Commonly asked questions on STIs

  • Am I at risk after an unprotected sexual encounter with a new partner?
  • I have smelly discharge and my private part is itchy, what is the cause?
  • Why do I have some lesions on my private part?

What is STI?

Sexually transmitted infections (STI) are infections which spread from one person to another through sexual contact either through oral, vagina or anus contact. Organisms which cause STI include bacteria, parasites, yeast, and viruses. The most common organisms include:

  • Chlamydia
  • Gonorrhoea
  • Herpes
  • Syphilis
  • Trichomoniasis
  • Human Papilloma Virus (HPV)
  • HIV (AIDS virus)


Most STI may have no symptoms initially. Symptoms may appear after 2-3 weeks (known as the incubation period) and they include:

  • Painful passing water
  • Vagina or penile discharge (which may be smelly)
  • Pain during sex
  • Lower abdominal pain
  • Itch or discomfort in the penis or vagina
  • Swollen lymph nodes around the groin region
  • Warts (which can be small or in clusters)
  • Testicle discomfort (in men)
  • Bleeding in between periods (in women)

Photo of Genital Warts

Treatment of STI

It is important to make the diagnosis and treatment early to prevent the disease to spread because it can cause infertility to both men and women. If you have any suspicion that you may be affected by STI, see your doctor as soon as possible to get a:

  • thorough body check up
  • genital swab of the discharge
  • urine test
  • blood test


The only way to reduce the risk of STI is to either wear a condom or get tested before getting into a sexual relationship with a new partner.

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Measles is a very contagious infectious disease caused by the measles virus. It is so contagious that up to 90% non-vaccinated persons will get infected after being in contact with the virus. The symptoms usually develop 10–12 days after virus exposure and the disease can last between 7–14 days.

Symptoms of measles

  • High fever (often over 40 degrees Celcius) for around 4 days
  • Cough and runny nose
  • Conjunctivitis (red eyes)
  • White spots inside the mouth by the cheeks by the molar teeth (known as Koplik’s spots)
  • Red flat rashes which starts on the face and behind the ears 3-5 days after the onset of fever before spreading to the rest of the body (trunk, arms, legs and feet).
References. ,


  • Diarrhoea
  • Ear infection and deafness
  • Pneumonia and bronchitis
  • Brain inflammation (in around 0.1%) which can lead to fits or permanent brain damage
  • Even death (in around 0.2%)


There is NO medication available once the person is infected. Treatment is supportive care to prevent complications and make the person feel more comfortable.

  • Maintain good fluid hydration. This also helps the sore throat
  • Adequate pain relief (such as Paracetamol. Avoid Aspirin)
  • Tepid sponging may help make the child feel more comfortable
  • A humidifier to moisten the air may help a child breathe easier
  • Treat any opportunistic infection during this period
  • Watch out for serious complications such as pneumonia, ear infection and epilepsy. The warning symptoms are shortness of breath, drowsiness, fits or confusion


Image Source: Freepik

The measles vaccine is effective at preventing the disease and is often delivered in combination with other vaccines (such as MMR in Malaysia – read article on “Vaccination for Children”) in 2 doses three months apart (at the ages of 9 and 12 months of age in Malaysia). The Advisory Committee on Immunisation Practices (ACIP) recommends that all adult international travellers who do not have positive evidence of previous measles immunity to get 2 doses of MMR vaccine before traveling to high risk areas.

Prevention of spread

The virus spreads from saliva from coughing or sneezing by infected individuals and can stay alive for up to 2 hours in the airspace. An infected person can spread the virus from 4 days before through to 4 days after the rash appears namely a total of 8 days. As such, take the following precautions when looking after your infected child:

  • Avoid sharing drinks or food and utensils
  • Wear masks to limit virus spread from sneezing or coughing
  • Wash your hands after tending to your child
  • Disinfect frequently touched surfaces like door handles, table tops and toys
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Image Source: Kementerian Kesihatan Malaysia

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Dengue fever is a mosquito-borne virus infection caused by the Aedes Aegypti mosquito with its characteristic white stripes on its black body.

