Martin T. W. Chio

Experience with the implementation of a web-based teledermatology system in a nursing home in Singapore.

We introduced a web-based teledermatology system, the distributed personal health information management system (DPHIMS), into a nursing home in Singapore. The introduction was conducted in two phases. Five staff nurses in Phase 1 and nine nurse aides in Phase 2 performed the data entry and uploaded digital images of the residents skin condition. By the end of Phase 2, there were 50 residents registered with DPHIMS. The average age of the participants was 82 years and 84% were women. There were 31 first-time referral requests registered in the system during Phase 2. The average time taken to complete a referral request was 86 minutes. The average time taken by the dermatologist to prepare and submit a diagnosis/treatment report was 11 minutes. An online survey form was given to the nurses and the dermatologists to gauge their level of satisfaction and their experience of using DPHIMS. All the nurses said they would readily recommend DPHIMS to other nurses. Overall, the dermatologists felt that DPHIMS was helpful in obtaining specialist care for the residents. However, some skin conditions required a face-to-face consultation. Thus a mixture of face-to-face consultations and consultations via teledermatology may be necessary to provide complete diagnosis and treatment to patients. Our experience suggests that understanding and addressing the organizational concerns is as important as solving the technical problems.

Syphilitic Uveitis in a Singaporean Population

Abstract Purpose: To report the presentations of syphilitic uveitides in Singapore. Methods: Retrospective noncomparative observational case series of 18 eyes from 12 patients with ocular syphilis between 2004 and 2009. Results: Patients were mainly male (91.7%). Median age was 49.5 (24–84) years. Initial visual acuity varied from 6/6 to counting fingers (CF) and was ≥6/12 in 7 eyes (38.8%). Blurring of vision (n = 11, 61.1%) was the most common presenting complaint. Anterior uveitis and panuveitis were both most common (n = 6, 33.3%). Treponemal and nontreponemal serologies were positive in 12 (100.0%) and 10 (83.3%) patients, respectively. Patients were treated systematically with penicillin therapy by infectious disease physicians. Conclusions: Ocular syphilis is seeing a worldwide resurgence. Although anterior uveitis and panuveitis were most common in this study, there was a large spectrum of ocular manifestations. Syphilitic uveitides can potentially cause severe loss of vision but are effectively treated by an appropriate regimen of penicillin.

Gender Differences in Partner Influences and Barriers to Condom Use Among Heterosexual Adolescents Attending a Public Sexually Transmitted Infection Clinic in Singapore

OBJECTIVE To compare gender differences in the factors associated with condom use at most recent voluntary intercourse among heterosexual adolescents attending a public clinic for sexually transmitted infections (STIs). STUDY DESIGN Between 2008 and 2011, we conducted a cross-sectional survey on 964 never-married adolescents between 14 and 19 years of age who reported having engaged in voluntary intercourse for most recent sexual encounter and were attending the only public STI clinic in Singapore for screening or treatment of STIs. Data were collected using a self-administered questionnaire. RESULTS The response rate to the questionnaire was 85.2%. In multivariate analysis, condom use at last intercourse for both genders was negatively associated with Malay race and peer connectedness and was positively associated with confidence in the ability to use a condom correctly. Being employed was positively associated with condom use for female respondents only. For male respondents only, condom use showed a positive association with living in better housing, older age at first intercourse, and engaging in sexual intercourse with commercial sex partners. Almost all (90%) commercial sex partners suggested condom use and provided condoms compared with 8.1% of non-sex worker partners. Condom use showed a negative association with inconvenience in its use among male respondents but not female respondents. CONCLUSION STI prevention programs for adolescents must promote condom use with nonpaying partners, address barriers to condom use, and develop condom application skills, taking into account gender differences. Future research should explore condom use within dating relationships.

