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Experiencing discomfort after sex? Is it truly an infection or an allergy from the condom used?

In this article, we delve into the medical part of condom allergy, the possible predisposition to other forms of allergies and alternative options to mitigate your concerns.

condom allergy singapore
Latex condom allergy may result in discomfort after sex.

What is a latex condom allergy?

In latex allergy, a person’s immune system recognises the protein in latex and mistakes them as harmful foreign bodies, releasing exaggerated antibodies to fight the protein. In the cascade of inflammatory response, one manifests clinically with allergic symptoms. 

As most parts of condoms are made up of latex, this can affect a person’s sexual well-being.

Why do I have a latex allergy?

In allergy, a person can develop three mechanisms of response to rubber/latex.

  1. IgE-mediated allergic response (type 1 allergic reaction): upon exposure to latex protein via contact, the immune system generates an antibody known as immunoglobulin E (IgE) that causes a cascade of inflammatory response. Clinically, one presents with acute allergic symptoms.
  2. Contact Dermatitis (Type 4 allergic reaction/cell-mediated delayed allergic reaction): as the name suggests, upon exposure to the latex protein 24 to 48 hours, the body is sensitised by the latex protein leading to an allergic reaction.
  3. Irritant Contact Dermatitis: this can be seen due to repeated close contact with the latex protein, which leads to skin irritation.

Based on the allergic mechanisms discussed above, it becomes evident that condom latex allergy may develop gradually with prolonged use, as the body becomes increasingly sensitised to the latex protein upon repeated exposure.

rashes hives
Contact dermatitis is a symptom of allergy.

What are the symptoms of latex condom allergy?

In comparison between men and women, women tend to experience more severe symptoms of latex condom allergy given the thinner mucous membrane of the vaginal tract with a larger surface area of contact and absorption of the allergens from the condom.

Thankfully, most patients with condom latex allergy present with mild allergic symptoms over the contact surface (genital region) of the condom.

Common symptoms of latex allergy include:

In some cases, symptoms may involve systemic symptoms such as wheezing, watery eyes, runny nose, facial swelling or flushing, and rashes over the body.

Rarely can one develop anaphylactic symptoms within seconds to minutes upon exposure to latex.

However, it is still important to be aware of severe allergic symptoms.

Severe symptoms of latex allergy include: 

In such a dire situation, please go to the emergency department immediately as anaphylaxis can be life-threatening, and it is a completely reversible condition if prompt treatment is given.

difficulty breathing
Go to the hospital immediately if you are experiencing shortness of breath.

What is a latex-fruit allergy? 

Interestingly, about 30-50% of people with latex allergies are predisposed to have allergies to certain fruits. This is in view of the cross-reactivity of the allergen from latex and fruits. The body, being sensitised to the protein in the latex, mistakenly recognises the protein in certain fruits, causing a similar allergic reactions in the case of latex allergy. This is known as latex fruit allergy.

One may be more allergic to fruits such as avocado, banana, kiwi, peach, tomato, potato, passion fruit, and bell pepper. 

If you are concerned about latex or fruit allergies, you can reach out to your doctor, who you are comfortable with, for further evaluation. In certain cases, you may be offered an allergy blood test (RAST test) to confirm your latex and fruit allergy.

Is it possible that I am allergic to other chemicals in the condom rather than latex?

Yes, it is possible. One can be allergic to chemicals in the condom such as spermicide (nonoxynol-9), lubricants that have paraben, propylene glycol, glycerin etc. Symptoms associated with sensitivity to other chemicals in condoms are similar to latex condom allergy, such as redness, itch, burning, and swelling over the genital region. 

Often, the symptoms can be challenging to differentiate from a latex allergy or even other differentials such as sexually transmitted diseases (STDs). It is worth speaking to your healthcare providers about your possible concern about allergy to the components of condoms and allow your physician to evaluate further.

latex allergy singapore
Talk to your doctor about your latex allergy.

If I have an allergy to latex condoms, what are my other options for barrier contraception?

You can consider latex-free condom alternatives such as:

When should I consider seeing a doctor if I am concerned about latex condom allergy?

If you are feeling uncomfortable down below following intercourse, with symptoms such as itching, discharge, pain, redness, swelling, rash, or fever that doesn’t resolve, you should reach out to your doctor for further checkup.

What can my doctor offer me?

Your doctor will obtain your relevant medical and sexual history and then offer a relevant physical medical checkup. In the event of a concern of condom latex allergy, your doctor may offer you an allergy test, such as a RAST blood test, to detect any latex antibodies present in your body. Depending on individual risk of exposure, if there is concern of a concurrent infection, your doctor may discuss with you further STD screening tests.

How is latex condom allergy treated?

In the case of latex condom allergy, avoidance of culprit allergen is key. Your doctor may counsel you on various alternative options of latex-free condoms or other effective modes of contraception.

Antihistamines and topical steroids may be offered for localised latex condom allergic symptoms. In life-threatening allergy reactions, urgent medical attention with an adrenaline injection may be required to reverse the allergy.

Take home message for today:

References

  1. Mahdy H, Shaeffer AD, McNabb DM. Condoms. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470385/
  2. S Wagner et al. The latex-fruit syndrome. Biochem Soc Trans.  2002 Nov;30(Pt 6):935-40.
  3. Turjanmaa K. Turjanmaa K. Rubber gloves and condom cause immediate hypersensitivity. Duodecim.1989;105(23-24):1905-8. 
  4. Rosenberg MJ, Waugh MS, Solomon HM, Lyszkowski AD. Rosenberg MJ, et al. The male polyurethane condom: a review of current knowledge. Contraception. 1996 Mar;53(3):141-6
  5. D A Levy et al. Allergy to latex condoms. Allergy.  1998 Nov;53(11):1107-8.
  6. C P Hamann et al. Cutis. Update: immediate and delayed hypersensitivity to natural rubber latex. Cutis. 1993 Nov;52(5):307-11

Herpes Simplex Virus (HSV) infection can affect newborn babies. The infection is associated with high mortality and morbidity in babies. HSV infection can also affect the infant's nervous system and eyes. 

In this article, we explore the effect of HSV infection on pregnancy and breastfeeding and discuss ways to reduce transmission to offspring.

HSV infection babies
HSV is associated with high morbidity and mortality in infants.

What is the Herpes Simplex Virus?

Herpes Simplex Virus (HSV) is a viral infection that causes cold sores (small blisters) on the skin, mouth, and genital region. It is common and can be passed on via direct skin contact from one infected person to another.

There are two types of HSV virus:

Caveat: With time, human evolution and changes in sexual orientation and habits, where one may engage in various forms of intercourse (oral, vaginal, anal intercourse), the types of HSV no longer determine the location of the cold sores.

What are the symptoms of Herpes Simplex Virus?

One can be asymptomatic even when carrying the HSV virus. However, one is symptomatic with HSV when one presents with symptoms of tiny blisters and erosions (cold sores) over the skin surface. These can commonly occur over the lip, mouth, genital mucosal region, or skin surface (hands/face).

Cold sores usually last 7-14 days and then slowly resolve. However, the virus remains dormant in a person’s nervous system. Symptoms may resurface when one has a poor immune system, which is known as reactivation of the disease.

HSV infection lips
HSV infection usually presents as cold sores or blisters on the lips.

Will Herpes Simplex Virus affect my pregnancy?

As mentioned, there is no cure for HSV infection. If a person has an HSV infection before, one may have further episodes during pregnancy due to changes in body physiology and immune system. 

We know that HSV can be infectious when it is active. If you acquired HSV infection for the first time during the early part of your pregnancy, you have a higher risk of miscarriage. As HSV is spread through skin contact, if you have a herpes outbreak over the genital region during your last few weeks of pregnancy, you have a risk of transferring the infection to your baby during vaginal delivery. Your obstetrician may offer you a caesarean section surgery rather than vaginal delivery if you have an HSV infection during the last six weeks of your pregnancy to reduce the risks of disease transmission to your infant.

Thankfully, with proficient medical care and effective medical treatment, most women with HSV can conceive uneventfully.

Can Herpes Simplex Virus infection occur on the nipple or breast?

Yes, it is possible, though nipple herpes infection constitutes only 2% of herpes infection cases that occur beyond the genital region. As it is rare, picking up such cases is tricky and often results in misdiagnosis and delay in treatment.

HSV over the nipple can be due to a new transmission vs reactivation of an old local infection over the region. HSV can be newly acquired from the baby to the mother (whereby the baby who is still sucking milk presented with oral herpes), or it can be acquired through oral sexual contact with a partner with mouth herpes. The other less common route of inoculation of disease is through a person’s infected hand (with herpes) to the nipple. 

baby herpes
Herpes nipple infection can occur when a baby with oral herpes suckles during breastfeeding.

Factors that may impede appropriate treatment for nipple HSV infection include:

Reaching the diagnosis promptly is imperative to manage the symptoms and shorten the duration of the symptoms. Proper treatment of HSV nipple infection shortens the disruption of the breastfeeding process and prevents the spread of the disease to the infant.

Is it safe for a woman to breastfeed if she has symptoms of herpes?

If the cold sore rashes are not over the breast or nipple, it is safe to breastfeed your child. 

If the cold sore occurs over the breast or nipple, you should avoid breastfeeding from the affected breast. The breast milk produced from the affected (cold sore) breast should be discarded, as it can be contaminated when it comes into contact with the skin lesions.

The cold sore region should be covered to prevent the lesions from touching each other. Strict hand hygiene practices are recommended to prevent the spread of the herpes virus from mother to baby.

If the mother has a herpes rash over the breasts, is it safe for the mother to offer breast milk through manually expressed milk or pumped breast milk?

No, this is because breast milk can be contaminated with herpes lesions during manual expression or pumping. Breast milk from the affected breast side should be avoided and discarded until the herpetic lesions are completely healed. 

It is worth noting that the mother is still encouraged to continue expressing the breast milk (of the affected breast) to ensure continuous breast milk production (do not feed the baby). Proper hand hygiene is very important, and the breast pumps should be cleaned properly. 

The breast milk from the unaffected breast is safe to be fed to the baby.

breast milk infected
Milk from the affected breast must be discarded to avoid transmitting the disease to the baby.

When should I see a doctor about herpes?

If you suspect you are experiencing an HSV infection and you are pregnant or breastfeeding, you should reach out to your doctor to discuss treatment options. Your doctor will also give you practical advice on how to manage your symptoms and avoid spreading disease during your pregnancy or breastfeeding period.

