Sexually Transmitted Diseases (STD's)

The most common health ailment that afflicts expats and tourists is a sexually transmitted disease.

gonorrhea     chlamydia     non-specific urethritus (NSU)

genital warts     mollusca ("the clam")     herpes     syphilus

HIV     Hepatitus B     Hepatitus A     getting drugged

Trichomoniasis (Trich)

Trichomoniasis, often called just "trich" (pronounced "trick"), has become the most common sexually transmitted disease in many countries, including the USA where estimates put it at 7.4 million new infections per year. In some southeastern Asian countries, it is approximately twice as common as gonorrhea, and five times as common as chlamydia and syphilis.

The symptoms are much worse in women, and sometimes asymptomatic in men, but can be similar to gonorrhea -- urethritis, burning when urinating, and discharge of green or yellow pus. Condoms can prevent transmission.

Trich is a single-celled protozoan parasite. An infection is diagnosed by taking a sample from the urethra just inside the penis, or the vagina, and looking for trichomonads under a microscope. Trichomonads can survive outside the body for up to about 45 minutes.

Treatment is usually with Metronidazole. Treatments with other drugs used for other sexually transmitted diseases may not work.

Like with other sexually transmitted diseases, HIV is transmitted more easily when there is also a trich infection.

Gonorrhea ("the clap")

Gonorrhea is a bacterium that is very easily picked up by sex without a condom. The bacterium transfers easily and is tough.

(As an experienced doctor in Bangkok put it, the two most common cases he gets are diarrhea and gonorrhea.)

Protection from female to male transmission is nearly 100% by condom use, though vice versa may not be the same due to easy semen leakage around the edges. It can also be transmitted by oral sx, and anal infections are common, as are throat and eye infections.

Symptoms usually occur in one to three days, starting with a small yellow discharge that stains the underwear, and quickly progresses to major discharges. This may come before or after painful urination. However, symptoms can sometimes take 10 days or more, and there are cases of asymptomatic gonorrhea whereby the body keeps the bacterium enough at bay to prevent overt symptoms.

The doctor may look at the discharge under a microscope to verify that what you have is gonorrhea. It could also be chlamydia or non-specific urethritis (NSU) as discussed in another section.

There are now just a few drug treatments for gonorrhea, due to antibiotic resistant strains, especially in Asia.

In the 1990s and early 2000s, the most common drugs used were quilones, such as ciprobay, cifloxacin, and various others of this class. Unfortunately, a large percentage of strains of gonorrhea have become resistant to these.

For example, in London in 2005 about 42% of gonorrhea was resistant, but it was less in the USA, typically between 10-20% in large cities. In Philadelphia, it shot up from 1% to 26% in just two years. Resistance has been higher in Asia for a long time on average than in the USA, and it's thought that these antibiotic strains came to the USA from Asia via California.

Nevertheless, I still hear of guys trying to treat themselves with these drugs, and even citing doctor prescriptions of them!

Gone-o-rhea:

As of 2007, a single oral tablet of 400 mg of Cefixime or Cefpodoxime (branded as Vantin) normally cures gonorrhea. Both of these drugs belong to a different class of antibiotics known as cephalosporins. It's normally that simple. You can take them with or without meals, but with a meal appears better.

(I've even heard of unfaithful guys grinding up and slipping this into the food of their girlfriend to secretly cure them.)

You can also take 2 grams (!) of Azithromycin at one time (e.g., four 500 mg tablets) if you can stomach it, which is another single dose remedy. Azithromycin is more common around the world than the other two drugs of 2007. Azithromycin will also knock off Chlamytia (see below, often found with gonorrhea). Take Azithromycin 1 to 2 hours before a meal.

Many hospitals will give you a shot of a cephalosporin. It can be painful, but it's usually unnecessary in view of the oral options.

There should be no consumption of alcohol and no sex or ejaculation (since the sugars in the ejaculate feed the gonorrhea bacteriums) while being treated.

With some treatments, the symptoms usually disappear within a day after the shot or oral treatment, but that does not mean the gonorrhea is gone. If your doctor gives you a pill regimen, then you must take the rest of your antibiotics or else you may have a relapse and develop an antibiotic resistant strain. I strongly suggest you look up your drugs on the web to make sure the doctor has kept up with the latest on gonorrhea and drug resistance.

