The next time you go to bed with your new partner, think about which other beds he might have shared before. HealthAnswers checks out the common but silent sexual diseases that plague Singapore women.

Dr Fong Yang
Gynaecologist

The incidence of sexually transmitted disease (STD) is not only on the rise, but the type of disease, the population that is affected, and the severity of the consequences are also changing. This is most likely a reflection of the early age of sexual activity in young girls these days, coupled with the larger number of partners they have, as well as the newer diseases that are infecting more modern women.

STDs in Singapore are beginning to resemble that of most developed countries in terms of the type of organism responsible. With the popularity of air travel, STDs are spreading faster than before, and treatment-resistance bugs are also transmitted faster across geographic boundaries and continents. A very good example is HIV, the virus responsible for AIDS. From its discovery in African green monkeys, its spread in the African continent and subsequent transmission worldwide has taken a mere two decades, something that was unheard of in the 1950s or 1960s.

In Singapore, the commoner STD encountered would include chlamydia and genital herpes. These may not be life-threatening, but they can compromise your reproductive health in the long run.

Chlamydia
Men and women who are infected usually do not have any symptoms, and are unaware that they have such an infection until they go for tests. Hence this STD can spread easily and quickly, infecting all sexual partners both directly and indirectly, through vaginal intercourse, oral and/or anal sex.

In women who do develop symptoms, they may complain of vaginal discharge, painful sexual intercourse or painful urination. If left untreated, chlamydia may affect the fallopian tubes (which bring the egg from the ovary to the womb for pregnancy to occur). In such women, the damage to the fallopian tubes may result in ectopic pregnancy (a life-threatening condition where the pregnancy is in the tube rather than the womb) or infertility (when the tube is totally blocked). Babies can catch this infection during vaginal delivery if the mother happens to be infected at the time of delivery; in these cases the eyes and lungs of the babies are usually involved.

Diagnosis is via special swab tests on fluid taken from the woman's cervix, or via special urine tests. Blood testing is not useful in diagnosing chlamydial infections.

Antibiotics are necessary for the treatment of this infection. However certain precautions have to be taken when treating women who are pregnant, or in children. It is also important to treat all sexual partners, in order to prevent re-infection after resuming sexual intercourse.

Genital Herpes
This is caused by the herpes simplex virus (type I or II), and is transmitted via vaginal intercourse or oral sex.

Women may not notice the initial phase of infection, and it usually happens without them knowing they have been infected. After the virus has entered the body, it may manifest days or years later with painful sores in the genital area (as genital herpes) or the mouth (as cold sores).

This may be associated with fever, body ache and swollen lymph nodes (glands). The sores will go away after 1-2 weeks, but the virus may remain in the body for the rest of your life, and may reactivate itself whenever the immunity of the body is low, for example after a bad flu, stress or even after menstruation.

This new appearance of sores does not mean a new infection, and is rather an indication of the presence of the virus in your system. The herpes virus can also be transmitted to your newborn baby during vaginal delivery if you have sores at that time.

Diagnosis is usually made from samples of fluid taken from the sores during an acute infection or reactivation. Blood tests are of limited use in most cases, as the virus remains in the body for a long time, and blood tests may simply reflect a previous infection rather than a current one.

Treatment is by way of anti-viral medication, either in the form of tablets or creams. Your doctor will be able to advise you on the appropriate form.

Genital warts are caused by the human papilloma virus (HPV), a different kind of virus. However it is also transmitted sexually, and has little or no symptoms in the early stages. In later stages, lumpy areas of skin may develop at the external part of the vagina. These are then known as warts, and are actually excessive growths of skin containing the virus. Like genital herpes, the virus may remain in your body for life.

Some forms of the HPV virus are believed to cause cervical cancer, which is why it is a good idea to go for Pap tests annually.

Other STDs
Although only chlamydia and herpes have been covered in this article, the other forms of STD are by no means rare, and can be equally damaging to a woman's general and reproductive health. STD like candidiasis (fungus), gonorrhoea, syphillis (bacteria), Hepatitis B (virus) and HIV (virus) are also commonly encountered in Singaporean women.

The Risk Of Multiple Infections
It is important to realise that several STD can be transmitted through one sexual encounter; this is usually the case rather than just one organism at a time. In other words, sex with a new partner may land you with chlamydia, herpes as well as HIV infections. Hence if you have sex with someone whose sexual history is unknown to you, or if you are uncertain if he has other partners (past or present), always insist that he uses condoms.

The contraceptive pill or calendar method do not protect you from STD; only barriers like condoms do. Furthermore, oral and anal sex also expose you to your partner's blood or body fluids, and are another source of infection. Hence you must always avoid coming into direct contact with his body fluids during sexual intercourse, whatever the route may be.

There are dangers lurking in every turn in the sexual roulette. It would be wise to remember HIV is still incurable, and that STDs can still affect your health in the future even if you have received treatment. Prevention may be your only ticket to any cure.

Date reviewed: 06 June 2000