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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10 things you didn’t know about this STD: Mycoplasma Genitalium

Mycoplasma Genitalium is a common STI (sexually transmitted infection). It can be transmitted by different forms of sexual contact including vaginal, anal and oral intercourse. The symptoms experienced can include painful urination, penile/vaginal discharge, and, specifically in women; pain during sex, bleeding after sex, inter-menstrual bleeding, and lower pelvic pains.

Mycoplasma Genitalium is not as well known as Chlamydia or Gonorrhoea. The key reason for this, is the difficulty in testing for the infection and also a lack of awareness about the condition.


Here are 10 interesting things that you didn’t know about Mycoplasma Genitalium

1. Mycoplasma Genitalium was first identified in the 1980s

The bacteria was first isolated in the urogenital tract of humans in 1981, and was recognised as a new species of Mycoplasma in 1983. As it is still relatively recent that Mycoplasma Genitalium was identified, there is lack of sufficient data and research, and perhaps more of the condition that we do not yet know about.


2. Mycoplasma Genitalium is one of the smallest free living microorganisms capable of self-replication

The Mycoplasma species are the smallest bacterial cells yet discovered, with sizes ranging from 0.2 to 0.7 micrometres. In fact, Mycoplasma Genitalium is too small to be visible under a light microscope, and the first detailed study of its structure was conducted under a transmission electron microscope (TEM). 

3. Mycoplasma Genitalium is one out of the 15 (known so far) named Mycoplasma species of the human origin

Hundreds of Mycoplasma species are known to infect animals and plants. Of these, about 15 are pathogenic in humans. Mycoplasma Genitalium was the 12th to be identified.

4. Mycoplasma Genitalium is more common than Gonorrhoea and is the second most prevalent STI after Chlamydia

Since its discovery around 30 years ago, Mycoplasma Genitalium is now recognized as an important cause of male urethritis. The US Centers for Disease Control and Prevention (CDC) states that it is more common than Gonorrhoea but less common than Chlamydia, and is responsible for approximately 15%–20% of non-gonococcal urethritis (NGU), 20%–25% of non-chlamydial NGU, and approximately 30% of persistent or recurrent urethritis.

5. It is possible to have Mycoplasma Genitalium and not know it, and there is a high chance that your partner is also infected

Infection with Mycoplasma Genitalium can cause the symptoms as mentioned earlier, but can also be asymptomatic. Studies have shown that in heterosexual couples where the male partner was tested positive, up to 30% of the female partners were positive for the bacteria. If the female was first tested positive, up to 50% of their male partners tested positive as well. In men who have sex with men, up to 40% of their partners tested positive for the bacteria in the rectum. This points to the fact that if a person is tested positive for the bacteria there is a good chance that their partner is also infected.

6. Mycoplasma Genitalium, like Chlamydia and Gonorrhoea, can lead to more serious complications with long term health consequences

Data suggests that Mycoplasma Genitalium can cause Pelvic Inflammatory Disease (PID) in females, as the bacteria is found in the cervix and/or endometrium of women with PID more often than in women without PID. Women with tubal factor infertility are more likely to have antibodies to Mycoplasma Genitalium than fertile women, suggesting that this organism might cause female infertility. Two studies have shown that infection with Mycoplasma Genitalium is associated with an increased risk of preterm delivery in pregnant women.

It remains unknown whether Mycoplasma Genitalium can cause male infertility. However, the organism has been detected in men with epididymitis in a limited number of cases.

7. Mycoplasma Genitalium is a slow growing bacteria; this leads to diagnostic challenges

Mycoplasma Genitalium is a fastidious, slow-growing organism. This makes detection and subsequent isolation of the bacteria extremely difficult. Culture can take up to 6 months, and only a few laboratories in the world are able to recover clinical isolates.

