STI Screening

Chlamydia is one of the most common bacterial STDs worldwide. It is caused by a bacterium called Chlamydia trachomatis. Many individuals with Chlamydia are asymptomatic. In fact, less than 50% of both men and women with Chlamydia develop symptoms. If symptoms do develop, they usually start to show between 1 to 3 weeks after exposure.

Symptoms of Chlamydia include:

• Painful urination

• Urinary frequency and urgency

• Abnormal discharge from the penis or vagina

• In men: Pain or swelling of the testicles due to an infection known as epididymo-orchitis

• In women:

  • Bleeding after sex and in between menstrual periods

  • Painful sexual intercourse

  • Chronic pelvic or abdominal pain and/or fever due to a complication known as Pelvic Inflammatory Disease, whereby the infection spreads upwards to affect the uterus and fallopian tubes

Chlamydia can infect other parts of the body as well, such as:

• Conjunctivitis, which is an infection of the eye lining, can occur after contact with infected fluids. Symptoms include eye discharge, irritation, redness and lid swelling.

• Proctitis, which is inflammation of the rectum due to anal sex, usually does not cause symptoms. If symptoms do occur, individuals may experience rectal discomfort, discharge or pain

• Throat Chlamydia, which results from providing oral sex, again usually does not cause symptoms. If symptoms do occur, individuals may experience sore throat, painless sores in the mouth, tonsillar swelling and painful swallowing.

Chlamydia can be tested using urine or swab samples from the infected site.

Gonorrhoea is a common STD caused by Neisseria gonorrhoeae, a bacterium that tends to grow and multiply in warm and moist areas of a woman's reproductive tract, mainly in the cervix, womb and fallopian tubes, and in the urethra of both men and women. Symptoms usually occur within 2-14 days after exposure.

The symptoms of Gonorrhoea are very similar to that of Chlamydia:

• Painful urination

• Urinary frequency and urgency

• Thick pus-like discharge from the penis or vagina

• In men: Pain or swelling of the testicles due to an infection known as epididymo-orchitis

• In women:

  • Bleeding after sex and in between menstrual periods

  • Painful sexual intercourse

  • Chronic pelvic or abdominal pain and/or fever due to a complication known as Pelvic Inflammatory Disease, whereby the infection spreads upwards to affect the uterus and fallopian tubes

Like Chlamydia, Gonorrhoea can also affect the conjunctiva of the eyes, the rectum and the throat. Gonorrhoea can be tested using urine or swab samples from the infected site.

HIV is a virus that causes weakening of the body’s immune system. It does so by destroying white blood cells that protect against bacteria, viruses and other harmful pathogens. Without these white blood cells, the body will no longer be able to defend itself effectively against such infections. The late stage of untreated HIV infection is referred to as Acquired Immunodeficiency Syndrome (AIDS). This is a spectrum of potentially life-threatening infections and cancers that are caused by the virus.

HIV is spread by 3 main routes: sexual contact, significant exposure to infected body fluids/tissues such as semen, blood, vaginal secretions or breast milk, and lastly, mother-to-child transmission.

HIV infection undergoes 3 stages:

• The first stage (Acute Stage) may present with flu-like symptoms, fever and a rash.

• In the second stage (Latent Stage), there may be some symptoms such as lymph node swelling, diarrhoea and weight loss, but most patients may not have any symptoms at all. The second stage can last anywhere from a few years to over 20 years. Many HIV-infected patients, especially during this stage, may not even know that they have contracted HIV.

• Last but not least, the third stage is the presentation of AIDS.

Untreated, HIV typically turns into AIDS in approximately 8 to 10 years. There is severe damage to the immune system and the patient would be more likely to develop opportunistic infections or cancers, which are diseases that normally would not occur in a person with a healthy immune system.

The signs and symptoms of some of these infections may include:

• Recurrent fever

• Sweats and chills

• Chronic diarrhoea

• Non-specific skin rashes

• Swollen lymph nodes

• Recurrent oral yeast infection (thrush)

• Drastic, unintentional weight loss

• Persistent fatigue

• Neurological issues

It is important to note that there are no definitive symptoms of HIV infection. The only way to know if you have been infected is to undergo a test. An early diagnosis leads to prompt treatment to get the infection under control. This way, patients are able to live healthy and otherwise normal lives.

Syphilis is an STI caused by a bacterium called Treponema pallidum. Individuals infected with Syphilis may not be prompted to seek medical advice because the initial symptom is simply a painless sore, or there may not even be any symptoms at all. In fact, Syphilis is often diagnosed incidentally on routine STI screening. If left untreated for years, Syphilis may affect multiple organs including the brain, heart and nerves, and can be potentially fatal. It is important that the infection is diagnosed early and treated with antibiotics.

