Explainer: What you need to know about HIV and AIDS

What is HIV?

HIV, or Human Immunodeficiency Virus, attacks and damages the human immune system. When left untreated, HIV kills a type of immune cell called a T-Cell.

As the condition progresses more T-Cells get attacked. This makes the body become increasingly susceptible to a range of illnesses and cancers.

HIV is not airborne, neither does it spread through water or casual, physical contact. Instead, HIV is transmitted via the following bodily fluids:

● Semen
● Blood
● Vaginal secretions
● Rectal fluids
● Breast milk

The virus does its work by inserting itself into the DNA of cells. Therefore, there is no known drug capable of removing it from the body, even as medical science strives for a cure.

At the moment, a treatment called antiretroviral therapy makes it possible for a person with HIV to live with the virus for many years. Without such therapy, a person infected with HIV is likely to develop the condition known as Acquired Immunodeficiency Syndrome, or AIDS.

What is AIDS?

AIDS is when the immune system is weakened to the point where it is unable to properly and sufficiently counteract infections. If left untreated, people with end-stage AIDS have about 3 years to live. This is why antiretroviral therapy is important for people who have HIV, as it enables them to live as long as people who do not have HIV.

A person can also be diagnosed with AIDS if they have HIV and develop an opportunistic infection or cancer.

When AIDS develops, a person is seriously susceptible to illnesses like:

  • Tuberculosis
  • Cytomegalovirus
  • Toxoplasmosis
  • Cryptosporidiosis
  • Various cancers

These illnesses can become severe, and shorten the lifespan of a person.

How does HIV progress to AIDS?

While related, HIV and AIDS are different things. It takes a period of time for HIV to progress to AIDS, which means that when action is taken, there is a possibility of preventing HIV’s progress to AIDS.

HIV cases progress through 3 distinct stages:

First Stage: Acute stage – First few weeks after infection

Second Stage: Chronic Stage

Third Stage: Progress to AIDS

As HIV progresses, the CD4 cell count slowly goes down. While an uninfected adult’s CD4 cell count runs between 500 to 1500 per cubic millimeter, a person with AIDS has a CD4 cell count that is sub-200 count per cubic millimeter.

The speed of HIV progression from stage 2 to stage 3 depends on the person. Some people can stay in stage 2 for a decade without treatment. However, with treatment, they can stay in stage 2 indefinitely. As mentioned above, there is no cure for HIV. However, antiretroviral therapy can give a near-normal life expectancy.

Similarly, there is no way to cure AIDS. However, treatment that can increase the CD4 count above 200 per cubic millimeter of blood exists. This means that they can be considered to no longer have AIDS.

The facts of HIV transmission

No one is immune to HIV, and anyone can contract the virus. Here are some ways that HIV can be transmitted between people:

● Unprotected vaginal or anal sex — This is the most common route of transmission
● Sharing drug paraphernalia
● Unsterilized tattoo equipment
● Pregnancy, labor, or delivery from a pregnant person to their baby
● Breastfeeding
● Premastication – the act of chewing a baby’s food before feeding it to them

Very rarely, HIV is transmitted via blood transfusion or organ donation.

It is extremely rare for HIV to be transmitted through:

● Oral sex
● Being bitten by a person with HIV
● Contact between broken skin, wounds, or mucous membranes and the blood of someone living with HIV

HIV does NOT transmit through:

● Unbroken skin-to-skin contact
● Casual contact like shaking hands
● Air or water
● Sharing food or drinks, including drinking fountains
● Saliva, tears, or sweat (unless mixed with the blood of a person with HIV)
● Insect bites

It’s important to note that if a person living with HIV is being treated and has a persistently undetectable viral load, it’s virtually impossible to transmit the virus to another person.

Early symptoms of HIV

In the acute infection stage, there can be symptoms. At this stage, the virus is reproducing rapidly. The person’s immune system responds by producing HIV antibodies, which are proteins that take measures to respond against infection.

During this acute infection stage, some people have no symptoms, while others might have the following symptoms:

● fever
● chills
● swollen lymph nodes
● general aches and pains
● skin rash
● sore throat
● headache
● nausea
● upset stomach

These symptoms are similar to the common flu. This is why infected people might not think that they need to see a doctor.