How can I protect my baby against Herpes Simplex Virus infection?

Is antiviral medication safe for breastfeeding?

Use antiviral medications such as acyclovir with caution, as a small amount can pass through into breast milk. For safety reasons, babies should be monitored for side effects such as vomiting, loose stools, skin rashes, irritability, and drowsiness. Valacyclovir can be considered, as it is converted into acyclovir before passing into breast milk.

Generally, topical use of antivirals is safer as they are less absorbed systemically; hence, there will be minimal concentration in breast milk.

You are encouraged to discuss with your physician the treatment options and advice on breastfeeding during a herpes infection.

What can I take home from this article?

References

  1. WAB Hammad et al. Herpes simplex virus infection in pregnancy – An update. Eur J Obstet Gynecol Reprod Biol. 2021, April: 259:38-45.
  2. James SH, Sheffield JS, Kimberlin DW. Mother-to-Child Transmission of Herpes Simplex Virus. J Pediatric Infect Dis Soc. 2014 Sep;3 Suppl 1:S19-23.
  3. Lawrence RA, Lawrence R. (2016) Breastfeeding: A guide for the medical profession, 8th.
  4. Brown Z. Brown Z. Herpes. Preventing herpes simplex virus transmission to the neonate. 2004 Aug;11 Suppl 3:175A-186A. 
  5. C Pietrasanta et al. Herpesviruses and breast milk. Pediatr Med Chir. 2014 Jun 30;36(3):5.
  6. El Hayderi L, Caucanas M, F. Nikkels A. Herpes Simplex Virus Infections of the Nipple. The Open Dermatology Journal. 2012: 6, 29-32.
  7. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/herpes.html#:~:text=In%20cases%20where%20a%20mother,until%20the%20lesions%20have%20healed

The flu is a common medical condition that invariably affects all of us at some point in our lives. Although one can develop rare complications from flu viruses, most recover uneventfully. Despite the spontaneous recovery over time, most of us experience downtime of feeling under the weather during the acute phase of the illness. Commonly, one experiences symptoms such as fever, lethargy, body aches, headache, sore throat, cough, or even swollen lymph nodes.

flu
We have all been affected by the flu at some point in our lives.

It is imperative to note that although STDs can present with flu-like illnesses and symptoms, they are usually not related to the common flu.  

In this article, we widen our differentials of such common symptoms. Are flu-like symptoms just the simple flu, or is it a warning sign of something more sinister brewing in the body system – such as a sexually transmitted disease (STD)? Read on to understand the similarities of flu symptoms in relation to STDs and ways to differentiate the two.

What flu-like symptoms may a person experience if they have STDs?

The flu-like symptoms that are associated with underlying STDs tend to be non-specific, such as fever, poor energy level, sore throat, nausea, vomiting, diarrhoea, headache, and the presence of lymph nodes. As these symptoms are commonly associated with various conditions, including flu or other viral illnesses, it can be tricky for both the patient and physician to unmask the underlying STDs.

What are the common STDs that can present with flu-like symptoms?

STDs that can present with flu-like symptoms include HIV, syphilis, herpes simplex virus, hepatitis A, B, and C infections

What should I do if I am worried about possible STD infections when I am experiencing flu symptoms?

You should inform your healthcare provider of your concern about exposure to STD infection. Your doctor may explore your sexual history to assess the risk and follow up with a medical checkup in the form of a physical examination, blood tests, urine and swab tests.

Caption: Make an appointment to speak to your doctor if you are concerned about an STD infection.

Alt text: patient-doctor confidentiality

When should I see a doctor if I am concerned about STD infections?

If you think you may have been exposed to STDs, regardless of whether there is the presence of flu symptoms, you are encouraged to reach out to your doctor. Your physician can assess your risk of exposure and discuss with you appropriate STD screening tests if required.

Role of STD screening in a person with flu symptoms

As flu symptoms can be nonspecific and most viral illnesses are diagnosed clinically unless there are overt STD symptoms, such as abnormal genital symptoms in the form of abnormal urinary symptoms, vaginal discharge (in females), and rashes over the genitals, there is no way to safely and accurately rule out STD.

Furthermore, STDs can infect a person insidiously – meaning one can be asymptomatic. The longer a person has an undiagnosed and untreated STD, the higher the risk a person may develop health complications from STD, and the person may also infect their surrounding loved ones as well.

STD screening allows a person to undergo laboratory testing to confirm or safely rule out STDs. Most STD tests are made up of rapid prick tests, blood tests, swab tests, and urine tests that are generally non-invasive, and there is minimal discomfort or pain during screening tests. There are effective medications to manage most STDs; hence, if you are concerned about being infected with STDs, do reach out to your doctor without further hesitation.

STD test singapore
STD testing can be conducted to rule out the presence of any sexually transmitted diseases.

If my flu symptoms recover, does that mean my underlying STD has resolved?

Unfortunately, STDs do not resolve or cure on their own. STDs require the right medication and the right dose of medication to treat the condition. Hence, even if the flu symptoms resolve over time if a person has an underlying undiagnosed STDs, the STDs remain in the body system and health complications from STDs may develop over time. Only by screening and early detection is one able to receive the appropriate STD treatment without further delay.

Which STD shows flu symptoms immediately?

Flu-like symptoms can occur as early as 1-2 days after intercourse in certain STDs, such as herpes viral infection. One may also experience subtle, seemingly benign flu symptoms during the HIV infective (seroconversion phase) within 1-2 weeks after exposure to STD. Please do not disregard your flu symptoms if you have concerns about STD exposure, and reach out to your healthcare provider for evaluation of the risk of exposure.

Shady symptoms of flu may be a warning sign of STD…

References

  1. Dosekun O, Kober C, Richardson D, Parkhouse A, Fisher M. It's not all swine flu...are we missing opportunities to diagnose primary HIV infection in patients with flu symptoms? Int J STD AIDS. 2010 Feb;21(2):145-6.
  2. Hierholzer JC, Stewart JA, Himmelwright JP, Everett RM. Herpes type 2 infection with unusual generalised manifestations and delayed diagnosis in an adult male. J Infect. 1983 Mar;6(2):187-92.
  3. Mohseni M, Sung S, Takov V. Chlamydia. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537286/
  4. Springer C, Salen P. Gonorrhea. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558903/
  5. Tumwesigye E. Telling signs and symptoms. Afr Women Health. 1994 Jul-Sep;2(3):31-7. PMID: 12318960.
  6. Freeman AM, Matto P. Adenopathy. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513250/
  7. Mehta P, Reddivari AKR. Hepatitis. [Updated 2022 Oct 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554549/

‘Dr, my pap smear is normal; that also means I am safe from STDs, am I right?’ This is a common question during consultation. 

Often, many patients think that pap smears and STD tests are similar as both involve ‘swabs’ from the genital region. This article aids readers in understanding what a pap smear test entails and the differences between a pap smear test and STD testing. The article also serves to facilitate readers to make informed decisions on which test is/are suitable based on individual history and risk of exposure.

pap smear test
Pap smears are not the same as STD testing.

What is a pap smear test?

A pap smear is a medical test procedure to screen for cervical cancer. A pap smear is performed at the bedside. Your physician will use a sterile speculum device to examine the vagina and then use a special brush to obtain cells from your cervix (neck of your womb, at the end of the vaginal tunnel).

A pap smear is offered to all sexually active ladies. Aside from detecting cervical cancer cells on pap smears, the test is also able to pick up early changes or abnormalities in cervical cells that may eventually lead to cervical cancer. Hence, a pap smear is the first step in preventing further development of cervical cancer and should be considered routinely even if a woman is completely well and asymptomatic.

What is an HPV test?

Human papillomavirus (HPV) is a common virus that affects approximately 80% of those who are sexually active at some point in their life. It can affect anyone regardless of their socioeconomic status. HPV can stay indolent for years before causing abnormal cervical changes and cervical cancer.

As more than 99% of cervical cancers are due to human papillomavirus (HPV) infection, women aged 30 and above are encouraged to go for HPV tests in conjunction with a pap smear. In some cases, your doctor may offer an HPV test rather than a pap smear. 

HPV test smear
An HPV test is conducted in the same way as a pap smear.

HPV test is a cervical swab test performed by your medical physician to screen for high-risk HPV strains that may infect the cervix. HPV test serves as a risk stratification against the development of cervical cancer. In patients found to have high-risk HPV strains, your doctor may advise you to consider HPV vaccination (if you are eligible and you have not done so), to follow up your pap smear and HPV test at closer intervals, to consider colposcopy, or even treatment option for the affected cervical region if needed. 

If you are unsure whether you require HPV testing or you have further questions regarding HPV, you can reach out to your doctor for further enquiry.

Can pap smear detect STDs?

Pap smear is a test modality used to screen for cervical cancer. The cervical cells and tissues will be swabbed with a sterile brush and stained on a smear slide. This will be reviewed under a microscope by the pathologist in the laboratory to look for any abnormal cervical tissue cells, including cancer cells. Commonly, a pap smear can pick up abnormal cell changes secondary to HPV infection. However, a pap smear does not specifically reveal which HPV strain (over 150 strains of HPV viruses) causes the abnormalities of the cells. This can be further evaluated with HPV testing.

As a pap smear involves microscopic visualisation of the tissue cells of the cervix, the presence of fungus such as Candida (commonly causing vaginal infection) can be seen.

Less commonly, infected tissue cells of the cervix due to herpes (HSV- herpes simplex virus) viral infection can be seen. Though this is usually inconclusive, your doctor may advise further HSV testing with blood and PCR swab tests.

HPV test swab
HPV testing involves microscopic visualisation of the cervix cells to identify any presence of HPV.

Does a pap smear test for STD infections?

Unfortunately, a pap smear has its limitations and is unable to rule out STDs such as chlamydia, gonorrhoea, HIV, and syphilis. Although these infections can be associated with cervicitis (inflammation of the cervix), the pap smear may only reveal non-specific inflammation of the cells. One will require specific STD tests to confirm these infections. Considering specific STD tests are crucial as treatment options for different types of STD are different – you will need the correct medication and the correct dose to eradicate STD. 

Using a pap smear alone to screen for STDs is insufficient. Conversely, just doing an STD test is unable to safely rule out cervical cancer either. You are encouraged to discuss with your doctor your symptoms (if any), concerns, risk of exposure and obtain professional advice on which test(s) are suitable for you.

What does it mean if I have an abnormal pap smear? Do I need to routinely do an STD test if I have an abnormal pap smear?

