Common STD Incubation Periods

STD Incubation Period. The incubation period for the various STIs (Sexually Transmitted Infections) is a common question asked by patients in our clinics. It refers to the time between acquiring the infection and the presentation of symptoms. This is different from the window period, which refers to the period after infection in which no current available tests are sensitive enough to detect the infection. The window period for the various STIs depends on which tests are used. 

As different STIs have different incubation periods, it is not easy to answer the question when symptoms will appear after a particular risky exposure. I will list below the common STIs tested for, their incubation and window period as well as possible initial presentation. 


The following are the Common STDs and their incubating periods:

#1 STD Incubation Period – Human Immunodeficiency Virus (HIV)

Early HIV infection refers to approximately 6 months after initial acquisition. It is estimated that 10 to 60 percent of all early HIV infections are asymptomatic, or without any symptoms. For early symptomatic HIV infection, the usual incubation period is around 2 to 4 weeks, although incubation periods as long as 10 months have been observed.

Acute symptomatic HIV infection present with a collection of signs and symptoms known as Acute Retroviral Syndrome (ARS). The most common findings for ARS are fever, sore throat, rash, swollen lymph nodes, body aches and pains. However, all these symptoms are not specific to acute HIV infection, hence please do not panic if you observe these symptoms after a risky encounter. See your doctor for further advice and testing

The Window period for HIV testing depends on the test that is conducted. The initially 10 days after exposure is known as the eclipse period, for which there are no tests that can pick up any infection. The earliest tests that can be done with conclusive results are the HIV ProViral DNA test or the HIV RNA PCR test, which can pick up possible acute infections 10 days after exposure.

4th Generation HIV tests will be conclusive around 28 days after exposure, while 3rd Generation HIV tests will be conclusive around 90 days after exposure. 

Anonymous HIV Testing is available at our Robertson Walk Branch. HIV Test results in 20 mins.


#2 STD Incubation Period – Syphilis

Approximately 50% of patients diagnosed with syphilis do not have any symptoms. This is because syphilis has 3 stages of infection: Primary, Secondary and Tertiary Syphilis and Primary and Secondary syphilis might have symptoms that are so mild that they are ignored by the patient.

Primary syphilis presents with a painless ulcer on the genitalia, known as a chancre. The incubation period for a chancre appears to range from 3 to 90 days, with an average of around 21 days. The chancre will heal within 3 to 6 weeks even without treatment. Within weeks to a few months after the chancre appears, around 25 percent of untreated individuals will develop Secondary Syphilis.

Secondary Syphilis can present with a widespread rash, ulcers, patchy hair loss, swollen lymph nodes, weight loss and fatigue. The infection subsequently goes into a latent phase lasting for years for which there are no signs or symptoms. This is the reason why the majority of syphilis picked up on routine screening are asymptomatic.

Neurosyphilis occurs when the infection reaches the central nervous system i.e. the brain or spinal cord. Neurosyphilis can occur at any stage of infection, but tends to occur in tertiary syphilis. Therefore, neurosyphilis can occur within a few months, but could also develop after 10 to 30 years, of a syphilis infection. 

The window period for syphilis testing depends on the stage of syphilis infection. The blood tests (FTA-ABS and TPPA) will be positive around 1 to 2 weeks after chancre formation. 


#3 STD Incubation Period – Hepatitis B and C

The majority of hepatitis B and C infection are asymptomatic. It has been estimated that around 30 percent of acute hepatitis B infection and less than 25 percent of acute hepatitis C infection are symptomatic. Symptoms of acute infection tend to be very mild and may include the following: Fever, Fatigue, Nausea/vomiting, Dark Urine, Pale stools and abdominal pain. 

The incubation for acute hepatitis B infection is estimated to be around 1 month to 4 month, while the incubation period for acute hepatitis C infection is estimated to be from 2 weeks to 3 months.

The window period for both hepatitis B and C testing for antibodies is on the average about a month. It will be much shorter if alternate tests such as the Hepatitis C RNA PCR test for Hepatitis B Viral Load are used instead.


#4 STD Incubation Period – Genital Herpes

Genital herpes is caused by both Herpes Simplex Virus 1 or 2 (HSV1/2). Genital herpes infections often do not have symptoms or mild symptoms that go unrecognized. It is estimated that one third of patients with new infections do not have symptoms. The initial presentation of symptoms range from severe with painful genitalia ulcers, painful urination, painful lymph node swellings and fever. However, patients also can have mild or no symptoms as well. The initial presentation does not depends on the type of virus (HSV1 vs HSV2)

The incubation period for genital herpes is around 4 days, with a range from 2 days to 12 days.

For asymptomatic infections, HSV 1/2 Antibodies will start appearing in the serum starting from 3 weeks and majority of patients would have antibodies by 16 weeks. The window period for testing for asymptomatic patients is hence from 3 weeks to 16 weeks. For patients with symptoms of the painful genital ulcers, the test of choice is Nucleic Acid Amplification Testing (NAAT) for which a swab of the ulcer is taken and tested for HSV DNA. There is no window period for NAAT.

Rapid Herpes Testing with Next Day Results is available in all DTAP Clinic in Singapore.


#5 STD Incubation Period – Gonorrhea

Gonorrhea causes different symptoms for men and women. For women, the cervix is the most common site of infection and the common symptoms are vaginal itch and discharge. Some women also have heavier periods or bleeding in-between periods. If the infection has ascended beyond the cervix into the uterus, this is a potentially more dangerous condition known as Pelvic Inflammatory Disease (PID) for which abdomen pain and fever are common symptoms. Up to 70 percent of patients with cervical gonorrhea infection are asymptomatic. 

For men, urethritis is the most common presentation of gonorrhea infections. It is characterised by purulent urethral discharge and painful urination. In contrast to infections in women, the majority of infections in men are symptomatic. 

In women, the incubation period for genital infection is around 10 days. In men, the incubation period for symptomatic infected men is around 2 to 5 days, with 90 percent of these individuals with symptoms of urethritis by 2 weeks.  

The gold standard for testing for gonorrhea infection is NAAT, a urine sample for men and a cervical swab for women. As NAAT is able to detect low numbers of organisms with good accuracy, there is no window period for NAAT testing.

Rapid Gonorrhea & Chlamydia Testing with Next Day Results is available in all DTAP Clinic in Singapore.


