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The recent popular Netflix documentary shedding light on contaminated food supplies and pathogens such as E. coli (Escherichia coli) has heightened awareness of these bacteria. Interestingly, at times, patients present with genito-urinary symptoms.
After a series of clinical tests, the diagnosis often points to an E. coli infection. This article delves into the less-discussed connection between E. coli and sexually transmitted diseases (STDs). This aims to inform you about the potential link between E. coli and certain STD symptoms, emphasising the importance of understanding this connection for your overall health and well-being.
Escherichia coli, known as E. coli, is a type of bacteria present in various sources such as raw foods, vegetables, undercooked meats (particularly beef and pork), contaminated water, and the digestive systems of both humans and animals [1].
In most cases, E. coli is harmless. However, certain strains of E. coli can be pathogenic and cause infections [2]. These infectious strains can penetrate the mucous membranes and blood vessels in the human body, leading to various infections. This includes those affecting the respiratory, gastrointestinal, and urinary systems.
It is important to be aware of the potential risks associated with specific types of E. coli to take appropriate precautions and seek medical attention if needed.
In technical terms, STDs (sexually transmitted diseases) are infections primarily transmitted through sexual intercourse, including oral, vaginal and anal intercourse [3].
While E. coli infections are not typically classified as STDs, they can be triggered during sexual activity [4]. E. coli bacteria naturally reside in the genito-anal region as part of a person’s normal bacterial flora. However, during sexual intercourse, these bacteria can be transferred to the urinary tract (this is in both men and women) or the vaginal area (in women), potentially causing an infection [5]. So, yes, E. coli can be sexually transmitted.
It is worth noting that compared to more common STD pathogens such as chlamydia, gonorrhoea, mycoplasma genitalium, ureaplasma urealyticum, or trichomonas, E. coli infections acquired through sexual contact are less prevalent.
As previously mentioned, E. coli is a common bacterium found in the human gastrointestinal tract and can also exist in the perianal area and faeces. When engaging in oral intercourse, which involves direct contact between the mouth’s mucous membranes and the genital or anal region, there is a potential risk of acquiring an E. coli bacterial infection through cross-contact with your partner.
Therefore, it is indeed possible for E. coli infection to be transmitted through oral sex. It is essential to be aware of this risk and practice safe hygiene and sexual precautions to reduce the likelihood of infection transmission during intimate activities.
Anyone exposed to the E. coli bacteria can potentially develop an infection.
You may be more predisposed towards an E. coli infection if you have the following risk factors:
What are the symptoms of an E. coli infection?
Generally, E. coli infections are mild and only cause transient symptoms such as diarrhoea. However, a specific strain known as E. coli 0157:H7 has the potential to lead to more severe symptoms [6]. This includes bloody diarrhoea, abdominal pain, and vomiting, which can progress to systemic issues such as kidney or organ failure.
Common symptoms of E. coli infection include:
You should seek medical attention if you notice persistent abdominal cramps or pain with associated profuse diarrhoea, blood in stools, persistent vomiting, lethargy, fever, or abnormal urinary symptoms.
General advice for everyone includes:
General advice for sexually active individuals includes:
Treatment for E. coli infection typically involves supportive care. Your doctor will often prescribe medications to relieve gastrointestinal symptoms and emphasise the importance of staying well-hydrated. In cases where severe diarrhoea leads to dehydration, hospitalisation may be necessary for more extensive treatment.
For E. coli-related urinary tract infections or those acquired through sexual contact, oral antibiotics such as ciprofloxacin, co-trimoxazole (Bactrium), nitrofurantoin, or ampicillin may be recommended based on the results of bacterial culture and sensitivity testing.
It is essential to follow your doctor’s guidance and complete the prescribed antibiotics course if they are necessary. Adequate hydration and rest are crucial elements of recovery from E. coli infections, whether they affect the gastrointestinal system or urinary tract.
Although rare, an untreated E. coli infection can become a life-threatening condition called haemolytic uremic syndrome (HUS). This risk is associated with a specific strain of E. coli known as Shiga toxin-producing E. coli (STEC), primarily affecting young individuals and those with weakened immune systems [7]. HUS is characterised by the destruction of red blood cells, leading to systemic clotting issues and kidney failure. It is an infrequent complication resulting from E. coli-related diarrhoea.
Patients with HUS experience more severe E. coli symptoms, including blood diarrhoea, abdominal pain, vomiting, fever, chills, rigours, and headaches. This condition involves multiple organs, such as kidneys, brain, and blood vessels, leading to symptoms such as lethargy, elevated blood pressure, bleeding, neurological issues, abnormal urination, reduced consciousness, coma, or even death. HUS patients typically require hospitalisation.
In complex E. coli infections, aside from the usual gastrointestinal symptoms, the infection can ascend, causing bladder infection (cystitis) or kidney infections (pyelonephritis), potentially resulting in chronic urinary tract inflammation or scarring.
It is crucial to understand that E. coli infection is preventable and treatable. Seeking prompt medical attention is vital to avoid complications, especially if you experience severe symptoms or suspect an infection.
In women, while uncommon, chronic E. coli infections can lead to pelvic inflammatory diseases (PIDs) [8]. This condition may manifest as persistent lower pelvic pain, irregular menstrual cycles, unusual vaginal discharge, or urinary symptoms. Chronic inflammation and scarring of the pelvis and the linings of the uterus and fallopian tubes resulting from the bacterial infection can ultimately lead to infertility in women.
In men, chronic E. coli infections, although rare, can be associated with inflammation of the prostate (prostatitis) or inflammation of the testicles (orchitis) [9]. Symptoms may include abnormal urethral discharge, painful urination, altered urinary flow, testicular pain and swelling, and decreased semen or sperm quality. These infections can contribute to fertility problems in men.
It is important to recognise that chronic E. coli infections, while infrequent, can have severe consequences for both men and women, affecting reproductive health. To prevent potential complications, seeking medical attention and appropriate treatment for persistent or recurrent symptoms is essential.
Currently, there is no vaccination or medication to prevent E. coli infection. The best way to avoid E. coli infection is to ensure preventive measures are practised at all times.
While we often ‘zoom in’ and fixate on common STD pathogens such as chlamydia and gonorrhoea, it is worth noting that E. coli, while not a typical STD, can pose a higher risk through sexual activity. Infections can be avoided by properly understanding the bacteria and its associated symptoms and practising preventive measures in daily life and sexual activities.
If you have any concerns regarding E. coli-related infection or STDs, it is important to address the concerns by consulting your doctor.
There is often confusion between a herpes viral infection and shingles infection. It can be challenging for patients, and even some physicians, to differentiate between both conditions. Both shingles and herpes infections affect the skin, resulting in acute blistering on the affected skin surface.
Understanding the differences between shingles and herpes is essential, as the treatment for both conditions differs.
Herpes is caused by the herpes simplex virus (HSV), which comes in two types: HSV type 1 and HSV type 2. HSV type 1 [1] is traditionally associated with rash symptoms on the mouth and face, while HSV type 2 [2] is linked to anogenital rash symptoms. However, due to human interaction and various sexual orientations, HSV type 1 infection can be observed in the anogenital region, and HSV type 2 infection can also manifest on the mouth or face.
Shingles is caused by the varicella-zoster virus (VZV), also known as the herpes zoster virus [3]. This is typically where the confusion arises – the herpes zoster virus differs from the herpes simplex virus. VZV is the same virus that causes chickenpox. A person usually acquires chickenpox in their younger years, and the virus remains dormant in the body until later years. Due to ageing or lowered immunity, the virus can be reactivated, leading to shingles.
Although shingles and herpes share some similarities, both infections are caused by two different viruses, and the treatment for each condition differs. Accurate diagnosis and prompt treatment often require guidance from healthcare professionals.