The incubation period (known as the time from being infected by mosquito bite to onset of symptoms) may be between 3-14 days (average 4-7 days). Most people affected with dengue have symptoms such as high fever and mild aches which recover within 4-7 days. However, around 5% get more serious symptoms which may be life-threatening and require hospitalisation. The infection can result in a reduction in blood platelets thereby causing the body to bleed (hence the term dengue haemorrhage fever).

Mild symptoms

  • Headache
  • Muscle and joint aches
  • Skin rash (which blanches on pressure using your hand)
Warning signs

  • Diarrhoea or vomiting (more than 3 times a day)
  • Abdominal pain
  • Fluid accumulation with breathing difficulty
  • Nose or gum bleeding
  • Gut bleeding
  • Drowsy (due to brain swelling)
  • Lethargic and feeling tired (due to bleeding or low blood pressure)
  • Abnormal liver function causing tender liver
  • Reduced urine output
  • Petechiae (small dot haemorrhages on the skin)


There is NO specific anti-viral medication for dengue. Treatment is supportive and is aimed at:

  • Maintaining adequate fluid balance (ideally fruit juice, barley or isotonic drinks such as 100-plus)
  • Making sure the patient is able to pass urine (normally should be 4-6 times daily)
  • Having adequate bed rest to help the body recover
  • Tepid sponging helps to make the patient feel more comfortable
  • Taking Paracetamol for fever and muscle aches (AVOID aspirin or NSAIDs such as Nurofen as this may aggravate risk of bleeding)
  • Avoid massage or cupping on the body

If the patient has evidence of bleeding, low platelets count, feeling dehydrated or weak, he/she should be admitted to hospital for close observation and daily blood tests to monitor the situation because the clinical profile may change from day to day.  The patient may need:

  • Intravenous hydration
  • Platelet or blood transfusion if there is anaemia or very low platelets in the body


  • Look for breeding places around the house and eliminate them
  • Have the patient rest under mosquito net to prevent spread to other members of the family
  • Report to the authorities so that fogging can be done around your housing area

Blood Test

Blood test looking for antibodies produced by the body against the dengue virus remains the most reliable way to diagnose dengue fever. Your doctor can perform the blood tests for dengue diagnosis and to check your blood and platelet level as well as kidney and liver function tests. These tests may need to be taken several times to monitor the disease progression. See your doctor asap if you suspect you may have dengue fever.

References: WHO,, Philippine Central Info Negros

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Most pimples and acne resolves spontaneously after puberty, but there are still people (usually women) who have acne as adults. Many adults do develop very mild and isolated outbreak of pimples but are not permanent in nature.

Why do you need professional treatment?

Non-inflammatory and mild inflammatory acne usually heal without scarring but moderate to severe inflammatory acne often leave scars, pigmentation or pitting lesions. The sooner you see your skin doctor, the less chance you will have of getting these complications.

Image Source: Freepik


  • Keep your face clean by maintaining a regular face cleaning regime. Stick with a mild and non-perfumed brand of cleanser. Don’t scrub your face too hard because that might make it worse! (read Pimple and Acne: What are they?)
  • Tie up your hair to prevent it from touching your face
  • Avoid heavy make-up which can clog up your skin pores. If you do use make up, remove thoroughly at night or look for ‘non-comedogenic’ make up to reduce clogging
  • Try not to pick your whiteheads or pimples as this can cause infection and pustule formation
  • Stop smoking or avoid smoky and dusty areas
  • Do regular exercise as sweating helps to clear the pores on a regular basis
  • Swimming is also good as chlorine in the water helps to dry up the skin
  • Avoid unhealthy diet high in sugar, oily greasy foods and refined carbohydrates

 Treatment of pimples and inflammatory acne

Image Source: Getty Images

Treatment of acne involves a combination of topical and oral medication directed at reducing sebum production, inflammation and bacterial counts. The patient must also be prepared to have lifestyle & diet modifications as well as perform regular cleansing regime.  Adherence to the treatment plan and regular maintenance follow-up with the doctor is important for success.  Remember that acne cannot be completely cured so it is important to have regular follow-up.

The oral medication is strong and has side-effects. You need to see your doctor to plan your treatment and maintenance regime for the best outcome for moderate to severe acne.  The earlier you seek treatment, the less risk of getting acne scarring and skin pigmentation or pitting associated with acne.