#6 STD Incubation Period – Chlamydia

Chlamydia causes similar symptoms as gonorrhea in both men and women. In women, the cervix is also the most common site of infection with a proportion of patients having a urethra infection as well. However the majority of infected women, around 85 percent of patients are asymptomatic with neither signs or symptoms.

Symptoms of chlamydia infection are similar to gonorrhea in men as well, with a clear to mucoid penile discharge and painful urination. The proportion of asymptomatic infection varies as well in men, ranging from 40 to 96 percent with no symptoms. 

The incubation period for symptomatic infection ranges from 5 to 14 days after exposure for both men and women.

The gold testing for testing for chlamydia infection is NAAT as well. There is no window period for NAAT testing.

Rapid Gonorrhea & Chlamydia Testing with Next Day Results is available in all DTAP Clinic in Singapore.


Asymptomatic/Mild Infections (%)Incubation PeriodSample TypesWindow Period
HIV10 to 602 to 4 weeksBloodProviral DNA : 10 days
RNA PCR : 12 days
4th Generation Ag/Ab :28 days
3rd Generation Ag : 90 days
Syphilis503 to 90 days
Average 21 days
BloodFTA-ABS : 1 to 2 weeks after chancre
Hepatitis BMajority Asymptomatic1 month to 4 monthBloodHbsAg : 1 month
Hepatitis CMajority Asymptomatic2 weeks to 3 monthBloodAnti-HCV Ab : 1 month
Herpes702 to 12 days
Average 4 days
Blood/
Swab
HSV 1/2 IgG : 3 to 16 weeks
HSV DNA PCR : No window period
GonorrheaWomen: 70
Men: Majority Symptomatic
Women:10 days
Men: 2 to 5 days
Swab/
Urine
Gonorrhea DNA PCR: No window period
ChlamydiaMajority Asymptomatic5 to 14 daysSwab/
Urine
Chlamydia DNA PCR: No window period

If you like to speak to our doctors on your STD concern, please visit any of our clinics in Singapore & Malaysia.

You can also email us at hello@dtapclinic.com, or call any of our clinics for an appointment


Common Medical Conditions That Are Asymptomatic

Signs and Symptoms are technical terms to describe the extent of disease in a patient. A sign is an effect of the disease that can be observed by another person or elicited through certain manoeuvres while a symptom is an effect that is experienced only by the patient. 

What does being asymptomatic mean?

Being “asymptomatic” is when the patient does have the disease but does not experience any effects of the disease. In this article, we will be discussing 5 diseases where patients are usually asymptomatic in the early stages of the disease but as the disease progresses, it adds an increased burden on the body leading to more pronounced signs and symptoms.

The 5 diseases were selected because while there is no way for patients to know if they have the disease early on due to the lack of symptoms these diseases can be easily detected during health screening with your General Practitioner. Therefore, we hope to highlight the importance of your health screening in allowing your doctor to detect these diseases early and prevent the disease from progressing to a more severe state.

So just before you brush off that health screening appointment because “I feel OK” , have a read to see the benefits or early detection and treatment.


5 Diseases where patients are asymptomatic

Human Immunodeficiency Virus (HIV)

What it is?

HIV infection is a disease in which the virus attacks specific cells (CD4) in the immune system and uses the cells to create more copies of the virus, killing the host cells in the process. In the early stages of HIV, the rate of CD 4 cell production can still cope with the loss from the viral infection, therefore patients are mostly asymptomatic.

Over time as the virus replication picks up pace, the CD 4 cell numbers dwindle and the immune system becomes less effective in responding to environmental insults such as bacterial or fungal infections. Major risk factors for HIV infection include, IV drug use, unprotected casual sex and anal intercourse.

How do you test for it?

Point of Care testing can be done at most clinics in Singapore, this involves taking a sample of blood from a finger prick and placing it into a test kit. Currently, the earliest you can be tested for HIV is 30 days after infection. Early treatment of HIV prevents the virus from replicating and thus prevents the disease from worsening and progressing to Acquired Immunodeficiency Syndrome (AIDS).
HIV Testing Singapore
Anonymous HIV Testing Singapore

Chlamydia

What it is?

Chlamydia is a common bacterial infection in both Men and Women. Infection is usually found in the genital tract but also in the rectum, throat and even eyes. Up to 70% of women and 50% of men are asymptomatic. Left untreated, the bacteria can replicate further to eventually lead to an inflammatory state in the pelvis. This results in severe discomfort and particularly in women the risk of infertility is especially raised if chlamydia is untreated.

How do you test for it?

Chalmydia Rapid testing can be carried out to detect the presence of Chalmydia within 24 hours. A sample is taken from the region, a vaginal swab for women and a urine sample for men, and a Polymerase Chain Reaction is used to detect any chlamydial genetic material. Treatment of chlamydia can be as simple as a single dose of antibiotics if detected at an early stage.
Rapid STD Testing Singapore

Chronic Illnesses

High cholesterol

What it is?

Cholesterol can be thought of in 2 forms, a high density form (HDL) and a low density form (LDL). HDL lowers the total cholesterol in the body while LDL increases it. An increase in cholesterol and triglycerides (both from fatty foods) results in plaques developing within your blood vessels (Atherosclerosis). As the plaques increase in size, blood flow to your vital organs like your heart and brain are compromised thus increases the risk of heart attacks and strokes.

How do you test for it?

A blood test usually done at your health screening enables your doctor to determine the cholesterol levels in your body. Not all elevated cholesterol has to be treated with  medications because changes in diet and lifestyle can also lower cholesterol in some cases. 

Hypertension

What it is?

Hypertension is when your blood pressure is persistently elevated, the normal blood pressure should be below 140 systolic and 90 diastolic. There are myriad of causes for elevated blood pressure including, high salt intake, stress or kidney disease.

However, many people have Essential hypertension, which is when the blood pressure is found to be elevated for no particular cause. Even though the cause may not be determined in most cases of hypertension, patients with an elevated blood pressure have a higher risk of strokes. This is because, the increased pressure in the blood adds additional strain to the blood vessels, eventually, the blood vessels become weaker and are more likely to break, resulting in a stroke.

How do you test for it?

The diagnosis of hypertension in an asymptomatic patient involves a Blood Pressure diary where the patient measures her blood pressure at the start and end of the day for 2 weeks. A persistently elevated blood pressure may prompt the doctor to start treatment, however there are also non-pharmacological means of lowering blood pressure.

Diabetes

What it is?