A friend of mine got a prescription from a doctor in a major foreigner-oriented hospital that was a short regimen of a particular antibiotic which, when we checked it on Internet, was noted as not recommended due to strains of gonorrhea in southeast Asia which are resistant to this particular kind of antibiotic, and this had been the situation for many years already.

The treatments that doctors prescribe have varied over time and from doctor to doctor. This may be partly to avoid additional antibiotic resistant strains.

You should inform all partners with whom you've had sex within the few days prior to the onset of symptoms so that they can be checked and, if necessary, treated. The symptoms in women are not painful, but mainly odor and sometimes a discharge, but if untreated will cause pelvic inflammatory disease (PID) and sterility. HIV is much more easily spread in the presence of inflammatory STDs such as gonorrhea. Pregnant women can easily transmit it to the eyes of their baby during delivery, which can cause a severe eye infection and blindness.

If you've gotten gonorrhea before, you don't have resistance to it. Once you go off the medication, you can get it again.

The best site I've found to date on gonorrhea is the U.S. National Institute of Health's web page at http://www.niaid.nih.gov/factsheets/stdgon.htm

Chlamydia

Chlamydial infection is caused by a bacterium, Chlamydia trachomatis. Like gonorrhea, it's easily transmitted by sex without a condom, including oral sex and anal sex. Unlike gonorrhea, a chlamydial infection usually has no symptoms, or else very mild symptoms.

Chlamydia is the most common STD in the U.S. caused by a bacterium.

The symptoms of a chlamydial infection are usually slight pain during urination or a slight discharge, early in the infection, usually within one to three weeks after infection. Many people have no symptoms. For those who do, the symptoms usually go away until the disease reaches an advanced stage and causes inflammation and pain around the testicles or in the female reproductive system or swelling of the lymph nodes. By then, if not treated soon, the female or the male may become sterile.

A pregnant woman can easily pass the infection on to the eyes of her baby during delivery, causing a serious eye infection and possibly blindness. Chlamydia may also show up as pneumonia in the baby within 3 to 6 weeks of birth.

To determine whether you have a chlamydia infection, the doctor needs to take a smear from the urethra of the man or the vagina of the female and perform tests. It should be determined whether what you have is gonorrhea or chlamydia or non-specific urethritis (NSU), or a combination thereof.

A simple regimen of certain antibiotics usually knocks off chlamydia, such as doxycycline 100mg twice daily for seven days. Alternatively, 1 gram (e.g., two 500 mg tablets) in one dose may be enough to knock off chlamytia.

The best site I've found to date on chlamydia is the U.S. National Institute of Health's web page at http://www.niaid.nih.gov/factsheets/stdclam.htm

Non-Specific Urethritis

Some people get pain and inflammation of the urethra or other organs within a few days or a few weeks after unprotected sex (especially with a commercial sex worker), which may not be caused by any of the above.

There are other known bacteriums which are categorized as sexually transmitted diseases, but no particular bacteriums stand out in the case studies. It is often difficult to identify the particular bacterium or organism at work.

All of these cases come under the category of "non-specific urethritis" or "NSU".

Without treatment, NSU which is not one of the above infections usually clears up in a matter of a few days to a few weeks, but in some cases drags on for months.

A strong, broad spectrum antibiotic is sometimes applied, but it's always risky to apply antibiotics to an unknown biological entity.

The most common treatment for NSU is the same as for chlamydia, such as 100 mg of doxycycline twice daily for seven days.

Genital Warts

Genital warts are one thing that a condom often won't protect you against, especially female to male transmission. They are also one of the most prevalent STD's, and the most prevalent viral STD in the U.S.

Genital warts will grow practically anywhere -- on skin or in mucous membranes. They are caused by the human papilloma virus, or HPV. There are more than 50 different types of HPV, with different characteristics.

In females, HPV can cause cervical cancer, especially if the female has been exposed to the herpes virus, too. Females diagnosed with genital warts are advised to have Pap smear checks every three to six months for early detection of cervical cancer.

Small genital warts can be removed by persistent application of certain acids, or surgically cutting them off or freeze-burning them off, depending upon the location and/or size of the wart. A user reports that Bumrungrad will burn them off fairly painlessly and quickly with a laser, and that it will completely heal in a week, and his bill was just under 5000 baht.

The best web source I've been able to find to date is: http://health.yahoo.com/health/Diseases_and_Conditions/Disease_Feed_Data/Genital_warts/

Trichomoniasis ("trich")

Trichomoniasis, also referred to by its slang name "trich", is caused by infection with a single-celled, flagellated protozoan parasite, Trichomonas vaginalis. It's common.