During this acute infection stage, the HIV viral load in the person is high, and this means that the virus can be easily passed on to another person during this period.

The acute stage symptoms resolve themselves within a few months as the person enters the chronic stage of HIV, which can last for decades with the appropriate treatment.

How can we diagnose HIV?

There are a few tests that can be used to diagnose HIV.

Antibody/antigen tests

Antibody/antigen tests are the most commonly used tests. They can show positive results typically within 2 to 4 weeks after someone initially contracts HIV.

These tests check the blood for both HIV antibodies and antigens. An antibody is a type of protein the body makes to respond to an infection. An antigen, on the other hand, is the part of the virus that activates the immune system.

Antibody tests

These tests check the blood solely for HIV antibodies. 3 weeks to 3 months after transmission, most people will develop detectable HIV antibodies, which can be found in the blood or saliva.

These tests are done using blood tests or mouth swabs, and there’s no preparation necessary. Some tests provide results in 30 minutes or less and can be performed in a clinic.

If someone suspects they’ve been exposed to HIV but tested negative in a home test, they should repeat the test in 3 months. If they have a positive result, they should follow up with their doctor to confirm.

HIV Viral RNA PCR or Nucleic acid test (NAT) – HIV Test

Viral PCR or NATs are expensive, and used for those who have early symptoms of HIV or have a known risk factor. This test looks for copies of the virus itself.

It takes from 5 to 21 days for HIV to be detectable in the blood. This test is usually accompanied or confirmed by an antibody test.

If you have queries, or think that you need a HIV screening test, please reach out to any of our DTAP clinics for a confidential and professional diagnosis. Anonymous HIV testing and rapid HIV test is also available.

Treatment options for HIV

Treatment should begin as soon as possible after a diagnosis of HIV, regardless of viral load.

The main treatment for HIV is antiretroviral therapy: a cocktail of daily medications that stop the virus from reproducing. Antiretroviral therapy protects CD4 cells, keeping the immune system strong enough to respond to disease.

Antiretroviral therapy also prevents HIV from progressing to AIDS, and reduces the risk of transmitting HIV to others.

When treatment is effective, the viral load will be “undetectable.” The person still has HIV, but the virus is not visible in viral PCR test results.

However, the virus is still in the body. And if that person stops taking antiretroviral therapy, the viral load will increase again, and the HIV can again start attacking CD4 cells.

Types of HIV medications

HIV medications work to prevent reproduction of HIV, stopping it from destroying CD4 cells.
These antiretroviral medications are grouped into six classes:

nucleoside reverse transcriptase inhibitors (NRTIs)
● non-nucleoside reverse transcriptase inhibitors (NNRTIs)
protease inhibitors
● fusion inhibitors
● CCR5 antagonists, also known as entry inhibitors
● integrase strand transfer inhibitors

HIV Medication Side Effects

Antiretroviral therapy side effects differ, but may include nausea, headache, and dizziness. These side effects are not permanent, and will often get better over time.
However, serious side effects can include swelling of the mouth and tongue, as well as liver or kidney damage. If you encounter these side effects, speak to your doctor about adjusting medications.

Preventing HIV

There is no cure for HIV, or AIDS. That is why It is important to know how to prevent the transmission of HIV.

Safer sex

HIV is most commonly transmitted via unprotected vaginal or anal sex. Short of abstinence, the only other way to prevent transmission is through protection via condom or another barrier method.

If you are concerned about HIV risks:

Get tested for HIV.
Always use condoms. Be sure to know how to use them correctly, as incorrect usage can expose you to HIV risks.
Take medication as directed if you have HIV. This lowers the risk of transmitting the virus to your sexual partner.
● Take medication called PrEP (Pre-Exposure Prophylaxis). This can be prescribed by your doctor.

Other prevention methods

There are a few other things you can do to prevent transmission of HIV:

Do not share needles or other drug paraphernalia. Needle sharing can spread HIV through blood contact.
Consider PEP. If you know that you have been exposed to HIV, talk to your doctor about getting post-exposure prophylaxis (PEP), which can reduce your risk of contracting HIV. It consists of three antiretroviral medications given for 28 days. PEP should be started as soon as possible after exposure. – HIV PEP Singapore

Is there a vaccine for HIV?