Diabetes, in particular Type 2 Diabetes, is a condition where the body is unable to regulate carbohydrate metabolism. This results in wide spread effects on the patient because sugar derived from carbohydrate metabolism is essential to many cellular activities in the body. Although patients are mostly asymptomatic in the early stages of the disease, patients can eventually have a variety of pathologies as the disease progresses such as loss of sensation in the hands and feet, poor wound healing, reduced immunity and even blindness.

How do you test for it?

Testing for diabetes also involves a blood test to measure the sugar levels in a fasting state to gauge the current level of sugar metabolism in your body and the Haemoglobin A1c (HbA1c) which is a gauge of the long term extent of sugar metabolism in your body. Depending on the extent of your disease, treatment of diabetes can range of lifestyle modification to injectable medications.


Having a disease in its early stages sometimes means that you still feel “fine” and not experience any symptoms. However, if left untreated, these diseases can progress and lead to severe complications in your health. Getting checked regularly is essential for detecting disease in the asymptomatic phase and treating it early. This prevents the disease from progressing to a more severe state and allows us to lead better, healthier lives. Speak to your doctor today!


Other Asymptomatic Medical Conditions:

Also on this site: Wart Removal Singapore, STD Check Singapore

Why you should not be embarrassed to get tested for HIV

Many people are still not getting regularly tested for HIV.

In my line of work as a Family Physician, I frequently assist patients in performing Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infection (STI) screening. I would like to share a story of a patient I recently treated. 

40-year-old Melvin (not his real name) came by one day for a clinic consultation. His friendly and cheerful demeanour was accompanied with a mild level of anxiety. He shared with me his background: he was a gay man, in a monogamous relationship with a long term partner. Like many people, he had had several previous partners – past relationships, and the occasional casual fling. However, he had never undergone any screening tests to evaluate his sexual health. The last time he had been tested for HIV was over 20 years ago, when he enlisted for National Service.

“The honest truth is I am embarrassed and also fearful of seeing a doctor to do these tests. In fact, it took me a lot of courage to come to visit you today!”, said Melvin rather sheepishly.

“I have always had this avoidance mentality towards HIV. I felt that I would rather not get tested, and just live my life more peacefully. And really, what are the chances? I have always used condoms and compared to other people, I don’t think I have had many sex partners in my life,” he added.

He lets on further that it was after a lot of encouragement from his partner that he decided to bite the bullet and visit a clinic.

The news came as a complete shock to him – he had unfortunately tested positive for HIV. It took some time for him to come to terms with the result, and the fact that his life was never going to be exactly the same again. The silver lining was that Melvin was still in the early stages of the infection. He has since promptly started on treatment and is doing regular follow-up monitoring of his condition. The good news is that by doing so, he will likely be able to keep the virus in check and thus maintain a healthy immune system. 

Melvin’s case highlights a perennial problem in mankind’s fight against HIV. Despite continuous  efforts by health organisations to educate the public on HIV and increase awareness on the importance of regular screening, many people are still not getting regularly tested for HIV. It is estimated that 15% (1 in 7) of people in the United States are presently living with HIV and unaware that they have the infection. In an update on the HIV situation in Singapore earlier this year, the Ministry of Health (MOH) stated that only 14% of newly reported HIV cases in 2018 were detected by self-initiated, or voluntary, screening.


Common reasons that deter people from getting tested for HIV

1. I am scared of getting tested positive for HIV

Fear and anxiety are probably the biggest reasons why people avoid getting tested. The truth is, living in the unknown is worse and often scarier. It is far better to get the testing over and done with. If it is negative, it will bring much relief. If unfortunately the result is positive, all is not lost. Knowing your status early is the first step to getting support and receiving treatment in order to stay healthy. 

2. If I test positive for HIV, people will find out

Medical clinics and testing centres endeavour to keep all patient records strictly confidential. Under the Infectious Diseases Act in Singapore, a positive test for HIV is notifiable to the Ministry of Health (MOH). This is mainly for public health purposes, such as disease surveillance, monitoring the HIV infection situation, conducting contact tracing and assessing disease prevention and management measures. Healthcare professionals and MOH do not inform the patient’s employer, insurance provider and certainly not family and loved ones.

3. I am afraid of being judged or being embarrassed 

Healthcare professionals are trained to provide professional and non-judgmental consultation. If you do not wish to visit your regular doctor, take some time to do a search online as there are plenty of alternative options that you can consider. It is important to find a sexual health clinic or testing centre that you feel comfortable with. 

4. I trust my partner

If two HIV-negative people are in a monogamous relationship, then certainly there is no risk of HIV, but we are all human and no one is perfect. If one member slips up outside of the relationship, then both parties could be at risk of HIV, especially if engaging in unprotected sex. It is important to have open and honest communication with your partner. If you or your partner has had sex with any casual partner, or if there is any doubt about your HIV status, then do get tested.

5. I am not at risk of HIV

Even if you think that there is no chance that you have been exposed to HIV, as long as you are sexually active, it is recommended to do HIV testing at least once a year, or more frequently if your behaviour puts you at higher risk.

6. Who should test for HIV?

It is recommended by the United States Centre for Disease Control and Prevention (CDC) that everyone between the ages of 13 to 64 should undergo HIV testing at least once as part of routine health care. However, if your behaviour still puts you at risk even after getting tested, you should consider getting tested again at some point later on. People who engage in higher risk activity should get tested regularly.

Also read: HIV SYMPTOMS – WHAT YOU NEED TO KNOW


If you answer ‘yes’ to any of the questions below, you should get an HIV test if not done recently:

  • Are you a man who has had sex with another man?
  • Have you had sex – anal or vaginal – with an HIV-positive partner?
  • Have you had more than one sex partner?
  • Have you injected drugs and shared needles or works (for example, water or cotton) with others?
  • Have you exchanged sex for drugs or money?
  • Have you been diagnosed with, or sought treatment for, another sexually transmitted disease?
  • Have you been diagnosed with or treated for hepatitis or tuberculosis?
  • Have you had sex with someone who could answer “yes” to any of the above questions or someone whose sexual history you don’t know?

What are some of the HIV tests available?

There are three types of HIV tests available. 

