A specialist on sexually transmitted diseases (STD) recently warned that the number of STD cases among the island's male population had reached an alarming level.

"In the first semester of 2008, the total number had reached 277 cases at the Sanglah General Hospital alone," Dr. Made Wardhana, a senior specialist at the hospital, said recently.

Wardhana believed the total figure was far higher than the numbers recorded at the state-run Sanglah hospital.

A large number of STD patients, he added, preferred private hospitals or specialist practices.

"STDs are a sensitive issue, so patients seek more privacy," he said.

"Private hospitals or practices are commonly perceived to provide better privacy and confidentiality."

Wardhana said there were several kinds of STD that commonly infected the island's male population.

"Based on reported cases at Sanglah, we found the diseases including syphilis, gonorrhea, chlamydia and herpes," he said.

"Less common were cases of hepatitis and HIV/AIDS."

Chlamydia is caused by the bacterium Chlamydia trachomatis which commonly infects women. However, it has also been known to infect men. Chlamydia can be transmitted during vaginal, anal and oral sex.

The U.S.' Center for Disease Control and Prevention (CDC) identified Chlamydia as a "silent" disease because about three quarters of infected women and about half of infected men show no symptoms. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure.

Men with signs or symptoms may have a discharge from their penis or a burning sensation when urinating. Men may also have burning and itching around the opening of the penis.

Wardhana suspected the high incidence of STDs among the male population was related to the fact that the majority of Balinese males are not circumcised.

Whereas circumcision is an obligatory tradition among Muslims, Bali is a predominantly Hindu island.

"An uncircumcised man is more vulnerable to STD infections than his circumcised counterpart," he said.

Wardhana further stressed that an uncircumcised man faced a much greater risk (ten to twenty times higher) of STD infection than circumcised men.

In an uncircumcised penis there is a hollow space between the foreskin and the glans penis.

"Circumcision removes the foreskin. As the foreskin disappears, so does the gap. Without the gap, it becomes easier to cleanse the penis thoroughly," Wardhana said.

Circumcision, Wardhana added, had not only reduced men's vulnerability to STD's but also other diseases such as prostate infections.

However, Wardhana warned, circumcision is not the only measure of one's vulnerability to STD infections.

"The most important determining factor is undoubtedly the sexual behavior of the individual," he said.

An individual who practices safe sex, he pointed out, would certainly be much less vulnerable to STDs than one with high-risk sexual behavior, regardless of whether they are circumcised or not.

Condom use and a limited number of sexual partners, he said, were two examples of safe sex behavior.

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