Here are the general differences between shingles and herpes:
| Shingles | Herpes | |
| Virus | Varicella Zoster Virus | Herpes Simplex Virus 1 & 2 |
| Method of transmission | -Direct contact with the blister fluid lesions -Breathing in air particles from the blisters | -Direct contact with blister fluid lesions during sexual contact |
| Patient demographic | -Older (though it can occur in a young person as well) -Weaker immune system | -Younger -Sexually active person |
| Rash characteristics | -Painful fluid-filled blisters-Rashes in a ‘group’- following the nerve supply of the skin (dermatome) | -Painful fluid-filled blisters-Can be itchy-Rashes in a group or ‘cluster’ |
| Location | -Any part of the body-Tends to be one-sided and seldom crosses the midline | -Occurs over the mouth, genital, and rectal region |
| Prodromal symptoms | Can have pain/burning sensation over affected skin 1-2 days before rash out | Can be itchy or painful over affected skin 1-2 days before the rash out |
| Associated symptoms | -Fever-Lethargy-Headache-Diarrhoea -Upset stomach | -Fever-Painful swollen lymph nodes-Lethargy -Body ache-Painful urination (if it affects the genital region) Symptoms are ‘less dramatic’ during recurrence |
| Duration of rash | Can last up to 2-4 weeks before clearance | Can last up to 7-10 days before clearance |
| Complications | -Can develop post-herpetic neuralgia (lasting pain over affected skin that had shingles)-Can be associated with brain inflammation, lung infection, hearing loss, vision impairment, or even death, though these complications are rare | -Can be associated with brain inflammation such as meningitis and encephalitis, though these are rare-Herpes infection increases the risk of other forms of STD infections (including HIV, syphilis, chlamydia, gonorrhoea, HPV infection, etc.) |
Yes, this can happen, although it is rare for a person to develop both herpes and shingles infections simultaneously. This tends to occur when a person has a compromised immune system.
If you have concerns about either herpes or shingles (or both), please do not hesitate to contact your physician for further confirmation of the diagnosis and seek medical treatment early.
Shingles occur due to the reactivation of the varicella-zoster virus. Shingles will only occur in individuals who have had chickenpox or received the chickenpox vaccination before (hence, they have been exposed to the varicella virus in the past).
Shingles is more likely to occur in people who:
Risk factors for contracting herpes, on the other hand, include:
Fun fact of the day: herpes is not transmissible through contact with objects such as dirty toilet seats, public toilets, door handles, swimming pools, linens, beds, etc.
You can speak to your doctor to further understand the modes of transmission for both shingles and herpes and discuss ways to reduce the risk of acquiring both viral infections.
Shingles tend to be triggered when a person's immune system weakens due to health illnesses or ageing.
Herpes can be initially acquired through sexual contact, and over time, recurring flare-ups may occur secondary to:
Sometimes, unfortunately, the triggering factors may not be obvious. It is worth discussing with your doctor if you experience recurring flare-ups of either herpes or shingles. Your doctor may advise you on lifestyle measures to reduce the risk of flare-ups or even recommend medication or vaccination to prevent flare-ups of both viral infections.
You should consult your doctor if you develop any blistering skin rash. Shingles are usually very distinct and can be promptly diagnosed by most physicians based on clinical history and presentation. However, occasionally, when the clinical diagnosis is uncertain, your doctor may offer you a swab PCR test to confirm the diagnosis or differentiate it from other conditions, such as herpes.
In the case of a herpes blistering skin condition, your doctor may offer you a swab PCR test to determine the diagnosis. Due to the associated risk of herpes with other sexually transmitted infections, your doctor may also recommend other tests such as HIV, syphilis, chlamydia, gonorrhoea, hepatitis, HPV testing, etc.
As both shingles and herpes are viral infections, they are treated with antiviral medication. However, depending on the condition, the dosage and strength of antiviral medicines used to treat shingles are much higher than herpes. Therefore, it is crucial to accurately diagnose the condition and promptly administer the proper treatment and medication dosage.
Common antiviral medications used include acyclovir, valacyclovir, and famciclovir.
Although there is no cure for herpes infection, treatment is available to alleviate symptoms, promote faster resolution of blisters, and reduce the risk of recurrence.
Yes, a vaccination available against shingles is effective in preventing shingles and reducing the risk of post-herpetic neuralgia. According to the CDC, the shingles vaccine [4] (Shingrix) is 97% effective in protecting against shingles infection in healthy adults aged 50-69 years and 91% effective in older patients above 70.
You may consider shingles vaccination if you are:
If you are considering vaccination against shingles, please consult your doctor to understand the benefits of vaccination. Your doctor will assess your suitability for the vaccine and discuss potential side effects.
Unfortunately, there is no vaccination available to protect against herpes infection. However, there are some tips to reduce the risk of acquiring herpes infection.
Herpes and shingles are two distinct viral infections that can result in blistering skin conditions, raising concerns about health and potential complications. While there may be overlapping clinical presentations, an accurate diagnosis of the condition is crucial to providing the correct medications for managing the viral infection.
Blistering skin conditions should prompt a clinical evaluation, so do not hesitate to seek medical advice early and avoid taking chances with the condition.
“A patient presented with recurring eye discomfort, pain, redness, and mucous eye discharge. Despite multiple treatments with eye drops for conjunctivitis, there was little improvement. His symptoms worsened, leading to blurry vision. Subsequently, he sought the expertise of an ophthalmologist who recommended sexual health tests due to concerns about an undiagnosed sexually transmitted disease. The test results confirmed a chlamydia trachomatis bacterial infection [1]. Given the seriousness of the situation, especially with ophthalmic involvement, the patient was prescribed appropriate antibiotics and experienced an uneventful recovery.”
Question: Chlamydial infection is always known to be a silent medical condition that most people tolerate with minimal or subtle symptoms. Are there potential sinister complications that we may not be aware of?
In 1907, chlamydia was discovered by Halberstaedter and Von Prowazek from a conjunctival sample taken from an orangutan. In Greek, 'chlamydia' means 'cloaked' or 'hooded.' Over the years, with its 'hooded' nature and evolutionary resilience, the bacterium has survived for centuries in both animals and humans. It is considered one of the most elusive bacteria that spreads surreptitiously when we are least aware.
Chlamydial infections are transmitted through sexual contact, including vaginal, rectal, or oral routes. A pregnant mother with untreated chlamydial infection can also transmit the infection to her baby during a vaginal delivery.
Theoretically, anyone who engages in sexual activity is at risk of acquiring a chlamydial bacterial infection. However, the risk of infection increases with the number of sexual partners, a history of unprotected sex, and those who also engage in oral and rectal sex.
One can be asymptomatic or develop only mild symptoms during the early stages of chlamydial infection. Occasionally, one may experience symptoms such as:
Chlamydia bacteria can go unnoticed for a while, as the bacterial infection does not initially cause many symptoms. However, chlamydial infection can lead to more serious health issues with long-term complications.
You should consider seeing your doctor and getting screened for chlamydia if you have had a sexual encounter that may suggest exposure to STDs [4]. You should also get screened if you are experiencing symptoms such as:
As a general piece of advice, if you notice abnormal lumps and bumps in your genital region, unusual discharge, or abnormal urination, you should seek advice from your doctor.
Depending on your medical history, risk of exposure, and sexual history, your doctor may offer you chlamydia tests such as:
If there is a risk of exposure to other STDs, your doctor may further advise you to screen for infections such as gonorrhoea, HIV, syphilis, herpes, hepatitis, HPV, etc.
Chlamydia infection can be effectively eradicated with medicines [5], such as antibiotics. Antibiotics may include azithromycin, doxycycline, or erythromycin, depending on a patient's drug history and medical compliance rate.
Unfortunately, in some health complications secondary to chlamydia infection, even with the resolution of the bacteria, there may be long-term scarring or chronic inflammation in the affected organ. This is unlikely to be reversible even with medical treatment.
Chlamydia infection can persist in our body without treatment, and one can have chlamydial infection for years. If chlamydial infection is not treated, you remain infectious and can transmit the infection to your sexual partner(s).
Human Papillomavirus, also known as HPV, is a common virus that can affect anybody, including those who are married or in a steady monogamous relationship.
There are over 150 strains of HPV viruses [1]. HPV viruses can be passed through skin-to-skin contact; hence, they can be transmitted through sexual activities. A vast majority of the sexually active population may encounter HPV infections at certain points in their life with most not showing any signs or symptoms of infection.