1. Nucleic Acid Test (NAT) 

Also known as an HIV viral load test, this test looks for the actual virus in the blood. If the result is positive, the test will also show the amount of virus present in the blood. NAT is very expensive and thus not routinely used to screen individuals unless they recently had a high-risk or possible exposure and there are early symptoms of HIV infection. NAT is usually considered accurate during the early stages of infection. However, it is best to get an antibody or antigen/antibody test at the same time to help in the interpretation of a negative NAT result. Taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) may also reduce the accuracy of NAT. (All our clinics provide HIV PrEP & PEP services.)

A NAT is able to detect HIV in the blood as early as 1 to 4 weeks (7 to 28 days) after infection.

2. Antigen/antibody test

Also known as a fourth-generation or combination test, this test looks for both HIV antibodies and antigens. Antibodies are produced by the immune system when one is exposed to bacteria or viruses like HIV. Antigens are foreign substances that cause the immune system to activate. In early HIV infection, an antigen called p24 is produced even before antibodies develop.

The fourth generation test is able to detect HIV in the blood 2 to 6 weeks (13 to 42 days) after infection, and is most accurate after a 28-day window period.

3. Antibody test

This is also known as a third-generation test. As mentioned before, antibodies are produced by the immune system upon exposure to bacteria or viruses like HIV. 

The antibody test is able to detect HIV in the blood in approximately 97% of people within 3 to 12 weeks (21 to 84 days) of infection. If a positive HIV result is obtained from any type of antibody test, a follow up test is required to confirm the result. 


What does the test involve?

In the clinic setting, all the tests are typically performed using blood samples. Laboratory testing can be performed for all three types of HIV tests, whereby blood is drawn from a vein and collected in a tube. Rapid testing is available for only the fourth-generation test and the antibody test, whereby a few drops of blood are obtained via finger prick, and the results are ready in 20 minutes. 

The rapid HIV antibody test can also be performed using oral fluids collected from the mouth and gums with a swab stick. Similarly, the results are ready in 20 minutes. This option is available in some clinics and community testing programs, such as Action for AIDS (AFA) Singapore. 

HIV Screening Singapore

Regardless of the test you choose, the process is simple and fuss-free, and no prior preparation is required – all you need to do is show up at the clinic. Pre and post-test counselling is always conducted professionally and non-judgmentally. 

Despite all this, there are many who still feel extremely self-cautious about approaching a doctor to discuss HIV testing, for fear of stigma and discrimination. This is where Anonymous HIV Test (AHT) comes in. AHT is offered as a means to encourage more individuals who suspect they might be at higher risk to step forward to do testing. There are only 10 clinics in Singapore that are licensed to offer AHT. AHT does not require any name, contact number or form of identification. Instead, a number is usually assigned to the patient for the purposes of providing the result later on. The patient is then required to fill up an anonymous questionnaire to provide some information on his/her sexual behaviour. When seeing the healthcare provider, he/she may be asked some further questions before undergoing the test. AHT is performed using rapid testing only. The entire process throughout is kept confidential and strictly anonymous, even if the test result is positive.  

Anonymous HIV Testing is available in our Robertson Walk Branch only.


What happens after the test?

If your healthcare provider uses a fourth-generation antigen/antibody test, you should get tested again 45 days after your most recent exposure. For other tests, you should test again at least 90 days after your most recent exposure to tell for sure if you have HIV.

If your last HIV test was negative, you can only be sure you are still negative if you have not had a potential HIV exposure since then. If you are sexually active, continue to take actions to prevent HIV, like using condoms the right way every time you have sex and taking PrEP if you are at high risk.

Please get tested if you have not done so recently!

The worst part about the prospect of HIV and/or AIDS is living in the unknown. Do not avoid getting tested simply out of fear. Understanding your health and having a solid plan to stay on top of it – regardless if you are HIV-positive or negative – is the best way to live a long and healthy life.

Next read: HIV WINDOW PERIOD – TIMELINES FOR ACCURATE HIV TESTING


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U=U: Science, Not Stigma

Sexual transmission of HIV can be stopped. While there are many barriers to ultimately reaching this goal, one of the most exciting and recently validated concepts resulting from large-scale studies is that of U=U, or Undetectable = Untransmissible.

U=U means that people living with HIV (PLHIV) with a suppressed/undetectable viral load have effectively no risk of transmitting the virus to their sexual partners. The landmark trial of HPTN 052, and subsequent PARTNER, and Opposites Attract studies showed that no linked HIV transmissions were detected between thousands of serodiscordant couples (where one partner is known HIV-positive and one is HIV-negative) as long as the viral load remained undetectable throughout the relationship. This was demonstrated for both heterosexual and homosexual couples, and the greater acceptance of the science has potentially vast implications for personal and public health, social and behavioural norms, and even legal matters.

In order for someone living with HIV to reach undetectable viral load, they will need to be on daily antiretroviral therapy (ART) for at least 3-6 months, and must continue on the medication to maintain viral suppression. Treatment as Prevention (TasP) has been strongly advocated for many years now by HIV specialists and other healthcare providers, but the science and messaging has finally caught up. And for PLHIV, growing awareness and acceptance of U=U will hopefully serve to reduce stigma and discrimination, as well as improve compliance to treatment and follow up.

In 2014, UNAIDS launched the 90-90-90 program which aims to diagnose 90% of all HIV-positive individuals, provide antiretroviral therapy to 90% of the people diagnosed and achieve viral suppression for 90% of those treated by 2020. Current estimates from the Ministry of Health are that only 72% of people living with HIV in Singapore know their status, out of which 89% are on treatment, with the proportion of people on treatment who had achieved viral suppression fairly high at 94%. While the latter two figures are encouraging, more needs to be done to improve HIV testing and diagnosis. Local data shows that only 23% of HIV cases are currently being detected via voluntary screening, while 41% of HIV cases are diagnosed in a late stage.

With over 6,000 people in Singapore currently diagnosed as living with HIV, this means that close to 2,500 are estimated to have the infection without knowing their status. With U=U being a reality, getting at-risk individuals tested and on treatment as early as possible is essential in our fight against HIV. For those who already know their HIV-positive status, there is now additional cause to adhere to ART, as doing so will protect potential future partners from potential transmission.

While U=U is great news overall, there are certain caveats we must remember. For U=U to be considered effective, PLHIV must have an undetectable viral load for a duration of at least 6 months on follow up. Furthermore, studies which have shown that over a quarter of HIV-positive gay and bisexual men in a serodiscordant relationship did not have an accurate understanding of their current viral load, with around 20% of men who believed they were undetectable actually having a detectable viral load. As such, regular condom use and testing is still strongly recommended, as is the wider uptake of Pre-Exposure Prophylaxis (PrEP). It’s also important to note that U=U only applies to HIV infection, so precautions should still be taken against other more common sexually transmitted infections (STIs) such as chlamydia, gonorrhea, and syphilis.