Currently, there are no vaccines to prevent or treat HIV.

HIV mutates quickly, and can often fend off immune system responses. Only a small number of people with HIV develop broadly neutralizing antibodies.

The good news is that in 2016, the first HIV vaccine efficacy study in 7 years was done in South Africa. This experimental vaccine is an updated version of one used in a 2009 trial that took place in Thailand. A follow-up after vaccination showed that the vaccine was 31.2 percent effective in preventing HIV transmission.

The study involved 5,400 men and women from South Africa.

Anonymous Syphilis Testing

Overview

Caused by the bacteria known as Treponema Pallidum, Syphilis is a sexually transmitted infection (STI) once thought to have been almost eradicated in the 1940’s and 50’s after the discovery of penicillin. In the past few decades, there has been a steady rise in rates of infection, especially in men who have sex with men, sex with commercial sex workers, and as a co-infection with HIV. The disease is mostly spread through penetrative sex (vaginal or anal) and oral sex. However, syphilis can potentially transmit through any other direct contact with an infected sore.

The Different Stages

Syphilis can be considered to have three main ‘active’ stages: Primary, Secondary, and Tertiary syphilis. During these active stages, symptoms such as an ulcer or chancre at the site of infection, body rashes, swollen glands, etc. may be present. In between these stages, the infection can be completely asymptomatic and be ‘latent’. The latent stage can last for months to years, or even decades. This is especially true after the secondary stage has passed. This is why syphilis should always be considered when doing a routine sexual health screen, even if someone feels perfectly well.

Syphilis is also known as The Great Imitator, as there are many symptoms which can mimic other more common conditions, possibly causing the diagnosis to be initially missed. For example, while the classical chancre in primary syphilis is usually solitary and painless, there are also cases of multiple painful sores which turn out to be syphilis. Rashes in secondary syphilis are typically spread evenly around the body and typically include lesions over the palms and soles. However, we sometimes see localized rashes over the scalp, trunk or limbs alone without any lesions on the hands or feet.

Anonymous Syphilis Testing

Screening can dependably detect syphilis, even if it is asymptomatic. A simple blood test is usually run for either treponemal antibodies (TPAb/TPPA) or non-treponemal antibody tests (RPR/VDRL). Even if someone is asymptomatic, there is still a risk that the infection can be spread.

Rapid point-of-care testing is also now available and will check for TPAb/TPPA antibodies. Testing only requires a finger prick blood sample, with results ready in 15-20 minutes. This test can be performed anonymously, along with other rapid STI tests for chlamydia and gonorrhea. Anonymous testing means no personal identifiers are required from the patient, and positive results do not need to be notified by name. Anonymous screening can reduce stigmatization of STI testing and improve accessibility to those who may not otherwise test. This means that infections may be picked up and treated at an earlier stage, helping to reduce the risk of ongoing transmission in the community.

Getting Tested

If you think you need an anonymous syphilis test, please reach out to our DTAP clinics for a confidential, and professional diagnosis.

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Anonymous Rapid Chlamydia & Gonorrhoea Test

According to both the US CDC and statistics in Singapore, Chlamydia and Gonorrhoea are the top 2 STIs. Left untreated, these diseases can cause serious long-term consequences like infertility and complications during pregnancy which affect unborn children.

Using real-time PCR (polymerase chain reaction) technology, which means that the test is able to detect the DNA of both Chlamydia and Gonorrhoea in real-time, we can now get accurate and quick diagnosis of these 2 STIs.

The test is up to 99% accurate.

DTAP clinics now offer this rapid test, with results are available by the next working day. All that is required are samples from either urine, endocervical, throat or anus, depending on where the infection is likely to be present. This will be determined by your doctor after the assessment. The diagnostic rapidity will facilitate prompt and appropriate treatment.

Getting tested for STIs can be daunting, with plenty of social stigma attached to it. We understand your need for confidentiality, which is why DTAP clinic now offers anonymous Chlamydia and Gonorrhea that uses real-time PCR technology.

