Sexually Transmitted Diseases

Sexually Transmitted Diseases

We are a clinic catering to Sexually Transmitted Disease testing and treatments in Johor. STDs are infections that are passed from one person to another during vaginal, anal, and oral sex. They’re really common, and lots of people who have them don’t have any symptoms. STDs can be dangerous, but the good news is that getting tested is no big deal, and most STDs are easy to treat.

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What is a Sexually Transmitted Disease (STD)?

Sexually Transmitted Diseases are a group of bacterial, viral, or fungal infections that are transmitted via sexual activity and they may cause many embarrassing moments and can be fatal in some cases. Another term for Sexually Transmitted Diseases (STD) is Sexually Transmitted Infections (STI). STDs are very common with the changes in social habits and activity, therefore accurate diagnosis and finding out the problem is important.

How do I know if I have Sexually Transmitted Disease (STD)?

Symptoms for Sexually Transmitted Disease (STD) varies from one person to another; there are some instances that some people are totally oblivious to the symptoms of Sexually Transmitted Disease (STD).

Everyone expects to see pus discharge, itching or ulcers at their private parts when they are infected with Sexually Transmitted Disease (STD). Nevertheless, you can have Sexually Transmitted Disease (STD) without any symptoms. It is important to anticipate the possibilities of sexually transmitted infections based on an individual’s sexual risk.

What increases my risk of acquiring Sexually Transmitted Disease (STD)?

Before one determines their risk, they have to ask themselves about their own sexual practices. Different sexual practices and sexual preferences can influence the risk of Sexually Transmitted Disease (STD) for example sex without condoms or sex workers.

Many people have a misconception about condoms.

In my clinic, I have done a survey regarding the assumption can condoms total prevent Sexually Transmitted Disease (STD) and based on my survey about 80% of my patients agree that condoms can totally prevent Sexually Transmitted Disease (STD). This assumption is untrue.

Most Sexually Transmitted Disease (STD) are transmitted via contact, namely sex. Condomless sex is, of course, going to increase the possibility of acquiring Sexually Transmitted Disease (STD) directly with possible infection. Condoms just act as a barrier but the failure of the condom can occur throughout the entire process of using a condom.

Steps and processes of condom usage can range from donning the condom, removal of condoms, and hygiene practices after sex. A slight mistake in the steps required can cause the condom to lose its integrity against Sexually Transmitted Disease (STD). This is the tip of the iceberg in determining your risk of contracting Sexually Transmitted Disease (STD).

Men to men sexual intercourses are of higher exposure risk. Is it because men are more prone to getting Sexually Transmitted Disease (STD)? Well, there are a few studies that have debunked the current assumption that men are more promiscuous than women. New census and surveys have been shown that women are more promiscuous, however, this is a study is conducted in America (USA), and cannot be assumed that Malaysia or Asia has the same statistics as America (USA).

Engaging with sex workers as opposed to a random hook-up or an acquaintance may increase the risk of Sexually Transmitted Disease (STD). I do not mean to be stereotypic but logically sex workers deal with many clients and some of their clients may carry some Sexually Transmitted Infections (STI). The more often sex is performed, then the higher the possibility of acquiring some sexually transmitted infection (STI). I have also come across some sex workers who told me that if they have clients who “last too long” because the condom reduces the man’s sensitivity to stimulation, therefore, prolonging the sexual service before ejaculation. In such cases, the sex worker may remove the condom and attempt to make their clients ejaculate faster in order to finish the service faster. Needless to say a random hook-up or having sex with an acquaintance does not mean that they are cleaner or have lesser risk as compared to a sex worker.

It may be vice versa because most sexually active men or women may have never done or do not test themselves frequently for possible Sexually Transmitted Disease (STD), therefore they may be carriers of infection without them knowing. Sex workers, on the other hand, get themselves tested 1 to 2 months once. The highest risk of acquiring Sexually Transmitted Disease (STD) is not based on whether they are sex workers, random hook-ups, or acquaintances. The highest risk of acquiring Sexually Transmitted Disease (STD) is when people are unaware, oblivious, ignorant and assume that they do not have Sexually Transmitted Disease (STD).

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What are the types of Sexually Transmitted Disease (STD)?

There are many types of infections that cannot be discussed here as they are extensive and impossible to cover in this article. I would advise that you should discuss with your doctor who is trained in the arts of Sexually Transmitted Disease (STD).

