While most STDs and STIs are caused by bacteria, viruses and parasites, we might not know that a few are actually a result of fungal activities. Although some of these fungal infections can be transmitted through sexual contact, some such as Candidiasis happens because of the presence of other diseases (diabetes), vaginal douching or taking antibiotics. Several genital infections that can spread through sexual activities or due to poor hygiene and allergic reactions include Tinea cruris, Balanitis and Candidiasis (yeast infections).

Who can potentially get fungal infections?

Anyone can suffer from these infections, but your risks of getting fungal infections may increase if:

• You are on antibiotics
• You are frequently wearing tight underwear or synthetic fabrics (nylon or lycra)
• You are washing or douching your vagina with perfumed products
• You have diabetes
• You are pregnant
• You engage in sexual contact with a person who has fungal infections
• You are allergic to particular perfumed bath products or condoms
• As for men, risks are amplified if:
• They do not regularly wash their foreskin

Tinea cruris (also known as ‘jock itch’)

Tinea basically refers to a collection of diseases caused by fungus. The most common forms of tinea are jock itch, athlete’s foot and ringworm. Tinea is normally not hazardous and not serious. It can, however, cause great discomfort to the infected person. Jock itch usually affects the groin, pubic area and thighs. This disease manifests in the form of chronic rash. Jock itch is caused by a dermatophyte fungus with the 2 most common ones being Trichophyton rubrum and Epidermophyton floccosum.

Tinea cruris can infect both sexes despite being more prevalent in men. Every person from every age group can catch this disease, but the two most commonly affected groups are adolescents and adults compared to children and the elderly. Residing in areas where the climate is humid and tropical may contribute to the emergence of jock itch.

Several factors that may amplify someone’s risks for getting this disease are:

• Obesity
• Diabetes mellitus
• Use of topical steroid
• Wearing tight clothing and underwear
• Having suffered from this disease or tinea pedis before

Diagnosing tinea cruris may involve skin biopsy and treatments for this disease include oral and topical antifungal medications (imidazoles or terbinafine). Sometimes, mild topical steroids might be used to relieve extreme itch. However, this type of treatment is not encouraged for long-term use. Several prevention methods for tinea cruris involve wearing loose-fitting clothing, applying antifungal powder after showering and overcoming existing health conditions such as obesity.

Balanitis

Balanitis refers to an inflamed foreskin and head of the penis. This condition is mostly found in men who are uncircumcised. The main causes that lead men to suffering from balanitis are poor hygiene, skin disorders (phimosis or tight foreskin that does not pull back over the glans), obesity, harsh soaps and bath products, and health conditions such as diabetes or another sexually transmitted infection. Although it seems complicated and scary, balanitis is a treatable condition.

Men who have balanitis often think they are infected with other forms of STDs. Balanitis usually manifests in pain, redness and foreskin discharge that is foul-smelling. Other causes of balanitis other than not being circumcised include:

• Suffering from yeast infection (candidiasis)
• Suffering from other sexually transmitted diseases
• Having scabies (a parasitic infection)
• Other skin problems and conditions such as psoriasis and eczema
• Diabetes

Symptoms of balanitis can appear all at once or emerge gradually. Besides the symptoms mentioned above, other notable symptoms may include:

• Swelling
• Itchiness under foreskin
• White or shiny areas on the penis skin
• Painful urination
• Red patches

Diagnosing balanitis may require several steps if truly needed. The first method used is physical examination where healthcare professionals assess the infection. The other method can involve taking a swab of the urethral opening to be sent to the lab for further testing. Urine or blood tests may also be included to detect diabetes or other infections.

Depending on what is causing the infection, treatments for balanitis may vary. Common treatments for this disease are antifungal creams such as clotrimazole to be applied to the head of the penis and foreskin, antibiotics (if it turns out that another sexually transmitted disease is the cause of the infection), practicing better hygiene so urine and sweat does not build up under the foreskin and circumsision (especially when balanitis is a recurring condition).

Candidiasis

Not only is our body filled with certain bacteria, some fungus also live in it. However, when the environment is fitting, fungus can thrive, multiply and grow out of control. Such conditions are true for a fungus called candida. This fungus inhabits the skin, throat, gut and vagina. Candidiasis is an infection mostly discovered in women, but men are not totally prone to this. Men can get candidiasis from having sexual intercourse with women who are suffering from vaginal yeast infection.

Genital yeast infections are common, and it is estimated that 3 out of 4 women will at least experience one yeast infection during their life. Several contributing factors to the emergence of candidiasis include:

• Pregnancy
• Consuming birth control pills
• Diabetes
• A weakened immune system
• The use of spermicide, lubricants, douches and other harsh products
• Taking antibiotics
• Occlusive clothings that do not allow the vagina to breathe

Candidiasis can be passed from one person to another during sex. Symptoms of this infection include intense itchiness in the vagina, redness, swelling of the vagina and vulva, painful urination and burning sensation, pain during intercourse, and vaginal discharge that resembles thick cottage cheese. As for men, yeast infections can manifest in an itchy rash around the penis.

Diagnosing candidiasis consists of several steps from being asked about your STI history, experiencing a pelvic exam (healthcare professionals may examine the outer genitals to check for signs of infections), to taking a sample of your vaginal fluids to be examined in the lab (to identify which kind of fungus is causing the infection so you can be prescribed to more accurate treatments).

Treatments for candidiasis can take the form of oral medications that last from 3 to 7 days and antifungal creams and ointments. In some cases, the doctor may prescribe you a single dose of Diflucan, although this single dose medication is not encouraged for pregnant women.

Shim Clinic is a GP in Singapore that focuses on Sexually Transmitted Diseases (STDs)  providing STD tests and treatments. We also carry prevention methods such as HIV PrEP, HIV PEP and HPV vaccine (Gardasil-9).