It is useful to note that (not all) abnormal pap smears are associated with HPV infection. HPV can be transmitted between partners during sexual intercourse. In such cases, in a person with an abnormal pap smear, your doctor may explore with you further your sexual history and risk of exposure to other STDs such as HIV, syphilis, chlamydia, gonorrhoea, herpes, etc. In the event of the presence of risk of exposure, your doctor may offer you further STD tests. 

STD testing and pap smears are screening for different medical conditions, as discussed above. Merely doing pap smear is unable to rule out STDs; similarly, if just doing STD tests, one is not able to know whether they are safe from cervical cancer.

std testing
STD tests and pap smears screen for different diseases.

How can females check for STDs?

STD tests for women usually involve vaginal swab tests, urine tests, blood tests/finger prick tests. In those who may be exposed to infection over the oral region, or the anal region, you may be offered further swab tests over the affected areas. The tests are usually done at the outpatient clinics with minimal discomfort and pain. You are encouraged to discuss with your doctor your sexual history and any abnormal symptoms that you are experiencing. Your doctor can advise you on which STD tests to consider. 

What are the differences between pap smear and STD swab tests?

A pap smear is a medical test offered for all women as part of cervical cancer screening to detect abnormal changes in the cervical cells. As cervical cell changes commonly are associated with HPV infection, the pap smear results may be suggestive of HPV infection. However, it will not tell specifically which type of HPV infection it is. This will require further testing with an HPV test. Pap smear does not automatically test for HPV strains. Pap smear is the swab of the cervix, which is the neck of the womb (end of the vaginal tunnel).

STD tests allow one to detect any sexually transmitted infections such as chlamydia, gonorrhoea, trichomonas, mycoplasma, ureaplasma, etc. You should discuss your exposure risk with your doctor so that your doctor will know which tests to consider screening for. 

Is it sufficient for me to do self-testing for STDs?

There are various STD self-testing kits available in the market. However, one should be wary when considering self-testing kits, as the test needs to be done correctly. This is especially important to female self-swab tests- one may need to be more familiar with the human anatomy, resulting in inappropriate or insufficient sampling. Furthermore, different STD infections may have different incubation periods/window periods before the test kits can pick the infection up. This can lead to a false negative result.

You are encouraged to see your healthcare provider that you are comfortable with for further guidance on STD tests, especially if there is involvement of swab tests or blood tests.

If my pap smear is normal, does it mean my HIV is normal? What is the link between HIV and pap smear?

No, unfortunately, even if your pap smear test is normal, that does not rule out HIV infection. Pap smear is a cervical swab test that evaluates for abnormal cervical cell changes; it does not test specifically for STD infections, including HIV. Pap smear does not detect HIV.

A pap smear is performed with a cervical brush inserted through the vagina to your cervix by your medical professional to obtain a sample.

HIV tests, on the other hand, are performed using blood tests, finger prick tests, and even salivary tests.

HIV, also known as the human immunodeficiency virus, is a condition in which, once a person is infected, the virus will progressively destroy that person's immune system, leading to low immunity against infections and disease. A person with HIV condition increases their risk of HPV infection (or any infection). HPV infection is associated with cervical abnormalities and cervical cancer. Hence, HIV infection does increase the risk of abnormal pap smears and cervical cancer. 

What have I learnt today?


References

  1. Okunade KS. Human papillomavirus and cervical cancer. J Obstet Gynaecol. 2020 Jul;40(5):602-608. doi: 10.1080/01443615.2019.1634030. Epub 2019 Sep 10. Erratum in: J Obstet Gynaecol. 2020 May;40(4):590.
  2. Chesson HW et al. Sex Transm Dis. 2014; 41: 660-664.
  3. Sigurdsson K. Cervical cancer, Pap smear and HPV testing: an update of the role of organized Pap smear screening and HPV testing. Acta Obstet Gynecol Scand. 1999 Jul;78(6):467-77.
  4. Madan A, Patil S, Nakate L. A Study of Pap Smear in HIV-Positive Females. J Obstet Gynaecol India. 2016 Dec;66(6):453-459.
  5. Ogbechie OA, Hacker MR, Dodge LE, Patil MM, Ricciotti HA. Confusion regarding cervical cancer screening and chlamydia screening among sexually active young women. Sex Transm Infect. 2012 Feb;88(1):35-7. 
  6. Daley E, Perrin K, Vamos C, et al. Confusion about Pap smears: lack of knowledge among high-risk women. J Womens Health (Larchmt) 2013;22:67–74. 
  7. Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.

Shaving or removing pubic hair is common worldwide, regardless of socioeconomic background. However, it is more common in women than men, more frequently seen in the sexually active group and the younger generation. How safe is this practice?

In this article, we explore the risks of shaving and STDs, the non-STDs related dermatological issues that can be caused by shaving, and ways to prevent issues revolving around shaving practices.

shaving pubic
Shaving or removal of pubic hair is a common practice worldwide.

Can shaving cause STDs?

No, shaving does not cause STDs. As the name suggests, sexually transmitted diseases (STDs) are passable through sexual intercourse. Without the act of sexual intercourse, shaving alone will not cause STDs.

Can shaving increase the susceptibility to STDs?

Yes, shaving can increase a person’s predisposition to acquiring STDs in the presence of sexual contact. The reason behind it is simple: shaving causes microabrasions, i.e. mini-cuts and mini-wounds on the skin surface that one may not even be able to visualise or feel. With a compromised skin barrier, STDs, bacteria, viruses, and fungi can enter and infect a person much more easily compared to someone without a shaving history and with an intact skin integrity. 

STDs such as herpes viral infection, HPV infection/warts, chlamydia, gonorrhoea, and syphilis are more frequently seen in a person with total pubic hair removal. To exacerbate things, there are suggestive associations of vulvar cancer in women who shave their genital hair frequently. It is unclear whether the increased risk of STDs is solely due to shaving or also due to other factors, such as a more sexually active behaviour observed in this group of patients.

STIs STDs
Sexually transmitted diseases are seen more frequently in individuals with total pubic hair removal.

What type of STDs can be exacerbated by shaving?

Shaving can worsen existing STDs such as herpes, HPV infection (warts), and molluscum contagiosum infection. The microabrasion on the skin surface following shaving allows transfer, inoculation, and entry of the viruses onto the skin with a compromised integrity.

Shaving and associated dermatological conditions

Folliculitis (also known as pseudofolliculitis barbae) is a common benign skin inflammatory condition associated with shaving habits. One may notice red razor bumps over the patch of skin that has been recently shaved. The affected area can be slightly red, raw, itchy, and tender. Occasionally, when it is infected, one may notice tiny white dots (papules) appearing like a pimple. 

Due to the hair on the skin surface being closely shaved off, the hair can curl back into the skin, injuring the follicles and causing an inflammatory response, which manifests as a clinical picture of folliculitis.

folliculitis
Folliculitis is characterised by red razor bumps and white spots, signs of an infection.

What are the similarities between shaving folliculitis and STDs? Can I differentiate between the two?

Shaving folliculitisHerpesHPV wartsMolluscum Contagiosum
SymptomsRed tiny, itchy/tender bumpsSome pimple-like Itchy/tender small fluid-filled bumpsShallow small ulcersFeverishPalpable lymph nodesSkin bumpsCan appear as red/skin-colored/whitishCan be itchySkin bumpsRed to skin colour, small bumpsCan be itchy
CharacteristicTends to be in a linear fashion, following the area of shavingTends to be in grouped/cluster
Can appear over the site of shaving
Can be individually seen or in a linear fashion, following the area of shavingCan be individually seen,Or in a linear fashion, following the area of shaving
Duration Resolve over a few days to weeks following shavingCan last up to 10-14 days before resolvingCan last for months to years Can last for months to year

It is imperative to understand that occasionally, folliculitis can present simultaneously with STDs. Even under professional medical review, it can confuse both physicians and patients. 

Hence, if you have concerns about exposure to STDs and you have noticed unusual bumps over your genital region, it is paramount to get yourself tested for STDs to confirm or rule out any infections. If in doubt, contact your healthcare professionals to check your symptoms. 

The danger of self-diagnosing

In the 21st century, we are generally well-informed via various resources such as the internet, discussion forums, friends, family, etc. One can even ‘Google’ pictures of rashes or medical conditions to compare with one’s symptoms. 

As discussed, non-STD dermatological conditions such as folliculitis can co-exist with STDs. By self-diagnosing, one may have a false sense of assurance that everything is okay and delay receiving appropriate treatment. This, in turn, can lead to passing undiagnosed STDs to your loved ones. 

Your health and your loved ones’ health are equally important. It is worth discussing your symptoms and potential risk of STD exposure with your doctor. Depending on your symptoms and risk of exposure, appropriate targeted STD tests and treatment can be offered.

STD testing
Discuss your symptoms and possible exposure with your doctor.

How can I prevent dermatological symptoms from shaving? If I continue to shave, is there any way to prevent or reduce the risk of STDs?

References

  1. Mezin-Sarbu E, Wohlrab J. Epilation and depilation in the genital area – motivation, methods, risks and recommendations from a dermatological point of view. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2023; 21: 455–462.
  2. Butler S. M., Smith N. K., Collazo E., Caltabiano L., Herbenick D. Pubic hair preferences, reasons for removal, and associated genital symptoms: comparisons between men and women. Journal of Sexual Medicine. 2015;12(1):48–58.
  3. Shaving Is Correlated to Vulvar Dysplasia and Inflammation: A Case-Control Study. Infect Dis Obstet Gynecol. 2017;2017:9350307. doi: 10.1155/2017/9350307. Epub 2017 Aug 27.
  4. Kirchhof MG, Au S. Brazilian waxing and human papillomavirus: a case of acquired epidermodysplasia verruciformis. CMAJ. 2015 Feb 3;187(2):126-128.
  5. Saleh D, Yarrarapu SNS, Sharma S. Herpes Simplex Type 1. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482197/

What is seborrhoeic dermatitis?

Seborrhoeic dermatitis is a chronic, recurring, benign skin inflammation that mainly affects the skin area with more oil glands (sebaceous glands). The rash presentation is frequently seen over the face, scalp, body, or the folds of the body – such as the armpit or groin. The rash manifests as dry, desquamated (flaky), greasy red patches seen over the greasy region of the face or body.

While the actual cause of seborrhoeic dermatitis remains unknown, it is an inflammatory skin condition associated with changes in a person’s hormone, neurological system, skin barrier and skin microbial environment. 

seborrheic dermatitis singapore
Seborrhoeic dermatitis typically occurs on the greasy or oily regions of the skin.