So, if you find out you are infected with HPV, is it all doom and gloom for your relationship? You may wonder if you have to tell your partner and how you will go about it.
Don’t despair; we are here to help you manoeuvre your way through this sticky situation. Keep reading as we go through everything you should know about informing your partner that you have HPV.
Before talking to your partner, you should understand HPV yourself, as getting your facts straight is paramount. Be sure to counter-check and ensure your HPV information sources are reputable and accurate rather than relying purely on Google and the internet.
Consult your trusted doctor if you have unanswered questions and queries on HPV infection that require further explanation. Bear in mind that your doctor may enquire about your previous sexual history and possible HPV symptoms (if any). This way, your doctor can stratify your HPV infection risk. Sometimes, doctors may suggest a physical checkup of the genital region or even an HPV test for further evaluation.
As sensitive topics such as HPV can cause a strain between couples, it is important to check your facts with your doctor and other reliable sources before you start the conversation with your partner.
HPV infection is prevalent, with almost everyone in a sexual relationship exposed to it at some point [2]. This does not mean you have done anything immoral or been unfaithful with your partner. Based on the CDC, 85% of the population who are sexually active will encounter HPV infection during their lifetime [3]. In Singapore, HPV infection prevails at 9.31% [4].
It is possible that a person may carry HPV for years, all while being asymptomatic. However, over time, one may present with HPV symptoms such as warts – viral lesions on the skin at the genital surface and oral or throat mucosa. Less commonly, in severe cases of HPV, one can develop cervical cancer, penile or anal cancer, or even head, neck, and throat cancer from an HPV infection.
As a person can have HPV without any symptoms, they may continue having different sexual relationships, thus making it difficult to trace the person’s sexual contact history.
The key to a successful long-term relationship is being constantly open and honest. It is normal to initially feel uncomfortable, worried, and distressed when you find out about an HPV infection.
Once you have gotten the correct facts and information on HPV, arrange a suitable time with your partner. Out of courtesy and respect, it is best to have a face-to-face discussion in a quiet, private, and comfortable place.
After the conversation with your partner, what comes next? If your partner is agreeable, you can also consider scheduling a discussion appointment with them and your trusted doctor to obtain first-hand professional input on an HPV infection. This also allows your partner to clear any doubts or answer their questions. Addressing this challenging topic this way is likely to assuage unnecessary relationship tension and anxiety.
Speaking to professionals, such as your trusted doctor, may be beneficial in guiding you and your partner on the next course of action following a diagnosis of HPV infection.
Here are some important questions to ask your doctor:
The HPV topic can cause friction and strain among couples. Thankfully, most HPV infections can be spontaneously cleared by a person’s immune system. This is why it is vital to know the realities of living with HPV and understand the facts.
If you or your partner are experiencing HPV-related symptoms, curative treatment is possible to manage the symptoms. You and your partner may be offered HPV vaccination to prevent further infections from HPV. Periodic and regular medical and dental checkups may be advised to screen for HPV-related symptoms.
The key takeaway points of HPV infections are:
Urinary tract infections (UTIs) and sexually transmitted diseases (STDs) are often confused for one another by patients or even physicians due to their overlapping symptoms. Understanding both conditions and identifying the differences between the two are important as the management and treatment for both differ.
The urinary tract system consists of the kidneys, the ureter, the bladder, and the urethra. An individual can develop a UTI when bacteria invade and infect any part of the urinary tract system.
The types of UTIs are named according to the part of the urinary tract that has been infected, these are:
STDs are a constellation of pathogens (bacteria/virus/fungi) that can be passed on during sexual intercourse or sexual contact, leading to an infection of the sexual partner. STDs are usually transmitted from one infected individual to another, thus requiring a source.
There are various types of STDs, some common STDs include:
There are overlapping symptoms between UTIs and STDs, though, there are also differences in both presentations. It is imperative to tease out the differences between the 2 conditions as their treatment varies.
These are some symptoms that may differ between UTIs and STDs:
| Symptoms | UTI | STDs |
| Painful urination | √ | √ |
| Increased urge and frequency of urination | √ | √ |
| Fever | √ | √ (less common) |
| Blood in the urine | √ | Unlikely |
| Cloudy and smelly urine | √ | Unlikely |
| Vagina/urethral/abnormal rectal discharge | Unlikely | √ |
| Genital itch | Unlikely | √ |
| Genital rash/sores/blisters | Unlikely | √ |
| Spotting/bleeding between periods | Unlikely | √ |
| Painful intercourse | Unlikely | √ |
| Vaginal/rectal pain | Unlikely | √ |
If you are experiencing any of the symptoms above or other unusual symptoms relating to the urinary or genital region, it is important to speak to your doctor to evaluate your symptoms further.
Yes, some bacteria from STDs can affect the urinary tract system, leading to urethral discomfort, discharge, or even painful urination. The treatment for STDs and UTIs is different, therefore it is essential to administer the right test based on a person’s symptoms presentation.
No, the bacteria that cause urinary tract infections are usually the bacteria floral found in the genito-urinary system or even the gastrointestinal system. They are generally not directly passed on through contact and are not transmissible through sexual activities. Likewise, treatment for UTIs and STDs differs, and it is equally important to see your doctor to evaluate your clinical symptoms and ensure you are receiving the right treatment.
If you have any abnormal urinary symptoms suggestive of a UTI, you should speak to your doctor and consider getting medical treatment for UTI before the symptoms deteriorate. Although there are possibilities of a mild UTI resolving spontaneously over time, severe cases of UTI can lead to ascending bladder infection, kidney infections, or even blood infection (sepsis) that can be dangerous. Hence, you should not delay seeking medical treatment if you suspect a UTI. Most uncomplicated cases of UTIs can be managed by your primary doctor with appropriate antibiotics and lifestyle modification advice.
Generally, STDs can be asymptomatic, or present with genitourinary symptoms (this was discussed in a previous article). It may even have symptoms that overlap with a UTI. If you have a risk of exposure to STDs or concerning symptoms, you are advised to speak to your doctor to guide you on the appropriate STD screening tests to consider. Your doctor can also advise you on measures in both medication and lifestyle to reduce your risk of acquiring STDs.
In the case of UTIs, as previously discussed, there is a chance of your UTI infection not resolving and resulting in an ascending infection – affecting the bladder, kidneys, or even bloodstream. In such circumstances, you can become unwell with symptoms such as a fever, chill and rigors, worsening urinary discomfort pain, blood in urine, and inability to pass urine, which may lead to hospitalisation or even potential life danger if an infection of the bloodstream occurs.
In terms of STDs, while most of the common STDs are treatable, there are some STDs that have more major implications for your long-term health as they may not be curable (such as HIV, Hepatitis infections, etc). Therefore, seeking medical assistance for both UTIs and STDs is paramount in preventing long-term detrimental health effects.
The following advice can be considered to reduce developing UTI after intercourse:
The below practice(s) helps to minimise the transmission of STDs:
Although bacterial vaginosis is not considered a sexually transmitted disease (STD), the condition increases the risk of acquiring STDs such as chlamydia, gonorrhoea, herpes, HIV etc [1,2]. Hence, it is worth getting treatment for bacterial vaginosis to protect yourself against acquiring STDs.
Bacterial vaginosis (BV) is a vaginal infection caused by a bacteria known as Gardnerella Vaginalis. Bacterial vaginosis typically occurs in women who are sexually active, though less commonly, can also occur in women who have never had sex.
Bacterial vaginosis is a common condition that generally affects women aged between 15-44 years old [3]. While the exact underlying cause of bacterial vaginosis remains unknown, bacterial vaginosis typically occurs when there is an imbalance in the vaginal microenvironment. There is an association between reduced lactobacilli bacteria and hydrogen peroxide production which ultimately leads to a rise in vaginal pH [4-6]. This leads to a disruption of the ‘good’ and ‘bad’ bacteria in the vagina, resulting in an overgrowth of the ‘bad’ bacteria. The ‘good’, protective bacteria such as Lactobacilli are hence outnumbered and not able to maintain a healthy balance of natural disinfectant in the vagina.