Sexually transmissible infection management practices among primary care physicians in Singapore

BACKGROUND Primary care physicians manage a significant number of sexually transmissible infections (STI); however, there has not been a survey to assess the standard of medical care, completeness of notifications, provision of counselling and contact tracing by primary care physicians in Singapore. METHODS An anonymous postal survey was conducted in which 1557 questionnaires were mailed out to general practitioners (GP), and government primary care and emergency department doctors. RESULTS In all, 736 questionnaires (47.3%) were returned, and the majority of respondents were graduates from the local medical school, worked in solo or group practices and were males. One hundred and thirty doctors (17.7%) indicated they had received training attachments or postings in dermato-venereology departments. Almost one-third (30.8%) had been working as doctors for fewer than 10 years and 87.8% reported that they managed STI in their practice. Almost half did not investigate genital discharge patients, and one-third would still use ciprofloxacin to treat discharges. In the management of ulcers, over half indicated that they would order syphilis serology, and a significant minority would use parenteral penicillin. Most doctors provided history taking, screening for other STI, testing for HIV infection and STI counselling. A small minority of doctors undertook contact tracing, and there was incomplete notification of many STI. CONCLUSIONS Overall medical management of STI by primary care physicians was acceptable. Skills in contact tracing and reminders on disease notification are areas that need particular attention.

Determinants of Chlamydia, Gonorrhea, and Coinfection in Heterosexual Adolescents Attending the National Public Sexually Transmitted Infection Clinic in Singapore.

Background Amidst recent trends in rising rates of chlamydia and gonorrhea among Singaporean adolescents, there are limited data on risk factors associated with these infections that may inform prevention strategies in this population. Methods A cross-sectional study of chlamydia and gonorrhea positivity was conducted among 1458 sexually active heterosexual adolescents between 14 and 19 years old attending the national public sexually transmitted infection clinic from 2006 to 2013. The association with demographic and behavioral characteristics was assessed by crude prevalence ratio, and negative binomial regression modeling was used to obtain adjusted prevalence ratios (aPRs). Results Chlamydia positivity was found in 23.6% of males and 36.6% of females, gonorrhea positivity in 33.1% of males and 15.9% of adolescent girl, and coinfection positivity in 10.2% of males and 10.1% of females. In multivariable analysis, chlamydia was positively associated with being Malay (aPR, 1.6; 95% confidence interval [CI], 1.1–2.1) and inconsistent condom use for vaginal sex (aPR, 6.5; 95% CI = 2.4–17.4) in males and with being Malay (aPR, 1.9; 95% CI = 1.5–2.4), inconsistent condom use for vaginal sex (aPR, 2.0; 95% CI = 1.1–3.9), and number of lifetime partners in females (aPR, 1.1; 95% CI = 1.0–1.1). Gonorrhea was positively associated with being Malay (aPR, 3.2; 95% CI = 2.4–4.4), inconsistent condom use for vaginal sex (aPR, 5.4; 95% CI = 2.1–14.4), and number of lifetime partners (aPR, 1.1; 95% CI = 1.0–1.1) in males and with being Malay (aPR, 3.7; 95% CI = 2.4–5.7) in females. Malays had a higher proportion of sexual risk behaviors compared with the non-Malays. Conclusions Ethnicity and high-risk sexual behaviors are important determinants of chlamydia, gonorrhea, and coinfection for adolescents attending this clinic. Targeted interventions are needed to lower the prevalence of high-risk sexual behaviors for the Malay adolescents in this clinic.

A retrospective review of cutaneous metastases at the National Skin Centre Singapore

Cutaneous metastases occur in up to 10% of all visceral malignancies. This study aims to determine the clinico‐epidemiological characteristics of patients diagnosed with cutaneous metastases at a leading Asian tertiary dermatological centre.

Role of topical tranexamic acid in hemostasis of locally advanced basal cell carcinoma.

Tranexamic acid (TXA) is a synthetic derivative of the amino acid, lysine. Conventionally used orally or intravenously, topical administration of TXA has the ability to reduce bleeding with minimal systemic absorption and, in turn, reduce the risk of systemic side effects. Previous clinical trials found that topical TXA reduces blood loss in cardiac, orthopedic, and otolaryngologic surgery.1 However, the hemostatic role of topical TXA for the skin has not been fully established. We describe a case of an elderly female with locally advanced basal cell carcinoma (BCC) of the scalp that was managed conservatively. The bleeding from the tumor was reduced with the aid of topical TXA.