So let me classify the groups of STDs available and which are commonly found.

How to test for Sexually Transmitted Disease (STD)?

Testing and diagnosis are not difficult but deciding on the best time, appropriate testing, treatment, and method to collect samples make testing and diagnosis of STD difficult. Simply withdrawing blood or sending urine for testing is the easy part. The art which an STD doctor practice is to determine the best time to take the sample, where to take the sample, how to take the sample, and why the sample is required. I have patients whose tests were negative while they were having symptoms. It is possible to be symptomatic but that does not mean you have to be positive on the lab test.

The art of testing and deciding on which tests are useful in detecting specific Sexually Transmitted Disease (STD) will determine a full-proof plan inpatient care and treatment. An STD doctor has to anticipate the possible infection they are up against to ensure that you get good efficacy.

First, you need to understand the specific bacteria’s or virus’ mode of transmission. If you do not understand the mode of transmission of the bacteria or virus; then you will not understand the proper test required.

Most of my patients always ask for a comprehensive Sexually Transmitted Disease (STD) test and they assume that a blood sample is enough to test for all sorts of Sexually Transmitted Disease (STD). It has been a norm that most clinics and also laboratories to have test packages for HIV, Hepatitis A, Hepatitis B, Syphilis, gonorrhea, and chlamydia in a blood sample. I will agree to do a blood test for HIV, Hepatitis A, Hepatitis B, and Syphilis, however, I disagree with gonorrhea and chlamydia testing through blood because gonorrhea and chlamydia are not found in the blood unless we are dealing with sepsis.

HIV, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E are transmitted via blood whereas Hepatitis A is infective via the fecal-oral route and it can show up finally in the blood, therefore, these infections can be detected via withdrawing of blood. Syphilis, on the other hand, is different. Syphilis is infective via skin to skin contact and blood contact however the endpoint is that syphilis will still turn up in the blood. Syphilis is caused by a spirochetes bacteria called Treponema Pallidum which has flagella (fins) around the bacteria; these fins make the bacteria mobile and able to swim through the skin. The initial form of syphilis is called primary syphilis which can result in ulcers at the private parts and during this phase, it is possible that syphilis is still not found in the blood yet. The best way to test for syphilis during the earliest part of the infection is to get a swab sample of the ulcer to pick up the bacteria from the skin and view it under a dark field microscope.

Your doctor must also understand the life cycle and also the incubation period of the bacteria and virus. If you are tested to be negative you need to know that if you have tested yourself during the incubation period, then you may probably need to retest again later.

What is the Incubation Period? The incubation period is a time frame when the bacteria or virus has infected the person but still does not elicit any symptoms and cannot be tested as the virus or bacteria is just too low to be detected.

Other infections like gonorrhea, chlamydia, mycoplasma, ureaplasma, trichomonas, Human Papilloma Virus, and Herpes should be tested via swab test with proper technique in order to obtain the best sample and result. If you do not get proper samples then the results may mislead your doctor and patient.

What happens if your test turns out to be negative despite having symptoms? You may have a false-negative test if the sample is taken incorrectly or testing errors. Usually, we will retest again if indicated to be sure. In my clinic retesting may be free if the criteria indicate an error. This is my additional bonus for coming to me!

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What are the treatment recommendations for Sexually Transmitted Disease (STD)?

There are many things taken into consideration when initiating treatment for STD:

Type of medication. There are multiple studies done regarding treatments that are specific to each type of STDs. Some medications fair poorly and some do better than others. Take for example Syphilis: Penicillin Benzathine G 2.4MU has shown that it is superior to Ceftriaxone and Doxycycline.

In a certain group of my patient who cannot tolerate Penicillin due to allergies, therefore, I may be forced to still use Rocephine or other drugs instead of Penicillin. Once I had a patient who had allergies to an unknown antibiotic. In this case, I had to do an antibiotic allergy test before the injection. This allergy test was life-saving because the high dose of Penicillin would have put him into a state of anaphylaxis and ultimately would have killed him. With this allergy test, I evoked a small allergic response which was localized to only his skin. As a result, I decided to give him Rocephine as the treatment of choice.

