Crabs STDs – Pubic Lice

Pediculosis pubis also known as the Crab Louse is a common insect infestation of the human genital area. As the infestation becomes more profound, it can also extend into other parts of the body including the eyelids. 

The louse is approximately 1 cm in size, which makes it visible to the naked eye. It has 6 legs, 4 of which have prominent pincer-like claws – much like a crab, which it uses to attach to its host. The louse feeds off its host by biting and drawing blood from the area. The lifespan of the louse is between 3 – 4 weeks, during which time, the female louse can lay as many as 80 eggs or nits. 

How do you get them?

Sexual transmission is the most common mode of transmission of the louse. Once the area has become infested with the louse, the patient will soon experience itchiness in the area. Prolonged infestation generally results in bluish bite marks in the skin. The louse requires a warm area and blood to thrive, hence they do not remain on inorganic surfaces such as tabletops and toilet seats for long. This means you do not usually get an infestation by touching such areas. 

The most at risk population are teenagers and young adults. 

How to get rid of Crabs STDs (Pubic Lice)?

The current treatment for Pediculosis pubis infestation is by topical treatment to the affected area. The aim of these treatments are to eradicate both the adult louse and nits. Although cure rates are high, it generally takes a few sessions of topical treatments to achieve complete eradication.

How to avoid getting Crabs STDs (Pubic Lice)?

The best way to prevent yourself from getting an infestation is to avoid contact with the louse. If you find out that your partner has an infestation, ensure that you clear the environment of any adult louse and eggs. Wash all fabrics such as curtains, bedding, towels and clothes with a hot cycle and a strong disinfectant. In the event you do find that you have an infestation see your doctor immediately so that treatment can be started early.

Next read: PARASITIC STIS – SCABIES

 
 

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Also on this site: hiv screening

Common Medical Conditions That Are Asymptomatic

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

What does being asymptomatic mean?

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

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

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


5 Diseases where patients are asymptomatic

Human Immunodeficiency Virus (HIV)

What it is?

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

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

How do you test for it?

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

Chlamydia

What it is?

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

How do you test for it?

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

Chronic Illnesses

High cholesterol

What it is?

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

How do you test for it?

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

Hypertension

What it is?

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

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

How do you test for it?

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

Diabetes

What it is?

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

How do you test for it?

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


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


Other Asymptomatic Medical Conditions:

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

Parasitic STIs – Scabies

Scabies are one of the more uncommon STIs (Sexually Transmitted Infections) present in Singapore. As it is rarely seen in a clinic setting and the signs are often unremarkable, it can be easily missed by both patient and the doctor. So what exactly is scabies? We will talk about it in a little more detail and how it is relevant to you and your sexual health.

Scabies – The hidden itch

Scabies are not an infection, but an infestation of microscopic mites, Sarcoptes scabiei. These tiny eight-legged creatures live within the human skin. After mating, female mites will burrow through the epidermis causing skin damage and lay eggs within the burrows. Larvae, after hatching, will grow and continue the whole lifecycle. 

Signs and Symptoms

These burrowing caused by the mites do not actually cause pain, but the allergic reaction to the mites, faeces and eggs leads to an intense itching that is typically worse at night. The itching starts 3 to 6 weeks after initial infestation. 

The typical physical finding is a extremely itchy pimple-like rash in areas such as:

  • Between fingers
  • Armpits
  • Wrist
  • Elbow
  • Genitalia
  • Waist
  • Buttocks

The back and the head are typically spared, except in very young infants.

Another more serious variant is Norwegian Scabies. This happens in patients with compromised immune systems, for example patients with HIV, lymphoms or long term steroid use. The mites will form deep, scaly rashes which are highly infectious.

How does one get it?

Scabies can be spread through direct and prolonged skin to skin contact, for example between family members or sexual partners. Casual contact is highly unlikely to spread scabies. 

Scabies can also be spread through indirect contact. As the scabies mites can survive up to 36 hours off a host, they can be indirectly transmitted through sharing clothes, bedding, towels with an infected individual. 

