What are the Common Misconceptions that People have about HIV?

There are multitude of misconceptions associated with HIV. These are some of the most common ones:
1) HIV is the same as AIDS. HIV (Human Immunodeficiency Virus) refers to the virus itself, whereas AIDS (Acquired Immunodeficiency Syndrome) refers to a spectrum of potentially life-threatening conditions that are caused by the virus.

Read: HIV, AIDS & Opportunistic Infection

2) HIV is a death sentenceThis may have been the case several decades ago, where without prompt and adequate 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 may never develop AIDS. This is why it is imperative to be on treatment, ideally as soon as possible after a diagnosis of HIV is made. It is also important to undergo regular HIV screening.

READ: HIV Treatment & Management

3) HIV can be 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/tissues such as semen, blood, vaginal secretions or breast milk, and lastly, mother-to-child transmission.

READ: How Long Can HIV Survived Outside The Body


Is a person infected by HIV any different from that of an uninfected person?

With or without treatment, a person infected with HIV may not appear any different from that of an uninfected person.
HIV infection undergoes 3 stages. The first stage (Acute Stage) may present with flu-like symptoms, fever and a rash. The second stage may present with lymph node swelling, but most patients do not have any symptoms at all. The second stage (Clinical Latency) 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. Lastly, the third stage is the presentation of AIDS symptoms.
HIV infected patients should receive prompt long term treatment and undergo regular follow up blood tests in order to reduce the viral load in their bodies to low levels. This allows their immune system to continue to function well and minimizes the risk of progression to AIDS. By doing so, they can essentially live very normal lives not any different from that of an uninfected person.

What are some of the treatments that a patient will receive upon diagnosis of HIV infection?

Upon diagnosis of HIV infection, a patient will have to start taking a combination of long-term daily medications. These are antiviral medications that work to prevent the virus from replicating. The patient will then be required to return regularly for blood tests to monitor the levels of HIV and the immune system. The goal of treatment is to keep the levels of HIV low, and thus allow the immune system to continue to function well.

How does AIDS affect a person’s health? What do AIDS patients die of?

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. HIV Related Opportunistic infections such as tuberculosis, recurrent pneumonia and esophageal candidiasis,  may occur as well. AIDS patients could also develop various viral-induced cancers.
The leading causes of death worldwide in patients with AIDS are, as mentioned, opportunistic infections and cancer.

Recently it was reported that in London, an HIV patient who underwent a bone marrow transplant subsequently had undetectable HIV levels. Does this mean that he is fully cured of HIV?


This is the 2nd ever reported case of an HIV patient being “cured” of HIV. In 2007, a patient in Berlin was also reported to have been cleared of the virus. Both of these cases have similarities: both HIV infected patients concurrently suffered from cancer (Berlin patient had Acute Myeloid Leukaemia; London patient had Hodgkin’s Lymphoma) and both patients received bone marrow transplant by donors who carried the rare CCR5 genetic mutation.
CCR5 is a protein on the surface of white blood cells that is involved in the immune system. It is one of the co-receptors that HIV uses to enter target immunological cells. This means that via CCR5, HIV is able to gain a mode of entry into a person’s immune system. People with CCR5 genetic mutation have resistance to HIV infection because the virus is unable to enter into their immune system like it usually does.
In the case of the London patient, subsequent blood tests have shown that the virus cannot be detected. However, this does not necessarily mean that he has been fully “cured” – the virus may simply be in a dormant, or “sleeping” state.
While the outcome was favourable in the two examples stated above, this form of treatment is not a viable large-scale strategy because bone marrow transplants carry significant risks and are extremely costly. However, it is undeniable that these two cases are landmark moments in the war against HIV as scientists continue to hunt for a cure. The hope is that by conducting more research on the editing of the CCR5 gene, we will one day be able to develop a safe, cost-effective and easy solution.

READ: HIV CCR5 Mutation & CCR5 Testing

Do you think that mankind can eradicate HIV eventually? Before this happens, what kind of support can we give to HIV infected patients?

I believe that with continued advances in medical research, there is hope of a cure for HIV in the future. However, this is a long and slow process that may require many years or decades. Until then, the best option is to ensure that the public are able to gain access to undergo HIV screening even if the risk is not high, and that HIV infected patients are able to receive prompt and long term treatment.
From the initial shock and disbelief of receiving a diagnosis of HIV; having to accept the reality of the situation; to having to live with HIV daily, these are just a few examples of the tremendous challenges that HIV patients face in their lives, and for many patients these have a detrimental impact on their psychosocial well-being.
There is still a terrible stigma today surrounding HIV, and it remains very much a taboo subject that most people are afraid to speak about or face up to. Nevertheless, we can offer many forms of support for HIV patients. For starters, government and healthcare organisations need to continue in their best efforts to increase awareness and educate the public about HIV and its misconceptions. If you have a family member or loved one who lives with HIV, the best kind of support would be your understanding, care and acceptance.
Lastly, if you are a person living with HIV, do not despair. Seek the appropriate treatment that you require, and turn to your family and friends for moral support.
Take Care!
Tags: hiv screening singapore, hiv test


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Advisory: On the Unauthorised Possession and Disclosure of Information from MOH’s HIV Registry

Singapore, 28 January 2019 – Singapore’s Ministry of Health (MOH) held a press conference to inform the public that the confidential information of 14,200 people living with HIV were leaked. This included 5,400 Singaporeans and 8,800 foreigners (source: https://www.straitstimes.com/singapore/data-of-14200-singapore-patients-with-hiv-leaked-online-by-american-fraudster-who-was). The records of the 5,400 Singaporeans leaked were up to January 2013. The records of the 8,800 Foreigners leaked were up to December 2011.

 

This is a trying time for people living with HIV in Singapore. For Singaporeans diagnosed after January 2013, there is no need to be concerned until more information is available from MOH. For queries, we urge you to contact the MOH hotline on +65 6325-9220.

 

Under the Infectious Diseases Act of Singapore, we would like to remind the community that it is an offence to disclose the identity of a person living with HIV except under very specific conditions (see Addendum 1 below). If anyone comes into contact with such information, we urge you to notify the Singapore police immediately at https://eservices.police.gov.sg/homepage.

 

We hope that even if the identities of people living with HIV are leaked that they are shown the same support and respect we have always given them. People living with HIV are no different from any of us. They are also of no danger to anyone. You cannot get HIV from casual contact such as shaking hands, hugging, sharing food or sharing a toilet.

 

We hope in this difficult time all Singaporeans can band together to show support for people living with HIV. They are our loved ones, our colleagues, our friends and our families.

 

 

Addendum 1: Singapore Infectious Diseases Act

Protection of identity of a person with AIDS, HIV Infection or other sexually transmitted diseases.

