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

How Do I Get Tested For An Anonymous HIV Test In Singapore

These 3 letters H, I, and V put together, or commonly known as the Human Immunodeficiency Virus, sets alarm bells ringing in most people’s minds. Often, the anxiety and concern that goes through one’s mind can often be allayed through a simple consult with our doctors to assess your risk and or a test to decide what to do next.
Still concerned? Read on to find out more and take the next step to schedule a consultation and Anonymous HIV Testing in Singapore with our doctors.

How is it Even Possible to Get HIV Tested Anonymously?

Yes it is that simple with our “3 step test” guide
Step 1:

  • Walk into our clinic at Robertson Walk.
  • Let our staff know you are here for the “AHT”.

Step 2:

  • Private consultation with the doctor.
  • The doctor will proceed with the “3 Step Test”.

Step 3:

  • After 20 minutes your results will be ready.
  • Reviewing of your HIV test result with our doctor.

Who Should Get HIV Tested?

If you have a concern for HIV transmission or even a sexual health concern, we advise you to see us get your queries addressed.
Where appropriate, we will support you with the HIV test.

How Is HIV Testing Done? I am Scared of Needles

A small finger prick is done, it will be slightly uncomfortable, and a few drops of blood are collected. No needles are involved.

How Long Do I Have to Wait for the HIV Test Results?

The results take 20 mins to be ready and your doctor will discuss the results with you

How Much Does the Anonymous HIV Test cost?

Rapid Fingerprick HIV (3rdGen Test) – (90 days after exposure)
$53.60 (after GST)
Rapid Fingerprick HIV Combo Test (4thGeneration) – (28 days after exposure)
$160.60 (after GST)
All results take 20 mins. Consultation charge is between $20 – $30.

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

Upholding Patient Confidentiality is our utmost priority. Therefore reports will NOT be snail mailed by post. Results can be communicated via phone or email.
During the private consultation, you can speak to our doctors about all of your HIV-related concerns. The doctor will then recommend the correct HIV Test or STD test.
Our registered doctors will administer the HIV and STD tests, which are approved by the Health Sciences Authority (HSA)


Other Reads:

  1. Low HIV Risk Doesn’t Mean No HIV Risk
  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. What are the Causes of Abnormal Penile Discharge?
  4. HIV PrEP for Travel – How You Need to Know
  5. An Overview on STD from an STD Doctor
  6. Why Do I Have AbnormalVaginal Discharge
  7. How Late Can a Period Be (Delayed Menstrual Cycle)
  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

Low HIV Risk Does Not Mean NO HIV Risk

As we approach the year-end festivities and parties, I am reminded of an article published more than 5 years ago on HIV (Human Immunodeficiency Virus) scares amidst getting a needle stick injury from infected blood.
http://news.asiaone.com/News/AsiaOne+News/Singapore/Story/A1Story20110801-292087.html
The story above went that a partygoer had been going to famous clubs and jabbing people with an HIV tainted syringe, presumably of her own blood, to take revenge on them.
The following excerpt reproduced from the AsiaOne article, explains this risk further
Quoting Professor Roy Chan, president of voluntary organization Action for Aids, said it is possible for HIV to be contracted in the way described. But for that to happen, the blood has to be injected within a few hours of it being drawn from the infected person.

“The needle must also penetrate the skin of the victim and reach some blood deposits.
“And it is possible for people who have been exposed to tainted blood to seek post-exposure treatment within the first day or two at a hospital to reduce the risk of contracting the infection,”

Prof Chan told TNP.

What are the odds?

So realistically what are the exact numbers and risk for such exposure? There haven’t been any studies of HIV infected needle transmissions studied outside the healthcare setting but the numbers in a comprehensive study are:

  • Blood Transfusion –  9250/10000 or 93% risk
  • Needlestick – 23/10000 or 0.23% risk
  • Needle sharing – 63/10000 or 0.63% risk

So far there hasn’t been any case reported or recorded, in the world of a successful HIV transmission from a needlestick attack or a needlestick injury outside the healthcare setting

So What about Tattoos or Piercings?

