Genital ulcer disease is a common presentation of sexually transmitted infections (STIs) and can cause significant morbidity in patients. Syphilis (chancre of primary syphilis) and genital herpes are the two most significant ulcerative STIs and are occasionally indistinguishable clinically. Infectious syphilis is on the rise in Singapore particularly in men who have sex with men (MSM); whilst genital herpes although showing a decreasing incidence in recent years still presents with more than 500 notifications a year as first episode genital herpes. Due to the breaks in the mucosa of the skin caused by the ulcers, the risk of acquisition as well as transmission of HIV infection are both increased making timely treatment of genital ulcers of utmost importance. Although uncommon in Singapore, chancroid, LGV and granuloma inguinale remain endemic in some parts of Asia and there should be a high index of suspicion for patients who have returned from these regions presenting with ulcerative lesions. All patients who present with genital ulcers should have their blood tested for syphilis and HIV as well as a swab for culture or PCR testing taken from the ulcer to exclude genital herpes.

In recent years HIV infections have declined in many parts of the world, however, there are still 35 million persons living with HIV infection and 2.1 million new infections occurred in 2011 worldwide. In many areas HIV continues to affect certain at risk communities viz. men who have sex with men, sex workers, clients of sex workers and injecting drug users. In Singapore the number of newly diagnosed HIV infections appears to have stabilised, however the current trend is that infected individuals are presenting at a late stage of infection and more HIV infections are being diagnosed among MSM and fewer in heterosexuals. The trend for other sexually-transmitted infections is generally stable, with gonorrhea, Chlamydia trachomatis infection and anogenital herpes showing decreases, whilst the incidence of syphilis showed an increase in 2012. Interviews with patients attending the DSC Clinic indicate that most STIs are contracted locally from casual partners. Unregulated sex workers are more frequently cited as primary contacts than are local regulated sex workers, who continue to have very low levels of STIs, underlining the benefits of the programme of routine screening, treatment and condom negotiation skills training provided by the Department of STI Control (DSC) Clinic in Singapore.

INTRODUCTIONThis is a review of the epidemiology and trends of sexually transmitted infections (STIs) in Singapore from 1994 to 2003.

MATERIALS AND METHODSData collated for both notifiable and non-notifiable STIs from 1994 to 2003 were analysed. This data consisted of STI notifications from medical practitioners in Singapore as well as from the Department of STI Control clinic itself.

RESULTSThere was a decline in the overall STI incidence in Singapore in the first half of the last decade from 215 cases per 100,000 population (7,200 cases) in 1994 to 162 cases per 100,000 population (6,318 cases) in 1999, followed by an increasing trend in the number of acute STIs (both bacterial and viral) over the past 5 years to 195 cases per 100,000 population (8,175 cases) in 2003 (P <0.001). The incidence of HIV has risen sharply over the last decade whilst that of other viral STIs has not decreased. Singaporeans are becoming sexually active at a younger age, with casual partners constituting the main primary contacts.

CONCLUSIONSAlthough there has been a significant decline in the overall incidence of STIs in Singapore over the last decade, a rise in acute STIs over the last 5 years has resulted in the need to identify the causal factors, and to intensify existing as well as develop new STI/HIV prevention programmes for the general population and certain core groups.

Adolescent ; Adult ; Child ; Female ; HIV Infections ; epidemiology ; Humans ; Incidence ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Sexually Transmitted Diseases, Viral ; epidemiology ; Singapore ; epidemiology

We reviewed the current human immunodeficiency virus (HIV) prevention education programmes in Singapore, discussed the challenges faced and proposed prevention education interventions for the future. Education programmes on HIV prevention have shown some success as seen by reduced visits to sex workers among the general adult population and a marked increase in condom use among brothel-based sex workers. However, we still face many challenges such as low awareness of HIV preventive strategies and high prevalence of HIV stigma in the general population. Voluntary HIV testing and condom use remain low among the priority groups such as men who have sex with men (MSM) and heterosexual men who buy sex. Casual sex has increased markedly from 1.1% in 1989 to 17.4% in 2007 among heterosexuals in Singapore, with the majority (84%) practising unprotected sex. Sex workers have moved from brothels to entertainment venues where sex work is mostly hidden with lack of access to sexually transmitted infections (STIs)/ HIV prevention education and treatment programmes. Education programmes promoting early voluntary testing is hampered because of poor access, high cost and stigma towards people living with HIV. It remains a challenge to promote abstinence and consistent condom use in casual and steady sexual relationships among heterosexuals and MSM. New ways to promote condom use by using a positive appeal about its pleasure enhancing effects rather than the traditional disease-oriented approach should be explored. Education programmes promoting early voluntary testing and acceptance of HIV-infected persons should be scaled up and integrated into the general preventive health services.
Adolescent ; Adult ; Aged ; Female ; HIV Infections ; prevention & control ; transmission ; Health Education ; methods ; Health Knowledge, Attitudes, Practice ; Health Promotion ; Homosexuality, Male ; Humans ; Male ; Mass Screening ; Middle Aged ; Safe Sex ; Sex Work ; Sex Workers ; Singapore ; Young Adult