Men usually have no symptoms, but it can cause tingling inside the penis, some pain during or after urination, and occasionally a penile discharge. In women, symptoms are similar but worsen during menstruation. Trich is a danger to pregnancy.

Trich is easily knocked out by antibiotics, often a single oral dose of metronidazole (Flagyl).

Chancroid

Chancroid is caused by a bacterium, pronounced "kain-kroid". It is common in tropical areas where hygiene is poor, but not very common in Thailand in general. You're especially vulnerable if you have any small scratches, cuts or open sores.

Chancroid causes bumps and sores which eventually fill up with pus and break open. From there, it may infect lymph nodes, which can in turn cause serious complications.

Washing after sex. If you get an infection, it's readily treatable by antibiotics and usually heals within a couple of weeks.

Molluscum Contagiosum ("the clam")

Molluscum contagiosum, also known as "the clam", is a recently recognized STD that is not well understood. After a friend notified me of this one (who picked it up from a prostitute on Sukhumvit) and reading a lot of literature on this one, here's what I've put together:

A small bump appears on the skin. It can be on the scrotum or penis or anywhere in the genital area. In the center of the bump is what looks like a pimple but is not a pimple. The skin is moist around the bump, within a radius of a couple of centimeters, when it first comes out. It doesn't hurt or itch. It's fairly benign, but it grows a little for a few weeks to a few months, and then goes away. Apparently, the body fights it off. It generally does not recur. My friend's doctor cut out the central pimple, which turned out to be a hard white bump, as the doctor says that if you don't cut that out, then it will get a lot bigger and take longer to go away. His doctor said he had seen a lot of cases of molluscum contagiosum in farangs on Sukhumvit over the last year. My friend said that the bump that the doctor cut healed up real fast, but two other bumps showed up on his scrotum without the central pimple, and grew for a couple of months, then went away entirely.

There is no medicinal treatment for molluscum. From what I've read on Internet, the doctor usually doesn't do anything surgically, either, unlike what the doctor on Sukhumvit did. However, my friend said that after the central white dot was cut out, the moisture and some other symptoms were reversed and went away quickly.

On the Internet, many people have expressed that sexual desire was unusually and significantly increased during the early stages of mollusca and/or while the bump is present. The speculation is that there has been a natural selection process in which the molluscum promotes its own spreading by making the host more sexually active.

No known negative effects of mollusca are known yet, and indeed not much is known about it.

The best source of information on the web on mollusca that I've found so far is on http://www.syntac.net/dl/Clam/ but I've noted that it's starting to show up in medical sites for consumers, albeit more formally and with less information.

Herpes

Herpes is caused by the herpes simplex virus. The symptom is a set of blisters close together, and they often merge to form one big blister before breaking, leaving a painful lesion which usually takes one to two weeks to heal.

Actually, there are two types of herpes. HSV-1 is the type that usually infects the lips, mouth and face. HSV-2 usually infects the sexual organs. However, either one can infect the other.

HSV-1 is quite prevalent among the general population. More than half of all Americans have been infected with HSV-1 by age 20. HSV-2 is not nearly as common, and statistics for HSV-2 may vary more between countries.

HSV-2 symptoms appear approximately two weeks after exposure. The extent of the symptoms can vary widely between different individuals.

Once you have either of the HSV viruses, you will have them for life. There is no cure. However, most of the time you will have no symptoms -- no blisters, no lesions, nothing. Many people don't have any recurrance of symptoms after the first time. However, most people have occasional relapses, whereby the blisters will come back, turn into lesions, and then heal, all in a time period of one to three weeks, and usually in one to two weeks. Minor relapses may go unnoticed. In many people, relapses tend to occur during time of stress, fatigue, heavy drinking, or excessive exposure to the sun. In a typical individual, there may be one recurrance every six months or year.

A person with herpes is contagious to others (i.e., sheds virus) around the time of a recurrance, but is usually not contagious when no blisters or lesions are present, except immediately before the blisters are about to arise. The fluid from the blisters is full of viruses and extremely contagious.

Herpes is generally harmless, and just a nuisance. However, a major exception is that a person with herpes can contract HIV much easier if they have sex with an HIV infected person while they have open lesions.