Again through numerous studies, the risk of HIV transmission through tattoos and piercings depend on a number of factors. Mainly the sterilization techniques of the equipment used.
Transmission occurs if the equipment (needles/tattoo gun) were contaminated with blood from a previously tattooed individual who carried HIV. Or even the use of dyes, wiping material (sponges/clothes) contaminated with blood. These are liquid solutions where at room temperature HIV virus may remain for up to 2 weeks
This percentage again is closely associated with the needlestick injury risk of 0.23%. However, repeated use of the needle/tattoo gun for the process does increase the overall risk percentage

What is the take-home message?

Around the world, HIV is a disease that has a stigma in society. And surrounding this stigma is a lot of unknowns and ultimately fear.
Only recently again in 2018 the media picks up on such another case in India where HIV transmission occurred during a blood transfusion.
https://www.channelnewsasia.com/news/asia/pregnant-woman-in-india-contracts-hiv-after-blood-transfusion-in-11063528
The good news is that in Singapore, all blood products are tested and screened by the authorities
If you suspect an episode which could lead to a possible HIV risk – tainted needle, needle attack, transfusion error, do speak to your doctors early to discuss this risk with us. If within 72 hours, there are options such as HIV Post Exposure Prophylaxis (PEP) which can significantly decrease the risk of HIV transmission by more than 90%

Low HIV Risk Doesn’t Mean NO Risk

From all of us at Dr Tan and Partners, stay safe and enjoy your festive season.
Take Care!

Other Interesting Reads:

  1. An Overview of STD – From an STD Doctor
  2. The HIV Pro-Virus DNA Test can be done 10 days post exposure.
  3. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  4. What are the Causes of Abnormal Penile Discharge?
  5. What are the Symptoms of HIV Infection and AIDS?
  6. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  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. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  12. Syphilis Symptoms (Painless STD Sores & STD Rashes) 


References

  1. Padian N Transmission of HIV Possibly Associated with Exposure of Mucous Membrane to Contaminated Blood.MMWR Morb Mortal Wkly Rep11;46(27): 620-3, July, 1997
  2. Bernard EJ Texas jury concludes saliva of HIV-positive man a “deadly weapon”, sentenced to 35 yrs jail.com, available online at: www.aidsmap.com/page/1430404/, 16 May 2008
  3. Pretty IA et al. Human bites and the risk of human immunodeficiency virus transmission.Am J Forensic Med Pathol. 20(3):232-9, 1999
  4. Gilbart VL Unusual HIV transmissions through blood contact: analysis of cases reported in the United Kingdom to December 1997.Communicable Disease and Public Health 1: 108-13, 1998
  5. Baggaley RF Risk of HIV-1 transmission for parenteral exposure and blood transfusion: a systematic review and meta-analysis.AIDS 20(6): 805-812, 2006
  6. Nishioka SA, Gyorkos TW. Tattoos as risk factors for transfusion- transmitted diseases. International Journal of Infectious Diseases 2001;5(1):27-34.
  7. Messahel A, Musgrove B. Infective complications of tattooing and skin piercing. Journal of Infection and Public Health 2009;2(1):7-13.
  8. Garland SM, Ung L, Vujovic OV, Said JM. Cosmetic tattooing: A potential transmission route for HIV? Australian & New Zealand Journal of Obstetrics & Gynaecolo- gy 2006;46(5):458-9.

10 Common HIV-related Opportunistic Infections

In late-stage HIV infection, the virus would have spread through the body and attacked the immune system for many years without treatment. On blood tests, the number of viral copies, or viral load (VL), will be very high, while the CD4 cells of the immune system would be very low.
When the immune system is in this weakened state, it is much easier for certain pathogens (bacterial, viral, fungal etc.) to invade and cause an infection – these types of infections are called Opportunistic Infections (OI’s). Sometimes, these infections can cause certain types of cells to become cancerous, and these are also classified as Opportunistic Infections.

What is an Opportunistic Infection?

In a healthy and normal functioning immune system, these pathogens do not usually cause infection, or they may cause very mild disease. Apart from advanced HIV infection, Opportunistic Infections may affect people who are on chemotherapy for cancer, immunosuppression for autoimmune diseases or post-organ transplant, among other conditions.
In HIV, many of these Opportunistic Infections are what we also term as “AIDS-defining illnesses” – that is, if these infections are found in someone who has HIV, we would classify them as having AIDS (Acquired Immunodeficiency Syndrome). Many of the symptoms and signs of late-stage HIV infection are due to these Opportunistic Infections rather than directly from the virus itself.

What is HIV Treatment?

