Mediclinic Al Sufouh
Knowledge Village - Dubai
Mediclinic Dubal Mall
Fashion Avenue - Dubai
Mediclinic Al Sufouh
Knowledge Village - Dubai
Mediclinic Dubal Mall
Fashion Avenue - Dubai
Knowledge Village - Dubai
Fashion Avenue - Dubai
Knowledge Village - Dubai
Fashion Avenue - Dubai
STD, or Sexually Transmitted Disease, is a recognizable illness developed from an infection transmitted through sexual contact. Bacteria, parasites, or viruses cause these sexually transmitted infections (STIs). We do not consider fungal infection (yeast infection) an STD because women, in particular, can get it not only after sex but also without having had any intercourse.
Symptoms depend on where the bacteria enter the body during sexual intercourse. The genital area is the most affected; symptoms might be itching, rash, wart, bump, and ulcer. However, it may involve the throat (sore throat) and the anus (anal discharge). When the infection occurs through the urethra, we may have yellow discharge and painful urination (dysuria). Sometimes symptoms are few and misleading. Even contaminated, non-symptomatic people might be carriers of infection.
STD test is essential to prevent the spreading of the infection by identifying contaminated people with no symptoms. However, an STD check is crucial in symptomatic patients to get an early diagnosis and prompt treatment. In this way, most STDs are curable without permanent complications.
This list includes STDs only (diseases caused by infection spread through sexual contact). Other conditions, including Zika, Ebola, and Monkeypox, can be transmitted sexually but are more often spread through ways other than sex. Also, we do not consider yeast infection (candida) as STD because it can arise without having sex:
Chlamydia is the most frequent bacterial STD in western developed countries. Most people with Chlamydia have no symptoms and don’t know they are infected. Others have symptoms even weeks after contact. People at risk should consider getting tested every year. DNA PCR testing through first-stream urine samples in men and vaginal swabs in females is accurate and reliable.
Any sexually active people can get Chlamydia. However, there are some higher-risk categories:
Some infections are not symptomatic. Common clinical manifestations of Chlamydia in men include urethritis, epididymitis, and vaginitis in females. Symptoms of chlamydia infection are:
Recent unprotected casual sexual intercourse in symptomatic persons is enough to raise suspicion of Chlamydia infection. However, since symptoms are similar to other sexually transmitted diseases, we need a specific test to differentiate Chlamydia. We submit the urine sample or the urethral swab in males and the vaginal swab in females. The Nuclear Acid Amplification Test can detect bacterial DNA even in small quantities. Therefore the Chlamydia test is sensitive and crucial to identify and treat those people who have no symptoms but they are still carriers of infection and can spread the disease among sexual partners.
Once the tested positive, we usually treat the patient with one azithromycin pill. The treatment is highly effective, and the symptoms do not last long. The relief is almost immediate the following day. We treat the sexual partner similarly because of the high infection risk. The patient must observe abstinence until symptoms subside.
Anyone sexually active can get Gonorrhea. If left untreated, Gonorrhea can cause serious complications, but we can radically cure it with the proper medication.
Similarly to Chlamydia, Gonorrhea is caused by bacterial infection of the genitals (urethra and vagina), rectum, and throat. Sexually active people spread Gonorrhea by having vaginal, anal, or oral sex with someone with Gonorrhea. A pregnant woman with Gonorrhea can give the infection to her baby during childbirth. Unlike Chlamydia, Gonorrhea is more common in developing countries where it is widespread, especially among young people ages 15-24. Chlamydia and Gonorrhea are the prevalent causes of urethritis in men and vaginitis/cervicitis in females. One is no worse than the other, and if left untreated, they do not go away on their own, might become permanent, and give complications in the long term.
Any sexually active people can get Gonorrhea. However, there are some higher-risk categories:
Symptoms depend on the site of infection. However, most people with Gonorrhea do not have signs, and they are potentially infectious. Symptoms of Gonorrhea are:
The diagnosis is easy when considering painful urination and urethral or vaginal discharge in a patient with a history of recent unprotected casual sex. However, most cases of Gonorrhea do not have symptoms. Therefore, higher-risk sexually active people who might be carriers of infection should be tested yearly and treated to prevent the disease from spreading among their partners. DNA PCR testing through first-stream urine samples in men and vaginal swabs in females and other infection sites is accurate, fast, and reliable.
Once the test detects Gonorrhea, we treat the patient with an injectable or oral antibiotic (Cephalosporin or Azithromycin). The treatment is highly effective, and the symptoms do not last long. The relief is almost immediate the following day. We treat the sexual partner similarly because of the higher infection risk. The patient must observe abstinence until symptoms subside.