FAQ

What does an anonymous rapid chlamydia and gonorrhoea PCR test mean?

DTAP now offers anonymous chlamydia and gonorrhoea PCR tests for those who think they may be at risk of getting infected, thereby removing fear of identification.

Practically, this means is that all you need to give us is your mobile number when you want to do an anonymous chlamydia and gonorrhoea test. For the purposes of this test, you are no longer identified by your identity card or passport number. A short questionnaire will be given to you to fill up, which will not ask for any identifiable information like your name, identity number or address. The short questionnaire will help us understand your risks so that the doctors can give you the appropriate advice.

A mobile number is required so that we can contact you about your results. You will be listed in our computer system as a random number with no identifiable information attached to it.

How do I know I need to be tested?

You will need to be tested:

• If you possess symptoms suggesting you may have been infected with Chlamydia (link to article on symptoms of Chlamydia) or Gonorrhoea (link to article on gonorrhoea)
• If your partner was tested positive for either one of those infections
• If you had a recent change in partner
• If you have multiple sex partners
• If you recently had unprotected sex

How long does it take for the results to be available?

Generally, results will be available next working day.

How accurate is the test?

In general, the test can be up to 99% accurate.

Which areas of the body can the test be used for?

Urine, endocervical, throat and anus

Do I need to prepare anything for the test?

For urine samples, it is best if you avoid passing urine 2 hours before the test. Otherwise, no additional preparation needs to be done before the test.

Is it painful?

There are no needles involved.

If you think that you may have been exposed to these 2 STIs, or if you have symptoms like penile/ vaginal discharges, burning sensations, and/or discomfort when you pass urine, you should get tested anonymously. Please visit our DTAP clinic and consult with our doctors to get tested with the Anonymous Rapid Chlamydia and Gonorrhoea test and get treated.

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How to check for HIV

Human Immunodeficiency Viruses (HIV) are two species of Lentivirus that can infect humans. If left untreated in the body, over time, they cause progressive failure of the immune system. As a result, life-threatening opportunistic infections and cancers can occur. This late stage of HIV infection is termed Acquired Immunodeficiency Syndrome (AIDS).

HIV is spread through contact of infected bodily fluids through mucous membranes, broken skin or wounds. Most people who get HIV get it through anal or vaginal sex, or sharing needles, syringes, or other drug injection equipment. HIV can also be transmitted from a mother to her baby during pregnancy, birth, or breastfeeding. However, because of advances in HIV prevention and treatment, it is possible for spread and infection to be mitigated.

There are a few ways that a person can test for HIV.

The most common test that is done is an antibody test. The antibody to HIV is only produced if you have been previously exposed to HIV before. Therefore, if you have the antibody to HIV, it is likely that you have been exposed to HIV at some point in time in your life. We can test for the HIV antibody from a blood sample, or from a sample of cells taken with a swab from inside your cheek. The HIV antibody test is commonly done together with a p24 antigen test. This combination testing is commonly termed a 4th generation HIV test. The p24 antigen is a distinctive HIV antigen; a structural viral protein makes up most of the HIV viral core, or ‘capsid’. Again, it will only be present in your blood if you have previously been exposed to HIV. If the doctor sends your blood to a laboratory, it is likely they use a technique known as ELISA/EIA (enzyme-linked immunosorbent assay/enzyme immunoassay). An antibody test or a 4th generation test can also be done as a rapid, point-of-care test, where all we need is a small amt of blood and 20 minutes wait time.

You might also have heard of a western blot test. A western blot is a different technique that laboratories use to test for HIV antibodies in a person. A western blot is usually used to confirm a positive ELISA/EIA result.

There are also tests which test for the HIV virus itself. This is termed a HIV PCR RNA or HIV viral load. This test can tell the doctor the concentration of HIV virus in a person’s blood. This test is also used to monitor how effective medications are in a HIV-positive patient undergoing treatment. This test is usually more expensive than the other investigations.

Window Period For HIV

The window period is time between HIV infection and the point when the test will give an accurate result. During the window period a person can have HIV and be very infectious but still test HIV negative. It is difficult to say exactly when the best time to test for HIV is, but in general, we can test for HIV as early as 10 days after exposure with a viral load test. For combination antibody testing, the result is usually deemed definitive 4-6 weeks after exposure.

