In the clinical practice of venereology and dermatology, HIV and STD clinics in Singapore see a wide range of infectious diseases and peculiar conditions. As our clinic is primarily a family medicine practice, the variety of unusual maladies and clinical encounters can indeed serve as fodder for some very interesting fiction.
Adam (not his real name) is an 18 year-old male polytechnic sophomore studying and living in Singapore. Life was uneventful until that fateful day when his friends decided to take him for dessert. It was a common, yet delicious local delicacy in our tropical climate – sago with gula melaka (a type of sugar) and coconut milk. Smooth whitish, semi-transparent pearls of sago mixed with that fragrant, thick coconut milk and brownish gula melaka. This dish will most certainly tantalize your taste buds. And if you do drop by Singapore this December, do remember to try this dessert available at many local hawker fares.
Adam came to see me on a stormy night, a scene made perfect by that strong northwesterly wind and a broken umbrella. He stumbled into the clinic half drenched in tropical rain. Needless to say he wasn’t looking his very best.
“Doctor, I think I have sago on my thighs.”
“Huh?”
“Doctor, you wouldn’t believe it. I spilled some coconut sago the other evening. And now, I think I’ve got something that looks like coconut sago on my thighs.”
He noticed numerous painless, pinkish growths on his lower abdomen, upper thighs (near the groin) and pubic area – exactly where he spilt his coconut sago dish. He seemed to have noticed these lesions after he had changed out of his soiled pants that evening.
“Er, I don’t think these lesions have anything to do with coconut sago, Adam,” I said.
On questioning, he confessed that he was sexually active with his new girlfriend for the last few months.
Physical examination revealed numerous 1 to 3mm smooth, erythematous (slightly reddish), waxy looking papules (bumps or sago-like). Most of these “sago” had central umbilication, and they were not associated with hair follicles or hairs.
Jokingly, I told him that the real “sago” was kept inside those bumps. I took a needle, unroofed one of them, and a central hard white core was subsequently expressed. The diagnosis was apparent – molluscum contagiosum.
This is an infection caused by the virus (and you probably would have guessed) called molluscum contagiosum virus (MCV). Beside sexual or salivary transmission, it can occur in young children for no apparent reason. In fact, most cases occur in young children.
Adam was made aware that he wasn’t a young child, and that it was likely due to his sexual activities with his girlfriend. Sexually transmitted lesions tend to have an incubation period of 1 week to 6 months (more typically 2 to 3 months).
The lesions typically appear as painless papules or wart-like bumps with a waxy, shiny surface and central depression or umbilication. These can go unnoticed for some time, until the lesions increased in numbers, or alternatively, when the patient spills some coconut sago onto the affected region. In which case, the logical fallacy of post hoc ergo propter hoc (Latin: “after this, therefore because of this”) was committed. That is, “I spilt the sago onto the area, therefore I get the rash.”
Adam’s lesions were easily treated with cryotherapy (liquid nitrogen). He was also screened for other sexually transmitted diseases such as chlamydia, gonorrhea, syphilis and HIV. He was also told to refer his girlfriend for treatment if she had those lesions.
I reassured him that coconut sago was safe for consumption, and that TripAdvisor has the location for one of the best-known coconut sago in Singapore.
Unfortunately, molluscum contagiosum (an STD, and not so uncommonly seen in HIV STD clinics in Singapore) has the uncanny penchant for recurrence. He was given topical imiquimod for self-treatment, in the event that new lesions do show up. He was also advised to expect complete resolution within the new few months.
In conclusion, if certain lesions that resemble your favorite dish pop up from nowhere, do consider dropping by our clinic for advice. Perhaps we might even reveal where the best coconut sago is in Singapore.