Approximately 50-75% of women with bacterial vaginosis are asymptomatic [3,7], while others may experience the following symptoms:
Unfortunately, 15-30% of women who have received bacterial vaginosis treatment can have a recurrence of the condition within 3 months [8,9]. Recurring bacterial vaginosis occurs when a woman presents with recurring or chronic symptoms of bacterial vaginosis requiring multiple or even long-term treatments.
Predisposing factors for recurring bacterial vaginosis include:
Speak to your doctor about individual risk management and treatment options to mitigate recurring symptoms.
Yes, women with female partners have a higher chance of acquiring BV as vaginal fluid can act as a carrier of the bacteria. Sharing of sex toys and barriers such as condoms/dental dams can pass on BV as well.
Yes, women may develop bacterial vaginosis as the vagina microenvironment can be disrupted through intercourse. Interestingly, Gardnerella Bacteria can be seen on men’s genitalia even though bacterial vaginosis is not considered an STD.
Bacterial vaginosis increases the risk of pelvic inflammatory disease (PID) which can cause an infection affecting the uterus, cervix, fallopian tubes, and ovaries [10]. In the long-term, this can be complicated with chronic pelvic or lower abdominal pain, increased risk of ectopic pregnancy, or even infertility.
If bacterial vaginosis occurs in a pregnant woman, there is a risk of premature delivery of the baby, thus increasing the risk of low birth weight in comparison to babies born to women without BV [11,12].
As previously mentioned, the risk of acquiring other STDs including HIV, chlamydia, and gonorrhoea is higher in women who have untreated bacterial vaginosis [1,2]. Additionally, a person who is HIV-positive coupled with untreated bacterial vaginosis, has a higher chance of passing HIV to other sexual partners.
The question here is whether the frequent episodes of bacterial vaginosis are due to re-infection or relapse. It is evident that some women who have the same sexual partner before and after bacterial vaginosis treatment, are likely to have recurring BV. Does this suggest a bacteria infection that is passed on back and forth between the woman and her sexual partner? Or is the repeated occurrence of bacterial vaginosis due to disruption of the vagina ecosystem due to intercourse?
Ongoing open labelled trials and randomised controlled trials to consider concurrent bacterial vaginosis treatment of the women’s sexual partner with oral antibiotics and topical antibiotics have shown that, although the recurrence rate of bacterial vaginosis may be lower in those whose partner is concurrently treated, there remains insufficient clinical evidence to recommend male partners to be treated concurrently with the symptomatic woman [13,14].
Yes. In view of the association between bacterial vaginosis and the predisposition to STDs, both partners are encouraged to undergo STD screening and treatment for any concurrent infections. It is also worth noting, especially in women, a vaginal infection can be associated with a predisposition to other forms of vaginal infection (including STDs). By screening and treating concurrent infections, vaginal health and microenvironment can be restored over time, hence reducing the risk of recurring bacterial vaginosis.
The 3-point approach method is advised to reduce the risk of recurrence of bacterial vaginosis:
In recalcitrant cases or persistent recurring bacterial vaginosis infection, your doctor will discuss further individual suppressive options for treatment. Please discuss with your doctor with regard to further management, as the treatment regimen is individualised and dependent on triggers and lifestyle.
You can reduce your risk of bacterial vaginosis by incorporating the following:
Bacterial vaginosis is a common vaginal infection that can affect your quality of life and brings in its wake possible health complications if left untreated. If you are experiencing abnormal or recurring vaginal symptoms, do not hesitate to reach out to your doctor for further screening and treatment.
Is it true that oral sex is generally safe and one no longer has to worry about spreading germs and infections? Do I need to consider any testing for sexually transmitted diseases (STDs) if I engage in oral sex?
According to the Centers for Disease Control and Prevention (CDC) [1], more than 80% of sexually-active adults between the ages of 18-44 years old, reported having oral sex at least once with a partner of the opposite sex, suggesting a common sexual orientation in our current population.
The risks of acquiring sexually transmitted diseases (STDs) through oral intercourse depend on the type of sex, number of sexual activities/partners, and what type of STDs (certain STDs may have a higher risk of transmission).
As everyone has different sexual lifestyle habits, it is worthwhile to pay a visit to your doctor to discuss your lifestyle and understand your risk factors. If there are risks involved, your doctor can guide you further to consider screening for infections.
A few facts worth reminding ourselves when engaging in oral sex:
| Types of STDs | Transmission through oral intercourse |
| HSV (Herpes Simplex Virus) | Yes |
| Chlamydia | Yes |
| Gonorrhoea | Yes |
| HPV (Human Papillomavirus) | Yes |
| Syphilis | Yes |
| Trichomonas | Yes |
You are advised to discuss with your doctor to consider screening for the above STDs if you do engage in oral sex and there is a possibility of acquiring STDs. Prompt treatment can be offered for most of the STDs above, hence do not hesitate to reach out to your trusted doctor.
Although the risk of acquiring incurable STDs such as human immunodeficiency virus (HIV) and HSV from oral intercourse is low, one is not completely safe from acquiring these infections.
In the case of HSV transmission, HSV can be transmitted through direct contact.
In the case of HIV transmission, the general consensus is that the risk of transmission is low (in comparison to vaginal or anal penetrative sex) however due to a lack of studies, the risk cannot be fully eliminated.
If you are at risk of acquiring STDs from oral intercourse, you are encouraged to reach out to your doctor for early testing and treatment.
The safety comparison of different sexual practices is not fully studied in the medical literature. Most people who engage in oral intercourse are also involved in other penetrative intercourse such as vaginal and anal sex. The risk of a person who engages in oral sex depends on the number of sexual activities/partners and the risk of the sexual partner as well.
Oral STDs such as chlamydia and gonorrhoea have higher risks of systemic disease as they are less often tested and hence delayed in their treatment. To further exacerbate things, persistent untreated STDs including chlamydia and gonorrhoea generally increase the risk of contracting HIV.
Engaging in high-risk oral intercourse can also possibly lead to cancer. It is clinically proven that HPV infection in the oral/throat region increases the risk of mouth and neck cancer [2,3].
Risk factors for developing STDs through oral intercourse include:
The best way of preventing STDs is abstinence, other ways in which you can reduce your risk include:
Oral sex may not be as safe as you wish. It is imperative to note that STDs can go unrecognised and hence untreated for years as most people have no symptoms and are unaware of their infectious status.
Speak to your doctor today. Understand your sexual risks, screen for infection, consider immunisation vaccines for prevention, and seek early treatment if required.
Monogamy suggests the practice of staying with the same sexual/romantic partner; in other words, a monogamous relationship involves being sexually and romantically exclusive to a single partner. A monogamous relationship can involve people from any sexual orientation.
Other types of relationships include open relationships, casual dating, and polygamy. This usually involves more than 2 persons with no expectation of exclusivity.
When a person transitions from one monogamous relationship to another after their previous relationship ends, it is called “serial monogamy” [1]. Despite each relationship being exclusive, it is important to note that this pattern can come with drawbacks and risks to sexual health. However, awareness about these potential disadvantages is often lacking among many individuals engaged in serial monogamy.
Sexual relationships are often believed to be much safer when they are within monogamous relationships. However, numerous health red flags related to sexually transmitted infections (STIs) in monogamous relationships have emerged over the years.
When both individuals in a monogamous relationship undergo STI screenings, the chances of transmitting STIs are relatively low. However, this scenario is not very common. In most cases, those in monogamous relationships do not get tested for STIs before starting their exclusive journey together. As a result, many are unaware that they might have STIs prior to entering the relationship.
Unfortunately, in many relationships, one partner may believe that both parties are practising monogamy, but this might not be the case. The expectation of exclusivity may not be mutual, leading to situations of infidelity or one partner being non-monogamous. This aspect relates to the concept of “serial monogamy”. In such cases, one may unknowingly contract STIs from their current or previous partner(s) who may have been carrying undiagnosed infections. To exacerbate matters, individuals in these relationships may still believe they are practising monogamy and fail to take proactive measures such as undergoing STI screenings. As a result, the risk of STIs in a serial monogamy relationship can be higher than what is commonly perceived.