HIV treatment and management consists of taking a set of correct HIV medicines to delay the control HIV, monitoring for and treating any opportunistic infections, and taking care of the patient’s general health and well being.

What are the most common Opportunistic Infections?

This is a list of some of the most common HIV-related opportunistic infections:

1) Candidiasis (Esophageal, Tracheal, Bronchial)

Also known as thrush, candida is a very common fungal organism that is found almost everywhere 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 HIV, there can be invasive candida overgrowth in the esophagus and airways. It is often the first sign of a weakened immune system in previously undiagnosed individuals.

2) Cryptococcosis

Caused by the fungus cryptococcus neoformans, this can infect any part of the body, but most commonly will invade the lungs (pneumonia) or the brain (abscesses).

3) Cytomegalovirus (CMV)

Caused by an intracellular virus, this infection can cause inflammation of the brain, lungs, intestines, and eyes. CMV retinitis of the eye is sight-threatening and should be treated as a medical emergency.

4) Herpes Simplex Virus (HSV)

Another common virus, Herpes Simplex Virus (HSV) can cause symptoms in people with a normal immune system as well – usually cold sores or blisters around the mouth, genital region or anus.
However, in people with a weak immune system, outbreaks tend to be more frequent, severe, and prolonged in duration, and can also invade the lungs and esophagus.

5) Mycobacterium Tuberculosis (TB) & other Mycobacterial infection

Tuberculosis (TB) would most commonly affect the lungs, but may also spread to lymph nodes, brain, kidneys, or bones. Symptoms of TB include recurrent fever, night sweats, chronic cough, and weight loss. Other mycobacteria are very commonly found in soil and around the environment, and very rarely would cause problems in healthy individuals; as Opportunistic Infections, they will usually affect the lungs but can spread throughout the body.

6) Pneumocystis Carinii Pneumonia (PCP)

Caused by a fungus pneumocystis carinii, now renamed as pneumocystis jirovecii, this infection is commonly one of the first signs of a late-stage HIV infection. Symptoms would include shortness of breath on exertion, dry cough, and high fever, and if left untreated can be deadly.

7) Salmonella septicemia

Salmonella is a common bacteria that is usually found in contaminated food or water. In healthy individuals, this may cause an acute ‘food poisoning’ with vomiting, diarrhoea, and sometimes fever. However, salmonella as an Opportunistic Infection can spread throughout the body and cause septicemia, or blood poisoning, leading to multi-organ failure and death.

8) Toxoplasmosis

This is caused by a parasite called toxoplasma gondii, which is found in the faeces of certain animals (normally cats, rodents, and birds), and can be found in undercooked red meat such as pork. It can cause infection of the lungs, eyes, liver, and brain.

9) Kaposi’s Sarcoma (KS)

This is a type of abnormal growth/tumor of connective tissue – more specifically, of the capillaries (small blood vessels). It can occur anywhere in the body, but if it arises on the skin or mucous membranes, KS will usually appear as firm reddish or purplish lumps. The cancerous changes in the cells are a result of infection by human herpesvirus 8 (HHV8),

10) Invasive cervical cancer

This is a cancer of the cervix, which is the neck of the womb, or uterus. Malignant changes can occur after infection with certain types of human papillomavirus (HPV), and all women (HIV or not) should be screened regularly with pap smears and HPV testing. It is also recommended to get the HPV vaccine (Gardasil 9), to prevent HPV infection, cervical cancer, and genital warts.

How can Opportunistic Infections be prevented?

As these infections only occur in people with a weakened immune system, the most important way to prevent them would be to treat the underlying HIV infection. Highly Active Antiretroviral Treatment (HAART) is very effective at treating HIV and ensuring the virus is adequately suppressed. With a low or undetectable viral load, the body’s immune system has time to recover – and when the CD4 cells have returned to sufficient numbers, the risk of Opportunistic Infections is lowered drastically. The earlier an HIV infection is diagnosed, the earlier treatment can be started and the better the chances of avoiding Opportunistic Infections.
For patients who are diagnosed with HIV later and have low CD4 counts at diagnosis (<500), it is important to consider Opportunistic Infections prophylaxis while we are waiting for HAART to work. This means starting patients on certain medications (e.g. antibiotics, antifungals, and/or antivirals) to prevent some of these specific infections. It may take 6-12 months for the CD4 counts to recover once HAART has been initiated; once the CD4 counts are improved, these prophylactic medications may be stopped.
Other general advice for people living with HIV would include:

  • Reducing or preventing exposure to other sexually transmitted infections
  • Getting vaccinated (e.g. HPV vaccine, annual flu vaccine, pneumococcal vaccine, etc.)
  • Avoiding undercooked or raw foods (including eggs, meat, unpasteurized milks and cheeses, etc.)
  • Avoid drinking untreated water
  • Speak to your doctor about any other changes that may need to be made at home, work, or when on vacation to reduce exposure to OI’s

Take Care!