HPV is the most frequent viral STD in developed countries. Many people get infected in their late teens and early 20s. Most sexually active people will eventually acquire at least one strain of the virus during their lifetime. Some HPV strain infections may progress into cancer. According to this risk, we distinguish between low and high-risk HPV strains.
HPV is one of the most common STDs. The main reason is that men infected with Human Papilloma Virus do not have any symptoms but can spread the infection through anal, oral, or vaginal sex. In those symptomatic people, the penile, anogenital, mouth, and throat warts are the visible sign of infection. Cancer may be a late complication. There is currently no approved test for HPV in men. There is no specific treatment for HPV. We can destroy genital warts with cautery or cryotherapy. We can now prevent HPV infection with vaccines.
We know about different types of HPV. Some of them increase cancer risk. The virus cannot survive alone for a long time outside the infected cells. Therefore, the infection is possible only during prolonged and intimate contact skin-to-skin or mucosa-to-mucosa. All kind of sex is at risk for disease.
Most new HPV infections occur in adolescents and young adults. Most sexually active adults have been exposed to HPV. However, new infections can occur with a new sex partner or when the patient has multiple partners.
After the contact, HPV can live inside the infected cells for months. The infection starts silent, and, in most cases, the competent immune system can eliminate the disease without the patient noticing. Most HPV infections are transient and asymptomatic and cause no clinical problems. In other cases, the virus survives and replicates, causing a wart, the typical skin or mucosal abnormality, the only visible sign of the viral infection.
Men and women have different expressions of the disease. In men, they can become visible to the human eye only after several weeks or months. They may be small. The top of the growths may look like a cauliflower. They may occur as a cluster of warts or just one wart. Rarely, however, genital warts can multiply into large groups in someone with a suppressed immune system.
HPV infection can cause changes in the body that lead to penile cancer in men if left untreated. Cancer develops very slowly and may not appear until years, or even decades, after HPV infection.
Any genital skin wart with a cauliflower appearance makes the suspect of HPV infection. However, warts may appear in the terminal part of the urethra and be partially or entirely hidden inside. In these cases, blood discharge could be a symptom.
The physical examination of the penile, scrotal, or pubic warts by a urologist, andrologist, or dermatologist is enough to diagnose the HPV infection. Warts have the typical appearance described above. Optical magnification helps diagnose microscopic warts hardly visible to the naked eye after treating the skin with trichloroacetic acid (penoscopy). The exploration of the terminal part of the urethra by gentle dilation of the terminal “hole” (meatus) is always recommendable to spot possible warts growing from the inside.
The only HPV test available is a Nuclear Acid Amplification Test (NAAT) which detects the viral DNA from the urethral swab.
No clinical antibody test can determine whether a person is already immune or still susceptible to any given HPV type.
The destruction of all visible warts is the only treatment to eradicate the virus. Laser, cryo-ablation, or electro-cautery are effective treatments. Radical treatment (destroying all macroscopic and microscopic warts) is crucial to eliminating HPV infection. We can highlight small warts or flat lesions not visible to the naked eye using trichloroacetic acid solutions and magnifying tools (penoscopy). Often, we need more than one session to complete the eradication treatment.
Topical creams have only limited use in the treatment of penile warts. While we need multiple applications, the results are not always curative, and the side effects can cause ulcers that delay healing.
Unfortunately, we do not know how long a person can spread HPV after treating the detectable penile warts. Long surveillance of both partners is advisable.
Prevention is the only reliable way to lower the risk of getting an HPV infection. Sexual abstinence is the best way to prevent HPV spread. The use of a condom may not give complete protection against getting HPV. It can infect the skin and genital areas not covered by a condom. HPV vaccines are safe and effective. They can protect men against warts and certain cancers caused by HPV. We should do vaccination before ever having sex. We do not recommend administering the vaccine after infection or after developing warts because it does not give tangible benefits—recommendations of the American advisory committee on immunization practices (2017).
If you or your partner have genital warts, you should avoid having sex until warts have gone or been removed. However, we do not know how long a person can spread HPV after the warts have gone.
HPV infections are usually temporary. A person may have had HPV for years before it causes health problems. If you or your partner are diagnosed with an HPV-related disease, there is no way to know how long you have had HPV, whether your partner gave you HPV, or whether you gave HPV to your partner. HPV is not necessarily a sign that one of you is having sex outside your relationship.
