastfeeding when you are on antibiotics treatment |
| HPV | Can breastfeed as long as there is no warts on the breasts/nipple/areola |
| Herpes | Breastfeeding is okay as long as there is no active herpes lesions on the breasts/nipple/areola and the infant or breast pump equipment is not in contact with the affected area. |
| Hepatitis B | Breastfeeding is possible, as long as the infant born from known Hep B positive mothers receive immunoglobulin/vaccine at birth ( this is within current hospital guidelines) |
| Hepatitis C | Can breastfeed. Based on CDC guidelines, as HSV is a blood-borne disease, no clinical evidence to prove breastfeeding can spread HCV |
Some of the STDs medication can be excreted into the breastmilk, though most of them are safe. It is important to discuss with your physician as well when you are on any medication treatment to ensure it is safe during breastfeeding.
References:
Ejaculation that is painful can be debilitating and distressing. This is the unbearable sensation that happens during orgasm. Painful ejaculation, also medically termed dysorgasmia, dysejaculation, odynorgasmia, is quite a common medical condition that can affect up to 25% of male. The pain that is experienced during ejaculation can last for seconds to minutes, or in some cases last up to days. The pain intensity can vary from mild dull pain to severe excruciating sharp pain.
This is a medical symptom that are under-diagnosed as patients may not openly discuss such embarrassing symptom and also due to the sensitive nature of the clinical presentation (present during orgasm). Despite the fact that most cases of painful ejaculation are not life- threatening, it can significantly affect a man's quality of life, leading to low self-esteem and sexual dysfunction.
This article strives to increase awareness of this medical condition that can affect men, and encourages patients with such symptom to reach out for medical evaluation and treatment.
There are 2 phases for a man to ejaculate:
Painful ejaculatory disorders may arise when pain occurs anywhere along this pathway of ejaculation.
The pain during ejaculation is being described as pain that occurs in the urethra that may extend to the scrotum, abdomen or the lower perineum. It can range from being a dull ache to an intense great pain that potentially last a few seconds to a few days long. Some men may also notice the presence of blood in the semen while experiencing painful ejaculation.
You should see your health care providers if you have above symptoms for further checkup and treatment.
While a painful ejaculation is usually not a dangerous symptom, it can have a negative impact in a person’s sexual wellbeing and esteem. Hence, understanding the cause of a person’s painful ejaculation symptoms can be the first step in regaining a man’s quality of life.
Possible causes include:
Although painful ejaculation is not a life-threatening condition, leaving the symptoms unattended can greatly impair a man's quality of life, sexual wellbeing and self-esteem. In some cases, it can also lead to infertility eventually.
You should consider consulting your doctor if you have:
Your doctor will obtain a history of your symptoms and physically examine your genital and perineum region. Sometimes your doctor may also offer a rectal physical examination to palpate the prostate. Depending on individual circumstances, your doctor may offer further tests including:
The treatment of painful ejaculation is dependent on the underlying cause of the symptom.
In some cases, the underlying cause of painful ejaculation may not be determined. Psychological counselling and cognitive behavioural therapy may be offered in managing the pain.
Erectile dysfunction (ED) is a medical condition when a man is unable to achieve or sustain an erection that is satisfactory for sexual intercourse. It is an alarming health condition that affects up to half of the men aged 30 and above in Singapore. It is slightly common in those with concurrent cardiovascular health risk factors.
Conventional treatment for erectile dysfunction involves lifestyle changes to improve underlying medical conditions and oral medication treatment with phosphodiesterase-5 inhibitors (PDE5i) such as sildenafil or tadalafil. In those who are unable to consume oral treatment or have poor improvement with oral treatment, more drastic and invasive options such as vacuum devices, injections, and penile prostheses may be considered. Patients with erectile dysfunction may also be susceptible to the exploitation of non-clinically proven medication or treatment options that are available in the market, leading to further waste of money with unsatisfactory outcomes.
Over the years, low-intensity shockwave therapy has slowly gained popularity among both patients and clinicians as one of the treatment options for ED. In this article, we want to understand and explore the efficacy and sustainability of this option in erectile dysfunction.
The effect of shockwave therapy relies on incorporating the theory of basic physics onto biologically targeted human tissue to achieve the desired outcome.
In physics, a shockwave is produced when:
As the name ‘shockwave’ suggests, the shock allows forward propagation of disturbance that moves faster than the speed of sound in the medium. The sudden delivery and discontinuity of the ‘disturbances’ in the medium allow shockwave to achieve an abrupt high-pressure level onto the targeted region. When the shockwave forces are applied to a localised area of the body, it leads to repeated and sudden sheer pressure, compression and expansion of the tissues.
In erectile dysfunction, the repetitive sheer pressure delivered by shockwave therapy stimulates the regrowth of blood vessels (neo-angiogenesis), improves micro-blood circulation, regenerates localised nerve (neurogenesis), activates progenitor cells to remodel, and restores erectile tissue from local inflammation and stress.
We now know that in most patients with erectile dysfunction, there is abnormal or reduced blood circulation through the erectile tissues. The idea of tissue regeneration with shockwave therapy changes the conventional treatment paradigm of erectile dysfunction.