 25.—(1)  Any person who, in the performance or exercise of his functions or duties under this Act, is aware or has reasonable grounds for believing that another person has AIDS or HIV Infection or is suffering from a sexually transmitted disease or is a carrier of that disease shall not disclose any information which may identify the other person except —

(a) with the consent of the other person;

(b) when it is necessary to do so in connection with the administration or execution of anything under this Act;

(ba) when it is necessary to do so in connection with the provision of information to a police officer under section 22 or 424 of the Criminal Procedure Code 2010;

[10/2008 wef 10/06/2008]

[15/2010 wef 02/01/2011]

(c) when ordered to do so by a court;

(d) to any medical practitioner or other health staff who is treating or caring for, or counselling, the other person;

[10/2008 wef 10/06/2008]

(e) to any blood, organ, semen or breast milk bank that has received or will receive any blood, organ, semen or breast milk from the other person;

(f) for statistical reports and epidemiological purposes if the information is used in such a way that the identity of the other person is not made known;

(g) to the victim of a sexual assault by the other person;

(h) to the Controller of Immigration for the purposes of the Immigration Act (Cap. 133);

 (i) to the next-of-kin of the other person upon the death of such person;

 (j) to any person or class of persons to whom, in the opinion of the Director, it is in the public interest that the information be given; or

 (k) when authorised by the Minister to publish such information for the purposes of public health or public safety.

[5/92; 13/99]

(2)  Any person who contravenes subsection (1) shall be guilty of an offence and shall be liable on conviction to a fine not exceeding $10,000 or to imprisonment for a term not exceeding 3 months or to both.

 
Dr. Tan Kok Kuan

When To Test For HIV During or After Completing HIV PEP

HIV Post-Exposure Prophylaxis (PEP) has been established as a cornerstone of HIV prevention in the last 20 years. With newer, well-tolerated medications and better access to medical care, PEP has shown itself to be a safe and effective weapon in our arsenal against HIV infection.

Read: A Guide to HIV PrEP & HIV PEP (Pills for HIV Prevention)

For those individuals who have been in the unfortunate position of needing PEP, the next question is invariable:

When can I test for HIV after I finish PEP?

There are very few studies that have examined the “earliest time” you can do an HIV test after taking PEP and have conclusive results. There are some theories that taking PEP can increase the window period for testing by delaying the appearance of HIV antigen or antibodies in the blood – these have neither been proven or debunked, although evidence is weighted towards the latter.
Current data would suggest that p24 antigen and antibody response is not significantly affected by these antiviral medications, but these studies have mainly been done on individuals taking Pre-Exposure Prophylaxis (PrEP). As the medications used for PrEP and PEP are essentially the same, we can extrapolate this data to post-PEP testing as well. Confounding factors to these studies include patient adherence to PrEP/PEP regime as well as any instances of ongoing high-risk exposures during the course of medication and/or after.

Immediately After Completing PEP

Both the US CDC 2016 guidelines and joint WHO/ILO 2005 guidelines for PEP recommend HIV testing at baseline before starting medication and immediately after completing PEP (i.e. 4 weeks post-exposure as per regular non-PEP users), as well as 3-6 months post-exposure.
Importantly, the US CDC guidelines also states that patients keen to start on HIV PrEP after their HIV PEP can do so immediately following the completion of 28-day PEP, and provided the patient has a negative 4th generation HIV Antigen/Antibody test: “Because no evidence exists that prophylactic antiretroviral use delays seroconversion and PEP is highly effective when taken as prescribed, a gap is unnecessary between ending PEP and beginning PrEP.” Again, this suggests strongly that testing immediately after completing PEP is sufficiently conclusive to exclude an HIV infection.
Some studies done in animals have shown HIV DNA/RNA PCR testing during HIV PEP can sometimes even show a positive HIV viral load, with follow up testing after completing the medication showing a negative result. This could represent a successfully aborted infection, which is exactly the point of PEP in the first place.
We do not usually recommend HIV DNA/RNA PCR testing during or after completion of HIV PEP, as we know that the medication can and will suppress the viral load the same way it does in chronic HIV infection – this means that even a negative PCR viral load test may be a false negative, with viral load increasing again in a true infection a few months after the medication has been stopped.

Read: HIV Window Period (Timelines for Accurate HIV Test)

Personally, I have not encountered any patients who have taken PEP and tested negative at 28 days to subsequently have their results change to HIV positive in follow-up testing, except in a single case where the patient had ongoing high-risk exposures during and after their PEP medication.

Read: How to Get An Anonymous HIV Test in Singapore

In summary, post-PEP testing can be performed immediately following the completion of medication (i.e. 28 days or more post-exposure) with a 4th generation Antigen/Antibody test with good certainty, although guidelines will still recommend one last test at 3 months or more post-exposure as a precaution.
Current clinical experience indicates that the test at the end of PEP is essentially conclusive and sufficient to ensure that PEP is successful and HIV infection has been prevented, but higher-powered studies are required to confirm this.
It is still best to speak to the doctor who prescribed you the PEP or who will be following up with your care, as they will be most familiar with local testing methods and guidelines.
If you believe you have had a potential high-risk exposure within the last 72 hours, you may consider Post-Exposure Prophylaxis (PEP). Please contact us for a consultation if you think you need PEP.
If you have any questions or concerns, please visit our online forum on sexual health, HIV and STDs.
If you wish to speak to any of our doctors in regards to HIV PEP or HIV Testing, you can visit any of our clinics or drop us an email at hello@dtapclinic.com for an appointment.
Take Care!


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How Long Can HIV Survive Outside the Body?

There are many fears and misconceptions about HIV survivability and infection risk.
We often get asked some form of this question by people who have come into contact with potentially infected blood or bodily fluids from surfaces or other objects and who are worried about HIV infection risk.
Most importantly, there have been no validated cases of HIV transmission through casual touching of surfaces or objects (e.g. toilet seats, toothbrushes, towels) to date.
However, it is true that HIV has been shown to survive outside the human body for up to several weeks in certain environmental conditions.

How Long Can HIV Survive Outside the Body?

So what does the evidence say so far?

1) Temperatures

  • At > 60⁰C – HIV is killed by heat temperatures of > 60⁰C are sufficient to kill HIV.

HIV is NOT killed by cold – It is known that the survival time of HIV increases in colder temperatures.

  • At 27⁰C to 37⁰C, the HIV can survive for up to 7 days in syringes (fresh blood)
  • At room temperature, the HIV can survive in dried blood for 5 to 6 days.
  • At 4⁰C, HIV can survive up to 7 days in dried blood
  • At -70⁰C, HIV can survive indefinitely without any loss of viral activity – this is the temperature that HIV-infected blood is stored at in laboratory experiments for future testing.

2) pH Level

  • HIV can only survive in a narrow band of pH between 7 and 8

DID YOU KNOW:

  1. HIV has been found to survive for a few days in sewage in laboratory based experiments; however, it has not been detected in urine or stool samples in any real-life setting.
  2. HIV has been found to survive in organs and corpses for up to 2 weeks after death, especially in cooler temperatures.
  3. HIV has been found in low levels in breast milk, with infective transmission possible from mother to baby; however, no studies have been performed to determine how long it is infective once it is outside the body

Semen or vaginal fluids outside the body

There have been no studies on HIV survival in semen or vaginal fluids outside the body, but so far evidence indicates that it is only present at very low levels and is unlikely to pose a risk of infection from contaminated surfaces.

These studies have mainly looked at HIV survivability in laboratory based experiments, and have not taken into account the effect of environmental conditions such as wind, rain, and sun exposure. Further studies are needed to more clearly elucidate the risk of certain exposures.
Also, just because HIV can survive outside the body does not mean that it is necessarily infective. Even when live HIV virus comes into contact with broken skin or mucosa, it must still be present in an adequate dose to establish infection (the tissue culture infectious dose), and must then undergo a complex series of steps before it actually causes an HIV infection.