U=U is a simple but important message based on a foundation of scientific evidence. The campaign makes a strong case for adherence to treatment and follow up, and allows PLHIV and the community to understand that they can live long, healthy lives, have children, and enjoy relationships without having to fear passing the infection to others. It will hopefully bring us a few steps closer to achieving the UNAIDS’ 90-90-90 target and help to reduce the stigma still faced by many living with HIV today.


Dr. Jonathan Ti is a GP at DTAP @ Robertson clinic. He has a special interest in sexual health and HIV, and is a co-author of the Community Blueprint to End HIV-transmission and AIDS in Singapore by 2030, and part of the National PrEP Taskforce.

Staying at home but still having a fever?

What Tests Can I Do For My Fever?

A DTAP Stay Home Series Part 3

We touched on the COVID19 situation and the active steps one can take to minimize and prevent infection risks on our past two articles.

Furthermore in our last article we also delved deeper into some of the situations one may face whilst at home, running out of needed medications or even repeated sneezing and scaring away every around. 

But wait, I don’t need further medications, I don’t need to get my sneezing checked but I have this fever which I am worried about. What should I do doc? 

Fever is one of the classic symptoms of one’s body responding to an infection. It is a signal that the immune system is reacting to a foreign invader. These foreign invaders can be anything from the seasonal Influenza Viruses, upper respiratory tract bacterial infections, Dengue fever, the dreaded COVID19 virus or even worse, the most feared HIV virus.

Before we get carried away, let’s explore the facts behind each of these concerns and hopefully we can provide you a handle on how to get these concerns further addressed. From the recapitulation of COVID19, to upper respiratory tract infections and last but not least prolonged fever from possible HIV. 

COVID 19 

Let’s start with a short recap of COVID 19, from the WHO-China joint COVID 19 mission, it was studied that those who are at great risk of severe disease and death include those above 60, those with underlying chronic conditions. And of course as previously discussed, the risks of COVID19 include travel to at risk countries including China, especially Wuhan and Hubei provinces, South Korea, Iran and Northern Italy as of March 2020.

Practically the same advice shared previously of personal hygiene and avoidance of crowded places and even ordering in the medications you need delivered to your home would still stand.

Also read: STAYING AT HOME AND ORDERING IN (A PIZZA) YOUR MEDICATIONS

Upper Respiratory Tract Infections 

Secondly if it were an upper respiratory tract infection caused by other viruses or bacteria, it would be good to have your doctor assess you especially if there are symptoms of fever, cough, sore throat or runny nose. In the current climate, these symptoms would warrant one to get extended rest at home with a doctor’s note (medical certificate) for at least 5 days. When we get an infection in the upper respiratory tract – nasal passages or throat, it is usually caused by either a bacteria or virus.

SYMPTOMS OF A COLD

A cold is a viral infection of our respiratory tract, and there are more than 200 types of viruses which can cause this. It is also a gradual Onset.

SYMPTOMS OF FLU

Sudden onset. Contagious after coming into contact with droplets. The FLU virus can cause a lung infection called pneumonia.

So doc, i’ve heard alot about antibiotics as well, can I just get them prescribed to me for my fever?

Antibiotics however only work against bacteria infections.

Instead of taking too many unnecessary medications, you can get tested to see if you have the flu or a bacterial infection.

Point of care testing is convenient, accurate and gives you an answer in 15mins. Furthermore for those at risk or diagnosed with Influenza (above 60 or have chronic diseases) – antivirals can be prescribed. These include XOFLUZA (a one off treatment) or TAMIFLU and lastly if it is likely a cold, vitamin C and zinc are shown to aid in recovery.

And last but not least, especially for those at risk, please do not forget your twice yearly flu vaccinations (Northern and Southern hemisphere strains respectively) and 2 different jabs for a lifetime protection against Pneumonia.


Fever from HIV

But that being said, what happens then if one’s fever is still persistent and there were concerns from a recent sexual exposure? Especially if it was a causal partner and or someone you met overseas?

The CDC page tells us that HIV is spread when anal or vaginal sex, without a condom occurs with someone who has HIV. The other way HIV is spread is through the sharing of needles or syringes, or even equipment used to prepare drugs for injection with someone who has HIV. Some studies have shown that HIV can survive in a used needle for up to 42 days depending on environmental factors. Temperature etc.

In rarer cases, HIV can be spread through oral sex.

The main transmission medium of HIV however is through fluids and these are predominantly blood, vaginal fluid, semen and even saliva. Here are some statistics from medical studies that have been done. And as you can see, needle sharing, needle use has the highest risk followed by anal intercourse.

Ultimately all these statistics mean nothing, if the concern is still there and there is an exposure, the best thing to do for an ease of mind would be to speak to your doctors and decide whether the Rapid HIV test is something necessary for you.

In summary, there are many causes of fever. In the current climate, fever persisting for more than 5 days can be worrisome. And common things being common, in the absence of a travel history, it is most likely due to an upper respiratory tract infection arising from a cold, influenza or even bacteria. The likelihood of COVID19 is low, but one must also keep a suspicion for infections such as dengue and in the rarest of events HIV. Seeing a doctor early would help you get some point of care tests done with results almost immediately to guide your clinical care and most importantly give you a peace of mind.

Take care, stay safe.