Over the years, there have been increasingly promising clinical studies showing that shockwave therapy can be used beneficially and safely in ED. Shockwave therapy is also seen to work as an adjunct to improve patients' responses to oral medications such as PDE5i.
Currently, the EAU (European Association of Urology) recommends shockwave therapy as a first-line alternative treatment for patients who are unable to tolerate oral medications such as PDE5i. The Asia-Pacific Society for Sexual Medicine (APSSM) also recommends shockwave therapy to patients with mild or moderate vasculogenic (blood-circulatory related) ED who do not respond to oral medications.
Shockwave therapy is a convenient and relatively quick treatment therapy that can be offered in an outpatient setting. You are not required to fast for preparation prior to the procedure.
Your doctor will place a hand-held shockwave device onto your penis. The device will release gentle shock pulses to trigger the regeneration of the erectile tissues. There will be no needle involvement, and no anaesthesia is required. The entire procedure takes about 30 minutes. As there is generally no downtime, you are expected to be able to drive home, go to work, continue sports activities, and go about your usual everyday routine.
Patients with erectile dysfunction who:
If you are taking blood thinner medications such as anticoagulants or antiplatelets, you should inform your healthcare providers before treatment. Depending on your circumstances and health risks, your doctor can advise you further on the suitability of shockwave therapy.
Shockwave therapy is not a completely new medical technology and treatment option. In fact, this therapy has been available for over 40 years in the medical field. It is used to manage health conditions, including kidney stones, pelvic pain, and musculoskeletal injuries such as frozen shoulder and plantar fasciitis.
In this article, we explore the difficulties encountered in delivering adequate cervical cancer screening and HPV preventive care to patients. The article also aims to debunk some of the common misconceptions about HPV, cervical cancer, and HPV vaccination. It is written to increase awareness of the importance of proactive measures in screening and preventing HPV infection and HPV-related cancers.
Cervical cancer is a preventable medical condition, yet hitherto remains the 10th most common cancer affecting females in Singapore. We now understand cervical cancer is due to a chronic infection of the cervical cells from human papillomavirus (HPV). While there are over 150 strains of HPV, high-risk HPV that can be associated with cancer includes HPV type 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68.
Through proper regular screening, early detection, and treatment of pre-cancerous stages of cervical cancer, this is a type of cancer that we can avoid. HPV vaccinations have proven effective by more than 90% in protecting against HPV infection and HPV-related cancers such as cervical cancer.
HPV vaccination is encouraged and offered to BOTH women and men from the age of 9 to 45 years old.
Following the introduction of the Cervical Screen Singapore programme in 2004, there had been a steady initial decline in the incidence of cervical cancer up until 2015, when the incidence of cervical cancer plateaued. Unfortunately, in recent years, there has been evidence of a possible rise in cervical cancer incidence.
In an attempt to eliminate cervical cancer by 2030, the World Health Organization (WHO) advocates a target goal of 90-70-90 where:
Currently, our local cervical cancer screening rate is only 48%, way below our national target rate of 70%.
Local awareness of cervical cancer screening and prevention in the younger adult group (age 25-29) is only 76.5%, while awareness is better at 91% in the older adult group (age 30-69).
The poor uptake of pap smear and HPV testing is multifactorial, involving the obstacles faced by patients, health care providers, and the health system as a whole. In this article, we focus mainly on issues faced by patients.
Three key points that will determine whether a patient will opt for the screening test:
Misinformation about HPV infection and cervical cancer is common. Although the majority of women have heard of a pap smear, the purpose of the test and the screening frequency of the tests remain uncertain to most patients. Patients also may deem screening against cervical cancer unnecessary as they ‘feel fine’, asymptomatic, or feel the test is not required due to ‘lack of sexual activity’.
Furthermore, the uptake of cervical cancer screening tests is correlated to a person’s educational background, personal beliefs, and cultural barriers. Patients tend to confuse HPV with other STDs (such as chlamydia, gonorrhoea, HIV, etc) and may view HPV testing as taboo. Additionally, one may have the wrong impression that HPV infection only occurs in a person who is promiscuous in their sexual habits. The stigma associated with HPV infection can dissuade a person from getting screened for cervical cancer.
Reluctance to get cervical cancer screening is often due to fear, embarrassment, and potential discomfort from the procedure. As cervical cancer screening is usually performed by health care providers involving examination of a female’s genital region, this can be a turn-off for females to undergo pap smear or HPV testing.
Other reasons for poor uptake of cervical cancer screening include the financial burden of regular medical screening, missed appointments, unable to find time for screening, and generally uninterested in screening.
The lack of HPV vaccination uptakes can be multifactorial. A few common reasons include:
The move towards better uptake of HPV vaccination and cervical cancer screening will require concerted effort from all parties, including the health care system, the government and legislation, the allocation and availability of resources, and the participation of patients and the community.
As a community and as a patient, we can each play our part as below:
Sexually transmitted diseases (STDs) are an umbrella term for infections that can be acquired through sexual intercourse. Based on the local epidemiological studies in Singapore, STDs affected 201.6 per 100,000 of the population in 2017.