Survivability ≠ Infectivity

HIV transmission thus far has only been shown to occur through sexual intercourse, contaminated needles (including tattoos and body piercing), blood transfusions, and very isolated cases of dental procedures and eyesplash incidents with infected blood. There have been zero cases of infection from casual contact with a contaminated surface or object to date.

In a Nutshell

All in All, if you have touched some surface or fluid that you think may be contaminated with HIV, do not worry – you will not get infected.
However, it is still important to practice proper hygiene and infection control measures to reduce the risk of other infections as well.
If you believe you have had a potential high-risk exposure within the last 72 hours, you may consider Post-Exposure Prophylaxis (PEP) – this course of medication can greatly reduce the risk of HIV infection following an exposure. Please contact us for a consultation if you think you need PEP.

If you have any other questions or concerns, please visit our Doctor Moderated Online Forum on Sexual Health, HIV and STDs.

If you are interest to go for an Anonymous HIV Testing, please visit our Robertson Walk Branch.
We are Singapore MOH Approved Anonymous HIV Test site in Singapore.

Take Care!


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  4. STD Risk for Receptive Unprotected Anal Sex in Men
  5. Low HIV Risk Doesn’t Mean No HIV Risk
  6. HIV PrEP for Travel – How You Need to Know
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  9. How Do I Treat Oral Herpes (Cold Sores)
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HIV Transmitted Risk – A quick overview

The neighbouring country has just built a wall to keep outsiders out. These outsiders do not have a passport and are trying to get over the wall through different means. The HIV virus is one of these outsiders, they will try all means to get across the wall
We will discuss in this article,  the vehicles the HIV virus can adopt to get over your wall. From taking a plane and DEFINITELY getting over the wall, to taking a ship around the border and MAYBE getting around the wall and lastly climbing over the wall which is NOT possible.
The HIV virus will need a vehicle to get past the wall and in the medical context, the HIV virus from a positive person will need to come into contact with a negative person. The fluids which carry the most viruses are blood and semen whereas saliva and vaginal fluid hold much less of the HIV virus.
DEFINITELY getting over the wall – definite transmission, for every 10,000 attempts this will be the number of times successful the HIV virus will get over the wall and cause infection during that activity

  • Blood transfusion – 9250/10000 (although this is rare, it still happens: https://www.bbc.com/news/world-asia-india-36457517).
  • Needle sharing in intravenous drug use – 63/10000.
  • Needlestick injury – 23/10000.
  • Receptive anal sexual intercourse – 138/10000.
  • Insertive anal sexual intercourse – 11/10000
  • Receptive penile-vaginal sexual intercourse – 8/10000
  • Insertive penile-vaginal sexual intercourse – 4/10000
  • Receptive and insertive oral sexual intercourse – low (too low for accurate numbers).

According to the Singapore Ministry of Health UPDATE ON THE HIV/AIDS SITUATION IN SINGAPORE 2014.

Estimated risk per exposure to HIV transmission: assume that the ‘source partner’ is always HIV-positive. For a partner of unknown status, the risk is affected by the prevalence of HIV in the relevant community – i.e., the chance that the partner does, in fact, have HIV. Unless otherwise stated, the sexual acts are always without a condom.

MAYBE getting around the wall – theoretical situations where there isn’t enough scientific data on where the HIV virus may get around the wall

  • Presence of blood getting into contact with an open wound, ulcer – this is a possibility but the risk is lower and unlikely. Open wounds should be treated early to reduce the risk of other infections such as bacterial infections. The risk of bacterial infections into an open wound is often higher than the risk of an HIV infection.
  • Blood getting into contact on mucosal membrane surfaces such as the eyes or mouth – this is again a possibility, but extremely unlikely
  • Dried blood on surfaces – some studies have shown that the HIV virus can survive in dried blood for a few days. However for that blood to infect another person, it would have to cross a thick layer of the person’s skin, mucous membranes and get into the bloodstream. The environment has to favourable for this to happen and transmission through dried blood is often very unlikely.

NO WAY of getting over the wall – not possible for transmission

  • Being in the same room as an HIV positive person and breathing the same air
  • Sitting on a toilet seat or touching a door handle
  • Hugging, Kissing (not french kissing), Shaking hands
  • Drinking from the same water cooler, water fountain
  • Sharing of food utensils.
  • Sharing equipment at the gym
  • Biting or scratching superficially that does not break the skin surface or draw blood.
  • Skin to skin contact with another person

We hope this short illustration answers and highlights questions people may have over possible ways of HIV transmission. Fluid-fluid contact is necessary for transmission and without this, there is NO risk for HIV transmission.
If you have any new questions, please feel free to ask them on https://www.dtapclinic.com/forum/
Take Care!


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  3. HPV Infection & HPV Vaccination for Men who have sex with Men
  4. STD Risk for Receptive Unprotected Anal Sex in Men
  5. Low HIV Risk Doesn’t Mean No HIV Risk
  6. HIV PrEP for Travel – How You Need to Know
  7. An Overview on STD from an STD Doctor
  8. Everything You Need to Know about Herpes Simplex Virus
  9. How Do I Treat Oral Herpes (Cold Sores)
  10. Syphilis Symptoms – Painless Sore & Ulcers
  11. HIV Symptoms – What You Need to Know
  12. 10 Common HIV related Opportunistic Infections
  13. The HIV Pro-Viral DNA Test can be done 10 days post exposure.


HIV Window Period – Timelines for Accurate HIV Testing

When it comes to HIV testing, two of the most common questions we are asked online or in person are: “When can I test for HIV?” and “Are my results conclusive?”
There is a lot of confusing information out there, so this article will try to break down the timelines for accurate testing, and why this is the case.

These Questions Are Basically Asking – What is the HIV Window Period?

The HIV window period is the time between viral transmission to be able to get a conclusively accurate test result. This time period depends on the type of HIV testing performed – different tests have different window periods, with newer generation testing allowing for earlier and more accurate diagnosis of HIV than what was available in the past.
As testing facilities vary from country to country, it is important to recognize local health authority guidelines and speak to the doctor if you have any uncertainties on your test.
If you are within 10 days from a possible HIV exposure, you are still in an eclipse period. This is the period of time where no current testing can detect the virus. HIV Testing in this time period will have no diagnostic utility.

However, if you are within 3 days (72 hours) from a potential HIV infection, please see your doctor or contact us immediately for Post-Exposure Prophylaxis (PEP).
HIV Post-Exposure Prophylaxis (PEP) can reduce risk of HIV infection or prevent HIV infection.

WhatsApp or SMS service (24/7) : +65 8728 7272

Also Read: When to get HIV Test after HIV PEP

So, What Types of HIV Tests are Available and How Do They Work?

For diagnostic purposes, most countries and guidelines now recommend first-line testing with the 4th Generation Antigen/Antibody test (also known as the Combo or Duo test). Other available testing includes 3rd Generation Antibody-only testing, HIV RNA/DNA PCR viral load and the HIV Pro-Viral DNA Test.
These tests are sometimes available as ‘point-of-care’ rapid tests, or alternatively can be performed in a laboratory with techniques such as ELISA or CMIA (don’t worry too much about the technicalities here). To understand the differences and rationale for each of these tests, we have to first understand what each of them is looking for.

The Core Structure of HIV is Made Up of a Protein (p24 Antigen)!