To prevent scabies, avoid skin to skin contact with infected individuals and do not share clothes and bedding. Condoms are NOT useful in preventing transmission as scabies spread through direct contact and not through body fluids and secretions.

Treatment options

Thankfully, scabies can be treated. A topical preparation known as Permethrin can be applied as a single dose to the whole skin from scalp to toe. Commonly, a single application is sufficient for eradication of scabies. An antiparasitic agent known as Ivermectin can also be given orally for eradication with good effect. To prevent re-infection, all contaminated clothing and bedding should be thoroughly laundered with hot water.

In conclusion, if you find mysterious pimple-like rashes which are intensely itchy after an exposure, see your doctor for further advice! 

Next read: CRABS STDS – PUBIC LICE

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Neurosyphillis

Syphilis is a Sexually Transmitted Infection (STI) caused by the bacteria Treponema Pallidum. It is a systemic infection with a multitude of signs and symptoms depending on the stage of the infection. As such, syphilis is also known as “the Great Imitator” because the clinical presentation may appear similar to many other diseases.

There are four stages of infection: 

  1. Primary syphilis – painless ulcer (or chancre) at the site of infection
  2. Secondary syphilis – manifestations that include, but are not limited to, skin rash, mucocutaneous lesions, and lymph node swelling
  3. Latent syphilis – this stage can last for a number of years with few or no symptoms
  4. Tertiary syphilis  – gummatous lesions (soft, non-cancerous growths), neurological problems, or cardiac symptoms

In this article, we will focus on neurosyphilis. You can learn more about syphilis as an overall topic in a previous article:



What is Neurosyphilis?

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

There are four different forms of neurosyphilis:

  1. Asymptomatic (most common form)
  2. Meningovascular
  3. General paresis (muscle weakness)
  4. Tabes dorsalis (slow degeneration of the neural tracts of the spinal cord)

Asymptomatic neurosyphilis occurs before symptomatic neurosyphilis. Early neurosyphilis affects the blood vessels and meninges (membranous coverings of the brain and spinal cord) whereas late neurosyphilis affects the brain and spinal cord itself.

Signs & Symptoms

Signs and symptoms vary widely depending on the form of neurosyphilis, including:

  • Stroke
  • Changes in personality
  • Dementia, mania, or paranoia 
  • Ataxia (loss of coordination of muscle movements, eg. leading to gait abnormality)
  • Ophthalmic symptoms (eg. blurred vision, reduced color perception)
  • Urinary symptoms (eg. bladder incontinence)
  • Headache
  • Giddiness
  • Hearing loss
  • Seizures 
  • Hyporeflexia 
  • Sensory impairment 

Risk Factors

The risk factors include: 

  • High risk sexual behaviour from unprotected sex and multiple sexual partners
  • Men who have sex with men
  • Recreational drug use

Diagnosis

Syphilis is diagnosed either via blood tests or direct visual inspection using dark field microscopy. In practice, blood tests are more commonly used as they are easier to perform.

To diagnose neurosyphilis specifically, cerebrospinal fluid (CSF), which is a fluid surrounding the brain and spinal cord, is obtained via lumbar puncture and the Venereal Disease Research Laboratory (VDRL) test is performed on the CSF. 

Other laboratory investigations that may be performed include: cerebral angiogram, computed tomography (CT) or magnetic resonance imaging (MRI) scan of the brain, brain stem or spinal cord.

Treatment

Syphilis is treated with intramuscular injection of the antibiotic benzathine benzylpenicillin. Early syphilis is treated with a single dose whereas late syphilis is treated with a once-weekly dose for 3 weeks. 

For neurosyphilis, however, the treatment course is different as penicillin penetrates the central nervous system poorly. Instead, the treatment requires intravenous penicillin every 4 hours for 10 to 14 days.

Generally, follow-up blood tests are performed at 3, 6, 12, 24, and 36 months to ensure the infection has fully resolved. Follow-up lumbar punctures for CSF analysis are performed every 6 months. 