Other Interesting Reads:

  1. An Overview of STD – From an STD Doctor
  2. The HIV Provirus DNA Test can be done 10 days post exposure.
  3. What are the Symptoms of HIV Infection and AIDS?
  4. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  5. What are the Causes of Abnormal Penile Discharge?
  6. Low HIV Risk Doesn’t Mean No HIV Risk
  7. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  8. 11 Causes of Dyspareunia (Pain During Intercourse)
  9. What is HPV Vaccination (Gardasil 9)
  10. 10 Causes of abnormal Vaginal Lumps and Bumps
  11. An Overview of Gonorrhoea
  12. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  13. Syphilis Symptoms (Painless STD Sores & STD Rashes) 

What are the Sign​s & Symptoms of HIV / AIDS

Human Immunodeficiency Virus (HIV) is a virus that can be spread through sexual contact, contaminated needles, blood transfusions, and other infected body fluids. It targets the immune system, specifically CD4 cells, and if left undiagnosed and untreated, can overwhelm the immune system and cause life-threatening complications.
HIV symptoms can appear at different times for different people, and some may not recall having any symptoms at all until diagnosis (which can be many years after the initial infection).

What are the Different Stages of HIV Infection?

HIV infection occurs in three main stages:

  1. Acute HIV Infection,
  2. Chronic HIV Infection (Clinical Latency Stage),
  3. and Late-Stage HIV or AIDS (Acquired Immunodeficiency Syndrome).

HIV symptoms may vary depending on the individual and the stage of infection, and some people may not have any HIV symptoms at all.

1) Acute HIV Infection

Within the first 2-4 weeks after initial infection, the virus replicates very quickly and HIV viral load will reach a high level. People may experience flu-like symptoms, which they may describe as ‘the worst flu ever’.
This is known as Acute Retroviral Syndrome or ARS. These acute HIV symptoms may occur in about 70-80% of people.
Acute Retroviral Syndrome ARS / HIV Symptoms may include:

  • Fever
  • Night sweats
  • Swollen glands
  • Sore throat
  • Body rash
  • Fatigue
  • Body aches
  • Headache
  • Nausea and vomiting
  • Diarrhea

Acute HIV symptoms can last between several days to several weeks, until the body can develop HIV antibodies to fight the virus. This is also the stage of the greatest infectious risk to others as the HIV viral load is very high. However, do remember that these symptoms are seen in other common conditions as well, and you shouldn’t assume you have HIV just because you experienced them.
If you are concerned about any symptoms or potential exposure, it is best to see a doctor to have them evaluated and consider HIV testing.
HIV Symptoms in a Nutshell

Different HIV tests are able to detect the infection at different times

The earliest you may be able to detect the virus is with HIV DNA/RNA PCR testing, which can be accurate from 10-12 days post-exposure. Other more common tests would be the 4th Generation HIV p24 Antigen/Antibody test, which is considered conclusive from 28 days post-exposure.
If you have had a potentially risky exposure within the last 72 hours, you can consider a course of medication called HIV Post-Exposure Prophylaxis (HIV PEP). This works to prevent the virus from replicating and taking hold in the body, and can reduce risk of transmission by more than 90%. It is only effective if started within 72 hours.

HIV Window Period & HIV Test Accuracy:

2) Chronic HIV Infection

After the early stage of acute HIV infection, the disease enters into a clinical latency stage, where the virus is developing in the body, but no symptoms are seen. During this time, the virus is still active but will replicate slowly inside the cells – it can still be transmitted to others, but the risks of transmission are lower than during the acute phase.
If you have been diagnosed with HIV and are on HIV antiretroviral treatment (HAART), the virus is often kept under control and you may experience a symptom-free period that can last decades. If the virus can be suppressed to undetectable viral load levels, we would deem the risk of transmission extremely low. This stage of HIV infection can last for 5-10 years.
If you have HIV but are not on treatment, then it will eventually progress to late stage infection, known as AIDS.