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  • References
  • Boily MC et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis 9(2): 118-129, 2009
  • Vittinghoff E et al. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. American Journal of Epidemiology 150: 306-311, 1999
  • Del Romero J et al. Evaluating the risk of HIV transmission through unprotected orogenital sex. AIDS 16(9): 1296-1297, 2002
  • Townsend C et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS 22: 973-981, 2008
  • Baggaley RF et al. Risk of HIV-1 transmission for parenteral exposure and blood transfusion. AIDS 20: 805-812, 2006


People Living With HIV In Singapore

The alarm chimes to life. As the incessant ringing crescendos the clock face starts to flash an LED blue. Mr. J stretches a slim arm out from under the blankets and pushes down on the snooze button. It was 6:00am on another nice balmy morning in Singapore. Because it was approaching the year end it was a cool 24°C. Jumping out of bed, Mr. J prepares for his morning run on the Park Connector, a network of roads and paths linking the various parks and gardens in Singapore.
A quick shower follows his run and he slips into his shite cotton shirt and blue cotton pants, all ready for a 20 minutes ride on the MRT to Raffles Place and his office in the financial hub of Singapore. After a hard day’s work a 10 minute walk takes him to Fullerton One where he enjoys a well earned dinner and drinks with his friends while the sun sets behind the Marina Bay Sands integrated resort. Another most typical day for a typical Singaporean in Singapore. Except for one difference. Mr. J is one of the almost 7000 people living with HIV in Singapore. 
I set up our first clinic at Robertson Walk in 2005 and in 2008 was awarded the mandate to conduct anonymous HIV tests. Mr. J saw me in 2009. He was recently married. His wife had to spend a few days out of town and he saw no harm in engaging the services of a sex worker. He did not use a condom. As the positive line slowly materialized on the test strip, I turned to Mr. J and said “It looks like the test is positive.”
He screamed and he screamed. He could not stop screaming. He grabbed the pillow on my examination couch and screamed into that. Even in the state he was in, he was considerate enough not to scare the other patients in the waiting room. He finally picked up his phone and called his brother. Soon after, his mother and his brother arrived. They spoke and they cried. I told him it was going to be OK but I knew nothing I said was getting through. A few days later Mr. J came back to the clinic, this time with his wife. She tested negative. She had forgiven him and they were going to have a family together. He would be strong, he would take his medicines and he would live what I promised was a long healthy and meaningful life. 


Since 2008 our clinic at Robertson Walk has conducted more than thirty thousand anonymous HIV tests. We have given good news most of the time and bad news more often than we would like. We have diagnosed people from all walks of life, all orientations, all genders, all vocations and a huge variety of nationalities with HIV. It is a virus that does not discriminate. Some took the news with stoic calm, some crumbled mentally, emotionally and physically. We tell everyone the same thing: it is going to be OK. HIV is not a death sentence. HIV is a chronic disease. It is no different from diabetes. You just have to take a single pill a day. You just have to see the doctor a couple of times a year. It is not so bad. It is not so bad. It is not so bad. It is going to be OK. We have held hands, wiped tears and held people together as they mended. 
After the initial shock comes acceptance and the relatively mundane work of getting the virus under control. We walk with them every step of the way from their first blood tests to their first pills. We link them up with emotional support services, we counsel them on their medical finances and step by step, piece by piece their lives reassemble and are made whole again.


On the 1st of April 2015, Singapore lifted its travel ban on people living with HIV. We opened our arms to all in the region who wished for our brand of care. We started seeing people living with HIV come from Malaysia, Vietnam, Indonesia and many other countries in the region. We provided the best care we knew how and watched like a proud parent as their viral loads dropped and the CD4 counts rose. 
2 to 3 out of every 1000 people in Singapore is living with HIV. Did you walk past a thousand people today? On the bus, on the train, in the mall, at your office? Then you have walked past a few people living with HIV. They are no different from anyone else. In fact, I often tell my patients that the people living with HIV I know are frequently in much better shape. Perhaps they appreciate their health more. It is also a myth that once a person is diagnosed with HIV in Singapore the authorities will come flying in and inform his family and his employer and every time he goes past immigration the officers will look at their screens and give him a dirty knowing look.
None of these happens. In fact, laws in Singapore protect the anonymity of people living with HIV and punish people who share someone’s status unnecessarily. Another myth is that HIV treatment in Singapore is unaffordable costing thousands of dollars a month. There are now many schemes in place to make treatment extremely affordable. What still needs a lot of work is the stigma and discrimination. That is why almost every person living with HIV in Singapore keeps their status a secret. That is also why we salute Mr. Avin Tan who went public with his HIV status and now works tirelessly to help others.


The theme of this year’s World AIDS Day is “Communities make the difference. Communities are the lifeblood of an effective AIDS response and an important pillar of support.” Because HIV/AIDS is not “their problem”, it is our problem. Less stigma means a lower barrier to testing which leads to earlier diagnosis and decreasing the risk to others. Less discrimination means more willingness to seek help and treatment which leads to earlier viral load control and less contagion. More support means people living with HIV staying on treatment and remaining physically, mentally and emotionally healthy and contributing to society.


READ: WORLD AIDS DAY PRESS STATEMENT

My Facebook just got updated. There’s a picture of Mr. J with his wife and 2 lovely twin daughters at the Singapore Barrage. They look like they are flying kites or at least trying to. His girls must be 6 years old by now. 6 years since I tested both of them to be negative for HIV. They look like a really happy family. A typical Singaporean family.
Speak to your doctor if you have any questions regarding HIV, Anonymous HIV Testing, HIV Screening and HIV Treatment & Management.


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艾滋病 (HIV) 的症状与治疗方法

大家好,今天黄医生谈谈艾滋病感染的症状。

HIV症状取决于个体和疾病阶段。

在最初感染后的前2-4周内,患者可能会出现流感样症状, 他们称之为“有史以来最严重的流感”。


这被称为急性逆转录病毒综合征。症状包括发烧,腺体肿胀,喉咙痛,皮疹,疲劳,身体疼痛和头痛。

艾滋病毒症状可持续数天至数周。请记住,这些症状可见于其他常见疾病,您不应仅仅因为体验过它而认为您患有艾滋病毒。还要注意许多早期HIV感染者没有症状。


在HIV感染的早期阶段之后,该疾病进入临床潜伏期,其中病毒在体内发展,但没有看到症状。如果您正在接受艾滋病治疗,那么病毒通常会受到控制,您可能会遇到可能持续数十年的无症状期。如果您感染了艾滋病病毒并且没有接受治疗,那么它将进展为艾滋病。您可能会出现严重的症状,包括体重迅速减轻,反复发烧,大量盗汗,极度疲倦,腺体肿胀,腹泻,口腔溃疡,肺部感染和神经系统疾病。

即使您遇到上述症状,除非您接受检测,否则无法确认HIV。


如果你担心自己有可能跟性(爱)产生接触或正在经历类似状况,请到我们的诊所进行相关咨询和诊测。

与医生预约

HIV / AIDS: The Differences & Myths Surrounding Them

HIV & AIDS in Singapore

There were 434 reported cases of HIV infection among Singapore residents in 2017. Of these cases, 94% were male and 6% were female, and 71% were between 20 to 49 years old. Among ethnic groups, 69% were Chinese, 19% were Malay, 6% were Indian and 6% from other ethnicities.
Sexual intercourse remains the main mode of HIV transmission, accounting for 96% of all cases. Heterosexual transmission accounted for 36%, while 51% were from homosexual transmission and 10% from bisexual transmission.  The number of new HIV cases among Singapore residents has remained consistent at about 450 per year since 2008. These are the latest statistics published by the Government Technology Agency of Singapore, which analyzes data provided by the Ministry of Health.
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What’s the difference between the two? 