To explain in simple terms, the skin's surface is an environment of its own with various microbes, including bacteria such as Staphylococcus spp, and fungi such as yeast (Malassezia spp). Malassezia spp thrives on the lipids and fatty acids present in the sebum produced by sebaceous glands. In seborrhoeic dermatitis, Malassezia spp feeding on sebum on the skin surface causes skin microbial alteration, skin barrier defects, and an inflammatory response. 

Facial seborrhoeic dermatitis occurs when the skin presentation of flakes, scales, and redness occurs over the oily (seborrhoeic) region of the face – in particular over the brows, nasolabial fold (the fold between the nose and the cheek), over the hairline and the ears.

What do you understand about HIV infections?

As most patients have no symptoms or very mild symptoms when having HIV, the only way to know of a person's HIV status is via HIV screening tests

Correlation between Seborrhoeic Dermatitis and an HIV infection

Medical literature reveals the frequency of seborrhoeic dermatitis in HIV-positive patients is higher and ranges between 30-80% of the general population, in comparison to 1-3% of seborrhoeic dermatitis in people without HIV. 

The presentation of seborrhoeic dermatitis in HIV-positive patients tends to be more severe, with more striking redness and extensive scaling with a broader spread affected region of the face or body. Although the condition is typically seen over the face and scalp region, it can also affect other body parts, such as the umbilicus, groin, and armpit region. Both patients and clinicians can commonly misdiagnose the rash as a fungus infection or even other autoimmune skin conditions.

seborrheic dermatitis HIV
Seborrhoeic dermatitis is common in individuals with an HIV infection.

Seborrhoeic dermatitis can occur during any stage of an HIV infection. It can happen during the early course of HIV disease when the CD4+ (a type of immune cell) count is between 400-500 cells/μL. Due to this reason, a sudden occurrence of severe seborrhoeic dermatitis in a person who has no previous history of similar skin rash warrants further screening for HIV in those with possible exposure risks of HIV.

Role of HIV screening in frequent flare up/un-resolving seborrhoeic dermatitis

While no clinical tests are required in most cases of seborrhoeic dermatitis, in severe or recalcitrant seborrhoeic dermatitis with an acute onset, an HIV test should be considered as part of the clinical investigations if there is a possible risk of exposure. 

Antiretroviral medications facilitate the resolution of the symptoms and reduce flare-ups and seborrhoeic dermatitis. 

Early screening, detection, and confirmation of HIV ensures a significantly better long-term prognosis of the condition. 

Do reach out to your trusted physician if you are concerned about possible exposure to HIV infection or have a skin rash that is unresolved.

Why should I get tested for HIV infection?

Getting HIV test results allows you to obtain treatment for HIV (if needed) without further delay. Importantly, knowing a person’s HIV status allows one to make proper conscientious decisions to avoid further spreading of HIV to other loved ones.

Although HIV infection is not reversible, there are antiretroviral medications in the pipeline to effectively control the progression of the disease, allowing a person to live a good quality long life.

HIV testing singapore
Early intervention treatment for HIV-positive individuals can improve quality of life.

What is the treatment of seborrhoeic dermatitis?

The goal of managing seborrhoeic dermatitis is to re-establish the skin microbial equilibrium and maintain a good skin barrier to minimise or prevent skin inflammation.

This can be achieved with a combination treatment of:

For patients with HIV and seborrhoeic dermatitis, the fundamental core treatment remains similar to a person without HIV.

What have I learnt so far?

References

  1. Cortés-Correa C, Piquero-Casals J, Chaparro-Reyes D, Garré Contreras A, Granger C, Peñaranda-Contreras E. Facial Seborrheic Dermatitis in HIV-Seropositive Patients: Evaluation of the Efficacy and Safety of a Non-Steroidal Cream Containing Piroctone Olamine, Biosaccharide Gum-2 and Stearyl Glycyrrhetinate - A Case Series. Clin Cosmet Investig Dermatol. 2022 Mar 18;15:483-488.
  2. Ippolito F, Passi D, Di Carlo A. Is seborrhoeic dermatitis a clinical marker of HIV disease? Minerva Ginecol 2000;25 (Suppl 1):54-8
  3. Paraskevi Chatzikokkinou , Konstantinos Sotiropoulos , Alexandros Katoulis , Roberto Luzzati , Giusto Trevisan. Seborrheic Dermatitis – An Early and Common Skin Manifestation in HIV Patients. Acta Dermatovenerol Croat 2008;16(4):226-230 
  4. Tucker D, Masood S. Seborrheic Dermatitis. [Updated 2023 Feb 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551707/
  5. Berrey MM, Schacker T, Collier AC, Shea T, Brodie SJ, Mayers D, et al. Treatment of primary human immunodeficiency virus type 1 infection with potent antiretroviral therapy reduces frequency of rapid progression to AIDS. J Infect Dis. 2001;183(10):1466–75.
  6. Dunic I, Vesic S, Jevtovic DJ. Oral candidiasis and seborrheic dermatitis in HIV-infected. HIV Medicine. 2004;5:50–4
  7. Hengge UR, Franz B, Goos M. Decline of infectious skin manifestations in the era of highly active antiretroviral therapy. AIDS. 2000;14(8):1069–70.
  8. Forrestel AK, Kovarik CL, Mosam A, Gupta D, Maurer TA, Micheletti RG. Diffuse HIV-associated seborrheic dermatitis—a case series. Int J STD AIDS 2016; 27(14):1342–1345. 
  9. Borda LJ, Wikramanayake TC.  Seborrheic dermatitis and dandruff: a comprehensive review. J Clin Investig Dermatol 2015; 3(2):10.13188/23731044.1000019. 

We often hear of sexually transmitted diseases (STDs) causing symptoms in the genital region, mouth, and throat areas. But do you know STDs can infect the eyes as well?

This article strives to increase awareness of eye diseases that can be related to STDs and encourage one to cast a broader net of medical differentials in the event of unresolved eye symptoms, considering early screening and prompt treatment for any underlying sexual infections.

STD eye infection
Unresolved eye infections may be linked to sexually transmitted diseases.

Why is the eye susceptible to STDs?

STDs tend to affect the areas of the body that are relatively thin. This includes mucosal surfaces such as the genital regions (urethral, vaginal, anal), the oral (lip, mouth, throat) region, and the eyes. As the mucosal areas are very thin and delicate, physical sexual intercourse predisposes one to a disrupted skin barrier, surface abrasion and cuts, which all, in turn, increase the transmissibility of bacteria and viruses – such as STDs.

STDs in the eyes are less common compared to symptoms in the genital region or the throat. Less commonly, in some developing countries, STDs of the eyes can be seen in babies or newborns from untreated infective pregnant mothers. The eyes are indispensable organs. Untreated STDs in the eyes can lead to eye inflammation or, in severe cases, even blindness.

What are the types of STDs that can cause eye symptoms?

STDs that are associated with eye symptoms include HIV, syphilis, chlamydia, gonorrhoea, herpes simplex virus, and hepatitis virus.

STDs and abnormal eye symptoms

Eye diseases secondary to STDs are usually due to direct transfer of the STDs infection through eye contact with the genital fluid (vaginal fluid/semen fluid) or through touching/rubbing of the eyes after touching the infected private areas.

Certain STDs, such as HIV, syphilis, and hepatitis virus, can be acquired through unprotected infected sexual contact, body fluid, needle or syringe sharing or blood transfusion, leading to predisposition of eye symptoms. 

STDs associated with eye symptomsEye structure affected Eye symptoms
Chlamydia, GonorrhoeaConjunctiva (Outer layer of the eyes)Cornea (ulceration)Eye discomfortRed eyesSticky eye dischargeRecurring tearing/watery eyesVision blurrinessEye painPermanent blindness
HIVRetina (can be due to HIV or HIV-related viruses such as cytomegalovirus, zoster virus, etc.)Conjunctiva (Kaposi Sarcoma)Blurry visionsRed eyesFloatersReduced vision acuitiesBlindness
SyphilisAny part of the eyeCommonly affects the uveaReduced vision acuityBlack spots in the visual fieldCan turn blind
Herpes Simplex VirusCorneaRetinaReduced visionEye PainBlindness
Hepatitis BSclera (due to jaundice from chronic liver inflammation)Optic (eye) nerveRetina blood vesselsVision deteriorationBlindness
Pubic Lice (Pthirus pubis)EyelashesIntense itchVisible ‘crab’ crawling on the hair lashes
HPV (Human Papilloma Virus)ConjunctivaWart (Papilloma) in the eyeEye discomfortEye irritationEye dryness due to incomplete eye closure Reduced vision

Further to the above discussion, untreated infected pregnant mothers can transmit STD infections to the fetus, leading to congenital (born and permanent) blindness. Chlamydia, gonorrhoea, and syphilis infections can affect infants’ eyes through vertical transmission from untreated mothers.

STD infection baby
Untreated STD infections can pass onto newborns from infected mothers.

What are the eye symptoms that I should be worraboutSTDs?

If you have an abnormal eye symptom that did not resolve for 1-2 days and have a history of exposure to STD, you are advised to see a doctor.

Symptoms that are worth checking with your doctor include:

Most STD-related eye conditions are treatable. STD screening is vital to nail down the culprit infection, allowing your doctor to prescribe the right medication without further delay. Delay of treatment may potentially lead to chronic inflammation and scarring of the eye structure and can be associated with deteriorated vision acuity and blindness.

Are eye diseases secondary to STDs treatable?

Thankfully, most of the eye diseases are treatable. Most eye diseases are treatable with eradication or management of the underlying STDs infections.

Early intervention and treatment of the underlying STD disease is paramount to prevent chronic inflammation and scarring that may lead to terminal blindness.

eye infection early intervention
Early treatment of eye infections secondary to STDs can help prevent vision loss.

Will I turn blind if I did not treat my STD-related eye disease?

This is possible if the eye infection is left unattended and the underlying STDs are not addressed, as the chronic inflammation of the eyes can lead to scarring of the eye structures, eventually leading to loss of vision.

Please seek medical help early and consider STD screening if you have concerns that your eye symptoms are abnormal and may be due to a possible STD infection.

What can I do to prevent acquiring STD-related eye diseases?

