By T Thirumoorthy
Fear of having a sexually transmitted disease, or STI, despite adequate treatment is common. This fear may drive a patient to seek further medical treatment even though he may have no symptoms.
It is medically acceptable to treat asymptomatic patients for an STI on strong epidemiological grounds. This may be so in case of a high-risk sexual relationship, or when there is risk of transmitting to another partner during the incubation period, and when the patient is traveling to locations where access to good medical care is not available. Moreover, in pregnant women, sometimes the appropriate strategy is to treat prophylactically.
Persons who are separated from their regular partners, for example, sailors, soldiers on overseas deployment, workers in a foreign land, or long -distance drivers, are at risk of casual sex and the use of commercial sex workers. Education for STI prevention and access to condoms are good public health measures.
The drawing is about a patient who does not have clinical evidence of STI.
In this case, the fear of infection is precipitated by the foreign worker’s upcoming home trip. The doctor gave the injection because of the patient’s incessant pleading, as he cannot be sure that the patient has not has renewed exposure since the last episode of STI. Should the doctor give a placebo injection instead of the antibiotic? In this situation, giving a placebo may betray the trust the patient places in his doctor.
There is an additional point to make here. In patients with no clinical or laboratory features of an STI, and in the presence of strongly held beliefs that defies medical information and reassurance, we may need to assess for psychiatric issues. In STI clinics, it is not uncommon to encounter patients with anxiety with somatization, or to uncover a latent obsessive-compulsive disorder, or monosymptomatic delusional disorder, after a causal sexual encounter.
———A/Prof T Thirumoorthy
T Thirumoorthy is the Group Chief Medical Officer with a private healthcare group who also teaches at Duke-NUS Medical School. He is a dermatologist and the founder director of the SMA Centre of Ethics and Professionalism.
The commentary and vignette were reproduced with permission from the book “Being Human, Stories from Family Medicine” edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore.
Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures.