If you feel that you might have been exposed to HIV, see your doctor early and the doctor can advise you on your risk, the best time to test and the type of test that is necessary. Also remember to practice safe sex to reduce your risk of contracting not just HIV, but other sexually transmitted infections as well.

 

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Risk of HIV Transmission Through Blowjob

A recent news report by Channel News Asia titled “HIV-positive man who donated blood during pandemic faces charge of lying about sexual history” may have caused some concern in the community with regards to the issue transmissibility of HIV through oral sex.

Based on the report, people may wonder just how transmissible is HIV via oral sex and how does it compare to other forms of sexual practices like vaginal sex.

Sexual Practice and HIV Transmission Risk

Based on the Department of STI Control Clinic in Singapore, the table below summarizes the risk of transmission of HIV based on the type of sexual practice.

Sexual PracticeEstimated risk of HIV transmission from a known HIV-positive individual not on effective HIV treatment

 

Receptive vaginal sex10 per 10,000 persons
Insertive vaginal sexAbout 8 per 10,0000 persons
Performing oral sex< 1 per 10,000 persons
Receiving oral sex< 1 per 10,000 persons

 

Can HIV be transmitted via oral sex yes, but the risk is roughly 10x less likely than vaginal sex.

 

So when is there no risk of HIV transmission?

  • Breathing the same air as someone.
  • Touching a toilet seat or door knob.
  • Drinking from a water fountain.
  • Hugging, kissing or shaking hands (although kissing may transfer fluids the level of virus in saliva is so low as to make the risk negligible).
  • Sharing food or utensils.
  • Sharing gym equipment.
  • Skin to skin contact with an HIV positive person even if they happen to have fluid of unknown origin on them (particularly applies to commercial sex workers).
  • Biting or scratching that does not break the skin or draw blood

 

How can we reduce risk of HIV transmission?

  • Monogomous relationship
  • Avoid casual sex or paid sex
  • Always use condoms
  • Regular testing if you are at risk – protect yourself and your loved ones

 

There are no way to know your HIV states unless you go for a HIV Test.

 


 

 

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Which STD Tests Should I Get In Singapore?

STD screening can be a confusing topic for many. For anyone who is sexually active, getting tested for STDs should be part of your regular health screening to protect yourself.

People often only get tested when they show symptoms, or if they have had recent new sexual partners whose health or infection status they are unsure about. However, individuals who are asymptomatic and with no specific sexual exposures of concern should still undergo routine STD screening.

Here are some of the screening recommendations suggested by the US Centers for Diseases Control and Prevention (CDC).

WhoRecommended testing Recommended interval
All adults between ages 13-64HIV screeningAt least once in lifetime
All sexually active women under 25Chlamydia and Gonorrhea testingAnnual
All sexually active women 25 and aboveChlamydia and Gonorrhea testingIf you have had new partners

If you have had multiple partners

 

If your partner has had an STD

All pregnant womenSyphilis, Hepatitis B and HIV testing

 

Chlamydia and Gonorrhea testing if you may be at risk of these

Early in pregnancy and repeated as required
All sexually active MSM (men who have sexual intercourse with men)Chlamydia, Gonorrhea and Syphilis testing

 

At least annually

 

More frequent testing (e..g 3-6 monthly intervals) is recommended for individuals with multiple partners or partners whose infection status’ they are unsure of

HIV testing3 to 6 monthly
Anyone who has had unsafe/unprotected intercourseHIV testingAt least annually

 

The above general recommendations detail the minimum sexual health testing that one should undertake as part of one’s routine screening. The types of tests recommended ultimately depend on your individual situation and symptoms.

If you have any reason to believe or be concerned about exposure to any STDs, or if you are having symptoms suggestive of an STD, a more thorough screen may be warranted. If you wish to find out more about STD screening, you can have an open conversation with your doctor about your sexual history and any possible concerns or symptoms you may have. Your doctor will then be able to best advise you on what relevant screening you can undergo.

 

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What Are Pubic Lice (Crabs) & How Do You Get Them?