Here are some practical tips to reduce your risk of acquiring STD-related eye diseases:

To summarise:

References

  1. Kreisel K, Weston E, Braxton J, Llata E, Torrone E. Keeping an Eye on Chlamydia and Gonorrhea Conjunctivitis in Infants in the United States, 2010-2015. Sex Transm Dis. 2017 Jun;44(6):356-358.
  2. Hammerschlag MR. Chlamydial and gonococcal infections in infants and children. Clin Infect Dis. 2011;53:S99–102.
  3. Kumar P. Gonorrhoea presenting as red eye: Rare case. Indian J Sex Transm Dis AIDS. 2012 Jan;33(1):47-8.
  4. Lorin AB et al. Sexually transmitted infection and HIV in ophthalmology. Clin Dermatol.2023. Aug; 13:S0738-081X(23)00090-1
  5. Usui M et al. STD in the eye. Nihon Rinsho. 2009 Jan;67 (1): 107-16.
  6. Dolange V, Churchward CP, Christodoulides M, Snyder LAS. The Growing Threat of Gonococcal Blindness. Antibiotics (Basel). 2018 Jul 12;7(3):59.
  7. Paulraj S, Ashok Kumar P, Gambhir HS. Eyes As the Window to Syphilis: A Rare Case of Ocular Syphilis As the Initial Presentation of Syphilis. Cureus. 2020 Feb 14;12(2):e6998. 
  8. Khawla AS et al. The eye in sexually transmitted infections: a review of the ocular complications of venereal diseases. Int Opthalmol. 2011 Dec; 31(6):539-50.
  9. Chalkia AK, Bontzos G, Spandidos DA, Detorakis ET. Human papillomavirus infection and ocular surface disease (Review). Int J Oncol. 2019 May;54(5):1503-1510. 

Reactive arthritis, known as Reiter’s syndrome, is an inflammatory disease [1] of the joints following an infection. This is commonly triggered by a genito-urinary infection or gastroenteritis. The onset of joint swelling, aches and pains tend to occur 1 to 3 weeks following an infection that you may not be aware of.

The condition is slightly more common in men but can also affect women.

Although reactive arthritis is uncommon, we occasionally encounter the condition in primary care. This article serves to increase awareness of the medical condition and encourage patients to reach out early for appropriate medical treatment.

reactive arthritis
While arthritis is common, reactive arthritis is uncommon but can be encountered in primary care.

What are the symptoms of reactive arthritis?

The classic triad symptoms of reactive arthritis include:

Arthritis

Urethritis

Conjunctivitis

In addition to the typical triad symptoms, patients may also present with:

Enthesitis 

Skin rash

Cardiac/heart symptoms

difficulty breathing
Shortness of breath can be a symptom of reactive arthritis.

Reactive arthritis and STDs

When reactive arthritis happens due to an underlying sexually transmitted disease, it is known as sexually acquired reactive arthritis [3] (SARA). 

Reactive arthritis can be triggered following an infection of the genito-urinary system secondary to sexually transmitted [4] pathogens. STDs such as chlamydia trachomatis [5], Neisseria gonorrhoeae, mycoplasma genitalium, and ureaplasma urealyticum can cause infective urethritis and are associated with SARA. 

SARA should be considered as one of the differentials when a young patient's profile is presented with unexplained acute joint inflammatory symptoms. Sexual history should be screened, and appropriate STD tests should be offered to avoid further delay in the treatment of the disease.

While abnormal joint symptoms are seen in SARA, patients may also present with abnormal urinary symptoms such as urethral discharge, pain during urination, increased urinary frequency, and testicular pain and swelling in men. In women, one may notice abnormal vaginal discharge, spotting in between periods, spotting after sex, or painful intercourse. Those that engage in anal intercourse may present with rectal discomfort, bleeding, discharge or tenesmus (feeling of incomplete defecation).

It is imperative to consider STD testing, as STD infections will require the correct dose and antibiotics to treat (depending on the type of STD), and STDs do not resolve on their own by the immune system.

imaging scan
Imaging scans help to evaluate the affected musculoskeletal region further.

Reactive arthritis and HIV

An unexplained arthritis symptom can be an early manifestation of HIV. Also, reactive arthritis can occur in HIV patients. In these patients, the symptoms progression of reactive arthritis can be faster, and the condition can be more severe. 

HIV infection should always be screened and considered as a differential in an unexplained inflammatory arthritis symptom. 

Can a non-STD infection cause reactive arthritis?

Yes, it is possible. Non-STD infections involved in reactive arthritis include bacteria that cause gastroenteritis or dysentery (a severe form of diarrhoea). These pathogens include Salmonella spp, Shigella spp, Campylobacter jejuni, Clostridium difficile, and Yersinia enterocolitica.

Patients with non-STD-related reactive arthritis may present with a history of severe diarrhoea, abdominal discomfort, vomiting, nausea, etc.

blood test
Individuals with the HLA-B27 gene are likely to develop reactive arthritis.

Genetically, can I be more susceptible to reactive arthritis?

Genetically, if a person is found to carry the gene [6] HLA-B27, they are 10 times more susceptible to developing reactive arthritis following an infection. 

Human leukocyte antigens (HLAs) are proteins found on the surface of white cells. They are genetically programmed to aid the immune system to differentiate the body’s own cells and noxious external particles.

The presence of HLA-B27 can be detected through simple blood tests.

When should I see a doctor if I have concerns about reactive arthritis?

You should see a doctor if you have abnormal joint symptoms following recent diarrhoea or genital infection. If you have concerns about exposure to STDs, you should also see a doctor for further checkups and treatment.

What should I expect when I see my doctor for reactive arthritis?

Your doctor will obtain a medical history that includes your sexual history. A physical examination involving the genital region, skin surfaces, joints, eyes, and cardiac areas may be offered.

Depending on your individual presenting symptoms and risks of exposure, tests that your doctor can offer include:

In addition to the tests, your doctor may refer you to a rheumatologist, ophthalmologist, or even a cardiologist if there are concerns about the involvement of the disease in other organs of the body.

NSAIDs
NSAIDs are a common type of medication prescribed to manage arthritis symptoms better.

What treatments are available for reactive arthritis?

Treating the underlying infection with appropriate antibiotics is key in managing reactive arthritis. In the case of STDs, sexual partners should be screened and treated concurrently to reduce the risk of reinfections. 

For the management of joint symptoms, non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed. In more severe conditions, steroids and immunosuppressive medications may be offered to manage the symptoms of reactive arthritis. 

What are the complications of not treating reactive arthritis?

Arthritis symptoms in this condition tend to resolve over a few months, though some patients may have recurring arthritis or long-term chronic symptoms. Chronically inflamed joints are predisposed to joint damage, leading to loss of joint function.

Those with eye inflammations that are not treated adequately may run a risk of cataracts in the future or irreversible loss of vision.

eye inflammation
Untreated reactive arthritis can affect your eyes, and you may risk losing vision.

What have I learned about Reactive Arthritis?

References

  1. Barth WF, Segal K. Reactive arthritis (Reiter's syndrome). Am Fam Physician. 1999 Aug;60(2):499-503, 507. PMID: 10465225.
  2. “Reactive Arthritis-Reactive Arthritis - Symptoms & Causes - Mayo Clinic,” Mayo Clinic, 2022, https://www.mayoclinic.org/diseases-conditions/reactive-arthritis/symptoms-causes/syc-20354838.
  3. Carlin E, Flew S. Sexually acquired reactive arthritis. Clin Med (Lond). 2016 Apr;16(2):193-6. doi: 10.7861/clinmedicine.16-2-193. PMID: 27037393; PMCID: PMC4952977.
  4. Rich E, Hook EW, III, Alarcón GS, Moreland LW. Reactive arthritis in patients attending an urban sexually transmitted diseases clinic. Arthr Rheum 1996;39:1172–7.
  5. Taylor-Robinson D, Keat A. Observations on Chlamydia trachomatis and other microbes in reactive arthritis. Int J STD & AIDS 2015;26:139–44.
  6. Colmegna I, Cuchacovich R, Espinoza LR. HLA-B27-associated reactive arthritis: pathogenetic and clinical considerations. Clin Microbiol Rev 2004;17:348–69.
hand rash
Your hand rash could actually be an STD.

Hand and STDs

Not all hand rashes are eczema. Some sexually transmitted diseases (STDs) can present on the hands. What should I do? Can I wash it away? Can I touch my face? Can I even shake another person's hand?

By understanding the potential STDs that can occur on the hands and the mode of transmission, hopefully, we can mitigate the risk of contracting hand STDs. In the unfortunate event of acquiring hand STDs, medical treatment should be sought without further delay.

What STDs can occur on the hand?

Herpes Infection (Herpetic Whitlow)

herpes
Those painful blisters on your hands and fingers could be herpetic whitlow.

Scabies

scabies
If you have a weak immune system, you could develop scabies more easily than others

Warts

warts
Warts can be very itchy.

Molluscum contagiosum

molluscum contagiosum
Round lesions that resemble pimples may be molluscum contagiosum.

Syphilis

syphilis
You may mistake syphilis for dermatological conditions such as eczema.

The hand can be a source or medium to transfer STD

One will not acquire an STD by shaking the hand of another person with an STD. Nonetheless, fingers and hands can be mediums to transport viruses such as herpes, molluscum, and warts onto the face, eyelids, or even the eyes.

What are the symptoms on the hands that may suggest an STD infection?

If you have an unexplained itchy or painful rash in the form of a lump, swelling, or ulcer that does not resolve, you should consider seeing your doctor for a physical review. It is worth highlighting to your trusted physician your concern about STD-related infection so that your doctor has a wider net of differentials when evaluating and diagnosing your condition.

What should I do if I am worried about having an STD infection on my hands?

Please arrange a physical appointment with your doctor that you are comfortable with so that the doctor can evaluate your hand symptoms and, if needed, offer the relevant STD tests to diagnose or rule out STD infection. This is important as STD infections (including hand symptoms) do not resolve on their own and will require appropriate medical treatment for complete eradication.

checkup
If your symptoms persist, you should consider seeking medical attention.

What do I expect my doctor to do for my hand symptoms?

Your doctor will have to examine the hand presentation symptoms physically. Concurrently, during the physical review, your doctor will obtain a dermatological history and relevant social and sexual history. Your doctor may physically examine the body, including the mouth and the genital region. In the event of suspicion of underlying STDs, your doctor may offer skin tests (in the form of scrape/ swab) or even blood tests, urine tests and potentially urethral (in men) and vaginal (in female) swab tests. 

Are STD hand rashes treatable?

Thankfully, most of the STD-related hand rash can be managed if appropriate medical care is given. Please do not hesitate to reach out to your physician if you have a concern about a hand symptom that may be due to an STD. It is a myth that STDs resolve on their own. Unless the right medications are offered, the STD infection may persist for months to years and risk spreading to people surrounding you.