3) AIDS (Acquired Immunodeficiency Syndrome)

Late Stage HIV / AIDS (Acquired Immunodeficiency Syndrome)
If you have HIV but are not on antiretroviral treatment, it will eventually weaken your immune system and progress to AIDS, or Acquired Immunodeficiency Syndrome.
Symptoms or signs of late stage HIV / AIDS may include:

  • Rapid weight loss
  • Recurring fever
  • Profuse night sweats
  • Extreme tiredness
  • Swollen glands
  • Persistent diarrhea
  • Mouth or genital sores and ulcers
  • Fungal infections, especially oral thrush
  • Shortness of breath, lung infections (e.g. PCP)
  • Memory loss, limb weakness and other neurological disorders
  • Mucous membrane and skin rashes and lesions (patches of reddish-purplish lesions may be characteristic of Kaposi sarcoma)

Many of these signs and symptoms in AIDS are due to Opportunistic Infections (OI’s), which are organisms that usually only cause infections in people with a weak immune system. People with normal functioning immune systems will typically be able to fight these types of infections off, or suppress them so they do not manifest with significant symptoms.
Common types of OI’s include candidiasis (thrush), pneumocystis carinii pneumonia (PCP), tuberculosis (TB), and salmonella colitis infection, among many others.
In someone who is diagnosed with late-stage HIV and whose CD4 cell count is found to be very low, doctors will usually start on certain medications such as antifungals or antibiotics to prevent these OI’s; they will be kept on these medications as prophylaxis, while they are taking their regular HIV medications, until their CD4 count is high enough (indicating their immune system is strong enough to fight off these infections by itself).
Even if you experience the previously mentioned symptoms, it is impossible to confirm HIV infection unless you get tested. If you are concerned about a possible exposure, please visit our clinics for a consultation and evaluation.
Take Care!


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What is HIV PrEP & Event-Driven Based HIV PrEP Strategy?

What is HIV PrEP?

HIV PrEP is an option for HIV prevention and involves taking medication that can reduce the risk of HIV transmission by up to 95% if taken properly.
Most of the time, Pre-Exposure Prophylaxis, or HIV PrEP for short is taken as a daily tablet and needs to be taken consistently to provide the greatest level of protection.
HIV PrEP is recommended for at-risk groups, including men-who-have-sex-with-men, patients who have a known partner who is living with HIV (PLHIV), or those with multiple partners of unknown HIV status.

What is the difference between HIV PEP (HIV Post Exposure Prophylaxis) & HIV PrEP?

HIV PrEP should not be mistaken for HIV PEP or HIV Post Exposure Prophylaxis.

HIV PEP is for any individual who is at risk of HIV infection after an HIV exposed to HIV to take HIV medicines for a month to reduce his or her chances of HIV infection.

HIV Pre Exposure prophylaxis and HIV Post Exposure Prophylaxis do not 100% reduce your chances of HIV infection, nor prevent you from being infected with other Sexually Transmitted Diseases (STDs) besides HIV.

HIV PEP as an HIV prevention strategy was first developed for healthcare workers, who are being exposed to contaminated blood or needles prick. It has since expanded to other HIV high-risk activities such as sexual exposure and intravenous drugs used.

Another development of HIV prevention is by using HIV Pre Exposure Prophylaxis (PrEP) as a strategy to reduce the chances of HIV infection even before any potential HIV exposure.

What is Event Driven Based HIV PrEP Strategy?

Some people may find that taking a daily table is just not suitable for them.
If this is the case, they may consider an option called Event-Based Dosing, or EBD for short.
This entails taking tablets one day before the exposure, the days of exposure, and for one day after the last exposure.
It is a much shorter course of tablets than regular HIV PrEP, and can still provide a high level of protection from HIV, with up to 85% risk reduction.
HIV PrEP is most effective when used in combination with other protective strategies such as condoms and regular STD screening.

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 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.

If you are interested in learning more about HIV PrEP or EBD, please come down to our any of our clinics to speak to our doctors, and see if these options are suitable for you. You can learn more about the What is HIV PrEP or HIV Pre-Exposure Prophylaxis.
We can advise you in more detail on the indications, dosage and timing, and potential side effects of the medications, as well as how to follow up with appropriate HIV Testing and STD testing.
Take Care!


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