Prevention

Neurosyphilis can be prevented with the following measures:

  • Safe sex practice, namely correct and consistent condom usage
  • Avoiding high risk sexual behaviour. Aside from abstaining from sexual contact, the surest way of avoiding STIs is to be in a mutually monogamous relationship with a partner who has been tested and is free of STIs
  • Regular STI screening and if syphilis has been detected, to receive early and prompt treatment
  • In the case of an individual diagnosed with a syphilis infection, prompt partner notification and treatment helps to reduce the risk of undetected syphilis

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Can I get an STD from a hand job?

This is a very common question that I get from patients who come to see me. Some are worried about contracting STDs when giving or receiving hand jobs or masturbation from another person. Generally speaking, there is very little risk of contracting STDs from a hand job.

Even though it is low risk, it is still not zero risk. Let me share with you some points about hand jobs and STDs.


You getting the hand job VS when you’re giving the hand job

Generally hand jobs have very low risk of transmission of STDs. However, if you give the hand job, you are at lower risk of getting an STD as compared to when receiving one. Why is that? STDs tend to affect genitals more than our hands. So if you are at the receiving end, it is your genitals that are at risk. If you are giving the hand job, it is less likely for you to get STDs unless you touch your own genitals after giving the hand job.


Type of STDs that might be transmitted through a hand job

Not all STDs are transmissible via handjobs. It is usually the ones that are passed on through skin to skin contact that are transmissible.

These include: 

  • Herpes Simplex Virus (HSV) Type 1 and 2. This usually causes painful sores or vesicles around the lips or genital areas. There is no cure for the virus but you can take antiviral medication when the symptoms appear to reduce the duration and severity of the symptoms.
  • Human Papilloma Virus (HPV): This virus usually causes genital warts. Warts are flesh coloured growths on the skin. There is also no treatment to treat the virus but there are different types of treatment available to remove the warts when they appear.
  • Molluscum Contagiosum: This is causes by a virus that lives on the skin. It can also be spread via skin to skin contact. It appears as small firm bumps on the skin which are generally harmless and painless. They usually go away on its own or you can get it removed by a doctor through freezing or laser removal.

How can you prevent it? What is considered “safe sex”?

As how we advise for all STDs, abstinence is best. 

Avoid multiple partners. Keeping to one partner minimizes the risk of STDs.

Avoid high risk exposure from sex workers or those who work in massage parlours. These workers have high exposure to several people a day so you will be at higher risk.

Condoms: Condoms may provide some protection. However do take note that areas not covered by the condom is still at risk of STDs.


Get tested to be sure!

If you’re ever in doubt, or unsure of your risks and or symptoms, do seek medical advice. The doctor will be able to advise if you need to get tested or get treated.


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Also on Dtapclinic.com: HIV Test Singapore, STD Test Singapore, Anonymous HIV Testing

Anal Warts: What you have always wanted to know, but were too embarrassed to ask.

Anal warts are definitely not a topic for polite conversation. As an affliction upon one of the more intimate parts of the human body, patients frequently have multiple concerns regarding cosmetic appearance, stigmatization, personal health and sexual relationships. It is also not commonly brought up to their spouses or doctors. We are here to find out more about this extremely common condition and dispel common misconceptions about it.


What are Anal Warts?

Anal warts are common skin growth around or inside the anal canal caused by a virus known as the Human Papillomavirus (HPV). They come in all shapes and sizes, ranging from a small pinhead-like growth to big cauliflower-like lesions. They usually do not cause patients much pain or discomfort and patients might not be aware that anal warts are present because of the nature of the location


What is HPV and how is it spread?

HPV is the most common sexually transmitted disease (STD) in the world. It is a family of viruses with more than 200 types. They are typically divided into low-risk and high-risk types based on associated risk for cancer in any body areas. The low-risk types HPV 6 and/or 11 are detected in around 90 percent of anal warts.

HPV is transmitted through contact with infected skin. Anal HPV infection is almost always acquired through sexual contact. Anal warts by themselves are not required for transmission but are highly infectious.