Herpes is a common viral STD caused by the Herpes Simplex Virus (HSV). It may affect the mouth (oral herpes or HSV type 1) or the genitals (genital herpes or HSV type 2). The HSV-2 infection occurs through direct contact with the genitals of an infected person. Through oral sex, herpes caused by HSV-1 can spread from the mouth to the genitals. This way of infection explains why some cases of genital herpes are due to HSV-1. Touch swab from skin sores is the sample for lab test when the disease is active. Since the HSV remains dormant in the body after infection, if you want to know if you have herpes, we should get a blood sample and test it for antibodies. The treatment is symptomatic only, and there are no vaccines.
Mycoplasma and Ureaplasma are considered emerging causes of STDs in developed countries. The infection occurs through the genitals (urethra and vagina), rectum, and throat, depending on sexual intercourse. The symptoms of the disease are burning or painful urination and urethral discharge. A person infected by Mgen but without signs or symptoms can transmit the infection. DNA PCR testing through first-stream urine samples in men and vaginal swabs in females is accurate and reliable.
Mycoplasma hominis is a common bacterium in almost all humans in the urinary tract. It is present in nearly everyone’s urinary tract in small quantities. Higher quantities cause the infection, which can be transmitted sexually. The symptoms of the disease are burning or painful urination and urethral discharge. However, in most cases, you can also have mycoplasma hominis and not experience any symptoms. Since Mycoplasma hominis can live in small quantities in the urethra or the vagina, even monogamous couples can suddenly experience mycoplasma hominis even after years of exclusivity. DNA PCR testing through first-stream urine samples in men and vaginal swabs in females is accurate and reliable.
Ureaplasma urealyticum is commonly found in the genital flora of most sexually active individuals (up to 70% of the sexually active population). Ureaplasma urealyticum often has no symptoms, and many infected people never experience any problems. The signs of infection are burning or painful urination and urethral discharge. If left undetected and untreated, ureaplasma urealyticum can cause infertility in females. Therefore, you should know your sexual health status and seek STI testing. DNA PCR testing through first-stream urine samples in men and vaginal swabs in females is accurate and reliable.
Although it is not considered a classic STD because of the low grade of infectious potential, Ureaplasma is a bacterium that can be transmitted through sexual contact. However, its role in STD seems to be only marginal.
Syphilis is a severe but curable bacterial STD. Who have syphilis must get tested for HIV because of the high incidence of concomitant infection. Infection may progress in stages (primary, secondary, latent, and tertiary) with different signs and symptoms. The transmission occurs when having sex with an infected person. Vaginal, anal, and oral sex have a similar risk of infection. Syphilis can also spread from a mother with syphilis to her unborn baby (congenital syphilis). We diagnose it with a specific blood test or testing fluid from a syphilis sore in the genital or anal area or the mouth. Early diagnosis and immediate antibiotic treatment are crucial for a full recovery. However, having syphilis once does not protect you from getting it again. The treatment of late stages is complex, and the results are uncertain when the complications have already occurred.
Trichomoniasis Vaginalis causes STDs frequently. This protozoan parasite causes the “trich.” The transmission occurs when having sex with an infected person. Vaginal, anal, and oral sex have a similar risk of infection. The parasite usually spreads during sex from a penis to the vagina or, the opposite, from a vagina to a penis. Vagina-to-vagina transmission is also possible. However, sometimes the parasite infects other body parts like the mouth, anus, or hands. The infection is still possible in a non-symptomatic person.
About 70% of people with Trich do not have any signs or symptoms. The symptoms resemble urethritis, with burning or painful urination, itching inside the penis, and penile discharge. Women with Trich may feel the same urinary irritative symptoms, pain during sexual intercourse, and a fishy smell discharge. Some people have symptoms within 5 to 28 days after infection. Symptoms can be recurrent. If left untreated, the infection can last for months or even years. Trich infection is a risk factor for other STDs. It means the infected person has an increased risk of getting another STD, HIV in particular.
DNA PCR testing through first-stream urine samples in men and vaginal swabs in females is accurate and reliable.
Trich is a fully curable STD. Your physician will prescribe a course of an oral antibiotic which is safe even for pregnant people. The infection does not develop a protective immune response. If the treatment eradicates trichomonas from the body, getting the disease again through sexual intercourse with the affected partner is always possible. This reinfection risk raises the importance of treating both sexual partners simultaneously. We recommend not having sex again until the complete treatment. Moreover, we recommend receiving confirmation testing again about three months after the treatment.
Chancroid is caused by the Haemophilus ducreyi, resulting in painful, superficial genital ulcers, often with swollen groin lymph nodes. Chancroid occurs in less developed countries and facilitates HIV transmission.