The answer is, yes! It is an untrue fact that only people with multiple partners will get STIs. STIs do not infect a person based on the individual’s personal virtues and morals. STIs can affect anyone who is in a sexual relationship whether one is monogamously married or in an open relationship.
So, don’t get into false assurances that one is safe from STIs as long as one is married.
Some STIs may cause overt symptoms, while others can be indolent, and live in an untreated host for months or even years. This gives the untreated person a false sense of assurance that his/her health is at its pinnacle pink and thus, unintentionally leaving STIs untreated.
This, therefore, leads to the spread of untreated STIs when the individual moves on to a new relationship. Although STIs are generally not life-threatening, one can develop complications such as infertility or even cancer over time.
An incubation period is the time required for the body to develop a response following an infection, this is the time between a person being exposed to an infection and the time when abnormal symptoms start appearing. STI viruses, such as herpes or the Human Papilloma Virus (HPV), can go unnoticed for years. STIs can even be mistakenly presented as other medical conditions, which delay a person from getting the right treatment for their undiagnosed STI.
Many married couples may easily assume that they do not need to undergo STI testing since they trust their spouse’s faithfulness and the monogamous nature of their marriage. However, as mentioned earlier, certain STIs can be present in individuals without any noticeable symptoms, leading to asymptomatic individuals. This false sense of assurance can lead the couple to believe that everything is fine until years later when evident signs of STIs start to emerge.
Do consider speaking to your trusted physician as different STIs may have different incubation periods and they can guide you on further tests depending on your individual risk of exposure.
You should consider consulting a doctor if you are experiencing unusual symptoms such as:
Bear in mind, some STIs may have longer incubation periods or may be asymptomatic. It is worth speaking to your doctor if you are in a relationship and considering STI screening.
Speak with your doctor regarding your previous medical and sexual health histories. In some cases, your doctor may also inquire about your partner’s sexual history (if available). Your doctor will then guide you on the STI tests that are suitable for you.
Tests available to screen for infections include:
Your doctor may advise you on additional or customised tests based on your risk factor(s). For women, your doctor may also recommend you get a Pap smear and HPV test to screen for HPV infection and cervical cancer.
If you fall within the age range of 9 to 45 years, it is worth considering getting vaccinated against the high-risk strains of HPV. This vaccination offers protection against these strains for both men and women, helping to reduce or prevent the risk of various HPV-related conditions such as genital warts, cervical, vaginal, penile, anal, and even throat cancers.
HPV infection is highly prevalent, with approximately 80% of sexually active individuals encountering it at some point [2]. This includes those who are in committed relationships or married. It is important to note that most people infected with HPV do not show any signs and symptoms, making it easy to unknowingly transmit the infection to others.
You are encouraged to speak to your doctor if you are considering HPV vaccination.
Discussing STI testing can be a stressful and daunting topic for couples. Most people feel uncomfortable discussing STIs with their couple— this can be a mixture of embarrassment, fear of the implication on the relationship, or simply having no idea how to broach the topic.
It is worth doing a little research or even consulting your trusted physician on STI test options and what are the recommended tests based on your own health history and risk of exposure. With a better understanding of STIs yourself, you will be better prepared when conversing with your partner.
It is always important to be open, empathetic, non-judgmental, and relaxed when discussing sexual health with your partner. It is also important to keep in mind that STIs as with any medical infections, can affect anyone regardless of a person’s background, religion, or socioeconomic status.
Finding a suitable time and place for discussion and thinking through the words to say is important. Discussing such topics in person, and avoiding text messages or over the phone can be useful as non-verbal language (such as body language or reactions) has an important role in communication.
Here are a few examples to discuss your conversation:
You are recommended to discuss with your doctor to obtain first-hand and accurate information on STIs, as this would aid your discussion with your partner.
According to the Centers for Disease Control and Prevention (CDC) [3], around half of adults aged 18 to 44 have never been tested for STIs, apart from HIV. This includes individuals in monogamous relationships. Additionally, couples who believe they are practising monogamy may be less inclined to prioritise STI screenings, assuming there is no need for such tests.
Certain STIs can be indolent or take months and even years before showing any symptoms. Consequently, even faithful couples may be at risk of contracting STIs due to untreated past infections.
If you have concerns about STI transmission or are considering getting screened, it is advisable to consult with your doctor.
While monogamous couples generally have a lower risk of acquiring STIs compared to those who are single or in open relationships, it is important to recognise the possibility of asymptomatic STIs that may go unnoticed and untreated. Engaging in proactive measures such as undergoing regular STI screenings with your partner is a beneficial practice for maintaining good sexual health within couples.
By breaking the taboo surrounding sexual health and prioritising open communication, understanding your own and your partner’s sexual health status can foster trust and enhance your sexual experiences.
Feel free to reach out to your trusted physician to discuss further on STI screenings.
Genital herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus type 1 (HSV-1) or herpes simplex virus type 2 (HSV-2).
A person actively infected with herpes tends to present with blisters/vesicles lesions over the genital, anal, or mouth region. During the first outbreak of herpes infection, one tends to have a more severe and longer duration of symptoms presentation. Systemic symptoms such as fever, swollen lymph nodes, body aches, lethargy, and general feeling of being unwell may be noticeable in patients.
In recurring outbreaks of genital herpes, the symptoms tend to be milder and with a shorter duration though a person may present with premonition symptoms such as tingling/shooting pain in the legs/buttock/pelvic region and genital pain before the presentation of herpes lesions.
The herpes simplex virus is passed on through contact with another infected person through mucosal surfaces, mouth, or genital secretions. Both HSV-1 and HSV-2 can be shed from a normal looking mouth or genital mucosa/skin. A person can get HSV-2 infection during genital contact with another person who has a genital HSV-2 infection. But if you receive oral sex from a person who has an oral HSV-1 infection, you can also acquire a genital HSV-1 infection.
Sometimes, contraction of the virus can occur when the infected partner has no active symptoms. In an asymptomatic person or someone without symptoms of HSV 2 infection, genital HSV shedding does happen but occurs less frequently compared to symptomatic individuals [1].
The Centers for Disease Control and Prevention (CDC), approximates that over 572,000 new cases of genital herpes occur annually in the USA [2]. The prevalence of patients who are diagnosed with HSV-2 infection is about 12.1% after adjustment to age (in 2015-2016) [2]. However the actual prevalence of genital herpes infection may be higher as some of the genital herpes infection may be due to HSV-1.
Upon the diagnosis of incurable STIs such as herpes, one can be overwhelmed by a plethora of emotions ranging from embarrassment, guilt, anger, sadness, grief, or even depression.
A combination of our cultural belief and individual educational upbringing may stir us onto the view that contracting a sexually transmitted disease generally occurs only to those who have done something ‘wrong’. This emotion is further exacerbated with the incomplete understanding of the pathophysiology of the virus and long-term medical sequelae of herpes virus infection.
To spiral things further, the concern of living with an ‘incurable’ disease such as herpes and potentially passing it on to people around us, paints a very bleak outlook for patients upon diagnosis of the disease.
The public awareness and openness against sexual health is still at an early stage and the incomplete medical understanding of herpes virus further adds to the tumultuous negative effect of social stigma. The question that usually arises is whether we should tell a friend/family member/romantic partner of the diagnosis. Will we get rejected by people around us if we reveal our medical status? Will I ever lead a normal life, establish relationships, and have offspring? All these unanswered questions can take a toll on a person’s mental wellbeing.
At this stage, let me share a few rebuttal points:
The truth is, even with the presence of chronic infections, we learn to co-exist, thrive, and continue to live our lives as normal as possible. This should also apply to the case of the herpes viral infection.
It is important to understand that contracting herpes virus is ‘okay’. It is a manageable medical condition, it is not a life sentence nor is it a punishment. It does not determine who you are and you should not be judged by others. Most couples with herpes are able to lead a normal life, and have healthy future generations.