HIV is a type of retrovirus, and much of its core structure is made up of a protein known as p24 antigen – this is the type of antigen we look for with 4th generation HIV testing.
The p24 antigen usually becomes detectable from 10-14 days post-exposure, reaching a peak at around 3-4 weeks, and dropping to lower levels after 5-6 weeks once HIV antibodies start forming.
HIV antibodies are proteins formed by your own body in response to the virus and usually start forming as early as 14-17 days post-exposure, with 99.9% of patients having a detectable antibody response by 3 months.

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

The 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. 

4th Generation HIV Test – 28 days or more post-exposure

The 4th generation Antigen/Antibody test has been shown to be conclusive from 28 days or more post-exposure. Remember, this test also checks for HIV antibody, so it will remain accurate for HIV diagnosis even after the p24 antigen levels drop, including years after initial infection.

3rd Generation HIV Test – 3 months or more post-exposure

The 3rd generation Antibody-only test is accepted as conclusive from 3 months or more post-exposure. If testing is done within these respective window periods, there is a chance of a false negative result.
For extremely rare cases where people do not mount an appropriate HIV-antibody response (known as seronegative infections), the 4th generation test will still be able to detect the p24 antigen, which is why it is considered the most accurate first-line test for HIV diagnosis.
You may also have heard of a test called the Western Blot; this is just another type of HIV antibody test that is usually used for confirmation testing, once a preliminary test has shown a positive result. As HIV is a serious and life-changing diagnosis, it’s important we get it right – most diagnostic algorithms require two separate tests showing a positive result before we confirm it to the patient. As the HIV window period may differ with these separate tests, it is important that your doctor chooses the right tests for you.
The last test type we’ll be looking at is the HIV RNA/DNA PCR test, also known as Nucleic Acid Amplification Testing (NAAT). This test has revolutionized HIV screening, especially for people at high risk. This test directly measures the amount of virus in a person’s blood and can detect conclusively from as early as 12 days post-exposure. It is also used to monitor viral load in people with a known HIV infection. Although this test is able to pick up HIV infection at the earliest stage, it is not widely available due largely to costs and turnaround time in Singapore. There is a slightly higher risk of false positive results with the HIV RNA/DNA PCR test.

Here’s How HIV Window Period & HIV Test Accuracy Works: 

In Summary

In summary, here are the tests you can do at the appropriate time:
Day 1-3: Consider Post-Exposure Prophylaxis (PEP)
Day 1-9: Eclipse period (no HIV testing available)
Day 10: HIV Proviral DNA Test
Day 12 onwards: HIV RNA/DNA PCR testing (may have false positives)
Day 14 onwards: 4th Generation Combo testing can start to pick up the infection (may have a false negative)
Day 28 onwards: 4th Generation Combo testing is deemed conclusive
Day 90 onwards: 3rd Generation Ab-only testing is deemed conclusive
At the end of the day, it is important to speak to your doctor and inform them accurately about any potential exposure risks, so they can decide on which test is appropriate. And remember, 4th Generation Combo testing is the first line test recommended by most guidelines today. Ask for this test if you have any doubts!
Do come to see us for any further advice on HIV testing, window periods, or other STD Testing, STD Screening & Treatment and sexual health-related matters.
We accept both walk-ins and appointment for all our clinics, please call us or email us at hello@dtapclinic.com.
Take Care!


Other Reads:

  1. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  2. HIV Pro-Viral DNA Test
  3. HPV Infection & HPV Vaccination for Men who have sex with Men
  4. STD Risk for Receptive Unprotected Anal Sex in Men
  5. Low HIV Risk Doesn’t Mean No HIV Risk
  6. HIV PrEP for Travel – How You Need to Know
  7. An Overview on STD from an STD Doctor
  8. Everything You Need to Know about Herpes Simplex Virus
  9. How Do I Treat Oral Herpes (Cold Sores)
  10. Syphilis Symptoms – Painless Sore & Ulcers
  11. HIV Symptoms – What You Need to Know
  12. 10 Common HIV related Opportunistic Infections

Do I Have HIV Rash? Or Are They From Other STD Related Rashes

Skin rashes and lesions are some of the most common signs and symptoms experienced in HIV infection. There is no single definitive HIV rash – individuals may have different types of rashes of varying severity, distribution, and appearance.
As there are many other conditions that can also cause skin rashes, including allergies, autoimmune conditions, and other infections, it is important to remember that there is no way to diagnose someone with HIV based solely on the presence of a rash. Conversely, there is also no way we can rule out HIV just because someone does not have a skin rash. The only way to know for sure is by doing an HIV test at the appropriate time.

Acute HIV Seroconversion HIV Rash

In the primary stage of HIV infection, viral replication progresses quickly and the viral load (VL) will be very high. Your body’s immune system will detect the virus and start producing HIV antibodies to try and fight off the virus – this process is called seroconversion. It is this activity of the immune system which can manifest in the typical symptoms of acute HIV infection, also known as Acute Retroviral Syndrome (ARS) – with fever, swollen lymph nodes, and rashes being the most common symptoms.
The seroconversion HIV rash usually develops around 2-6 weeks from exposure. It will appear as reddish macules (flat lesions) and papules (small swollen bumps) spread over a generalized region, typically over the chest, back, and abdomen, sometimes extending to the arms and legs as well. It can be very itchy for some people, but not always. Symptoms of itch can be reduced by antihistamines and topical creams.
These rashes may last a few weeks or months, but will eventually resolve by themselves, even if the HIV infection has not been diagnosed and treated. This happens as the HIV antibodies bring down the viral load and infected individuals enter the clinically latent stage (chronic HIV infection). Many people may have missed the diagnosis of HIV if they were told by a doctor their rash was due to some allergy or viral flu but did not get tested properly.

Other Infections

When a person contracts HIV, they are also at increased risk of other infections. Some of these are sexually transmitted and can be contacted at the same time as HIV (e.g. syphilis, herpes simplex virus, etc.), while some can occur later in the disease due to a weakened immune system (e.g. candida/thrush). These infections can also cause skin rashes or lesions to develop, so it is important to look out for any abnormal skin changes if you are concerned about any potential exposure risk, and also to inform your doctor of your concerns.

Syphilis

Syphilis is a sexually transmitted infection caused by the bacteria Treponema Pallidum and is commonly diagnosed together with new HIV infection as they share common risk factors. The primary stage of syphilis infection is a painless chancre or ulcer at the primary site of infection (usually genital, rectal, or oral), but it may go unnoticed by many people. The secondary stage of syphilis is a skin rash which can look very similar to acute HIV rash, with reddish papules around the trunk, arms and legs, and usually over the palms and soles as well – most of the time, this rash is not itchy or painful. Most people who present with a skin rash after potential exposure risk should be tested for both HIV and syphilis together.

Herpes Simplex Virus

Another sexually transmitted infection, herpes simplex virus (HSV) can cause small crops of fluid-filled blisters that can start off looking like a reddish rash. They are usually slightly itchy or painful, and may then burst to form small ulcers which will then dry and crust over. Sometimes, the initial herpes outbreak may be preceded by some viral, flu-like symptoms including fever and swollen lymph nodes. There is no ‘cure’ for herpes, but usually, your immune system will help to control the infection and keep it dormant, although reactivation and clinical outbreaks can still occur (around 2-3x per year on average). Herpes can be contracted both together with acute HIV or can recur frequently in late-stage HIV – persistent or chronic HSV lesions in the setting of untreated or late-stage HIV is considered an AIDS-defining illness, as the immune system has been weakened by the HIV virus and can no longer keep the HSV infection suppressed.