The symptom of Chancroid occurs 4-10 days after exposure. The typical sign is a skin abnormality in the genital area at the site of infection. Initially, a pustule breaks down to form a painful, soft ulcer with a necrotic base (dark color) and irregular borders. Sometimes, the skin lesions are multiple. We commonly see painful swelling in the groin (lymph nodes). In these cases, fever, chills, and malaise may also develop. Other possible symptoms of Chancroid include painful urination, vaginal discharge, rectal bleeding, pain with bowel movements, and pain.
PCR testing is not commonly available. Only selected labs can offer this test after swabbing the ulcer. This test is crucial to differentiate Chancroid from other ulcerative STDs like Syphilis, Herpes, and Lymphogranuloma Venereum because treatments differ.
Lymphogranuloma venereum (LGV) is an emerging sexually transmitted disease caused by variants of Chlamydia trachomatis (CT). We had known about this disease since 2003 when we registered an LGV outbreak among men who have sex with men (MSM). Since then, it has spread across other industrialized countries. MSM, unprotected sex, other concomitant undiagnosed STDs, and symptoms of proctitis (i.e., rectal pain, rectal discharge, bloody stools, constipation, and tenesmus) are risk factors for infection.
The rectum is sensitive to these Chlamydia Trachomatis infections. This predisposition is the reason why LGV affects mostly men having sex with men (MSM) and why the symptom of acute rectal infection (proctitis) is the most common clinical presentation. Anal sex also exposes women to getting infected. The rectal infection may mimic noninfectious inflammatory bowel diseases, like Ulcerous Rectocolitis, with mucoid or hemorrhagic rectal discharge, anal pain, constipation, fever, or rectal tenesmus (constant urge to pass stools). A common sign of LGV among heterosexuals is tender inguinal or femoral lymph node involvement (swollen groin or swelling of the proximal internal part of the legs), typically on one side only. The swollen lymph nodes can be severe, with the production of pus. Ulcerations are possible oral manifestations of this disease and might be associated with a swollen lateral neck (cervical lymphadenopathy). The genital ulcer is another possible picture with a self-limited ulcer or papule that sometimes occurs at the inoculation site. However, when persons seek care, the lesions have often disappeared. Persons with genital or colorectal LGV lesions can also experience an over-infection with other sexually and no sexually transmitted pathogens. LGV proctocolitis can be an invasive, systemic infection. If not treated early, it can lead to chronic colorectal fistulas and strictures that are hard to cure; physicians also reported reactive arthropathy (inflammation of the joints) in their patients. However, some patients may have no symptoms but remain highly infectious.
We can make a definitive LGV diagnosis only with LGV-specific molecular testing by searching for bacterial DNA in samples collected from the affected site (rectal, genital, and open inguinal lesions swabbing). However, these tests are not widely available, and results are not typically available in a time frame that would influence clinical management. Therefore, diagnosis is based on clinical suspicion and epidemiologic information, excluding other causes of proctocolitis, inguinal lymphadenopathy, or genital, oral, or rectal ulcers. Only a few equipped laboratories can make the test for the definitive diagnosis with results in a reliable time.
We treat Lymphogranuloma Venereum with at least three weeks of antibiotic treatment and drainage of inguinal abscesses. The treatment must start on the day of the first consultation, based on the clinical suspicion of LGV. The diagnostic confirmation will come later with the DNA test.
Granuloma inguinale (donovanosis) is a genital ulcerative disease caused by the intracellular gram-negative bacterium Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis). The disease rarely occurs in western developed countries; health authorities reported sporadic cases in India, South Africa, and South America. In Australia, where the infection was endemic, it became infrequent.
Clinically, the disease is characterized as painless, slowly progressive ulcerative lesions on the genitals or perineum without regional lymphadenopathy; subcutaneous granulomas (pseudobuboes) also might occur. The lesions have high vascularity (i.e., beefy red appearance) and can bleed. The infection can extend to the pelvis or intra-abdominal organs, bones, or the mouth. The lesions can also be over-infected with other sexually transmitted pathogens or other bacteria.
The Klebsiella-causing granuloma inguinale is complicated to culture, and diagnosis requires visualization of dark-staining Donovan bodies on the cells of infected tissues. Although no FDA-cleared molecular tests for detecting K. granulomatis DNA exist, molecular assays, like Nuclear Acid Amplification Test (NAAT), might help identify the causative agent.
Multiple antimicrobial regimens have been effective; however, only a limited number of controlled trials have been published. Antibiotic treatment has been reported to stop the progression of lesions, and healing typically proceeds inward from the ulcer margins. Prolonged therapy is usually required to permit granulation and reepithelialization of the ulcers. Relapse of the disease with ulcer recurrence is the primary concern and can occur 6–18 months after apparently effective treatment.