Pediculosis Pubis is an infestation by the crab louse, Pthirus Pubis. Also known as “crabs”, pubic lice infestation is a relatively common but unreported sexually transmitted disease (STD) and it is estimated that 2% of the world population has had this infestation prior.

Pthirus Pubis

The crab louse is a small, translucent parasite around 1mm in length. It is one of the 3 species of lice that infects humankind and is differentiated by its almost round body. Crab Lice is exclusively found on human hosts and requires human blood to survive. As its name suggests, it is usually found in the hair at the pubic region but it can also be found in other coarse hair of the body, like eyebrows, armpits, beards for example.

Symptoms

The main symptom of a pubic lice infestation is intense scratching, typically at the pubis and the perineum. There can be also pale bluish discoloration of the skin following prolonged infestation as a result of injection of lice salivation during feeding.

When the eyelashes are involved, there can be crusting/matting of the eyelashes with eye irritation as well. Children might be seen continuously rubbing their eyes.

Thankfully, pubic lice are not known to be any vectors of any harmful diseases, unlike the body lice.

Diagnosis

Diagnosis is usually made by direct visualization of the lice or nits (lice eggs) by the patient or the doctor. No other blood tests or swabs are required.

Transmission

Transmission is usually during sexual contact with skin to skin contact.

Transmission via the environment, for example through clothing, towels or linen may also occur but are less common.

One is unlikely to catch pubic lice from a toilet seat as the organism gravitates towards a warm environment and is not adapted to crawl on smooth surfaces.

Treatment

Topical medication is available for treatment of pubic lice and a few applications might be required for complete eradication.

Shaving of the affected area is not required but the manual removal of nits with a nit comb or tweezers is recommended.

It is also important for close sexual contacts of the affected patient to be screened for pubic lice infestation as well. Abstinence is also recommended until re-examination to rule out persistent infection.

Bedding and clothing of the affected patient should also be machine washed in hot water and dried. There is no need for fumigation of the entire room.

 

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How to Test for Oral STDs

It is a common misconception amongst both men and women that oral sex (i.e. fellatio, cunnilingus, and analingus) is completely risk-free when it comes to infections. While oral intercourse is often thought to be a safer option compared to penetrative intercourse or conventional sex, the reality is that a variety of STDs can still be transmitted through direct contact with the mouth, lips, tongue or throat.

As such, it is important to monitor for symptoms of these infections as well as proactively test if there is a potential exposure risk, especially as a large proportion of these infections can be asymptomatic, or have symptoms that develop much later.

The most common infections transmissible through oral sex are Chlamydia, Gonorrhea, Herpes Simplex Virus (HSV), and Human Papillomavirus (HPV), and Syphilis. In this article, we will be outlining some of the common symptoms seen with these infections as well as how they can be tested.

Chlamydia and Gonorrhea

These are two of the most common STDs seen globally, and are caused by the bacteria Chlamydia Trachomatis and Neisseria Gonorrhea respectively. They will usually infect the genital region, urinary tract, anus, and oral cavity, although other sites of infection have been noted as well. While symptoms such as sore throat and throat discharge may be present in some individuals, up to 70-80% of throat infections with chlamydia and gonorrhea may be asymptomatic and a large portion will remain undiagnosed and untreated.

The most accurate method of testing for throat chlamydia and gonorrhea infections will be with Polymerase Chain Reaction, or PCR testing – this looks for specific genetic sequences from the DNA of these bacteria. Standard bacterial cultures are usually insufficient to pick up these infections.

Herpes Simplex Virus

There are two main types of HSV infection. Type 1 HSV is more commonly seen, and can be spread through both oral-to-oral transmission such as kissing, as well as oral-to-genital transmission. Type 2 HSV is more typically seen through genital-to-genital transmission, although it can also be spread to the mouth, tongue, and throat through oral sex. These viral infections can cause outbreaks of painful ulcers or cold sores at the site of transmission, and infection is carried lifelong. There is risk of transmission of these infections even without symptoms.

Testing for herpes infections can be performed either with blood serology testing or via PCR testing if there are symptomatic lesions. Serology or antibody testing will only be able to detect possible past exposure 1-3 months after transmission, and is not useful to detect new or acute infections.