Kaposi Sarcoma

Not quite a rash, but rather an abnormal growth of capillary blood vessel tissues, Kaposi Sarcoma (KS) is actually a type of cancer that can be found in late-stage HIV.
It is caused by an infection with human herpesvirus 8 (HHV-8) which is an opportunistic infection and is also considered an AIDS-defining illness as the transformation of the skin cells only occurs in the presence of a weakened immune system. KS appears as either a single or multiple reddish purplish bumps over the skin or mucous membranes.
They are usually painless and not itchy but can cause other symptoms if they grow on internal organs such as the gastrointestinal tract or the lungs (e.g. GI bleeding, shortness of breath, etc.).
Also, read the 10 Common HIV-Related Opportunistic Infections (IOs)

Candidiasis

Also known as thrush, candida is a very common fungal organism that is found in the environment and can be isolated from around 30-50% of healthy people. Most of the time, it does not cause any symptoms of infection; however, in people with a weakened immune system, there may be an invasive overgrowth of the organism which leads to symptoms. Common areas of candida infection are the nails, skin, mouth/tongue, and genital region. Depending on the region affected, symptoms may include an itchy rash, with scaly or flaking skin, sometimes with a soft whitish layer which can be scraped off.
These are just some of the different types of skin rashes and lesions that may be present in an HIV infection. There is no single type of HIV rash that we can consider to be diagnostic by itself. It is important to assess clinical features of the rash, timing, and potential exposure risk. At the end of the day, the only way to diagnose an HIV infection will be through appropriate HIV testing at any of our clinics.
Join the HIV discussion in our Forum with our Doctors. For HIV Testing, you can walk-in to any of our clinics, for an appointment you can email us at hello@dtapclinic.com, or call any of our clinics.
Take Care. Be Safe!


Other Interesting Reads:

  1. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  2. World AIDS Day (2018) #KnowYourStatus – By Dr Tan Kok Kuan
  3. 4 Things You Need to Know About Penile Health
  4. Sexual Health Advice For Travellers 
  5. What are the Symptoms of HIV Infection and AIDS?
  6. Things You Need to Know about Travelling & HIV PrEP
  7. 11 Causes of Dyspareunia (Pain During Intercourse)
  8. What is HPV Vaccination (Gardasil 9)
  9. 10 Causes of abnormal Vaginal Lumps and Bumps
  10. An Overview of Gonorrhoea
  11. What is the Treatment for Cold Sores? What causes Cold Sores?
  12. Herpes: Everything You Need to Know!
  13. The HIV Pro-Viral DNA Test can be done 10 days post exposure.

A Guide To HIV PrEP and HIV PEP – Pills for HIV Prevention

Nearly every day here I see a person who is super anxious and has put their life on hold for anywhere from a month to three months in fear that they have contracted HIV from a momentary lapse of judgement. You can lose sleep, your appetite, your hair can fall, you can be visibly emaciated as well with this amount of stress in life on a daily basis for such a long period.
When it comes to staying safe against HIV in a lifestyle where one is exposed to the virus, it is crucial that one adopts multiple precautionary measures against transmission of HIV.
Apart from choosing partners wisely (we always encourage STI testing prior to being sexually active with someone) and using condoms, there is an additional safety precaution when it comes to safeguarding yourself against HIV transmission.
So in this article, let’s talk about the HIV medication you can take to help protect yourself against HIV. Basically, this is a lifestyle choice that you’d have to make based on as much information as possible. Let’s go over some of the details right.

First off, what is HIV and why are we so worried about it?

Would you like to hear the scary part first? Basically, after decades of studying the virus, we still do not have a cure for it. Now, that doesn’t mean everyone with HIV will die of HIV complications but more that if you do pick up HIV sometime in your life, chances are you’ll die with the HIV still in you. How’s that for a daily nightmare?

HIV Infection

HIV stands for Human Immunodeficiency Virus. HIV is a virus spread through certain body fluids that attacks the body’s immune system, specifically the CD4 cells, often called T cells. Now, once the virus starts infecting the cells, it goes on a continuous rampage of self-replication and destruction. Basically the more of the virus that is present, the worse of an infection it can create. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. Untreated, HIV reduces the number of CD4 cells (T cells) in the body. This damage to the immune system makes it harder and harder for the body to fight off infections.
So imagine your body is fighting a losing battle with HIV, other bacteria, virus and fungi know that your body is already weakened and they do attack the body at that time. These are called opportunistic infections.
So in combination of HIV and opportunistic infections (see: 10 Common HIV Opportunistic Infections), the body gets worn down over time until it succumbs to these infections.

What is AIDS (Acquired Immuno-Deficiency Syndrome)?

AIDS is the most severe phase of HIV infection; basically, it’s the bigger, older, more aggressive older brother that will stop at nothing until your organs cease to function as intended.

HIV mode of transmission

Only certain body fluids—blood, ejaculate or pre-ejaculate material, rectal fluids, vaginal fluids, and breast milk—from a person who has HIV can transmit HIV. Bear in mind that a simple contact or a touch gesture does not guarantee transmission of the virus. These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to occur.

How Would I Know if I Picked Up the Virus?

Acute Retroviral Syndrome (ARS) – Initial HIV symptoms
There are a few stages to an HIV infection. The very first few symptoms can occur within five to 12 days of exposure to the virus. This is the ARS (Acute Retroviral Syndrome) phase. Now this stage is particularly challenging to diagnose because more often that now, you wouldn’t even go through this phase.
In the off chance that you do have ARS, the symptoms can be so vague and misleading that it may be discarded as something completely different if you do not provide a history of a situation where you might have picked up HIV.
If at any time after a potential exposure episode you happen to develop features as listed below, it would be wise to seek medical attention as soon as you can.

  1. Fever – This is usually a high-grade temperature (>38.5) accompanied with chills, tremors, and the occasional night sweats
  2. Rash – Look out for an upper chest angry rash that is reminiscent of a chicken pox rash. Think red, fast growing, vesicular like rashes that can be painful or uncomfortably itchy in general.
  3. Muscle aches – That feeling that your body is heavy and you just don’t want to get out of bed.
  4. A sore throat
  5. Swollen lymph nodes – Look out for any abnormal swelling around your neck, behind your neck and under your armpits especially
  6. Mouth ulcers

So ideally these HIV symptoms will all come in about the same time with a recent history of potential exposure. This can prompt your physician towards a diagnosis of HIV ARS.
It’s also important to recognise which stage the virus is in so we can expect certain infections and treatment with the aim of covering as wide a net as possible when dealing with HIV.

You can learn more about HIV Window Period & False HIV Positive in this video:

That being said, we’re here to emphasize protecting yourself against HIV instead of being vulnerable to it and its effects on life in general. As I earlier mentioned, nearly every day we see people who lose weeks worth of sleep being so anxiously paranoid that they might have picked up HIV.
The ideal would definitely be the prevention of HIV transmission to begin with.

We’ll start with Pre-Exposure Prophylaxis (PrEP)

This is where the modernisation of medicine plays a huge part in society. The idea of Pre-exposure prophylaxis or PrEP is that it works similar to how a vaccine would in terms of offering protection against a disease.
The premise is simple. You take a tablet once a day and if taken correctly; combined with safe sexual practices, and there are no other complications, there is an up to 99% chance you will not get HIV if ever exposed to the virus.
HIV PrEP is basically using anti-retroviral medication (basically HIV medications) to prevent the acquisition of HIV infection by an uninfected person. PrEP is offered here in the form of a combination tablet containing tenofovir and emtricitabine (both medications we use to treat HIV).