Getting the correct medical information regarding herpes medical condition is paramount. It is one of the key ways to come to terms with the diagnosis and overcome the emotional turmoil associated with the condition. Understanding the fact that even though herpes is ‘incurable’, there are effective medical treatment options to manage the symptoms. One may consider scheduling a medical consultation with your trusted physician to address your concerns on herpes infection.
Although there is currently no cure for herpes, antiviral medication can prevent or reduce the herpes outbreak when the person is taking the medication. Studies have shown that antivirals are an effective medical option to significantly suppress the transmission of HSV [3]. You are advised to discuss with your doctor for further advice and medication guidance.
The topic of breaking the diagnosis of herpes to your intimate partner can be difficult. Concerns of being judged, relationships ending, and sexual activities being hindered, are all valid social issues with regards to genital herpes. Although many may fear sharing the diagnosis with their partners, most partners take the news well, and are appreciative of the honesty and trust in disclosing personal health information with them. It is also proven that with good awareness of the medical condition, the chances of transmission of herpes to partners are reduced.
One of the best ways to break bad news to your partner is by choosing suitable language when discussing the topic with them. It is always imperative to be honest, open, constructive, and hopeful.
Bringing your partner to your doctor’s visit to obtain the right information on herpes is definitely useful for partners to debunk any myths that are associated with ‘incurable herpes STI’.
Having better patient education on the herpes virus, general symptoms to anticipate, and understanding the progression of disease over time are important. While doing your own reading and research regarding herpes virus can be beneficial, verifying your study materials and resources with your trusted physician can avoid anxiety due to misinformation from the condition.
Be kind, empathetic and non-judgemental towards your loved ones and people around you, everyone is fighting their own battles.
Patients with herpes generally are able to lead a fulfilling and normal life. Most of them are able to have successful long-term relationships with their partners. They are able to have family and children uneventfully. Herpes is a virus that does not generally damage your health. The symptom outbreaks do go away with or without treatment, and overtime the flare ups get less frequent, and recurrence symptoms tend to be milder.
If the topic of herpes remains a sore bothering point, do not hesitate to reach out to the health care professionals for further advice and guidance.
Embarking on a new relationship is an exciting chapter of life and a phase that nearly all of us will go through. Love is in the air, hormones are raging, and the days (and nights) are sweet and lovely.
It may be a happy and exciting time, however, you must not forget to always take care of yourself. Aside from looking after your mental health, do remember to take charge of your physical well-being- especially your sexual health!
Sexual health is important because it allows both men and women to express themselves sexually while being free of risk from sexually transmitted diseases and unplanned pregnancies [1].
This guide will keep you informed and educated on the key elements of good sexual health. It is vital to be aware of these steps, and then put them into action, when embarking on a new relationship so that you keep both you and your partner safe and healthy.
Despite practising good sexual health, there are still risks that come with being sexually active. This guide will also inform you of what to do in these cases.
Prevention is always better than cure. It is always good practice and social responsibility to take proactive measures to screen for both yourself and your partner(s)’ risk of contracting sexually transmitted infections (STIs).
Sexually transmitted infections are often indolent. Taking proactive measures to consider a range of preventive sexual health services are good ways to ensure you are always healthy. It is always good to detect early and treat any underlying medical condition promptly.
Here are the recommended sexual health screening services our clinic offers:
| Recommended Screening Sexual Health Services | Male | Female |
| Chlamydia screening | √ | √ |
| Gonorrhea screening | √ | √ |
| HIV screening | √ | √ |
| Syphilis screening | √ | √ |
| Trichomonas screening | √ | √ |
| HPV screening | *Consider protection with vaccination | √ *Consider protection with vaccination |
| Hepatitis screening | √ *Consider protection with vaccination against Hepatitis A and B infections | √ *Consider protection with vaccination against Hepatitis A and B infections |
| Herpes screening | √ If you have exposure risk or are symptomatic | √ If you have exposure risk or are symptomatic |
You are advised to speak to your trusted physician about your concerns, possible symptoms, exposure risk, and the timeline of exposure risk. Based on your individual risk, your doctor will then guide you on the appropriate tests to screen for sexually transmitted infections.
In the event of possible exposure to HIV, or risk of becoming infected with HIV, you may wish to consider post-exposure prophylaxis (PEP) medications [2]. PEP medication should be offered within the first 72 hours after a possible exposure to HIV.
Having said that, every hour counts. PEP has little or insignificant effect in reducing the risk of acquiring HIV infection if taken after 72 hours of possible exposure. You should speak to your doctor before starting PEP. You may consider PEP if you do not have HIV and in the last 72 hours, you have:
Some patients are unsure whether they are required to consider PEP if they have a regular risk of exposure to HIV. You may wish to discuss your concerns further with your doctor, although PEP should only be used during emergency situations. This is because repeated use of PEP may lead to antiviral resistance against HIV infection. In such a situation, your doctor may discuss with you about the PrEP (pre-exposure prophylaxis medication) option to lower the risk of HIV.
If you are sexually active, it is a good idea to get vaccinated for certain serious sexually transmitted diseases.
These include:
Human papillomavirus (HPV) infection is extremely common. Although in most people, HPV infection resolves spontaneously due to a person’s immune system, some strains/subtypes of HPV can cause cancer such as cervical, throat, penile, anal, vaginal, vulvar cancer, and genital warts.
HPV vaccination protects against the common subtypes of HPV against genital warts and cancers against the cervix, vulva, anus, penis, and throat. Currently, the high covalent HPV vaccination is recommended for patients up to the age of 45, as the studies show benefits even in older age groups (until age 45). You can find out more regarding HPV vaccination and your eligibility with your doctor.
Hepatitis B is a virus that can cause inflammation and destruction of the liver tissues. Hepatitis B is spread through infected body fluid, blood, or even semen. People who are infected with hepatitis B may be asymptomatic and cause further liver function deterioration over time.
Vaccination against hepatitis B is the best way to protect your liver against hepatitis B. In Singapore, hepatitis B vaccination is part of our childhood immunisation schedule. However, we may have lost immunity over time and may require a top-up booster. Speak to your doctor for further understanding of the need for vaccination, and the schedule of the vaccinations.
Hepatitis A virus can lead to liver tissue inflammation and damage. Hepatitis A can be passed on through kissing and salivary transfer. Though most people recover from hepatitis A infection without liver harm, some may have severe liver inflammation.
Currently, there is no treatment for hepatitis A and the management goal is mainly supportive. Vaccination against Hepatitis A is effective and safe. Do speak to your doctor to understand hepatitis A vaccination further.
4. Lifestyle tips for reducing the risk of contracting STD
If you have just started a new relationship and are unsure how to protect yourself from STDs, it is a good idea to discuss with your doctor about lifestyle tips to protect yourself.
Lifestyle tips often include:
5. Paying attention to your body
One of the major steps in taking care of your body is paying attention to the signs and symptoms of your body.
If you are sexually active, take note of any abnormal physical symptoms such as a fever, sore throat, new rash, ulcers, lumps or bumps, swelling, or growth over the genitalia region. You may also want to look for any abnormal urinary symptoms. If you have any unexplained symptoms, consult your doctor.
6. Reviewing your need for contraception
Both men and women should be aware of contraception. If you are in a new relationship, you should discuss the method of contraception with your partner before starting sexual activities. For men, the options are more limited. They include wearing condoms and a vasectomy (surgical male control).
Women have more options when it comes to contraception. However, this does not mean that only women need to use contraception during sexual activities. It is generally recommended that both partners use forms of contraception for the best protection against unwanted pregnancies and sexually-transmitted infections and diseases.
Contraception options for women include:
The morning after pill/plan B is an available option if you have unprotected sex. Emergency contraception is used to avoid pregnancy in a person who has not had adequate contraception during intercourse.
You are advised to take the pill as soon as possible (within 72h or 120h after intercourse – depending on the type of medication). Your doctor will guide you on the medication, potential side effects, and efficacy of the medication.
You can speak to your healthcare providers for information and advice on which are the most suitable contraceptive options for you.