Common myths about anal warts

Myth #1 – My partner has anal warts, he/she is cheating on me!

This myth is responsible for a great deal of anxiety and anger. HPV infection can lie dormant in the body for months and years before causing anal warts. There is no way to find out when the infection was acquired. 

Myth #2 – Anal warts can lead to anal cancer.

Anal warts are almost always benign. They are caused by low-risk HPV types 6, 11, 42, 43 and 44 and do not develop into cancer. 

Myth #3 – HPV is incurable, and recurrence of anal warts are common.

It is indeed true that there is no known cure for HPV. However, warts and precancerous lesions can be easily treated when detected. Recurrence of anal warts is not a given, and some patients might find recurrence getting less frequent and eventually stopping with time. 

Myth #4 – Condoms use during sex will prevent HPV transmission

Unfortunately, that is not the case. Condom use will prevent transmission of pathogens such as HIV and syphilis that are spread through bodily fluids. They are not so effective against other pathogens such as herpes or HPV as they are spread through skin-to-skin contact. This is because condoms do not cover the entire external genitalia.

Nonetheless, condom use can still lower the risk of HPV transmission and other STDs. They still play an important role in sexual health and STDs prevention strategies. 


Diagnosis of anal warts

Diagnosis of anal warts is normally done at the doctor’s office clinically through a thorough history and physical examination. The majority of anal warts do not require a biopsy for diagnosis.

HPV screening for anal warts is not routinely recommended. This is because all commercial laboratories will only test for high-risk HPV types and not low-risk HPV types that causes anal warts.


Treatment

Anal warts treatment depends on the size, number, site as well as patient’s preference.

Home treatment with preparations such as Imiquimod cream or Podofilox solution are available. However, they are limited in utility due to the locations of the warts which might not be easily reached by the patient. 

Cryosurgery is the use of extremely low temperature through liquid nitrogen to destroy the abnormal anal wart cells. It can be done as an office procedure but will require multiple cycles for treatment depending on the size of the warts.

Radiofrequency ablation is a procedure in which heat, which is generated through an electric current, is used to destroy the abnormal anal wart cells. It can also be done as an office procedure. An injectable pain-killer is commonly given before the procedure to numb the area and commonly a single session will be sufficient for anal warts removal.

Finally, if the anal warts are too large or too extensive, surgical excision under general anasthesia might be considered by a surgeon. 


Prevention 

By observing safe sexual practices such as use of condoms during sex and limiting the number of sex partners, patients can reduce their chance of contracting HPV.

A vaccine (Gardasil 9) is available for males and females to prevent ano-genital warts but it will not treat existing HPV or ano-genital warts. This vaccine can prevent most cases of genital warts in persons who have not yet been exposed to wart-causing types of HPV.

Next read: WHY IS MY SEMEN GREEN OR YELLOW?

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Why you should not be embarrassed to get tested for HIV

Many people are still not getting regularly tested for HIV.

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

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

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

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

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

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

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


Common reasons that deter people from getting tested for HIV

1. I am scared of getting tested positive for HIV

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

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

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

3. I am afraid of being judged or being embarrassed 

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

4. I trust my partner

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

5. I am not at risk of HIV

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

6. Who should test for HIV?

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

Also read: HIV SYMPTOMS – WHAT YOU NEED TO KNOW


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

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

What are some of the HIV tests available?

There are three types of HIV tests available. 

1. Nucleic Acid Test (NAT) 

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

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

2. Antigen/antibody test

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

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

3. Antibody test

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

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


What does the test involve?

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

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

HIV Screening Singapore

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

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

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


What happens after the test?

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

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

Please get tested if you have not done so recently!

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

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


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U=U: Science, Not Stigma

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

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

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

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

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

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

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


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

Staying at home but still having a fever?

What Tests Can I Do For My Fever?

A DTAP Stay Home Series Part 3

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

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

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

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

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

COVID 19 

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

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

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

Upper Respiratory Tract Infections 

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

SYMPTOMS OF A COLD

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

SYMPTOMS OF FLU

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

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

Antibiotics however only work against bacteria infections.