The incubation period for Syphilis ranges from 10 days to 3 months. The infection is almost always transmitted through sexual contact with an infected person, specifically direct skin-to-skin contact with a syphilis sore (ulcer). Sores can be present on the skin of the penis or vagina, on the anus, lips, and in the mouth. The bacteria can also be spread through broken skin on other parts of the body. Syphilis can also be transmitted from a pregnant mother to her unborn baby, resulting in congenital syphilis.

Syphilis cannot be spread by sharing food or utensils, or contact with non-living objects like toilet seats, swimming pools, bathtubs and clothing.

The disease is divided into stages, with each stage exhibiting different signs and symptoms. It is important to note that the stages may overlap, and symptoms do not always occur in the same order.

• Primary stage

  • The first symptom is usually a single sore called a chancre. This normally occurs around 3 weeks from the time of exposure. The start of the first symptom ranges from 10 to 90 days. The chancre is usually small, firm and painless, and is usually the location where the bacteria entered the body. It usually heals completely within 4 weeks without any treatment.

• Secondary stage

  • This highly contagious stage begins around 2 to 4 months after exposure and may last up to 2 years.

  • It is characterised with a flat, reddish brown skin rash that appears on one or more areas of the body, including the palms of your hands or soles of your feet. The rashes may be easily mistaken for rashes caused by other diseases.

  • Other symptoms may include fever, sore throat, unintentional weight loss, swollen lymph nodes, hair loss (especially of the eyebrows), joint and muscle aches and fatigue.

  • Secondary Syphilis may resolve with or without treatment. People who are left untreated at this stage will enter the latent stage of infection, which may put them at risk of serious complications.

• Latent stage

  • The latent stage is the hidden stage as the infected person does not exhibit any signs and symptoms. The infection remains in the body and can last for years.

• Tertiary stage

  • The tertiary stage may occur 10 to 30 years after the initial infection. By this stage, the disease may have damaged vital organs of the body such as the heart, blood vessels, brain, nerves, eyes, liver, bones, and joints. Complications of Syphilis may lead to serious consequences, possibly even death.

There are several ways to diagnose Syphilis, but the easiest method is a blood test to detect and measure antibodies against the bacteria.

Herpes is a contagious infection caused by the Herpes Simplex Virus (HSV). There are 2 types: HSV-1 and HSV-2. HSV-1, also known as oral Herpes, can cause cold sores and blisters around the mouth or face, while HSV-2, also known as genital Herpes, can cause painful blisters around the genitals or anus.

HSV is transmitted in the following ways:

• Skin-to-skin contact, such as unprotected sexual intercourse

• Exposure to the saliva of an infected person, such as kissing, sharing food or sharing utensils.

• A pregnant mother with a flare of genital Herpes who does not seek immediate treatment can risk passing the infection to her unborn baby, potentially leading to serious pregnancy-related complications.

Infected persons may occasionally experience flares, which may not occur immediately upon infection, and could appear days, weeks or even years later. The rest of the time individuals remain asymptomatic. Some people may never develop flares.

Symptoms of a HSV-1 flare include:

• Cold sores or blisters on the lips or inside the mouth. They could potentially appear on the genitals as well if the virus was transmitted via oral sex.

• The sores or blisters may develop into shallow, painful ulcers, then gradually crust over and form into scabs before eventually healing.

• Swollen, red gums

• Swollen neck lymph nodes

Symptoms of a HSV-2 flare include:

• Painful sores or blisters on the skin around the genitals, buttocks and anus.

• Similarly, these sores or blisters may develop into ulcers, then crust over and form into scabs before healing.

• Pain during urination

• Swollen groin lymph nodes

The first flare is usually the worst and the above symptoms may be accompanied with fever and muscle aches. Generally, subsequent flares become less severe and occur less frequently over time.

There is unfortunately no cure for HSV. The virus lies dormant in the spinal nerve ganglia, from which it can periodically emerge, causing symptoms. Recurrent herpetic eruptions may be triggered by:

• Febrile illnesses

• Physical or emotional stress

• Immunosuppression

• Overexposure to UV light

HSV flares are usually diagnosed clinically by physical examination, and can be confirmed with a swab test of the lesions. In the absence of a flare, blood tests for HSV antibodies can be performed to assess if a person has been previously exposed to the virus.