GENDER DIFFERENCES IN FACTORS ASSOCIATED WITH ANAL INTERCOURSE AMONG HETEROSEXUAL ADOLESCENTS IN SINGAPORE

Using a cross-sectional survey, we examined the gender differences in prevalence of and factors associated with anal sex among adolescents attending the only public STI clinic in Singapore. Data were collected from 1035 sexually active adolescents aged 14 to 19 and analyzed using Poisson regression. Prevalence of anal intercourse was 28%, with significantly more females (32%) than males (23%) ever engaged in it. On multivariate analysis, the factors associated with anal intercourse for both genders were oral sex and the nonuse of contraception at last sex. For males, anal intercourse was associated with younger age of sexual debut and greater perceived external control. Among females, it was associated with higher rebellious scores and lack of confidence to resist peer pressure to engage in sex. Consistent condom use for anal sex was 22% and 8% for males and females, respectively. STI prevention programs for adolescents should address anal sex, be gender-specific, and take into consideration individual personality characteristics.

An Abstinence and Safer Sex Intervention for Adolescents Attending the Public Sexually Transmitted Infection Clinic in Singapore

PURPOSE The objective of this study was to evaluate the efficacy of a behavioral intervention in increasing secondary abstinence and safer sex among heterosexually active adolescents aged 16-19 years. METHODS This was a randomized controlled trial conducted at the only national sexually transmitted infection clinic in Singapore. The intervention focused on information giving, motivation, and skills building to abstain or practice safer sex. The outcome measures were self-reported secondary abstinence, consistent condom use, and keeping to one partner in the past 6 months over a 12-month period. We recruited 688 adolescents, with 337 participants receiving intervention and 351 receiving standard care (control). RESULTS At the 12-month follow-up, 187 (56%) intervention participants and 189 (54%) control participants were retained. Over the 12-month period, the intervention had a significant effect on secondary abstinence in adolescent boys (42% vs. 27%, adjusted risk ratio [aRR] 1.80, 95% confidence interval [CI] 1.29-2.34) but not in adolescent girls (21% vs. 24%, aRR 1.10, 95% CI .68-1.66). Consistent condom use was higher among intervention adolescent girls than control adolescent girls (40% vs. 20%, aRR 2.01, 95% CI 1.32-2.82), but this effect was not evident in adolescent boys (51% vs. 43%, aRR 1.27, 95% CI .78-1.88). Intervention effect on keeping to one partner was evident in both adolescent boys (76% vs. 45%, aRR 1.35, 95% CI 1.06-1.50) and adolescent girls (79% vs. 65%, aRR 1.20, 95% CI 1.02-1.23). CONCLUSIONS An intervention targeting adolescents in a clinical care setting did achieve an increase in secondary abstinence in adolescent boys, consistent condom use in adolescent girls, and keeping to one partner in both genders at 1-year assessment.

Assessment of psychosocial impact of genital warts among patients in Singapore

UNLABELLED Background Genital warts (GW) are a common sexually transmissible infection (STI) among young adults and are associated with poor quality of life (QoL). We investigated the functional and psychosocial effect of GW on Singaporean patients and evaluated for any variations in QoL between genders. METHODS Patients with GW completed a standard questionnaire containing the Short Form-36 (SF-36) health survey and the Cuestionario Específico para Condiloma Acuminado in a cross-sectional survey. QoL deficits were determined by comparing the SF-36 scores with local population norms. Variations in SF-36 (norm-based) scores among patients with different characteristics were examined using multiple linear regressions. All data analyses were performed for male and female patients separately. RESULTS The mean age of male (n=100) and female patients (n=80) was 31 years. The typical patient profile was male, ethnic Chinese, single, tertiary education level and presenting with recurrent warts and a history of prior STIs. Compared with the general population, male patients had similar or better functioning and wellbeing, whereas female patients had lower levels of productivity, mental health and general health. Among male patients, individuals afflicted with their first episode of GW and currently with a partner had better QoL. In contrast, for females, tertiary education, older age and being a nonsmoker were positively associated with better QoL. CONCLUSIONS Patients with GW have a significant psychosocial burden, with differences in certain aspects of QoL between genders. We hope that with active intervention, we will be able to mitigate the associated negative impact to QoL.