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

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

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


Fever from HIV

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

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

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

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

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

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

Take care, stay safe.


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


Oral Gonorrhea / Throat Gonorrhea – What do you need to know

What is Gonorrhea?

Gonorrhea is a sexually transmitted disease (STD) that is caused by a bacterium known as Neisseria gonorrhoeae. It thrives in warm and moist areas like the genital tracts, mouth and anus.

Gonorrhoea is a common STD in Singapore. MOH reports an incidence rate of 33.4 per 100,000 population in 2016.

What are the symptoms of Gonorrhea infection?

In men, up to 60% of patients with urogenital Gonorrhea might not have any symptoms (asymptomatic). Symptoms of urogenital Gonorrhea in male may include:

  • Discomfort, itchy along the urinary tract
  • Painful urination
  • Penile discharge
  • Testicular Pain (Epididymitis)

In women, up to 70% of patients with urogenital Gonorrhea might not have any symptoms (asymptomatic).

Symptoms of urogenital gonorrhea in female may include:

  • Vaginal itch, discharge or bleeding
  • Painful urination
  • Abdominal/Pelvic Pain
  • Pain during sexual intercourse

What are the complications of Gonorrhea infection?

Untreated Gonorrhea infections for females can lead to Pelvic Inflammatory Disease with abdominal pain and abnormal vaginal bleeding. It can cause infertility if the sexual organs are scarred by the infection. Gonorrhea can also lead to multiple complications during pregnancy for the infected mother and can even be passed on to her baby.

For men, untreated Gonorrhea infection can result in scarring of the urinary tract and urinary obstruction. Testicular/Epididymal infection can also cause infertility if left untreated.

What is Oral/Throat Gonorrhea and how is it transmitted?

Oral/Throat Gonorrhea is the infection of the pharynx by the same bacterium and it is commonly transmitted through oral sex. It is an oral STD.

How common is Oral/Throat Gonorrhea and what are the symptoms?

A recent study in 2016 has estimated the prevalence of throat Gonorrhea infection to be as high as 30% for straight woman, 15.5% for straight men and 17% for homosexual men.

The most common presentation of throat Gonorrhea is a sore throat. Some patients may have swollen neck lymph nodes. However, the majority of patients do not present with any symptoms at all.

Oral ulcers are not a presentation of throat Gonorrhea. If oral/peri-oral ulcers are present, other STDs such as Herpes and Syphilis need to be considered.

I do not practice oral sex. Why should I be screened for Throat Gonorrhea?

Throat Gonorrhea transmission can occur even in the absence of reported oral sex.

Even though the majority of throat gonorrhea are asymptomatic, in 0.5% to 3% of infected patients the bacterium can penetrate the mucosae and enter the bloodstream, leading to a widespread infection. This blood-borne invasion (Disseminated Gonococcal Infection) can lead to to a variety of dangerous conditions including:

  • Multiple joint inflammation
  • Tendon Sheath inflammation
  • Skin dermatitis
  • Joint Infections

Hence, even in the absence of oral sex or symptoms, patients with new or multiple sex partners or a sex partner with a diagnosed STD should go for STD screening.

How is Gonorrhea screening performed?

Gonorrhea Testing. NAAT (Nucleic Acid Amplification Test) is routinely performed to detect N.gonorrhoeae. The doctor will swab the suspected area of infection (throat/anus/vagina) or request a urine sample for diagnosis of gonorrhea infection. It has been shown to be superior to traditional methods of culturing the bacteria with far more rapid results.

How is Gonorrhea treated and how can I prevent Gonorrhea infection?

Gonorrhea is treated with a single antibiotic injection and a course of oral antibiotics.

Gonorrhea transmission can be prevented by observing safe sexual practices. This includes the use of barrier protections like condoms or dental dams, cutting down the number of sexual partners as well as ensuring regular STD screening for both the patient and their sexual partners.

Next read: WHAT IS ANTIBIOTIC RESISTANT GONORRHEA OR SUPER GONORRHEA?


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