Long-acting contraception includes implants such as IUD, Mirena, Implanon, while short-term methods include injection, birth control pills, contraceptive patch, and barrier contraception. In some ladies who have completed family planning, permanent contraception option with ligation can be discussed.
7. General health screenings
When life is already busy, and we add a new relationship to the mix, we tend to put our health on the back burner. You may want to take a breather to revisit your daily eating habits and exercise routine. It is good practice to be proactive and always take charge of your physical health, especially when committing to a new partner.
General health screening allows a person to understand and screen for asymptomatic chronic conditions such as diabetes, hypertension, elevated cholesterol, and cancer. These conditions are common and you don’t want to wait until major health adversaries take their toll on you.
For ladies, regular pap smears for screening of cervical cancer if you are or were in a sexual relationship, should also be considered.
8. Taking care of your mental health
Starting and maintaining a relationship often has its ups and downs. It is a journey to understand yourself and others. It is about growing, learning your own shortfalls, and your partner(s) shortfalls, and attempting to make the best out of the relationship.
Sometimes, heartbreaks may occur. Looking after your mental health is important so you can avoid indulging in self-pity and instead, empower yourself with your strengths and surrounding resources.
Ensure you have strong social support- good friends and family to support you along the journey. If you are struggling with your mental health, or having suicidal ideation, you can always reach out to healthcare professionals to help you through the rough patch.
The bottom line is that while starting a new relationship is a beautiful and exciting chapter in your life, you must always remember to be safe and take care of yourself. Remember that you are always in charge of your sexual health and well-being. If you have any concerns at all, you can discuss them with your trusted healthcare provider.
1. What is Sexual Health? Retrieved from The National Coalition of Sexual Health: (http://www.nationalcoalitionforsexualhealth.org)
2. 14 September 2022. Guide to Sexual Health Services. Retrieved from NHS UK: (https://www.nhs.uk/nhs-services/sexual-health-services/guide-to-sexual-health-services/)
Where does syphilis come from?
Syphilis tends to affect various organs and presents a wide range of symptoms thus earning the distinction of being called “the great mimicker”[1]. Recent evidence indicates that this venereal disease was contracted during Christopher Columbus’ voyage to North and South America, subsequently spreading the pathogen to the European region [2].
What is syphilis?
To understand secondary syphilis, one must first understand syphilis as a disease by itself. Syphilis is a bacterial infection that is caused by spirochete Treponema pallidum [3].
It is a type of sexually transmitted infection (STI) which is passed on through:
Syphilis has been one of the main public health concerns worldwide, affecting millions of people throughout the world. The level of concern is justified as this disease can result in significant morbidity and affect various organs of the body including the nervous system, cardiovascular system, and even the eyes.
In some developing countries, syphilis is common in those with lower socioeconomic status and those with limited access to healthcare services [4]. Syphilis is also more common in people with multiple partners[4].
The short answer is, yes. Initially, the spread of syphilis was identified particularly among men who have sex with men (MSM) [5], regardless of socioeconomic background. However, recently, concern was heightened when reports of syphilis resurgence were noted among heterosexual men and women in the USA [6], Australia [7], and Japan [8]. Even more concerning was the sudden rise of syphilis among women of childbearing age increasing the risk of transmission of syphilis from mother to child.
Syphilis occurs in three stages; 1,2 and 3 [10]. Before diving into secondary syphilis, let’s first review the symptoms of primary syphilis. The typical characteristic of primary syphilis is individual painless nodules and lesions known as a chancre which typically manifests over the genital region, fingers, nipple, mouth, or back of the throat (tonsils).
When the lesions are left untreated, the syphilitic infection remains in the body resulting in eventual dissemination throughout the bloodstream. The dissemination subsequently leads to the graduation of secondary syphilis.
In secondary syphilis, the clinical manifestations tend to be more florid and dramatic. Secondary syphilis symptoms affect multiple organs and have various presentations, thus earning the infamous title of being the ‘great imitator’. If both primary and secondary syphilis is left alone without treatment, the patient can progress into a latent phase of syphilis infection; the tertiary syphilitic stage which progresses over 10-30 years.
The third stage of syphilis can be devastating and debilitating. It even increases the risk of morbidity. Often, third-stage syphilis is accompanied by cardiovascular and nervous system involvement.
Prompt treatment and symptom resolution are achievable in secondary syphilis, hence avoid further delay and do seek medical attention if you have any symptoms to suggest syphilis infection.
What are the signs and symptoms of secondary syphilis?
The signs and symptoms of secondary syphilis are evident and blatant. Typically, there are signs manifesting on the skin with occasional involvement of other organs.
Signs include:
If you are not sure about the presentation of your symptoms, it is always better to be safe than sorry. Consult your doctor on your concerns, and evaluate further with the appropriate tests to screen for syphilis.
Syphilis is passed on from one person to another via direct contact with a syphilitic sore. This happens frequently during sexual activity. Secondary syphilis specifically occurs when a person, during the initial infective stage (primary syphilis), missed the treatment window period, allowing the bacteria to progress to the second stage with haematogenous spread.
You should consider screening for syphilis if you are:
Given that there is an array of signs and symptoms for syphilis, there are sequential steps to diagnosing and obtaining treatment for syphilis.
Your doctor will first collect your medical history and lifestyle information on top of conducting a primary physical examination.
The information collected will include:
If suspected of syphilis, your doctor will order specific blood tests as screening measures. You would also be ordered to conduct these tests if suspected of risk of transmitting syphilis to others without any overt signs and symptoms of syphilis.
Blood tests will be repeated within a certain time frame to monitor syphilis activity in blood during and after treatment of the condition.
There are a few types of syphilis tests in the current market, mainly looking at antibodies against syphilis- which is a protein that the immune system produces upon contract of syphilis.
These tests include:
During your consultation, your doctor will guide you on further tests for evaluation of your symptoms or concerns of syphilis.
The treatment for syphilis (including secondary syphilis) includes a benzathine penicillin injection. In patients with penicillin allergies, you can discuss with your doctor regarding other alternative medications such as doxycycline, tetracycline, or even ceftriaxone for treatment.
Your doctor will work closely with you during the treatment of syphilis. You will be counselled on the medication indications, side effects, and followed-up closely with subsequent blood tests to ensure there is an appropriate serological response following treatment.
Yes, syphilis is a curable and treatable condition. Prompt treatment and early detection will provide you with the best chance of recovery.
Unfortunately, the answer is yes. If you have a new exposure risk to syphilis, even with successful treatment of syphilis, you are not immune towards the disease. Occasionally, a person after treatment of syphilis may have a recurrence of infection due to reinfection or treatment failure. If you have a higher risk of exposure, you are advised to consider regular screening for syphilis or other STIs. You can discuss with your doctor about the risk of exposure and appropriate measures for monitoring.
It is imperative to follow-up with your doctor after the completion of the treatment of syphilis. Your doctor will follow-up with you periodically to monitor for signs and symptoms of recurrence and offer you regular serological/laboratory blood tests to monitor the syphilis titre value for any possibilities of recurrence of infection. Preventative measures such as condom use and maintaining monogamous relationships will aid in avoiding recurrence.
You are advised to abstain for at least 7-10 days and until the sores/symptoms have resolved after treatment of syphilis. Discuss with your doctor about individual presentation and response to medication as different patients may have different responses against treatment. Some may need a longer time of abstinence until symptoms/conditions resolve.
A person with untreated syphilis has an increased chance of acquiring HIV infection. Active syphilis with genital open sores presentation predisposes a person to transmission and acquisition of HIV infection. The presence of syphilis or other forms of STIs is suggestive of a person’s lifestyle and exposure risk, placing a person with a higher possibility of contracting HIV.
HIV is caused by a virus known as a retrovirus. The combination of medications used to treat HIV is known as antiretroviral therapy (ART).
Although there remains no cure for HIV infection, ART enables people with HIV to live a normal, healthy and quality life. ART controls and reduces the amount of virus in a person’s body fluids and blood, hence, slows down the progression into AIDS and death.
ART is recommended to everyone with HIV, regardless of at what stage, and how healthy the person is. ART also reduces an infected person’s risk of spreading HIV to others.