Descovy As New HIV Medication For HIV PrEP

Descovy (brand name) is a FDA approved new drug combination of tenofovir alafenamide (TAF) + emtricitabine for use as HIV PrEP, which has shown to be equally effective in preventing HIV infection whilst touting an improved safety profile for renal and bone toxicity.

Descovy is currently available in all Singapore Dr Tan & Partners (DTAP clinics) only. It is a prescription-only medication and must be prescribed by a doctor. Speak to our doctors for more information about Descovy and find out if a HIV-1 treatment that contains Descovy is right for you.

Can Anyone Take HIV PrEP?

HIV PrEP was initially created for people who are in the high risk group for contracting HIV. This included people whose spouses were HIV positive . Trying to have a healthy relationship is trying enough as it is. HIV PrEP allows for intercouse with a significant less amount of stress and worries about contracting HIV.
Among other people who are in this high risk group include people who:

  • are sexually active in the last 6 months and NOT in a sexually monogamous relationship with a recently tested HIV-negative partner, and who
    • is a man who has sex with men, and who… (see: STD risk from unprotected Anal Sex in Men)
      • engage in anal sex
      • has had a sexually transmitted infection in the past 6 months
    • or is a sexually active adult (male or female with male or female partners), and who…
      • is bisexual (riskier if you have a very active sex life with multiple partners at the same time)
      • has sex with partners at increased risk of having HIV (e.g. injection drug users, men who have sex with men) without consistent condom use.

As we have evolved into prescribing PrEP, we realised that the level of protection it offers should not be confined to a certain group of people but to anyone who is wanting that added layer of protection against HIV transmission.
So really, all you have to do is to speak to your doctor, undergo a few simple tests to ascertain that you are healthy and have had no exposure to HIV prior to that before starting PrEP.
When you first start PrEP you may experience side effects like:

  • nausea
  • dizziness
  • headaches
  • fatigue
  • stomach cramps

More serious side effects include:

  • kidney problems, including failure
  • Liver problems
  • Reduced bone density

This is why, when on PrEP, it is important to regularly monitor the health of the organs that can be affected by this medication. We’ll have to get regular blood and urine screening is done with regular HIV testing and also bone scans if necessary in some cases. It is always best to continue on these medications with the advice of a physician.
Both our Robertson Walk (Singapore) & KL Eco City (Malaysia, Kuala Lumpur) provide Anonymous HIV Testing if you wish to keep your HIV status anonymous.

Frequently Asked Questions of HIV PrEP

1. Can I get STD even if I am on PrEP?

Yes, of course. HIV is just one type of a STI. There are other STI that aren’t even viruses but are bacteria. In these situations, taking PrEP is irrelevant to the situation. PrEP is designed to protect you against specifically HIV, not all STIs.

2. Do I still need condom even if I am on PrEP

Safe sex practices are always encouraged regardless if you are on PrEP or not. Basically, it is better to be safer really. Using a condom adds another barrier of safety in terms of picking up an HIV infection so really, why compromise on that?

3. Do I need regular HIV testing?

This is indeed encouraged. Its best to go for regular routine check-ups & HIV Testing and discuss your lifestyle and potential risk encounters with your physician to clarify any doubts. We’d also need to confirm that you are not already exposed to the virus before or during your time on PrEP.

4. When can I stop PrEP?

Basically, you can determine that. At any time when you see your lifestyle as not posing a risk of you contracting HIV, you may decide to stop taking the medication. There is no hard and fast rule to this. You can be taking the medications for months or decades if you choose to do so.
Either way, it is imperative that you are safe and in good health whilst taking the medication.

5. Do I have to take it on a daily basis?

Taking PrEP on a daily basis is recommended. This is to ensure compliance to the medication and to allow it to build some sort of protection against the virus. However, if your lifestyle does not call for it, you can choose to do event-based dosing where you take a total of four tablets spaced out over four days before and after a risky encounter.
Obviously, this is less stable a method of acquiring protection against HIV but it is an alternative to people who choose not to take medications on a daily basis ie people who have sexual encounters infrequently.

 Here’s a video on Event Based Dosing for HIV PrEP

Now what is HIV Post-Exposure Prophylaxis (PEP)

So now that we have covered PrEP, let’s move on to PEP (Post Exposure Prophylaxis). This is again a very similar ideology to PrEP where we aim to provide as much protection against transmission of HIV to you. Where it differs is that pre-exposure means before an incident that potentially made you vulnerable to HIV whereas post exposure is the period immediately after you have been potentially exposed to the virus.
Early on in this article, I recounted my experiences dealing with very anxious clients who have lost a weeks worth of sleep because they had to wait out the window period to test for HIV (this is at the least ten days).
This is where PEP comes into play. If for whatever reason you feel that you have been exposed to HIV, come in, see your doctor and get PEP prescribed to you within 72 hours of that and if taken correctly, there is an up to 99% chance you will not get infected with HIV.
See the difference? Immediate action within 72 hours after an HIV potential exposure episode can save you weeks worth of anxiety.
So let’s recap what some potentially dangerous incidences are, shall we? If you are in a position where:-

  1. you think you may have been exposed to HIV during sex (for example, if the condom broke), or if you are unsure about your partner’s status
  2. there was an abnormal exchange of body fluids – exposed to blood during intercourse or you noticed open cuts and active bleeding from your partner
  3. shared needles and works to prepare drugs (for example, cotton, cooks, waiter, medical personnel), or
  4. were sexually assaulted

All of the above are just some examples of a risky contact situation which can potentially transmit HIV to you and these are situations where if you have not already been on PrEP, it is advised to get PEP to safeguard against HIV infections.

How do I take PEP?

HIV PEP is a combination of three drugs likely given to you in two tablets. This is similar to PrEP but with the addition of another agent to the regime. Like aforementioned, time is of the essence when it comes to PEP so be quick to get to it and start taking it well within the 72 hours golden period for the best results.
The medications should be taken once or twice daily for a minimum of 28 days consecutively. Keep in mind that this is crucial. Missing out on one dose or even worse, one day’s worth of PEP is definitely not advisable. (HIV PEP is available in all our clinic in Singapore and Malaysia)

How does PEP work?

Essentially, PEP will prevent the replication of HIV in the body. When it cannot replicate, it cannot create a strong enough infection to overwhelm the body’s immune system. Ideally, that will result in the virus eventually dying off because it is unable to further survive in the body with its presence there being insignificant.

How would I know if PEP worked?

As with any medication, we will have to do pre and post therapy testing. Prior to starting PEP, it is ideally advised to get HIV testing done to make sure you have not already been exposed to HIV. Once you have started the medication, try and take them at the same time everyday for at least 28 consecutive days then we’ll have to get you tested within the next two months.
If throughout that time you appear to be well and there is no evidence of HIV picked up in your tests, we can clear you from that particular incident.

Side effects of PEP?

Because the medication regime is somewhat similar to PrEP, you can expect a similar range of side effects but this may be amplified somewhat. Apart from that, it is fairly undramatic.

Can HIV PEP fail?

