Sexually transmitted infections (STIs) can be difficult to talk about and many people with symptoms delay or avoid seeing a doctor. There are many reasons for this, but the best results can be achieved when the topic is approached in an open and positive way.
I see many patients for sexual health screening, and one of the primary concerns raised is confidentiality. Some people believe that the government is notified whenever a person is diagnosed with an STI, which is not true. There are however, some valid considerations here which are worth outlining briefly.
Will you notify my insurer?
If you plan to claim for sexual health screening or treatment, then your insurer will wish to know your diagnosis. This is not an issue for many of my patients as most insurance policies have exclusions around STIs.
Will you inform the government?
Clinics and laboratories in Singapore have a duty to notify the Ministry of Health (MOH) about positive HIV results. However, there are clinics in Singapore that can offer this test confidently. Many other infectious diseases are notified to the MOH in order to monitor case numbers, but these do not include any personal information about the individual involved.
Will you notify anyone else?
Doctors have a duty to break confidentiality if they suspect a serious crime has been committed or if someone involved is in imminent danger.
Who gets tested?
The people I test for STIs fall into two groups; those who have symptoms or are concerned that they have been exposed; and those who feel well but undertake regular (normally 6-12 monthly) screening because they are sexually active or have a new partner.
Chlamydia & Gonorrhea
These are tow of the most common STIs and are often discussed together as there is considerable overlap of symptoms. Symptoms can show up any time from a few days to a few weeks after exposure and the common signs are burning on passing urine, discharge and frequent urge to pass urine. More serious cases can present with fever and abdominal pain (especially in women) it is possible to get these infections in the eyes, throat and rectum as well. Despite all this, many people have no symptoms at all!
There are some other infections which are less well-known which cause similar symptoms: trichomonas, mycoplasma and ureaplasma are some of the others. Generally, all these infections are tested for either with a swab or urine sample. They are all curable with antibiotics, although resistance is becoming an issue in some cases.
Herpes is incredibly common. Random blood testing has shown that around a third of people in many countries have been exposed, but only a small fraction of these will ever notice symptoms. There are two types of herpes virus, one causes cold sores around the mouth and the other causes similar sores in the genital area although there is some overlap between the two.
Symptoms can be variable but normally involve a visible blistering rash which develops into small painful sores which then scab and heal. Generally, the first outbreak of this rash is the most severe, and outbreaks diminish over time. Herpes is usually diagnosed based on its typical appearance but this can be confirmed with a skin swab.
There are antiviral medicines which can shorten the duration of a herpes outbreak and reduce the risk of infection to others, but there is no cure or vaccine yet. In my experience people can find this condition incredibly distressing but often feel much better after we have talked through all the facts and addressed some of their concerns, often based around reading they have done online.
Often mistakenly thought of as a disease of the past, syphilis is easy to treat with antibiotics if caught early. The classical sign is a painless ulcer, but this often goes unnoticed. Secondary symptoms include skin rash, swollen lymph nodes and fever. It is diagnosed with a simple blood test.
HIV and Hepatitis B/C
These are often referred to as blood-borne infections as sexual transmission is not the only way of catching them. These are potentially life-threatening conditions which can be present for many years without causing symptoms so it is important to get tested if you think you may have been exposed even if you feel well. Hepatitis C is now curable and hepatitis B and HIV are manageable conditions, but the best outcomes are in those who are diagnosed and treated early.
What can you do for yourself?
- Reduce your risk of exposure by practicing safe sex. Condoms are highly effective against most of the above conditions.
- Get tested. Sexual health screening is quick and painless and should not be a cause for embarrassment or shame. As doctors we have these conversations every day and will talk to you in an open and relaxed way about your concerns.