ART usually comes in a combination of 3 or more drugs. With medical advancement, there are available options of 1 pill to combine multiple drugs together.
You should begin antiretroviral therapy (ART) as soon as possible after the diagnosis of HIV infection. Any delay of treatment will allow HIV virus to continue to destroy your immune system, putting yourself at higher risk of developing AIDS.
Your doctor will take into account your other concurrent medical conditions and any other medicines that you may be taking as there may be interactions with ART.
You will need more regular follow up with your doctor at the initial stage of starting of ART treatment. You will be offered regular blood tests to monitor whether you are responding well to the ART treatment.
Two important blood tests are:
Most people who take HIV ART treatment daily are able to reach undetectable HIV viral load within 6 months of starting treatment. Following ART treatment, the CD4 lymphocyte cells count usually rise slowly. These 2 blood tests will determine whether HIV infection is well controlled.
Often, your doctor may recommend you to change your HIV medicine if notice your medication is not working as well as they should. You should let your doctor know if you or your partner is pregnant or planning for pregnancy.
Some common side effects that you may experience:
YES. When your HIV viral load has diminished and reached an undetectable level when you are on ART, it means your treatment is working, and you should continue your medication. If you stop your ART, the HIV virus will no longer be suppressed and it will multiply rapidly. It is important to keep your viral load at an undetectable level so that you can remain healthy, and this slows down the progression to AIDS. Also, an undetectable viral load places you at low risk of transmitting HIV to other people.
It is important to reiterate the imperativeness of taking your HIV medicine regularly. This is the only way to keep your HIV viral load low and CD4 lymphocytes cell count high. A poor compliant of medicine will allow HIV virus to multiply fast, damage your immune system, and place you at higher risk for AIDS.
AIDS (Acquired Immune Deficiency Syndrome) is used to describe a condition when a HIV person has a severely damaged immune system, leading to potentially life-threatening illness and infections.
Currently, unfortunately, there is no cure for HIV, but there are effective medications to help most people with HIV to control the virus and live a long and quality healthy life.
Early diagnosis and good control of HIV are important to prevent develop AIDS.
Approximately 2-6 weeks after HIV infection, some people may experience transient, flu-like symptoms.
80% of people who are infected with HIV may experience flu-like symptoms such as:
If you have several of these symptoms and you are at risk of HIV infection for the past few weeks, you should get yourself tested for HIV.
The symptoms will eventually disappear, and one may experience no symptoms for years. The HIV virus may silently damage your immune system until much later stage. When the immune system has become severely weakened, you may develop symptoms such as:
Most cases of HIV are spread by having sex with another person with HIV without the use of a condom. A HIV infected person without symptoms can still transfer the disease to another person. A HIV infected person who is on HIV treatment can significantly reduce the risk of transmission of disease to others.
Sexual contact
As mentioned, most people acquire the HIV virus through unprotected vaginal or anal sex.
Although you can get HIV through unprotected oral sex, the risk is lower.
It is riskier if:
Other modes of transmission of HIV include:
Some categories of people are particularly high risk of acquiring HIV, this include:
HIV virus thrives in blood and some body fluids. To acquire HIV, one of these infected fluid need to get into your bloodstream.
Body fluids that may contain HIV to infect others include:
Interestingly, body fluids such as saliva, sweat, urine do not contain sufficient virus to infect other people. Hence HIV cannot be transmitted through:
Once inside the bloodstream, the HIV virus can attach itself to an immune system cell known as CD4 lymphocyte cell. (CD4 lymphocytes protects the body from bacteria, germs and viruses). Once attached to the CD4 lymphocytes, the virus enters the cells, replicate and make thousands of copies of itself. In the midst of this, the viral copies will kill the CD4 lymphocytes. This process continues until eventually, the CD4 lymphocytes cells die, and the number of the cells (CD4 counts) will diminish to a dangerous level where the immune system stops working.
This can take up to 10 years, where an infected person can feel perfectly well.
Having other STIs are a risk factor of getting and transmitting HIV.
If you are HIV negative but have another STI, you are 3 times likely to acquire HIV if you have unprotected sex with someone with HIV. If the STI causes skin irritation, skin breaks or sores, this will allow HIV virus easier to enter the body during sexual contact. In STIs that does not cause breaks or open wounds in a person, you still have a higher risk of acquiring HIV as STIs can cause body inflammation leading to increase the number of immune cells to be used as target cells for HIV.
If you are HIV positive and have another STI, you are about 3 times likely to transmit HIV through sexual contact. This is because you have increased concentration of HIV in the semen and genital fluid in comparison to an HIV person without STI.
Case reports of female-to-female transmission of HIV are sparse. Having said that, vaginal fluid and menstrual blood can contain HIV and exposure to these fluids with vagina or mouth can still possibly spread HIV.
Despite the association of HIV with fear, stigma, discrimination, and other repercussions, it is a condition that many are able to live a normal and quality life with the proper taking of HIV medication.
Aside from taking your HIV medication regularly, you should lead a healthy general lifestyle such as:
You should ensure your flu vaccination up to date yearly, and you are recommended pneumococcal vaccination.
Being diagnosed with HIV can be a life-changing event. It can cause tremendous emotional distress. One may commonly feel anger, hopeless, depress and anxious. You are not alone. Seek help, speak to your doctor. Your doctor will address your concerns and expectations. You may be linked up with trained counsellor or psychologist to give you further emotional support.
Some people find it helpful to speak to others who have HIV via support groups or internet chatroom.
It is common to feel angry, upset, or even embarrassed about disclosing HIV health status to your current or former partners. Having said that, it is important to inform your current sexual partner or any sexual partners regarding your HIV status, so that they will get tested and treated. Untreated HIV can lead to serious illness (AIDS) and death.
If you have any concerns, you may speak to your doctor for further advice. Your doctor will advise you to disclose your status to your future partners and how you can reduce the risk of transmitting the virus to others.
No, there is no legal obligation to inform your employer of your HIV status, unless you are at a frontline job that performs invasive procedures.
If you are pregnant:
If you are planning a pregnancy:
If your immune system is damaged by HIV virus, you are at risk of developing certain infections that a person with an intact immune system will not. The name opportunistic infections are termed to infections that occur when your immune system is very weakened.
The four main types of opportunistic infections are:
People with HIV are also at risk of certain cancer such as cancer of the lymphatic system (Lymphoma), Kaposi’s sarcoma.
Regular follow up with your doctor and compliant to your HIV medicine is important to maintain your immune system and prevent opportunistic infections.
Take care, stay well.
This article mainly highlights both Scabies and Pubic Lice as other types of STIs. Further discussion on both individual parasites may be shared in more detail in other articles.
Scabies infection is caused by parasite Sarcoptes scabiei. In adult, Scabies is often transmitted through sexual contact. This is not the case in children with scabies.
When a person is infected with Sarcoptes scabiei parasite, it takes a few weeks for the body to be sensitized towards it, then only one will experience the classical symptoms of intense itch. Interestingly, in subsequent re-infestation of Scabies, one can develop itch symptoms within 24hours. This is because the body has already been sensitized by the Scabies parasite.
People with poor immune systems, elderly or the young can acquire scabies rash affecting the head. This is termed Crusted Scabies also known as Norwegian Scabies.
Speak to your doctor if you have a poor immune system or other medical conditions such as HIV that may place you at risk of developing widespread Scabies, known as Crusted Scabies.
Apart from the discussed discomfort symptoms from Scabies, Scabies can cause outbreaks in Institutional settings such as residential places, nursing homes, hospitals. It is important to prevent and contain the infectious Scabies infection before it turns into an epidemic by treating the affected population.
Pubic Lice also medically termed pediculosis pubis or also colloquially known as ‘crabs’ are tiny parasites that thrive on pubic hair.
The lice can also be found in other areas such as
Pubic lice can be spread by sexual contact by close body contact with an infected person. It is unrelated to poor personal hygiene. Pubic lice crawl from hair to hair, but they are not able to fly or jump. They feed on human blood for survival.