How are STD hand rashes treated?

This will be dependent on the cause/type of STDs that lead to the symptoms on the hands. Treatment options can include oral medication (antibiotics, antivirals), topical creams, injections, or bedside procedures such as cryotherapy or electrosurgery.  

Once the diagnosis is confirmed, your doctor will discuss and work with you to develop a practical medical solution to address your infection and symptoms.

couple treatment
Both you and your partner must seek medical attention should symptoms arise.

If the hand rash is due to an STD, can I pass it to my partner(s)?

Yes. As the name suggests, STD stands for sexually transmitted disease. If left untreated, the STD infection can be passed on to your sexual partners. It is imperative to seek medical treatment early to reduce or prevent the risk of passing STD infections to your partner(s) and avoid long-term complications (to yourself) if the STDs are left untreated. 

Golden Rules to Reduce the Risk of STDs on the Hands

References

  1. Betz D, Fane K. Herpetic Whitlow. 2023 Jul 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29494001.
  2. Wu IB, Schwartz RA. Herpetic whitlow. Cutis. 2007 Mar;79(3):193-6. 
  3. De Koning GA, Blog FB, Stolz E. A patient with primary syphilis of the hand. Br J Vener Dis. 1977 Dec;53(6):386-8.
  4. Ehlers S, Sergent S, Ashurst J. Secondary Syphilis. Clin Pract Cases Emerg Med. 2020 Nov;4(4):675-676.
  5. Hughes Y. Do not miss secondary syphilis: examine the palms and soles. BMJ Case Rep. 2020 Nov 24;13(11):e237725.
  6. Gilson RL, Crane JS. Scabies. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544306/
  7. David N, Rajamanoharan S, Tang A. Are sexually transmitted infections associated with scabies? Int J STD AIDS. 2002 Mar;13(3):168-70.
  8. Al-Mutairi N. Unusual presentations of molluscum contagiosum. J Cutan Med Surg. 2008 Nov-Dec;12(6):295-8.
  9. Meza-Romero R, Navarrete-Dechent C, Downey C. Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment. Clin Cosmet Investig Dermatol. 2019 May 30;12:373-381. 
  10. García-Montero P, Serrano-Pardo R, Ruiz-Rodríguez R, Sánchez-Carpintero I. Molluscum Contagiosum on the Palms: An Uncommon Location. Actas Dermosifiliogr (Engl Ed). 2019 Sep;110(7):615-617.
  11. Al Aboud AM, Nigam PK. Wart. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431047/

Cheilitis, pronounced as 'Kay-lie-tis', is a medical term for inflammation of the lips. This can occur acutely or run a more chronic course. It can affect the skin surrounding the lips or occur over the corner of the mouth. As the face/mouth is our forefront facade during our daily social interactions, cheilitis can be obvious; hence, it is a common presentation in medical clinics. 

This article aims to create awareness of various underlying causes of lip inflammation and encourage readers to seek appropriate medical treatment if required.

inflamed lips
Lip cheilitis is an inflammation of the lips.

Can lip cheilitis be an STD?

Good news: most lip cheilitis are due to localised inflammation of the lip or skin and are non-infectious. 

Bad news: lip rash can also be due to underlying infectious causes such as herpes viral infections, syphilis infection, or tell-tale signs of underlying STDs such as HIV.

As the skin around our lip and mucosal area of the mouth is thin, sensitive, and easily grazed, viral or bacterial infections such as herpes or syphilis can be inoculated to the contact region such as the mouth or lip surfaces during sexual intercourse. If this occurs, one may present with STD symptoms of oral cold sores/herpetic infection and oral/lip chancre. 

Even though these STDs are unlikely to pose any short-term health complications, one should consider getting reviewed, screened, and treated to reduce transmission to other partners and prevent longer-term health threats. STDs do not resolve with one's immune system and require the right medication and the right dose of medication to manage conditions.

If you are uncertain about your lip cheilitis symptoms and may have been exposed to STD, reach out to your doctor for further checkups and treatment.

What are the symptoms of lip cheilitis?

Cheilitis tends to present with uncomfortable symptoms of the lips, such as: 

You are encouraged to consult your doctor if you have the above symptoms over the lips for advice and treatment of your symptoms.

lip cheilitis types
Lip cheilitis can present several symptoms, such as dry or flaky lips, bleeding lips, blisters, redness, and ulcers on the lips.

What are the common causes of lip cheilitis?

Various medical causes of cheilitis include skin pathologies, infection, medications, or even underlying systemic conditions and environmental/lifestyle factors.

Dermatological causes of lip cheilitis

actinic cheilitis
Sun damage to the lips is typically seen in older individuals due to progressive changes in the lips.

Infective causes of lip cheilitis

herpes lips
Herpes can cause blisters to form on the lips.

Drug causes of lip cheilitis

Other causes of lip cheilitis

crooked teeth cheilitis
Misaligned teeth or dentures can cause lip cheilitis.

The causative list for cheilitis can continue and be exhaustingly long. Every patient has a different exposure risk and condition when present with cheilitis. Reach out to your doctor for further evaluation and treatment of your cheilitis.

When should I consider seeing my doctor for cheilitis?

If you develop a rash over the lip and have associated abnormal symptoms that we have discussed above to suggest cheilitis, it is good practice to consider getting your doctor to review your symptoms.

If you have concerns about the cheilitis due to an infection such as STD, please reach out to your doctor without further delay.

What should I expect my doctor to do when reviewing for lip cheilitis symptoms?

Your doctor will obtain a relevant medical, social, and sexual history associated with the lip symptoms. Your doctor will then physically examine your lip area, oral mucosal region, back of the throat, and surrounding skin on the face and neck. Sometimes, your doctor may extend the physical examination to the general body or limb region if required. 

If you are concerned about infection or underlying systemic illness, your doctor may offer you tests in the form of swab samples and blood tests. Discuss this with your doctor, as every patient has a different presentation and associated risk; your doctor will advise and recommend suitable test(s) if needed to arrive at the right diagnosis of your condition.  

blood test
Blood tests may be necessary to rule out infection or underlying systemic illness.

What will happen if I don't seek medical help for lip cheilitis?

Although lip cheilitis is generally a benign condition, and most people recover uneventfully, persistent and unaddressed inflammation and infection of the condition can lead to pigmentation changes of the lip and potentially long-term scarring. Do seek medical attention if you have abnormal rash or symptoms over the lip.

How is lip cheilitis treated in Singapore?

Depending on the cause of cheilitis, your treatment medication may include:

Final key question: Is cheilitis due to kissing the wrong person?

As we have discussed, there are a myriad of non-infectious causes of cheilitis. Nonetheless, some of the infective causes of cheilitis can be passed on from a partner. It is always good to be safe and proactive in contacting your doctor for further checks and understanding of your lip symptoms.

References

  1. Lugović-Mihić L, Pilipović K, Crnarić I, Šitum M, Duvančić T. Differential Diagnosis of Cheilitis - How to Classify Cheilitis? Acta Clin Croat. 2018 Jun;57(2):342-351.
  2. Bhutta BS, Hafsi W. Cheilitis. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470592/
  3. Goel K, Sardana K. Herpetic cheilitis. Indian J Med Res. 2015 Aug;142(2):229-30. 
  4. Gilligan G, Leonardi N, Garola F, Sanfedele A, Beltramo A, Panico R, Piemonte E. False cheilitis (fausse cheilitis) as a clinical manifestation of oral secondary syphilis. Int J Dermatol. 2022 Feb;61(2):180-183.
  5. Li D, Zhang M, Yin J, Chen K. A Case of Secondary Syphilis with the Extragenital Chancre of the Lips and Tongue. Clin Cosmet Investig Dermatol. 2023;16:2185-2188
  6. Bajpai S, Pazare AR. Oral manifestations of HIV. Contemp Clin Dent. 2010 Jan;1(1):1-5.
  7. Casariego Z, Pombo T, Pérez H, Patterson P. Eruptive cheilitis: a new adverse effect in reactive HIV-positive patients subjected to high activity antiretroviral therapy (HAART). Presentation of six clinical cases. Med Oral. 2001 Jan-Feb;6(1):19-30. 

Have you heard of Mycoplasma Genitalium infection? This is a name that is less heard of by most of us. This article strives to increase awareness of mycoplasma genitalium infection and highlights the importance of screening and treating this condition.

mgen
Mycoplasma Genitalium infection is a type of sexually transmitted disease (STD).

Background of Mycoplasma Genitalium

Mycoplasma genitalium, aka Mgen, is a type of sexually transmitted disease (STD). It first appeared in the 1980s when it was found in the urinary tract opening (urethral) sample of 2 male patients in London. Since then, it has been known to be associated with urethritis (infection of the urinary tract opening) in men and many gynaecological complications, including pelvic inflammatory disease in women.

Why should I screen for Mycoplasma Genitalium?

1. An unheard/less heard of medical condition, Mycoplasma Genitalium does not equate to the non-existence of this medical condition

Mycoplasma Genitalium remains a bacteria that is elusively thriving in the community as it is less heard of and less screened for. Over the years, increasing demographic evidence has shown that the infection is rising in society.

Based on CDC data, Mycoplasma genitalium infection is associated with 15-20% of non-gonococcal urethritis cases in men. Mycoplasma genitalium is also associated with cervicitis (10-30%), pelvic inflammatory disease (4-22%), and infertility issues in women. The risks of gynaecological complications increase twice in a female with untreated Mycoplasma genitalium. Mycoplasma genitalium is also associated with rectal infection, where it is slightly more common in MSM (men-sex-men), contributing up to 26% of the cases and affecting 3% of rectal infections in women.

PID
Mycoplasma Genitalium has been linked to pelvic inflammatory disease in women.

2. Untreated Mycoplasma Genitalium increases the risk of other STDs, including HIV and HPV infections

During infection, the Mycoplasma Genitalium bacteria attach and invade the surface of the affected skin cells, weakening the skin barrier integrity. This increases the risk of transmission, acquisition, and reproduction of other STD infections, such as HIV and/or even HPV, and allows the affected person to shred the viruses easily through the skin surface.

A person with untreated sexually transmitted disease is more predisposed to acquiring other STDs, including HIV. In Mycoplasma Genitalium infection, as the infective symptoms can be vague and one may not routinely screen for the infection, this leads to further risk of contracting other STDs during sexual contact.