Yes, unfortunately, there have been reported cases of PEP failure. This means that even with taking medications, the client still got a HIV infection. This is not common and is usually linked to poor compliance or a pre-existing medical condition that may impair the way PEP works.

All in All

To summarise, there are ways to protect yourself from potentially deadly viruses like HIV. You have to be in the know and be responsible for your own health in terms of how you choose to live your life and how to best be safe in it.
As a physician, I am glad to help you out in every step of the way in getting you as safely healthy as possible while allowing you to lead the life you feel will make you happiest and to achieve your full potential.
It is certainly debilitating to catch a virus like HIV when you’re just out doing what you do. It can throw a spanner into your life goals and bring life as you know it into a screeching halt.
Having said that, I hope this article has given you at least a rudimentary idea of how to keep yourself protected and to stay safe. Remember, prevention is always better than cure.
Take care.
This Article is Written By Dr. Kaarthig Ganesamoorthy from Our KL EcoCity Branch in Kuala Lumpur.


Other Reads:

  1. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  2. What are the Causes of Abnormal Penile Discharge?
  3. HPV Infection & HPV Vaccination for Men who have sex with Men
  4. STD Risk for Receptive Unprotected Anal Sex in Men
  5. Low HIV Risk Doesn’t Mean No HIV Risk
  6. HIV PrEP for Travel – How You Need to Know
  7. An Overview on STD from an STD Doctor
  8. Everything You Need to Know about Herpes Simplex Virus
  9. How Do I Treat Oral Herpes (Cold Sores)
  10. Syphilis Symptoms – Painless Sore & Ulcers
  11. HIV Symptoms – What You Need to Know
  12. 10 Common HIV related Opportunistic Infections
  13. The HIV Pro-Viral DNA Test can be done 10 days post exposure.

STD Risk from Receptive Unprotected Anal Sex in Men

Anal sex, not only consists of penile insertion into the anus (bottom) but also allowing your partner to use his mouth on the anus (analingus) or insertion of fingers and sex toys into the anus.
It is highly recommended to use condoms and lube during anal sex to reduce the risk of contracting a sexually transmitted disease (STD).

What is the STD that you can potentially get from anal sex for Men-Who-Have-Sex-With-Men (MSM)?

1. Chlamydia and Gonorrhea

The reason why we clumped them together in this article is that chlamydia gonorrhoea can present with similar symptoms and may present together in certain patients. These bacteria’s can present in a few ways:

Anal Discharge

Discharge is a term used when liquid is seen coming out of the anus. This is usually very minimal and patients usually notice a small number of stains on their underwear. In very rare situations, the volume may be high and appear yellow in colour. see more of Rectal Gonorrhea

Anal Discomfort

Patients usually present with mild discomfort in the anal region and some of them describe it as a feeling of constant urge to poo. It is never painful, and if patients present with severe pain, it is usually due to haemorrhoids or a tear at the opening of the anus.

Anal Bleeding

This is very rare. If patients present with bleeding, it is usually due to piles or a tear at the opening of the anus.

Lower Urinary Tract Symptoms

The insertive partner (or top) may present with a burning sensation when passing urine, urethral discharge, an increase in urinary frequency, waking up in the middle of the night to pass urine and the feeling of incomplete bladder emptying. However, keep in mind a large proportion of men may not show these symptoms.
It is best to get tested via anal swab or urine test for these bacteria if you have had an exposure as it can be easily treated with antibiotics.
Prostate infection and inflammation can be due to non-Sexually Transmitted infections & Sexually Transmitted Infections.
We provide Rapid Chlamydia & Gonorrhea PCR Screening (Next Day Results).

2. Human papillomavirus (HPV)

HPV is, in fact, one of the most common STD’s out there but is less well known. It is usually transmitted through skin to skin contact, through contact with infected mucous membranes or bodily fluids. In other words, condoms will not protect you from this virus. There are many different strains and can cause anal cancer and cauliflower-like growths in the anus and surrounding skin. It is recommended to see a doctor screen for anal warts, or other genital warts because some warts may be inside the anus and may not be visualised externally.
Warts can be treated and you should see a men’s health doctor if you have any suspicious lumps. It is highly recommended for men who engage in anal sex to get the HPV vaccine.
Rapid HPV Testing (Next Day Results) is available in our clinics.
Check out: How to Get Rid of Warts

Read: Is HPV Vaccine Necessary for Males?

3. Herpes

There are 2 kinds of herpes virus, HSV type 1 and HSV type 2. These viruses can be easily passed through skin to skin contact, which means condoms have a very limited to a negligible role in reducing the transmission. They usually present in the area of contact with multiple, small and painful ulcers or blisters within a week or sometime months after exposure. If there is any suspicion, the doctor will perform a dry swab to diagnose the lesion. Unfortunately, there is no cure but there is treatment available for flares.

4. Molluscum Contagiosum

Molluscum Contagiosum is caused by a virus call Poxvirus and presented with lesions that may appear anywhere on the body. The lesions are small, raised and usually white or flesh-coloured with a dimple or pit in the centre. The size can range from 2 to 5 mm in diameter and may be itchy or sore. This virus can be passed through skin to skin contact or thru contaminated materials such as clothing, towels, pool equipment or even toys. The good news is that these lesions usually do not cause long-term medical problems and can be easily treated. Water Wart Removal is available in our clinics.

5. Syphilis

Syphilis an STD which is transmitted thru any form of sexual contact. It is caused by a bacteria known as Treponema pallidum. This disease can present in many ways, from a single, big and painless ulcer in the area of sexual contact, to rashes around the body and palms. In certain cases, they can cause an infection in the brain and spinal cord. This symptom can present any time between 9 to 90 days after being infected. The good thing is this disease is usually curable with antibiotics.

6. HIV

The riskiest sexual behaviour for getting and transmitting HIV in men is anal sex. The receptive anal sex is much riskier as the bottom partner’s risk is 13 folds higher than the insertive partner. This virus can pass through blood, semen, pre-seminal fluid (Pre-cum) or rectal fluids.
This risk is higher when recreational drugs are used.
Condoms and HIV pre-exposure prophylaxis (PrEP), if used consistently can reduce the risk of getting HIV significantly. The condom reduces the risk of getting HIV by 63% for the insertive partner and 72% for the receptive partner if they engaged in anal sex with an HIV infected partner.
Yes. it is not 100%!!. PrEP can reduce the risk of getting HIV by more than 90%. If you think you have been potentially exposed to the virus and did not use a condom, you can see a doctor within 72 hours of the exposure to start the HIV post-exposure prophylaxis (PEP) treatment.
Also, a regular HIV Test is recommended if you are sexually active with unknown HIV status partners.
If you think you have had an exposure to HIV or any form of STD thru risky sexual activity, it is recommended you get tested and seek treatment early to reduce any untoward complications and risk of passing it to your partner.
Take Care!
Take Care!