It is my duty to ensure that I decide on the best antibiotic for you after taking into account possible side effects and allergies. In another scenario is you can see many clinics giving out Ciprofloxacin which is alarming. Ciprofloxacin is a fluoroquinolone group of antibiotics which in a few studies has cautioned its usage as it tends to cause antibiotic resistance. I usually avoid giving Ciprofloxacin to my patients as I have had a few experiences with it.
The dose of medication.
Your doctor needs to understand the basics of pharmacology like timing to initiate treatment and understand the clearance of the drug in the body. When taking your medication always remember the rule about medication dosing, “fast-acting mean short-acting” or “slow-acting means long-acting”. This means that drugs that require frequent dosing may act fast but does not last long in the body or vice versa.
Take for example Clarithromycin IR 250mg (IR showing Immediate Release) which is taken twice a day as compared to Clarithromycin MR 500mg (MR showing Moderate Release) which is taken daily. The Clarithromycin IR 500mg starts acting within 2 hours and the Clarithromycin MR 500mg requires about 6 to 10hrs to start acting.

If you have pus discharge, you would naturally want to have a quick resolution, therefore, I would choose Clarithromycin IR 250mg over Clarithromycin MR 500mg. When using Clarithromycin IR 250mg effect and resolution of symptoms occur fast as compared to Clarithromycin MR 500mg but Clarithromycin MR is easier to consume as it is once a day. It does not mean that Clarithromycin IR 250mg is superior to Clarithromycin MR 500mg as both have the same endpoint of total cure but the resolution of pus discharge may be faster in the normal Clarithromycin IR 250mg. There was a comparative study that both Clarithromycin IR and MR also have rather similar curative rates however based on my experience Clarithromycin IR may be faster in the resolution of initial symptoms.
The duration of treatment makes a world of difference in terms of efficacy. There are many recommendations about the duration of treatment and they are constantly updated. The duration of treatment depends on:
- Type of Bacteria. Some bacteria have structures that are susceptible to certain antibiotics therefore your doctor needs to think hard before initiating treatment.
- Mycobacteria Tuberculosis is a slow-growing bacteria and many people never experience any symptoms until many months later. Mycobacteria Tuberculosis can grow to about 32,768 bacteriae in a month as compared to E Coli which is 68,719,476,636 bacteriae in a day.
- The course of treatment for Mycobacteria Tuberculosis is about 6 months whereas E. Coli will be about 5 to 10 days. It does not make much sense right? The amount of E. Coli is much more than Mycobacteria Tuberculosis but Mycobacteria Tuberculosis requires a longer duration of antibiotics.
- Longer treatment is required for Mycobacteria Tuberculosis because antibiotics work only when the bacteria are actively dividing (replicating), and Mycobacteria Tuberculosis can rest (dormant) without growing for long periods. This treatment is necessary to keep the latent TB infection from developing into an active disease. Therefore, the type of bacteria plays an important role in the treatment and course of action.
Bacteria Resistance. Resistance is seen as nature's law of survival of the fittest. A study was conducted on E. Coli to investigate the rate of E. Coli gaining resistance. The bacteria is placed on a dish with nutrient agar on opposite sides of the dish. A quadrant from the periphery to the central is drawn up and each quadrant is saturated with different types of antibiotics from the lowest to the strongest strength. The bacteria are studied to determine the rate of the bacteria gaining resistance against antibiotics.
Location of infection. Based on the location of the infection, the duration of antibiotics may differ. Usually, brain infections may require 14 to 21 days of antibiotics as compared to urinary infections which, may require 7 to 14 days course. It also the duration will be based on the type of antibiotics used.

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What can I do if my Sexually Transmitted Disease (STD) becomes drug-resistant?

Sometimes STD bacteria, virus and fungus becomes resistant to treatment, then we need a contingency plan to ensure you are properly treated with the right drugs, right dose, right duration, right route, and right timing. I have had multiple situations with bacteria, viruses, and fungal resistance; most of them require a lot of patience and anticipation in terms of more specific treatment and testing to ensure that my patient gets the optimum result. Testing like cultures usually can help to detect which are the most suitable antibiotics but it is impossible to detect every type of pathogen, therefore you can only discuss with your doctor who is well versed with STD.

PEP (Post-Exposure Prophylaxis Against HIV)

PEP (Post-Exposure Prophylaxis Against HIV)

Sexually Transmitted Diseases

Sexually Transmitted Diseases