3. Signs and symptoms of Mycoplasma Genitalium can mimic Chlamydia Trachomatis infection

Patients or even physicians can sometimes be confused about symptoms of Mycoplasma Genitalium as there are similarities of symptoms with common bacterial STDs such as chlamydia or gonorrheal infection.

If you have abnormal genito-urinary symptoms, do reach out to your trusted physician for further sexual health screening.

urethritis burning sensation
Painful urination is one of the symptoms of urethritis typically caused by Mycoplasma Genitalium.

4. Mycoplasma Genitalium infection can lead to long-term complications in women

You are encouraged to get screened and treated early if you are at risk of acquiring Mycoplasma Genitalium. You can speak with your trusted doctor to understand more about the screening and treatment options.

5. Mycoplasma Genitalium infection can lead to long-term complications in men

Mycoplasma Genitalium infection plays a role in non-gonococcal urethritis (15-20%). Chronic inflammation from Mycoplasma Genitalium infection may also contribute to male infertility issues due to underlying epididymitis and prostatitis.

As discussed, rectal infection and pharyngeal symptoms with Mycoplasma Genitalium can be seen more frequently in MSM (men-sex-men). The symptoms presented can be vague, or the patient may not even have any concerning symptoms at all, thus giving rise to further opportunities for the infection to spread insidiously and rampantly to other sex partners.

epidiymitis mgen
Epididymitis is an inflammation of the epididymis and can be caused by Mycoplasma Genitalium.

6. Rising antibiotic resistance against the treatment of Mycoplasma Genitalium

The concern with treatment failure of Mycoplasma Genitalium infection is due to the rise of antibiotic resistance. Azithromycin, in particular, is a type of macrolide antibiotic frequently used in genitourinary infections. However, there are increasing reports of resistance against azithromycin leading to treatment failure. Currently, the CDC recommends combination antibiotics for the treatment of Mycoplasma Genitalium.

Given the rising antibiotic resistance, it is prudent for both patients and physicians to consider screening tests before offering treatment to avoid unnecessary repeated blind antibiotics treatment. Post-treatment clearance tests may be provided to ensure the infection has been eradicated successfully.

7. Your immune system will not clear off Mycoplasma Genitalium itself

Unfortunately, It is a myth that one will eventually clear off STD infections such as Mycoplasma Genitalium over time with good immunity. While an excellent immune system allows a person a better response to overall treatment and a quicker recuperating period, you will need the right antibiotics and the right dosage of antibiotics to ward off the infection. STDs will not resolve on their own.

8. Mycoplasma Genitalium is different from other forms of mycoplasma infection

Commonly, one may wonder whether Mycoplasma Genitalium is similar to Mycoplasma Pneumoniae –  a type of respiratory tract infection that can be associated with pneumonia requiring hospitalisation. The answer is no; despite the name, they are different types of bacteria. Mycoplasma Genitalium is transmitted sexually, while Mycoplasma Pneumonia can be transmitted through contact with respiratory droplets.

respiratory infection
Mycoplasma Pneumoniae is transmitted via respiratory droplets.

9. Sexual practices may predispose to mycoplasma genitalium or other STDs

Sexual practices such as multiple sexual partners, casual sex, and becoming sexually active at a young age predispose a person to STDs, including Mycoplasma Genitalium infection. It is noted that the risk of contracting Mycoplasma Genitalium increases with the additional number of sexual partners.

In a local population study conducted across over 2000 sexually experienced Singaporean men (60.1%),  16% were involved in casual sex and 78.4% were involved in commercial sex services. The studies may not even reflect the actual demographic pattern as the results were likely underreported due to the local cultural and social barrier to disclosure of one’s sexual history.

To screen or not to screen…

In a realistic world, while the cost of screening for Mycoplasma Genitalium may take a toll on the healthcare expenditure of a patient and the healthcare system, the long-term complications of untreated Mycoplasma Genitalium and treatment costs are factors worth considering.

It is good practice to discuss with your trusted doctor your sexual history and risk of exposure so that your doctor can guide you with a suitable STD screening plan in the context of your individual risks and social background.

References

  1. Ona S, Molina RL, Diouf K. Mycoplasma genitalium: An Overlooked Sexually Transmitted Pathogen in Women? Infect Dis Obstet Gynecol. 2016;2016:4513089. doi: 10.1155/2016/4513089.
  2. Manhart LE, Broad JM, Golden MR. Mycoplasma genitalium: should we treat and how? Clin Infect Dis. 2011 Dec;53 Suppl 3(Suppl 3):S129-42. doi: 10.1093/cid/cir702.
  3. Sethi S, Zaman K, Jain N. Mycoplasma genitalium infections: current treatment options and resistance issues. Infect Drug Resist. 2017 Sep 1;10:283-292. doi: 10.2147/IDR.S105469.
  4. Heng BH, Lee HP, Kok LP, Ong YW, Ho ML. A survey of sexual behaviour of Singaporeans. Ann Acad Med Singap. 1992 Nov;21(6):723-9.
  5. https://www.cdc.gov/std/treatment-guidelines/mycoplasmagenitalium.htm
HIV
HIV is an incurable disease, but it can be prevented.

The word ‘HIV’ brings in its wake the fear of an incurable disease and lifelong social stigma in most people. HIV (Human Immunodeficiency Virus) is a virus that progressively destroys the immune cells of an infected person. Over time, the person with HIV will have a diminished immune system. The final complicated outcome known as AIDS (Acquired Immunodeficiency Syndrome) is a condition where the person with HIV is no longer able to fight against daily infections.

Currently, there remains no cure for HIV infection. Once a person is infected with HIV, they will remain with the infection for the rest of their life. HIV infection can be transmitted through unprotected sexual contact, body fluid, needle sharing, and/or blood transfusion with an infected person.

The silver lining here is that with the improvement of medical research and proper medical care, we can control HIV. Patients with HIV who are receiving prompt treatment can still live a long and quality life.

In this article, we discuss the availability of PEP medication to reduce the risk of acquisition of HIV when a person may potentially be exposed to HIV. The awareness of PEP can be life-changing and life-saving.

What is PEP?

PEP (Post-Exposure Prophylaxis) is an anti-retroviral medication option that can be offered to a person to reduce the risk of HIV infection after a potential exposure. PEP medication must be started within the first 72 hours (3 days) after exposure. This is time-sensitive, and the earlier you start on PEP, the better your chances of avoiding getting HIV infection. Hence, every hour is vital and may make a difference; don’t hesitate!

It is also imperative to take note that though PEP significantly lowers a person’s risk of acquiring HIV (when appropriately taken), PEP does not 100% guarantee the prevention of HIV infection after exposure. You should still practice safe sex at all times.

When should I consider PEP?

You can consider PEP medication as an option if you are concerned about a high-risk exposure to HIV within the last 72 hours.

High-risk exposures include unprotected penetrative sex (vaginal or anal) with:

If you are unsure of your risk of exposure to HIV, please do not hesitate to reach out to your trusted healthcare provider for further evaluation of your risk and whether you are a suitable candidate for PEP.

What is my risk of exposure to HIV infection?

A person’s risk of contracting HIV can be higher in situations such as:

The risk of acquiring HIV infection also depends on the type of sexual intercourse a person engages in.

The risk increases as follows (from lowest to highest):

  1. Insertive vaginal sex
  2. Receptive vaginal sex
  3. Insertive anal sex
  4. Receptive anal sex

The risk of HIV transmission in oral sex is low, with no actual accurate estimation of risk. However, there are HIV cases documented through oral sex. If there is a history of receptive oral intercourse with ejaculation, it is worth discussing with your physician if PEP is necessary.

Sources such as blood, body fluid secretion such as vaginal fluid, semen, and breast milk may transmit HIV. Sources such as saliva, tears, sweat, urine, and faeces are not able to transmit HIV. The risk of HIV with other activities such as sharing sex toys, biting, touching semen, and saliva is very low and negligible.

If you have any concerns about your HIV risk of exposure, please consult your doctor as soon as possible, as PEP can only be given within the first 72 hours after exposure.

HIV concern
It is a cause for concern if you (and/or your partner) have sores, ulcers or wounds over your genital or anal region.

What does PEP entail?

PEP consists of a combination of anti-retroviral medications.

Drugs that have been recommended in PEP include:

It is important to inform your doctor about your medical and medication history. This ensures your doctor prescribes the suitable PEP medication for you.

HIV
HIV in your immune system.

How effective is PEP?

PEP is clinically proven to be effective in reducing the risk of HIV infection in a person who is exposed to HIV if it is started within 2 hours (ideally) and not later than 72 hours after exposure.

Upon exposure to HIV via the skin and mucous membrane, HIV will replicate in the macrophages (a white blood cell that maintains the immune system by eating or engulfing pathogens such as bacteria and viruses).

Following the next 2 to 3 days, the viruses will multiply and replicate in the surrounding lymph nodes. In 3 to 5 days, the virus will be disseminated into the bloodstream and other parts of the body. A person’s HIV infective status will then be established and irreversible.

By understanding the timeline and events that will eventually occur in HIV replication, we now know that the PEP regimen is time-sensitive to block viral replication and has the best potency and effectiveness if given at the earliest possible time.

What are the common side effects of taking PEP?

The common side effects include lethargy, stomach upset, nausea and diarrhoea, and headache. Thankfully, the discomfort tends to be mild, and most patients can tolerate the full course of the PEP medication.

In rare cases, PEP can affect a person’s liver function. Your doctor will usually recommend blood tests before and after the completion of PEP medication.

Speak to your doctor to understand more about PEP's side effects and medication profiles.

What should I expect when I see my doctor for a PEP consultation?

Your doctor will obtain a relevant history to assess your risk of exposure to HIV. Your medical history is also important to understand any medical condition or long-term medication that may interfere with the PEP medication. Your doctor will then offer you baseline blood tests before starting on PEP medication. You will also be counselled on the side effects to anticipate when you are on PEP.

What should I do after the completion of PEP?

Your doctor will usually schedule a follow-up appointment with you. You will be advised to get blood tests done upon completion of PEP to ensure you do not develop any long-term side effects from the medications. You will also be offered an HIV test to check your status at the end of your PEP course. It is good practice to consider a comprehensive STD screening in view of the recent exposure risk.

HIV test
Your HIV status can be checked with HIV blood tests.

Who is not suitable for PEP?

PEP is not suitable for anyone who has repeated exposure risk to HIV from unprotected sex. As the name suggests, PEP is used only for emergency circumstances. In frequent high-risk exposure to HIV situations, you may discuss with your doctor about PrEP (Pre-Exposure Prophylaxis) option instead.