Other Reads:

  1. The HIV Pro-Virus DNA Test can be done 10 days post exposure.
  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. What are the Causes of Abnormal Penile Discharge?
  4. HPV Infection & HPV Vaccination for Men who have sex with Men
  5. Low HIV Risk Doesn’t Mean No HIV Risk
  6. 7 FAQs HIV Preexposure prophylaxis (HIV PrEP)
  7. HIV PrEP for Travel – How You Need to Know
  8. An Overview on STD from an STD Doctor
  9. Everything You Need to Know about Herpes Simplex Virus
  10. How Do I Treat Oral Herpes (Cold Sores)
  11. Syphilis Symptoms – Painless Sore & Ulcers
  12. HIV Symptoms – What You Need to Know
  13. 10 Common HIV related Opportunistic Infections

7 FAQs HIV Pre-Exposure prophylaxis (HIV PrEP)

HIV Pre-exposure prophylaxis (PrEP) is a combination of 2 HIV medicines, sold under the name of Truvada (Tenofovir and Emtricitabine), when taken daily lowers the chances of a very high-risk HIV negative individual from getting infected with HIV.
Do not mistake this for Post-exposure prophylaxis (PEP) which is taken for 28 days after potential exposure to the HIV virus.
The precept is simple, take one pill a day and you are protected from getting HIV.
Also Read: A Guide To HIV PrEP And HIV PEP – Pills For HIV Prevention

7 Frequent Asked Questions on HIV Pre Exposure Prophylaxis (PrEP):

1) How effective is HIV Pre-exposure prophylaxis (PrEP)?

When used daily, it can lower the risk of getting HIV from sexual intercourse by 99%.
The protection against getting HIV from sharing needles is lower at about 70%.
Being on PrEP is NOT AN EXCUSE for going bareback. Using a condom further reduces the risk of getting HIV. Also, PrEP does NOT protect against other STDs. But condoms DO!
Also, remember that medicines work only if they are taken properly.
Also Read: STD Symptoms – That You Need to Know 

2) How to Take HIV Pre exposure prophylaxis (PrEP)

a. Event-Based HIV Dosing


On-Demand PrEP Regimen: 
Planned condom-less sex 24 hours in advance:
Strictly:

  • take 2 pills 2 – 24 hours before sex
  • take 1 pill on the day of sex
  • take 1 pill 24 hours later

If having sex for an extended period of time, perhaps over a few days or a weekend, continue to take a pill every 24 hours until you have 2 sex-free days.

Type: 

  • Only for Anal sex
  • More studies required to show effectiveness in Vaginal/Frontal sex

Considerations:

  • This option is not recommended if you have an active hepatitis B infection. The drugs in PrEP also suppress the hepatitis B virus and so starting and stopping HIV PrEP can potentially cause viral flare-ups and liver inflammation.

b. Daily PrEP

Daily PrEP Regimen: 

  • Lead-in time 7 days.
  • Taken daily at the same time  +/- a few hours ok

Type:

  • Anal, Vaginal/Frontal sex

Considerations:

  • Can be taken any time of the day with or without food
  • In the event a pill is missed, adequate protection is still conferred.

c. Ts and Ss (Tues, Thurs, Sat, Sun dosing)


Ts and Ss Regimen:

  • Daily dosing for 7 days,
  • then dropping down to 4 pills per week on Tues/Thurs/Sat/Sun

Type: 

  • Only for Anal sex
  • More studies required to show effectiveness in Vaginal/Frontal sex

Considerations:

  • If you only have sex once or twice a month, you might not want to take a pill every day.
  • 4 pills per week will maintain a good baseline of the drug in your system and you can choose to increase up to daily 7 pills per week when you know you’re in a more sexually active period.
  • Some people using PrEP On Demand find that they might be taking 4 pills per week most weeks of the month and so opt for structuring this into the Ts and Ss instead.

d. Holiday PrEP

Holiday PrEP Regimen:

  • PrEP before a pre-planned block of time when your risk of exposure to HIV will be higher due to:
    • an increased number of partners of unknown HIV status
    • situations where condoms are not easily or always used
    • where alcohol or substances might be used
    • having sex while travelling to a country with a high HIV prevalence
  • Based on a 7-day period we recommend 7-7-7:
    • 7 days daily dosing before the period
    • 7 days daily dosing during the period (or for as long as the specific period lasts)
    • 7 days daily dosing after the period.

Type: 

  • Anal, Vaginal/Frontal sex

Considerations:

  • 7 days of PrEP before and after your last sexual encounter for several reasons:
    • 7 days lead-in provides adequate levels for both anal and vaginal or frontal sex.
    • 7 days lead in before the holiday or travel will allow the body to adjust to any possible side effects; most people do not experience any, but should you have side effects, these will usually have subsided within a week.

3. Who should consider HIV Pre exposure prophylaxis (PrEP)?

  • If your partner is living with HIV
  • If you are not is a mutually monogamous relationship
  • If you have been diagnosed with an STD in the past 6 months

4. How long after initiation of HIV PrEP will it then provide protection?

The general rule is that you have to be on PrEP for 7 days before you are protected.
There are ways to speed this up and there are circumstances when this is longer. Please check with our doctor when you consult for your PrEP prescription.
Also Read: When To Test For HIV During Or After Completing HIV PEP

5. What are the side effects of HIV PrEP? Is it safe to take it long term?

PrEP is relatively safe. When side effects do occur, most common symptoms are nausea and diarrhoea. Generally, these symptoms usually subside over time. No serious side effects have been recorded and the side effects are never life-threatening.
However, if you do develop side effects that are not improving with time, please contact the doctor that prescribed you the PrEP.

6. How can I purchase PrEP?

You will need to consult a doctor first and he may go through with you your risks based on the type of sexual behaviour. The doctor will also run some blood tests, including HIV, Hepatitis screen, and other blood tests such as full blood count, kidney function test and liver function test. If there are no contraindications, the doctor will then prescribe you PrEP.
Learn more about Anonymous HIV Testing

7. Since PrEP is effective in providing protection, can I not use a condom for oral and anal sex?

Always use a condom. PrEP doesn’t give you 100 per cent protection. Using a condom while on PrEP significantly lowers your risk further. Besides that, HIV PrEP doesn’t protect you against other sexually transmitted diseases (STDs) such as gonorrhoea and chlamydia which can infect the throat, anus and penile urethra.
While on PrEP it is recommended to screen for HIV and other STDs regularly. We provide Rapid HPV Testing & Rapid Gonorrhoea & Chlamydia PCR Testing (Next Day Results).
Learn more about Descovy (New HIV Medication For HIV PrEP)

Descovy (brand name) is a FDA approved new drug combination of tenofovir alafenamide (TAF) + emtricitabine for use as HIV PrEP, which has shown to be equally effective in preventing HIV infection whilst touting an improved safety profile for renal and bone toxicity.

Descovy is currently available in all Dr Tan & Partners (DTAP clinics) in Singapore. It is a prescription only medication and must be prescribed by a doctor. Speak to our doctors for more information about Descovy and find out if a HIV-1 treatment that contains Descovy is right for you.

Take Care!


Other Reads:

  1. HPV Infection & HPV Vaccination for Men who have sex with Men
  2. A Guide To HIV PrEP and HIV PEP – Pills for HIV Prevention
  3. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  4. What are the Causes of Abnormal Penile Discharge?
  5. STD Risk for Receptive Unprotected Anal Sex in Men
  6. Low HIV Risk Doesn’t Mean No HIV Risk
  7. HIV PrEP for Travel – How You Need to Know
  8. An Overview on STD from an STD Doctor
  9. Everything You Need to Know about Herpes Simplex Virus
  10. How Do I Treat Oral Herpes (Cold Sores)
  11. Syphilis Symptoms – Painless Sore & Ulcers
  12. HIV Symptoms – What You Need to Know
  13. 10 Common HIV related Opportunistic Infections