HIV is a virus that causes weakening of the body’s immune system. It does so by destroying white blood cells that protect against bacteria, viruses and other harmful pathogens. Without these white blood cells, the body is will no longer be able to defend itself effectively against such infections.
AIDS refers to a spectrum of potentially life-threatening conditions that are caused by the virus, and is the end stage of HIV infection.


How does HIV progress to AIDS? 

HIV infection undergoes 3 stages. The first stage (Acute Stage) may present with flu-like symptoms, fever and a rash. The second stage (Latent Stage) may present with lymph node swelling, but most patients may not have any symptoms at all. The second stage can last anywhere from a few years to over 20 years. Thus, many HIV-infected patients, especially during this stage, may not even know that they have contracted HIV. Last but not least, the third stage is the presentation of AIDS. 
Without adequate treatment, up to 50% of HIV-infected patients develop AIDS within 10 years. Elevated levels of HIV affect the patient’s immune system and prevent it from functioning properly, eventually leading to AIDS. This may result in the individual being more prone to infections. Patients may develop symptoms such as prolonged fever, tiredness, swollen lymph nodes, weight loss and night sweats. Various virus-induced cancers, and opportunistic infections such as tuberculosis and recurrent pneumonia may occur, and these are the leading causes of death worldwide in patients with AIDS.


Who should test for HIV?

Everyone! It is recommended by the United States Centre for Disease Control and Prevention (CDC) that everyone between the ages of 13 to 64 should undergo HIV testing at least once as part of your routine healthcare. However, if your behaviour still puts you at risk even after getting tested, you should consider getting tested again at some point later on. People who engage in higher risk activity should get tested regularly.


Are you at risk?

If you answer “yes” to any of the questions below, you should get a HIV test if not done recently.

  • Are you a man who has had sex with another man?
  • Have you had sex – anal or vaginal – with a HIV-positive partner?
  • have you had more than one sex partner?
  • have you injected drugs and shared needles or works (for example, water or cotton) with others?
  • Have you exchanged sex for drugs or money?
  • Have you been diagnosed with, or sought treatment for, another sexually transmitted disease?
  • Have you been diagnosed with or treated hepatitis or tuberculosis?
  • Have you had sex with someone who could answer yes to any of the above questions or someone whose sexual history you don’t know?

What are some of the HIV tests available?

There are four types of HIV tests available.
1. Nuclecic Acid Test (NAT) 
Also know as a HIV viral load test, this test looks for the actual virus in the blood. If the result is positive, the test will also show the amount of virus present in the blood. NAT is very expensive and thus not routinely used to screen individuals unless they recently had a high-risk or possible exposure and there are early symptoms of HIV infection. NAT is usually considered accurate during the early stages of infection. However, it is best to get an antibody or antigen/ antibody test at the same time to help in the interpretation of negative NAT result. Taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) may also reduce the accuracy of NAT.
NAT is able to detect HIV in the blood as early as 1 to 4 weeks (7 to 28 days) after infection.
2. Antigen/ Antibody Test
Also known as a fourth-generation or combination test, this test looks for both HIV antibodies and antigens. Antibodies are produced by the immune system when one is exposed to bacteria or viruses like HIV. Antigens are foreign substances that cause the immune system to activate. In early HIV infection, an antigen called p24 is produced even before antibodies develop.
The fourth generation test is able to detect HIV in the blood 2 to 6 weeks (13 to 42 days) after infection, and is most accurate after a 28-day window period.
3. Antibody test
This is also known as a third-generation test. As mentioned before, antibodies are produced by the immune system upon exposure to bacteria or viruses like HIV.
The antibody test is able to detect HIV in the blood approximately 97% of people within 3 to 12 weeks (21 to 84 days) of infection. If a positive HIV result is obtained from any type of antibody test, a follow up test is required to confirm the result.
4. HIV Pro-Viral DNA Test

The HIV Pro-Viral DNA test can be used in specific situations where there are challenges to getting an accurate HIV diagnosis with other available HIV tests including HIV Antibody tests (3rd Generation HIV test), HIV Antibody and Antigen tests (4th Generation HIV test) as well as HIV RNA PCR test.

It is especially useful in the following situations:

  1. Diagnosing HIV in newborns born to HIV +ve mothers
  2. Elite controllers with undetectable HIV viral load despite not being on anti-retroviral treatment
  3. Individual with sero-negative HIV infections i.e. People who get infected with HIV but do not develop anti-HIV antibodies : see FALSE NEGATIVE HIV ELISA TEST

It can be used for situations where the diagnosis of HIV is challenging. It has a lower false positive rate compared to the HIV RNA PCR test when used for diagnosis and it can be done 10 days post exposure.


Can you share the 4 most common myths about HIV? 

1. HIV is a death sentence. 

This may have been the case several decades ago, where without prompt and adequate HIV treatment, the infection progresses and causes the immune system to weaken, leading to AIDS. However, thanks to advances in modern medicine, most HIV-infected patients today are still able to lead healthy, productive lives and may never develop AIDS.

2. HIV can spread by kissing, sharing of food or close contact. 

It is extremely unlikely to contract HIV via these methods as HIV is not spread by saliva. However, if the person you are in contact with has mouth sores/ulcers, bleeding gums or open wounds then there is a possible risk. HIV is spread by 3 main routes: sexual contact, significant exposure to infected body fluids such as semen, blood, vaginal secretions or breast milk, and lastly, mother-to-child transmission. 

3. HIV can spread through mosquito bites. 

This is completely untrue as the virus cannot survive and replicate within the mosquito’s body.

4. There is no need to use a condom during sexual contact if both partners already have HIV. 

Different strains of HIV exist. If two HIV-infected partners are carrying different strains of HIV, having unprotected sexual intercourse may result in the exchange of these strains, leading to re-infection. Treatment in this situation becomes more difficult as the new HIV strain may be more resistant to the current treatment, or cause the current treatment to become ineffective.