1) Mild inflammatory acne

Use topical antibiotic or benzoyl peroxide cream for isolated lesions (see below)

2) Moderate acne

One course of oral antibiotic (such as Tetracycline, Minocycline, Doxycycline and Erythromycin) plus topical therapy

3) Severe acne

Oral isotretinoin plus topical therapy

4) Cystic acne

Intra-lesional triamcinolone injection

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How common is acne?

Acne is so common that it is affects almost all of us at least once in our life especially on our face.  About half of us will experienced acne on our back while acne on the chest and scalp is not so common (around 10-15%).

How a pimple forms

  1. People with acne have excess oil (sebum) production
  2. There is keratinocyte (skin cells) hyper proliferation at the hair follicle opening (pore)
  3. Propionibacterium multiples in the blocked pore
  4. Finally results in inflammation and disruption of skin barrier

Image Source: Amathair

In the early stage, a blocked gland due to plugged congealed oil or skin cells results in a whitehead. When this oil plug gets exposed to air, it becomes darker into brown or black, hence the term blackhead. Both whitehead and blackhead are non-inflammatory and not painful.  A pimple forms when bacteria gets inside (due to poor hygiene or using fingers to pick the pimple) resulting in inflammation and swelling.

Types of acne lesions which can be found

  • Comedones
  • Papules (small inflamed bump)
  • Pustules (pimple with pus at the tip also known as ‘zit’)
  • Nodules (large solid painful lumps)
  • Cystic lesions (painful pus-filled lesions)

Common sites for pimples

Acne typically appears on your face, forehead and nose (the typical T-zone). It can also occur on the chest, upper back and shoulders as well as the scalp.

Factors which worsen acne

  • Hormones produced during puberty in teenagers cause the sebaceous glands to enlarge and produce lots more oil. Hormonal changes during pregnancy, menopause or while taking oral contraceptive pills can cause pimples too
  • Medications such as steroids and testosterone can cause pimples
  • Unhealthy diet rich in refined sugars or fat, carbohydrate-rich foods and milk aggravate acne in some people. Fried or greasy foods, shellfish or nuts not proven but try to avoid
  • Stress can cause acne because of the stress hormones released in the body
  • Not removing make up from your face results in blocked pores


  • Keep your face clean by maintaining a regular face cleaning regime. Stick with a mild and non-perfumed brand of cleanser. Avoid skin products which block skin pores
  • Tie up your hair to prevent it from touching your face
  • Try not to pick your whiteheads or pimples as this can cause infection and pustule formation
  • Stop smoking or avoid smoky and dusty areas
  • Do regular exercise as sweating helps to clear the pores on a regular basis
  • Swimming is also good as chlorine in the water helps to dry up the skin
  • Avoid unhealthy diet high in sugar, oily greasy foods and refined carbohydrates

Source: ,

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Hiruscar Anti-Acne Pore Purifying Cleanser

Salico Acne Foaming Cleanser

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Constipation is defined as abnormally delayed or difficulty in defecation (bowel opening). If your child continues to have symptoms despite changing the diet, modifying the lifestyle and increasing fluid intake (see previous article Constipation in Children – What Is It?), then your child may need treatment.

Treatment of childhood constipation

Around 97% of cases of constipations are functional which can be managed using the by modifying their diet or with medication if required as directed by your doctor. Rare causes of constipation due to structural gut abnormalities such as anal stenosis or imperforate anus, anal tear (fissure) or Hirschprung’s disease require surgical intervention by a paediatric surgeon. Neurological disease such as spinal bifida or cerebral palsy can also cause constipation.

Medication options

  1. Faecal softeners such as DUPHALAC, LACTUL & FORLAX work by drawing fluid into the faeces making it soft to pass out. Take the medication as directed by your doctor or pharmacist.




  1. Suppository such as DULCOLAX works by softening impacted stool at the rectum. Take the medication as directed by your doctor or pharmacist.



Once the cycle of constipation is treated successfully, you still need to encourage your child to change the habit and lifestyle to prevent recurrence by following these principles:

  • Increase fluid intake
  • Increase dietary fibre and avoid fatty, sugary or starchy foods
  • Avoid sweet drinks before meals
  • Encourage your child to exercise (avoid being sedentary)
  • Develop a regular meal schedule
  • Get the child to have regular bathroom breaks
  • Encourage your child not to be frighten of going to the toilet

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