Human Papillomavirus

HPV infections are one of the most common prevalent STDs worldwide. There are many subtypes of HPV, usually divided into low-risk and high-risk categories. Low-risk types include type 6 and 11, which are responsible for about 90% of genital warts or papillomas – these are benign, cauliflower-like growths on the skin and mucous membranes that can develop weeks to months after initial transmission. High-risk types include type 16, 18, 31, 33, 45 etc. and are more related to cancer risk, including cancers of the cervix, anus, penis, and mouth/throat. It is estimated that approximately 20,000 HPV-associated oral cancers are diagnosed per year in the US alone.

Warts from HPV are usually diagnosed clinically and do not require any specific testing; however, high-risk HPV infections are usually asymptomatic and would require PCR testing to be detected. Guidelines currently recommend women over the age of 30 to do regular HPV PCR testing together with their pap smears, and for men who have receptive anal sex to screen for rectal HPV if they are HIV positive. While oral HPV testing can be performed with the same type of test, there are no specific recommendations to do so, with the costs and benefits of the test to be determined by the individual and their doctor. HPV infections can be prevented with the HPV vaccine, which is now available for both males and females 9 years of age and older.

Syphilis

Syphilis infection is caused by the bacterium Treponema Pallidum. While incidence of syphilis had initially decreased with the availability of penicillin treatment in the 1940’s, rates of infection have been rising steadily for the past two decades, and it is commonly seen as a co-infection with Human Immunodeficiency Virus (HIV). Syphilis infection can be spread through direct contact to mucous membranes and compromised skin from an infected sore or chancre, usually at the genital region, anus, and mouth; it is estimated that around 20% of syphilis infections are transmitted through oral sex alone. Symptoms will depend on stage of infection at presentation, and can include sores or ulcers in primary syphilis, and a diffuse rash in secondary syphilis. Many cases are not detected when symptomatic and may be considered in the latent stage when screened on blood testing, or may even reach the tertiary stage many years after initial infection – this can cause complications with the heart and blood vessels (cardiovascular system), or with the central nervous system (neurosyphilis).

Syphilis testing is mostly performed with serological tests, which look for certain antibodies in the blood that can be detected 2-5 weeks after infection. Other forms of testing include dark-field microscopy, direct fluorescent antibody, and PCR testing; however, these are rarely performed in the clinical setting due to cost and availability of equipment and experienced lab personnel.

 

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Symptoms of Sexually Transmitted Diseases in Women

Sexually transmitted diseases (STD) are a major issue amongst women of any age. They may lead to a variety of complications as they can affect the reproductive health of women if left untreated. Therefore, it is important to recognize their symptoms and the need for early medical review and treatment cannot be emphasized strongly enough.

Some of the STDs are caused by:

1) Human papillomavirus
2) Chlamydia trachomatis
3) Neisseria gonorrhoea
4) Genital herpes
5) Trichomonas
6) Mycoplasma genitalium
7) Syphilis
8) HIV
9) Hepatitis B
10) Hepatitis C

It is important to note however, that many people with STDs do not know that they carry the infection. This is called asymptomatic infection. Therefore, even if you have no symptoms and are concerned about an exposure that may have been high risk (e.g. unprotected sex, a recent STD diagnosis in a partner, substance or alcohol use during sex or having multiple sexual partners), then STD tests should be performed to rule out asymptomatic infection.

Symptoms that may suggest that you have STD are as follows:

1) Abnormal vaginal discharge

Any discharge that is unusual for the woman such as a change in quantity, consistency, colour (yellow to greenish) and if there is blood mixed in may indicate an infection.

2) Vaginal itch

This is usually felt externally in the vulva area and may indicate an infection within the vagina.

3) Abnormal vaginal odour

A malodorous discharge or odour without discharge may be abnormal and can be caused by STDs.

4) Vaginal discomfort, pain or burning sensation

This can range from a mild discomfort to full-blown pain or a burning and stinging sensation down below.

5) Painful urination

Burning or a painful sensation during peeing or sometimes just a “hot” sensation during the process though may indicate a urinary tract infection (UTI) but do note that it could also point to an STD.

6) Painful sexual intercourse

This is also called dyspareunia and if it feels deeper inside, it may indicate an infection involving deeper areas such as the cervix.