PEP is also not suitable if you are known to be HIV positive or if you have a history of hepatitis. Due to how strong a PEP regimen can be and its potential side effects, you should consult your doctor before commencing.

PrEP
PrEP is suitable for repeated high-risk exposures to HIV.

Can I take PEP every time I have frequent unprotected sex?

No, you should only consider PEP during emergencies. If you are concerned about the repeated high risk of exposure from your sexual encounters, you should speak to your doctor to consider PrEP HIV medication instead.

Key take-home message

While HIV is incurable, PEP medication can be life-saving as it can effectively reduce the risk of HIV infection when taken promptly within the first 72 hours of exposure. If you are uncertain of your encounter and are considering PEP, please contact your healthcare provider as soon as possible.

References

  1. DeHaan E, McGowan JP, Fine SM, et al. PEP to Prevent HIV Infection [Internet]. Baltimore (MD): Johns Hopkins University; 2022 Aug 11.
  2. “PEP,” 2023, https://www.cdc.gov/hiv/basics/pep.html.
  3. Beekmann SE, Henderson DK. Beekmann SE, et al. Prevention of human immunodeficiency virus and AIDS: postexposure prophylaxis (including health care workers). Infect Dis Clin North Am. 2014 Dec;28(4):601-13.
  4. Ford N, Shubber Z, Calmy A, Irvine C, Rapparini C, Ajose O, Beanland RL, Vitoria M, Doherty M, Mayer KH. Ford N, et al. Choice of antiretroviral drugs for postexposure prophylaxis for adults and adolescents: a systematic review. Clin Infect Dis. 2015 Jun 1;60 Suppl 3:S170-6. 
  5. John SA, Quinn KG, Pleuhs B, Walsh JL, Petroll AE. John SA, et al. HIV Post-Exposure Prophylaxis (PEP) Awareness and Non-Occupational PEP (nPEP) Prescribing History Among U.S. Healthcare Providers. AIDS Behav. 2020 Nov;24(11):3124-3131.
  6. “GUIDELINES,” 2019, https://www.eacsociety.org/media/guidelines-11.1_final_09-10.pdf.

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.

e coli
E. Coli has been linked to sexually transmitted diseases.

What is E. coli?

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.

Is E. coli sexually transmitted?

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.

e.coli STD
E. Coli can be sexually transmitted.

Can E. coli be transmitted through oral sex, too?

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.

What is the risk of acquiring an E. coli infection?

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:

kids and elderly e.coli
The young and elderly are more at risk of an E. coli infection.

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:

When should I see my doctor if I am concerned about an E. coli infection?

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.

vomiting
Vomiting is a symptom of an E. coli infection.

How can I prevent acquiring an E. coli infection?

General advice for everyone includes:

General advice for sexually active individuals includes:

What is the treatment for E. coli infections?

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.

antibiotics
Oral antibiotics may be prescribed to treat an E. coli infection.

What will happen if I do not treat E. coli infections?

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.

Can E. coli infection lead to infertility?

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.

prostatitis
Prostatitis or an inflamed prostate is associated with chronic E. coli infections.

Is there a vaccine to prevent E. coli infection?

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.

Final message…

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.

References

  1. Centers for Disease Control and Prevention. (2023, April 25). E. coli and Food Safety. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/foodsafety/communication/ecoli-and-food-safety.html
  2. Matthew Mueller, C. R. (2023). Escherichia coli Infection. Florida: StatPearls Publishing.
  3. Michael Ray Garcia, S. W. (2023). Sexually Transmitted Infections. Florida: StatPearls Publishing.
  4. Michael Dan, T. G. (2012). Sexually transmitted Escherichia coli urethritis and orchiepididymitis. Sexually Transmitted Diseases, doi: 10.1097/OLQ.0b013e31823156a0.
  5. Betsy Foxman, S. D. (2002). Uropathogenic Escherichia coli Are More Likely than Commensal E. coli to Be Shared between Heterosexual Sex Partners. American Journal of Epidemiology, 1133–1140.
  6. Ji Youn Lim, J. W. (2010). A Brief Overview of Escherichia coli O157:H7 and Its Plasmid O157. Journal of Microbiology and Biotechnology, 5-14.
  7. James L. Smith, P. M. (2014). Chapter Three - Shiga Toxin-Producing Escherichia coli. Advances in Applied Microbiology, 145-197.
  8. Alison Laura King, N. S. (2020). Concurrent Escherichia coli tubo-ovarian abscess and Campylobacter jejuni gastroenteritis: A case report. Case Reports in Women's Health, doi: 10.1016/j.crwh.2020.e00192.
  9. Chaudhary Ehtsham Azmat, P. V. (2023). Orchitis. Florida: StatPearls Publishing.

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.

What is herpes?

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.

oral herpes
Herpes virus outbreak on the lips can manifest as small clusters of fluid-filled blisters.

What is shingles?

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.

shingles
Shingles usually manifest as a cluster of red, blister-like sores forming a linear pattern on a person's skin, typically following a nerve pathway.

What are the key differences between shingles and herpes?

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:

ShinglesHerpes
VirusVaricella Zoster VirusHerpes 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 symptomsCan have pain/burning sensation over affected skin 1-2 days before rash outCan 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 rashCan last up to 2-4 weeks before clearanceCan 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.)

Can a person have both herpes and shingles at the same time?

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 body
Shingles typically occur in ageing individuals or individuals with a compromised immune system.

What are the risk factors for developing shingles and herpes?

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.

What triggers herpes or shingles?

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:

stress shingles
Stress can trigger a shingles infection.

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.

How can I differentiate or confirm whether it is a shingle or herpes?

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.

What is the treatment for shingles or herpes?

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.

antiviral drugs
Antiviral medications are used to treat viral infections like shingles and herpes.

Can I protect myself against shingles?

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.

Can I protect myself against herpes?

Unfortunately, there is no vaccination available to protect against herpes infection. However, there are some tips to reduce the risk of acquiring herpes infection.

Summary

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.

References

  1. Saleh D, Yarrarapu SNS, Sharma S. Herpes Simplex Type 1. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK482197/ 
  2. Mathew Jr J, Sapra A. Herpes Simplex Type 2. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK554427/ 
  3. Nair PA, Patel BC. Herpes Zoster. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK441824/ 
  4. https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html 

“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.” 

chlamydia
Chlamydia infections tend to produce mild symptoms that most people ignore.

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?

What is Chlamydia Trachomatis?

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. 

How can I contract chlamydia trachomatis infection?

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.

Am I at risk of acquiring a chlamydial infection?

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.

What are the usual symptoms of chlamydial infection?

One can be asymptomatic or develop only mild symptoms during the early stages of chlamydial infection. Occasionally, one may experience symptoms such as:

chlamydial infection symptoms
Chlamydial infections are usually characterised by painful urination, painful intercourse, abnormal vaginal discharge, or painful and swollen testicles.

What complications can result from an undiagnosed chlamydial infection?

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. 

Women

Men

Both women and men

painful urination chlamydia
Painful urination is a common symptom in women with chlamydia.

When should I see my doctor if I am concerned about chlamydia?

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:

Women

Men

Women and men

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.

What tests will my doctor offer to screen for chlamydial infection?

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. 

urine test chlamydia
Urine tests can be conducted to check for a chlamydia infection.

What are the treatments for chlamydial complications?

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.

How long can chlamydia last in our body if left untreated?

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).

Key points to note

References

  1. Satpathy, Gita, et al. “Chlamydial Eye Infections: Current Perspectives.” Indian Journal of Ophthalmology, vol. 65, no. 2, Feb. 2017, pp. 97–102. PubMed, https://journals.lww.com/ijo/fulltext/2017/65020/chlamydial_eye_infections__current_perspectives.6.aspx  
  2. Paavonen, J., and M. Lehtinen. “Chlamydial Pelvic Inflammatory Disease.” Human Reproduction Update, vol. 2, no. 6, 1996, pp. 519–29. PubMed, https://academic.oup.com/humupd/article/2/6/519/708087  
  3. Goulart, Ana Carolina Xavier, et al. “HIV, HPV and Chlamydia Trachomatis: Impacts on Male Fertility.” JBRA Assisted Reproduction, vol. 24, no. 4, 2020, pp. 492–97. PubMed Central, https://doi.org/10.5935/1518-0557.20200020
  4. Clarke, Ian N. “Evolution of Chlamydia Trachomatis.” Annals of the New York Academy of Sciences, vol. 1230, Aug. 2011, pp. E11-18. PubMed, https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.2011.06194.x 
  5. STD Facts - Chlamydia. 4 Oct. 2022,  
    https://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm.

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.

1. Get your HPV facts checked!

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 facts
Know the facts and understand what HPV is all about before talking to your partner.

2. Understand that HPV infection is very common. 

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.

3. Find a suitable opportunity to discuss with your partner.

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. 

couple talking
Sharing the news about your HPV infection should be done in a quiet, comfortable, and safe space.

4. Work through the next steps together. 

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:

HPV
Having a discussion with your doctor about HPV infection along with your partner can help clear up doubts and anxiety.

5. Know the reality of living with HPV.

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. 

What to take note of when it comes to HPV infections

The key takeaway points of HPV infections are:

HPV vaccination
Your doctor can guide you through HPV vaccination and treatments.

References

  1. Burd, E. M. (2003). Human Papillomavirus and Cervical Cancer. Clinical Microbiology Reviews, 1-17.
  2. Harrell W. Chesson, E. F. (2014). The Estimated Lifetime Probability of Acquiring Human Papillomavirus in the United States. Sexually Transmitted Diseases, 660-664.
  3. Centers for Disease Control and Prevention. (2021, November 10). Reasons to Get HPV Vaccine. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/hpv/parents/vaccine/six-reasons.html
  4. Sun Kuie Tay, L. L. (2014). Prevalence of cervical human papillomavirus infection in healthy women is related to sexual behaviours and educational level: a cross-sectional study. International Journal of STD and AIDS, 1013-1021.
  5. Supitcha Kamolratanakul, P. P. (2021). Human Papillomavirus Vaccine Efficacy and Effectiveness against Cancer. Vaccines (Basel), doi: 10.3390/vaccines9121413.
  6. Johannes Huber, A. M.-A. (2021). Human papillomavirus persistence or clearance after infection in reproductive age. What is the status? Review of the literature and new data of a vaginal gel containing silicate dioxide, citric acid, and selenite. Women's Health (London), doi: 10.1177/17455065211020702.
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