Phthirus pubis causes Pediculosis pubis (called pubic lice). Sexual contact with someone infested already can transmit the disease. Pubis pruritus is the primary patient complaint. We suspect Pubis Pediculosis in patients with typical symptoms of itching in the pubic region. We complete the diagnosis by observing Lice and nits on pubic hair. The treatment is topical by spreading creams or powders on the affected area.
Sarcoptes scabiei causes a skin infestation called Scabies. The primary patient complaint is pruritus, which is not directly related to the parasite or its products but to its immune response. At the first infestation with Sarcoptes scabiei, sensitization and then itchiness takes weeks to develop. However, pruritus might occur less than 24 hours after further recurrent infestation. Scabies is not an exclusive sexually transmitted infection. However, among adults frequently is sexually acquired, although Scabies among children usually is not. We diagnose Scabies when we identify burrows, mites, eggs, or the mites’ feces from affected areas. Skin scrapings can be examined under a microscope to identify organisms. Alternatively, skin examination using video dermatoscopy, video microscopy, or dermoscopy. Low-technology, cheaper, readily available strategies include burrow ink and adhesive tape tests.
Anyone sexually active can get an STD. We can prevent STDs through actions taken to decrease the chance of getting infected. Abstinence, vaccination, and condom use are the most effective prevention measures against STDs. It does not need complete sexual intercourse to get an STD. Skin contact only is the way of spreading Herpes and HPV.
Prevention works better if we identify who is at higher STD risk:
The most effective prevention is not to have sex (i.e., anal, vaginal, or oral). Abstinence and refraining from sex with multiple partners and instead opting for a monogamous honest, and trusted sexual relationship is the best way to prevent STDs. It is still crucial that you and your partner get tested and that you share each other your test results. Safe sex does not exist when it is made casually and with different partners.
With vaccination, we can safely and effectively prevent hepatitis B and HPV. Generally, this STD shot makes sense before being exposed to the virus. Therefore, we recommend preteens ages 11 or 12 (or can start at age 9) get vaccinated and everyone through age 26 if they still need to be vaccinated. We do not recommend vaccination for everyone after the age of 26. However, some adults aged 27 through 45 who are not vaccinated may get the HPV shot after considering the risks and benefits of vaccination. The benefits of immunization after 27 are uncertain because the older, the greater the risk of already being exposed to HPV. Hepatitis B vaccination is a standard at young ages in several countries. Just be aware of your vaccination status.
Mutual monogamy is an agreement of sexual exclusivity. With this agreement, two persons decide to be sexually active only with the sexual partner. Monogamous relationships with an uninfected partner are the most reliable ways to prevent STDs. But you must both be sure you are STD-free. An open and honest conversation between two sexual partners and getting tested is essential.
The constant use of the male latex condom is highly effective in reducing STD transmission. We must use condoms during all kinds of sex (anal, vaginal, or oral). In case of latex allergies, we recommend synthetic non-latex condoms. However, these condoms have higher breakage rates than latex condoms. We do not recommend natural membrane condoms or lamb-skin condoms.
It refers to doxyPEP, a day-after doxycycline pill that, if taken within 12 hours from exposure, can prevent Gonorrhea and syphilis only. The risk of increasing antibiotic resistance connected to frequent use is a severe problem that makes further infections hardly curable. Moreover, there is a risk that uninformed people resort to this pill without any prescription, thinking it generally prevents all STDs. In this way, most diseases continue to spread and cause complications.
Many people may have an STD without having symptoms. It means that casual sex out of a trusted and stable relationship is at a high risk of getting infected. When starting a new relationship, the couple should consider completing STD testing and treating non-symptomatic infections. This promising start of the relationship is the only way for a stable couple to eliminate any risk of having STDs.
For sexually active people, it is crucial to get tested for STDs to protect themselves and their sexual partners. However, an open and honest conversation about sexual history with a doctor and asking whether we should get tested for STDs is also essential.
The sample collection is the first stream of urine or urethral swabs in males, vaginal swabs in females, and blood samples, rectal and oral swabs in both.
We tailor the testing recommendations according to high STD risk:
If you are in Dubai and uncomfortable talking with your regular healthcare provider about STDs, you can only fill out this form anonymously with your contact details. I’ll refer you to a trusted laboratory where you can get tested and get the results in hours. If you need treatment, I’ll call you, assess your allergy status, and send the antibiotic prescription.
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