7) Lower abdominal discomfort or pain

This again may mean infection of the deeper structures such as in pelvic inflammatory disease.

8) Bleeding outside of menses

This may again indicate pelvic inflammatory disease but may also be due to sinister conditions like cancer of the cervix.

9) Vulva blisters, sores, ulcers or wart-like lumps that can also involve other areas such as anal and oral areas

STDs can manifest as rashes or ulcers in the vulva areas or other places as stated above. A blister-like rash is typical for genital herpes whereas a single ulcer (painless or painful) may be early syphilis. Genital warts are due to an infection with human papillomavirus.

10) Non-specific flu-like symptoms such as sore throat, mild fever, headache, tiredness and fatigue

Though these symptoms may not seem to indicate anything serious (apart from suspicion of covid-19), a recent infection with viruses such as HIV and hepatitis B and C may manifest with any of these symptoms. These symptoms are due to the body’s antibody production against these viruses, also called ‘acute seroconversion syndrome’. It is important to think about these conditions particularly after a high-risk sexual exposure event.

11) Swollen (painful or painless) lymph nodes either widespread or limited to the groin area

An STD may cause regional lymph nodes to swell up and may cause pain or discomfort.

12) Widespread rash mainly in the trunk or back which can involve palms and/or soles

Generalised rash involving the body which can involve the palms or soles or both is one of the common symptoms of syphilis.

Though you may feel that you are unlikely to have an STD as you don’t feel any symptoms at all, as mentioned earlier, a large proportion of people who have STDs may not exhibit any symptoms. Thus one should exercise caution when it comes to engaging in high-risk activities (e.g. 100% protection including during oral sex, reduce number of sexual partners, avoid alcohol or substance use etc) and to always seek medical attention should a partner is diagnosed with an STD.

The importance of early diagnosis and treatment of STDs cannot be emphasized enough and this is so that the risk of transmission to others is eliminated and to also reduce the risk of development of complications from STDs.

Should you have any concerns regarding STDs or are experiencing any of the above symptoms, do consider making an appointment with us at DTAP clinic.

 

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Transcript from video:

Hi, I’m Dr. Jonathan Ti from Dr. Tan and Partners, and today I’d like to talk about HIV PrEP.

PrEP stands for Pre-Exposure Prophylaxis, and it has emerged in recent years as one of the most effective ways to prevent HIV infection. Individuals taking PrEP can reduce their risk of getting HIV by upwards of 95%. This type of medication must be taken before any risk exposure to be effective. It is different to Post-Exposure Prophylaxis, or PEP, which is taken immediately after a possible exposure and uses additional medications.

PrEP is usually taken as a once daily tablet, a combination of antiviral drugs tenofovir and emtricitabine. Other types of dosing regimens are available as well, depending on the unique lifestyle of the individual. Studies have shown that PrEP is generally safe for long term use, but some may experience side effects such as a reduction in kidney function and bone density, especially with the older version of medication called Truvada. The US FDA recently approved a newer drug called Descovy for use as PrEP, which has shown to be equally effective in preventing HIV infection whilst touting an improved safety profile for kidney and bone toxicity. The main difference between Descovy and Truvada is the form of tenofovir drug present – the newer Descovy uses TAF, which enters target cells more efficiently than Truvada’s TDF, and means that a much lower dose of tenofovir is needed. This means that other tissues such as kidney and bone are exposed to a much lower dose of the drug and there is less risk of drug toxicity and side effects.

HIV PrEP is recommended for individuals who belong to a high-risk group for HIV infection, and who do not have any current established HIV infection. HIV high-risk groups may include:

  • Someone who has an HIV-positive partner
  • Someone who has multiple sex partners, a partner with multiple partners, or a partner whose HIV status is unknown and does not practice safe sex; there is higher risk in men who have sex with men or transgender women
  • Someone who has sex with commercial sex workers
  • Someone who has recently had a sexually transmitted disease
  • Someone who injects drugs, or has unprotected sex with someone who injects drugs

Both Truvada and Descovy are available in our clinics. They are only available by prescription. Please speak to our Doctors if you think PrEP is right for you.