The main treatment of herpes is a topical ointment with the chemical acyclovir. In the past it was very expensive, but the patent on the treatment expired and generic brands have hit the market at lower rates. Care must also be taken to keep the lesions from getting infected by bacteria, hence cleanliness is important, as is drying out the lesion and/or applying an antibiotic cream.

Some people get recurrances often. For these people, taking acyclovir by tablet can usually prevent recurrances. However, the tablets are expensive.

Some people can tell when they're about to get an onset, by a slight itchiness or redness of the skin, and can apply ointment and/or take tablets to prevent or minimize the recurrance.

When treating a herpes lesion, it is important to be careful not to touch anywhere else on your body or anyone else afterwards until one has washed their hands thoroughly. Some men who get herpes sores near the head of their penis still have sex with a condom covering the lesions. If so, one must be very careful not to expose one's partner.

Pregnant women should check to make sure they aren't having a recurrance before a vaginal birth. However, they should consult their doctor before taking any kind of medicine.

The best source of information I've found on herpes is at http://health.yahoo.com/health/Diseases_and_Conditions/Disease_Feed_Data/Herpes_simplex/

Syphilis

Syphilis is caused by a spirochete bacterium called Treponema pallidum.

There are 3 stages of a syphilis infection. In the first stage, painless "sores" or spots called chancres appear in the genital area, some time between 10 days to 6 weeks after exposure. They appear for about a month or two and then disappear.

The second stage is a skin rash which can occur anywhere. It can start any time from a week to 6 months after the first stage. The chancre spots may reappear. These lesions are very infectious. The rash during this phase often gets the sufferer into the doctor's office.

The third or last phase has no symptoms, but syphilis is reaching the stage where it is ravaging the body. There may be relapses of the second stage symptoms, but what will start to become apparent is the widespread infection. Syphilis infects the internal organs, bones, the heart, the brain and the nervous system. One of its better known symptoms is insanity. Untreated syphilis may eventually lead to permanent disabilities and death.

A syphilis infection is determined by a blood test. It's cured by antibiotics. The patient is not called cured until two follow-up blood tests show no recurrance, which takes a minimum of six months. The patient must abstain from sex until they're called cured.

Syphilis can be transmitted to a fetus via the placenta after the 10th week of pregnancy, and transmission occurs practically 100% of the time. Syphilis causes many stillbirths.

The best web age on syphilus that I've found to date is at http://health.yahoo.com/health/Diseases_and_Conditions/Disease_Feed_Data/Syphilis/

HIV (AIDS)

The ThailandGuru has a separate page on HIV (AIDS), click here.

Hepatitus B

The ThailandGuru has a separate page on hepatitus B, click here.

Hepatitus A

The ThailandGuru has a separate page on hepatitus A, click here.

Getting Drugged

Worth mentioning in this section is getting drugged by a sex worker. This happens often. They slip something into your drink or food and you pass out. Then they rob you thoroughly.

This can happen in your hotel room, your home or even in a bar or restaurant.

This is a health risk. The biggest health risk is death. Sometimes they put in more drug than is necessary, sometimes MUCH more, for one reason or another -- just to make sure you're very much asleep and won't interfere in their robbing activity, or to speed up the effects, or so that a small bite will get enough of the drug but maybe you eat or drink too much. In any case, a large dose can mean that you stop breathing or your heart stops ... and you die.

In lesser cases, foreigners have been known to wake up DAYS later. With the worst headache of their life, sometimes very dehydrated. And, of course, with no money, no credit cards, and often no identification. Hopefully, they have enough change to take a bus to their embassy or somewhere to beg, maybe some water and food somewhere.

The preventative measures are common sense.

A couple of notable experiences:

A number of farangs have reported that they've been drugged at bars and discotheques by having something dropped into their drink while they were on the dance floor or in the toilet. If you go to the toilet, bring your beer with you! The motive here is questionable, but it has happened to quite a number of people. Rare, but does happen.

A variation on this is that you get drugged and then someone who says they are your friend pays your bill and "helps their too drunk friend" out of the establishment, where they are robbed.

Some people have been robbed at a bar. Some people have died in bars.

This happens to a small fraction of farangs who live in Thailand for a long time, but it does happen.

Taxi drivers have also been known to do the same thing. They give you a sweet or popcorn or something. Don't accept food from taxi drivers. Women have gotten raped and men robbed.

(According to one source, many years ago an entire tour bus on a long distance trip was robbed when the driver and ticket taker conspired and served drinks late at night. This is an exceptionally rare kind of event, but this is what I heard from a longtime expat here.)




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