Currently, there is no vaccine available against HSV. Instead, the focus remains on preventive measures, which include:

• Avoid sharing food or utensils when you or someone else has symptoms of oral Herpes

• Avoid close skin-to-skin contact when you or someone else has symptoms of Herpes

• Safe sexual practices

• Maintain a strong immune system through healthy lifestyle habits

Human Papillomavirus (HPV) is the most common STI worldwide. In fact, nearly all sexually active people will become infected with at least one strain of HPV at some point during their lives. The more sexual partners one has, the more likely it is to get infected with HPV.

There are over 100 strains of HPV, about 40 of which are known to infect genital skin. Approximately 90% of genital warts are caused by HPV types 6 and 11. These are known as low-risk HPV types because they are unlikely to cause cancer. Instead, high-risk HPV strains can potentially lead to cancer in the cervix, genital skin or anus. The most common high-risk strains are HPV types 16 and 18.

HPV is transmitted through vaginal sex, anal sex, oral sex or close genital contact, and is unlikely to be passed on from touching non-living objects such as toilet seats or towels.

HPV can be tested in women by using a soft brush to collect cells from the cervix. It is important to note that this test is performed for cervical cancer screening purposes and not for STI screening. This is because the HPV test only looks for high-risk HPV strains. According to local guidelines, women aged 30 and above are recommended to undergo an HPV test every 5 years.

The HPV test is officially indicated only for cervical testing and not other sites such as the penis. Routine testing for men is thus not recommended. However with growing evidence from research, along with increasing demand, these days more and more healthcare providers are offering HPV tests for men. In particular, anal HPV screening may be performed for men who may be at increased risk for anal cancer, including men with HIV or men who receive anal sex.

The HPV vaccine is the best prevention against infection. It can prevent certain high and low-risk strains of HPV. Typically, the vaccine is recommended for girls and boys as young as age 9, and women and men up to age 26. However, in 2018 the United States Food and Drug Administration (FDA) raised the recommended age up to 45 years old, which is good news for those who did not receive the vaccine earlier in life.

Keep in mind that the HPV vaccine prevents new infections but does not treat existing HPV infections or diseases. HPV vaccine works best when given before any exposure to HPV.

Hepatitis B is a serious liver infection that is often only diagnosed in the later stages, when patients start seeking medical help for advanced liver problems. It is caused by the Hepatitis B virus. About 3.6% of the population aged 18-79 in Singapore, or about 150,000 people, are Hepatitis B carriers, but many are unaware of their condition.

Acute Hepatitis B infection lasts less than 6 months. Your immune system likely can clear the infection from your body, and you should recover completely within a few months. However, if the immune system is unable to clear the infection within 6 months, it can lead to chronic Hepatitis B (permanent liver inflammation). Over time, serious complications can include liver cirrhosis (permanent liver scarring and shrinking), liver failure and liver cancer.

Hepatitis B is the cause for 60 to 70% of liver cancers. In fact, Hepatitis B carriers are 100 times more likely to develop liver cancer than non-carriers.

The Hepatitis B virus is spread through the following ways:

• Sexual contact with an infected partner

• Direct contact with open sores of an infected person

• From an infected mother to her newborn child during childbirth

• Sharing of injection needles among drug abusers

• Exposure to sharp instruments or needles contaminated with a Hepatitis B infected person’s blood, eg. acupuncture, body/ear piercing, tattooing, nail clippers or shaving blades

• Transfusion of unscreened blood and blood products

Hepatitis B cannot be spread through coughing, sneezing, breastfeeding, hugging, kissing or sharing of utensils.

Hepatitis B infection may not show any symptoms at all. If symptoms do develop, they appear approximately 90 days after exposure, and may include:

• Yellowing of the skin (jaundice)

• Dark coloured urine

• Pale stools

• Fever

• Prolonged tiredness

• Poor appetite

• Abdominal pain

• Nausea or vomiting

Hepatitis B is diagnosed by a blood test that detects Hepatitis B surface Antibodies and Hepatitis B surface antigen. Active or past infection is distinguished by a Hepatitis B core antigen.

Hepatitis B is a vaccine-preventable condition. If you have never been immunised or do not have antibodies from past Hepatitis B infection, you are at risk of Hepatitis B infection. In addition, all family members, close household members, and sexual partners living with a chronically infected individual should be tested and subsequently vaccinated.

Hepatitis C is a liver condition caused by the Hepatitis C virus (HCV). The virus can cause both acute and chronic hepatitis, ranging in severity from a mild illness to a serious, lifelong illness including liver cirrhosis and cancer. There are an estimated 150 million HCV carriers worldwide, with over 500,000 to 750,000 dying annually from HCV-related liver disease. In Singapore, the prevalence rate is about 0.2%.