This leads us to the following questions:
We will explore the above points in this article.
STDs can have a detrimental effect on male hormones and can result in prostatitis and sexual dysfunction.
Testosterone is an essential male sex hormone that regulates the male libido, sperm production, general energy level, fat and muscle mass distribution, and red blood cell production. Testosterone hormone is produced mainly in the testicles, and the level can fluctuate. Common causes of reduction of testosterone hormone include ageing, diabetes, trauma, thyroid disease, hormonal disorders, tumour, and infection.
STD Infections can cause inflammation of the testicles (this is known as epididymitis), leading to impairment of the production of testosterone. Common STDs that are associated with low testosterone include HIV, chlamydia, gonorrhoea, and syphilis.
The prostate gland is a small chestnut organ located at the neck of the bladder, just in front of the rectum, and at the base of the urethra (the urinary tube that delivers urine). It is an important organ in the male reproductive system and aids in the production of semen to ensure the sperm is viable and able to move. Due to its location, the prostate gland can easily become infected by pathogens such as STDs.
Untreated STDs, such as HIV, gonorrhoea, and chlamydia, can infect the prostate, leading to prostatitis – inflammation of the prostate. When the prostate is inflamed, the surrounding blood circulation to the genitals can be compromised; there will be lesser blood flow to the penis which can result in difficulty in sustaining an erection.
Urethritis is a type of urinary tract infection that affects the urethra. The urethra is the opening tube that allows urine to flow from the bladder to the external body. Due to the proximity to the external environment, it is easily infected by STDs. Chlamydia and gonorrhoea remain two of the most common STDs associated with urethritis. However, there are other bacteria, such as syphilis, trichomonas, mycoplasma spp, ureaplasma spp, candida, etc that may contribute to urethritis symptoms.
Abnormal urinary symptoms such as painful urination, itching or burning sensation, and discharge over the urethral can occur in untreated urethritis. Untreated STD-related urethritis can be associated with the further spread of the disease to the surrounding reproductive organ, resulting in peri-pelvic infection or abscess, urinary tract scarring, inflammation of the testicles and prostate, etc. These can all lead to penile discomfort, pelvic pain, and inflammation and again affect a person’s sexual function.
Thankfully, most STDs that affect male sexual function are treatable with the correct diagnosis and medications.
STDs have been known to have a negative role in menstrual cycle and PMS.
Although STD infections do not affect the female hormonal axis, they can be associated with abnormal vaginal discharge and spotting symptoms. One may notice spotting from light to dark brown/red discharge when they are not having their usual period or after intercourse. Less commonly, STDs can be associated with irregular periods or missed periods, though other causes such as pregnancy, PCOS (polycystic ovarian syndrome), or thyroid disorder should be considered as possible differentials as well.
In chronic untreated STD infections, one may develop more severe complications such as inflammation and scarring of the pelvis and reproductive organs, including the uterus, fallopian tubes, and ovaries. In such instances, the ovulation or menstrual cycle can cease to function, leading to clinical presentation of irregular or missed periods.
Common bacterial STDs can be associated with abnormal menstrual cycle or vaginal symptoms. STDs bacteria including chlamydia, HPV, gonorrhoea, trichomonas, and mycoplasma genetalium, are common culprits. Unfortunately, as most symptoms of abnormal vaginal discharge or abnormal menstrual spotting tend to be mild, one may delay seeking medical treatment. If it is a case of an untreated STD, delaying treatment increases the risk of long-term complications such as pelvic inflammatory disease and can affect future fertility.
Studies have shown that there may be a link between untreated STDs and worsening premenstrual symptoms (PMS). Premenstrual symptoms such as headache, sadness, and longer period of cramps are exacerbated by untreated STDs (such as chlamydia, herpes, HPV) based on a clinical study in Oxford using a period-tracker app for smartphones.
The hypothesis suggests that with the associated inflammatory phase and falling of progesterone level prior to menses, STDs can worsen further this inflammation, hence, exacerbating PMS symptoms.
Aside from the physical complications from STDs, these infections are also associated with negative psychological impacts. The way general society stigmatizes STDs, a person’s upbringing and cultural background may affect a person’s mental outlook against STDs.
Emotional responses such as anger, depression, guilt, shame, and isolation can occur. This can be followed closely with reduced self-worth, low self-esteem, anxiety, and depression when one is dealing with STD conditions. Over time, constant mental stress against STDs can be associated with restlessness and reduced sexual desire or satisfaction.
One may be scared of contracting STDs to the extent of being unable to be aroused sexually. In males, psychogenic erectile dysfunction can occur out of fear of STDs. In females, one can experience sexual dysfunction symptoms such as vaginismus, reduced libido, painful intercourse, etc.
This will depend on the underlying cause of sexual dysfunction. If the root of the medical condition is due to underlying STD infections, treating or managing the underlying culprit STD infections is likely to improve a person’s overall sexual function. However, bear in mind that most cases of sexual dysfunction can be multi-factorial, and it may benefit to discuss your concerns with your doctor to address any other causes.