What are the 4 things (facts) we should all know about HIV that we probably don’t know already?

  1. Under the Infectious Diseases Act, it is an offence for people who know that they are infected with HIV or AIDS in Singapore to not inform their sexual partners of their HIV status before engaging in sexual intercourse.
  2. For those who are worried but too afraid to undergo HIV screening, there are 10 clinics in Singapore that offer Anonymous HIV Testing (AHT). AHT is made available so as to encourage more individuals who suspect that they are at risk to go for early HIV screening. There is no requirement to provide any form of personal particulars, even if the test comes back positive.
  3. Persons who plan to engage in high-risk sexual behaviour can reduce their risk of HIV infection by taking Pre-Exposure Prophylaxis (PrEP). This is an oral medication that, when taken correctly, can reduce the risk of HIV transmission through sex by over 90%. Persons who did not take PrEP prior to engaging in high-risk sexual behaviour are eligible for Post-Exposure Prophylaxis (PEP). This is a one month course of oral medications that must be started within 72 hours of the sexual exposure, the earlier the better.
  4. The current tagline in HIV is Undetectable = Untransmittable (U=U). In recent years, there is overwhelming clinical evidence proving that people living with HIV who achieve and maintain an undetectable HIV viral load by adhering to their treatment cannot sexually transmit the virus to uninfected partners. Several large studies had been conducted over a course of 10 years between 2007 to 2016, involving thousands of heterosexual and homosexual couples. In these studies, there was not a single case of HIV transmission from a virally suppressed person to their uninfected partner. This is life changing for people living with HIV. In addition to being able to choose to have sex without a condom, this news allows them to approach existing or new relationships with a sense of liberation. 

Speak to our doctors for professional advice or if you wish to find out more information on HIV and AIDS.
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World AIDS Day 2019 Press Statement

World AIDS Day is a day to remember all those who have lost their lives to the illness. At the end of 2018, it is estimated that 32 million lives were lost worldwide to the disease. WHO had previously set the 90-90-90 target for countries in the world to achieve by 2020, 90% of those living with HIV will know their status, 90% of those who are positive are on ART treatment and 90% of those who are on treatment have undetectable levels of the virus. Let us take stock of what we have been able to achieve thus far.


Since then Singapore has risen to the challenge to achieve those goals.
 Singapore has done well with 2 of the goals – 89% of those who are positive are on ART treatment and 94% of those who are on treatment achieved undetectable viral loads. However, much has to be done to improve on getting those living with HIV to know their status as only about 72% are aware they are positive for HIV.
Thus we need to encourage more people who are at risk of HIV infection to get tested. At Dr Tan and Partners we have been strong advocates of screening of HIV and STIs for at risk persons and provide a non-judgmental and LGBT-friendly environment to discuss your concerns. This is to help to protect their families and their loved ones. It is not uncommon for people that I see in my practice to tell me one of the reasons why they are reluctant to get tested is because they are afraid of what will happen if their families or their loved ones find out.
The other common concern is that they will lose their jobs. Finally there are still many misconceptions about how HIV is transmitted. I have patients who are concerned that because they share food with their families they can transmit HIV to their family which is of course not true. HIV is NOT transmitted via casual contact like sharing of food and drinks or shaking hands.


Of note in Singapore as of 2018, of all those who were tested positive more LGBTs are stepping up to get voluntary testing for HIV (20%) compared to heterosexuals (9%). Also importantly, in all newly diagnosed HIV persons in Singapore both homosexuals (42%) and heterosexuals (43%) contribute equally to number of cases. What this shows is that contrary to what some believe, HIV is NOT a homosexual disease but it is a disease that affects all sexual orientation.
Finally, there is strong evidence from large studies involving thousands of sero-discordant couples (that is one partner is HIV positive and the other partner is HIV negative) who have sexual acts between 2007-2016 showed that there was not a single case of HIV transmission to the HIV negative partner if the HIV positive treated partner has undetectable levels of HIV virus. This highlights the importance of treatment of HIV, that treatment of HIV can be successful in achieving undetectable levels of virus and that transmission of HIV is effectively blocked when levels of the virus is undetectable.


We are proud that our Doctors at DTAP have been actively involved in the fight against the HIV epidemic. Our Anonymous HIV Testing site at Robertson Walk has provided a safe space for thousands of people seeking confidential HIV testing since 2005. Our Doctors were the lead and co-lead authors of the Community Workforce section in the Blueprint to end HIV transmission and AIDS in Singapore by 2030. Our Doctors were also part of the Singapore HIV PrEP Taskforce and helped write the first ever local Singapore guidelines for the clinical management of HIV PrEP.
We will continue this fight until we see a world free of stigma, free of discrimination and hopefully free of HIV.


Dr. Julian Ng

Dr Julian Ng has 10 years of medical practice experience. He currently serves as the Chief Medical Officer of the DTAP Group of clinics in Singapore, Malaysia and Vietnam. He is also a member of the Singapore Men’s Health Society. His special interests are in the field Andrology, especially sexual health. He is currently practising at Dr Tan and Partners (DTAP) clinic at Novena Medical Centre.

A Case of HIV from Vampire Facial

Our clinics recently diagnosed a case of HIV from a vampire facial.
A Vampire Facial is a type of cosmetic treatment that was made popular by celebrity Kim Kardashian.
The treatment involves taking the patient’s own blood and spinning it down until the cells separate out of the liquid portion (plasma). Small needles known as micro-needles are then used to make multiple small holes in the patient’s face. The plasma is then poured over the face so that it soaks into these holes.
Two cases of HIV infection from such treatments were reported earlier this year in Albuquerque, New Mexico in the US. https://www.medscape.com/viewarticle/912436
Vampire Facial treatment is NOT approved in Singapore.

What Can You Do to Protect Yourself?

Before undergoing a treatment, ensure that the establishment has all the proper local licenses required.
Ensure that the therapist conducting the treatment has all the training certifications required.
Do not undergo any treatments in non-medically licensed establishments that involves blood or body fluids.
For treatments that involve puncturing or breaking the skin, ensure that the instruments used are properly packaged and sterilized. 
Insist on seeing the operator open the sealed package in front of you.

If you feel you might have been exposed to an infection, see your local Doctor immediately for a discussion on HIV PEP and screening for other blood-borne infections like Hepatitis B and Hepatitis C.


Learn More about Other STDs & Other STD Symptoms