Acute HCV infections are usually asymptomatic and most do not lead to a life-threatening disease. Around 30% of infected persons spontaneously clear the virus within 6 months of infection without any treatment. The remaining 70% will develop chronic HCV infection. Of those with chronic HCV infection, the risk of cirrhosis ranges from 15% to 30% within 20 years.

The Hepatitis C virus is spread through the following ways:

• Sexual contact with an infected partner

• Direct contact with open sores of an infected person

• From an infected mother to her newborn child during childbirth

• Sharing of injection needles among drug abusers

• Exposure to sharp instruments or needles contaminated with a Hepatitis C infected person’s blood, eg. acupuncture, body/ear piercing, tattooing, nail clippers or shaving blades

• Transfusion of unscreened blood and blood products

Hepatitis C cannot be spread through coughing, sneezing, breastfeeding, hugging, kissing or sharing of utensils.

Hepatitis C is diagnosed by blood tests for anti-HCV antibodies. There is no effective vaccine against Hepatitis C so prevention depends on reducing the risk of exposure to the virus in health care settings and in higher risk populations.

The Mycoplasma species are the tiniest bacteria known to man. There are about 200 different species, of which about 15 are known to infect humans. Depending on the type of species, they can infect different parts of the human body like the lungs, skin and urogenital tract. The routes of transmission vary accordingly. The Ureaplasma species also belong under the Mycoplasma family.

The strains that are known to affect the urogenital tract are Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum and Ureaplasma parvum. They are passed through sexual contact, and are associated with having multiple sexual partners.

These Mycoplasma and Ureaplasma infections may simply inhabit the urogenital tract and not cause any symptoms. If symptoms do develop, you may experience:

• Painful urination

• Irritation, itching or discomfort in the urethra

• Abnormal discharge from the penis or vagina

• In men: symptoms related to Prostatitis

• In women: pelvic pain and abnormal vaginal bleeding

Mycoplasma and Ureaplasma can be diagnosed by testing vaginal swabs or urine specimens. For women, vaginal swabs are more accurate. It is advisable to treat such infections if a patient is symptomatic. If a patient does not have any symptoms at all, then treatment is not necessary.

Trichomoniasis is a STI caused by a tiny parasite called Trichomonas vaginalis. This infection usually spreads through unprotected vaginal sex, i.e. from a penis to a vagina, from a vagina to a penis, or from a vagina to another vagina. It can also be spread by sharing sex toys contaminated with the parasite. It is not common for Trichomoniasis to infect other body parts like the hand, mouth or anus, therefore it is not usually spread through oral and anal sex. Also, it cannot be passed on through kissing or hugging.

Infection is more common in women than in men. In women, the most commonly infected part of the body is the lower genital tract (vulva, vagina, cervix, or urethra). In men, the most commonly infected body part is the urethra.

Only about 30% of infected people develop any symptoms of Trichomoniasis, which usually show up within 5 to 28 days from the time of infection. However, infected people without symptoms can still pass the infection on to others. It is unclear why some people with the infection get symptoms while others do not.

Symptoms of Trichomoniasis in men include:

• Itching or irritation of the urethra

• Burning or discomfort during urination or after ejaculation

• Discharge from the penis

Symptoms of Trichomoniasis in women include:

• Abnormal vaginal discharge (increased volume, thin or frothy, yellow-green in colour, which may also have an unpleasant fishy smell)

• Yellow-green vaginal discharge which may have an unpleasant fishy smell

• Pain during urination or when having sex

• Soreness, swelling and itching in and around the vagina

Trichomoniasis can be diagnosed by testing vaginal swabs or urine specimens.

Molluscum Contagiosum (MC) is a relatively common infection caused by the Molluscum contagiosum virus. The result of the infection is a mild skin disease characterised by lesions that can grow anywhere on the body. These lesions are small, raised, white, pink or flesh-coloured bumps that have a pearly appearance, often with a dimple in the centre. They are not painful, but may sometimes become inflamed and itchy.

MC is not exclusively sexually transmitted. The virus can be transmitted via direct skin contact or touching contaminated objects such as towels, toys or clothes, and the bumps can appear on areas such as the face, neck, torso or abdomen. In fact, around 9 in every 10 cases happen in children. However when MC appears on the genitals of adults, it is considered as an STI, and in such cases are spread as a result of close genital contact or sexual intercourse. If the bumps are scratched or injured, the infection can spread to surrounding skin.

MC is a benign, self-limiting condition that typically resolves within 6 to 12 months without residual scarring. Once the lesions are gone, the virus is eliminated from the body and the individual is no longer contagious. However, treatment to remove the lesions is usually recommended for adults because the lesions are very contagious. Treatment is also advised for those with weakened immune systems.