Therefore, the preferred method of testing is by Nucleic Acid Amplification Test (NAAT), typically using Polymerase Chain Reaction (PCR). NAAT detects genetic materials (DNA or RNA) rather than antigens or antibodies, and is highly accurate. Testing can be done on urine, urethral, vaginal, and cervical swabs and endometrial biopsy. However, to date there is no diagnostic test for Mycoplasma Genitalium that has been approved for use by the US Food and Drug Administration (FDA).

8. Mycoplasma Genitalium does not have a cell wall

The Mycoplasma Genitalium bacteria lacks a cell wall, which makes treatment of the infection more difficult as certain classes of antibiotics that work by targeting bacterial cell walls are ineffective against this organism.

9. You can get reinfected with Mycoplasma Genitalium even after you have been treated for it 

Much like many other STIs, it is possible to get reinfected with Mycoplasma Genitalium even after one has been successfully treated for it. Therefore, safe sexual practices including using barrier protection, reducing your number of sexual partners and knowing your partners’ infection status is important in keeping yourself safe and healthy.

10. It is possible for vertical transmission of Mycoplasma Genitalium to occur?

Although uncommon, it is possible for vertical transmission of Mycoplasma Genitalium from mother to baby to occur, as previously reported in one case. 

Next read: MYCOPLASMA GENITALIUM (MG) – STD SCREENING, TESTING & TREATMENT


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ZIKA IS AN STD!! – Battling the STD Stigma

The Zika virus gained notoriety in Brazil when it was blamed for causing a spate of birth defects known as microcephaly. Babies born with microcephaly had abnormally small heads and often also suffered concurrent problems with brain development. Some children born to Zika infected mothers had normal sized heads but their heads would fail to develop normally. These are obviously horrible consequences for both the mother and child. 


Zika is a virus that is spread by mosquitoes very much like Dengue. However, it was soon discovered that Zika was also sexually transmitted. And that consistent and correct use of condoms protected pregnant women from the Zika virus and consequently their unborn children to the devastating effects of Congenital Zika Syndrome.  

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But wait a minute? Does that mean Zika is an STD? Technically it seems to fit. STD is an acronym for Sexually Transmitted Disease. Zika is a disease that is sexually transmitted. But it is predominantly transmitted via the bite from an infected mosquito. So is it an STD? If Zika is an STD then is raises other uncomfortable questions like: if a person catches chickenpox from his/her partner because they had sex, is chickenpox then an STD too? Or even the common Flu, which is spread as an airborne virus, can also easily be caught via sexual intercourse. So the common Flu is an STD!


I’ve had this discussion many times with my patients when they have been diagnosed with an infection and they ask me “is it an STD?” Sometimes, this is rather easy to answer. If they have, for example, an infection of Gonorrhoea of the penis, one can be confident to say that they caught it from a sexual contact. But at times, things get murky. A good example is an infection with Ureaplasma Urealyticum. We know this tiny bacteria can be sexually transmitted. We also know that it can seem to appear out of nowhere in mutually monogamous couples. We also know that it can be just a commensal and not a disease causing pathogen. So when a patient with an infection of his urinary tract caused by Ureaplasma asks me “is this an STD?” I am unable to give a direct black and white answer. 


The same goes for what I would describe as the most feared STD by many, and that is HIV. For a fact, the commonest way that HIV is transmitted is via sexual contact. However, we also know for a fact that HIV can be transmitted by sharing needles, contaminated surgical instruments, transfusion of contaminated blood and transplant of contaminated organs. Albeit the last 2 hardly happens anymore due to increased awareness, better infection screening protocols and technology advancement. But let’s be honest, if and when we find out someone is infected with HIV, getting injured by surgical instruments is not likely the first reason to pop into our heads.


And therein lies the issue. Answering the question “is this an STD?” does not in any way contribute to the clinical management of the disease except perhaps for contact tracing. For partner protection, the same advice will be given if the disease can be transmitted sexually regardless of whether or not it is called an “STD”. The issue, I believe, is stigma. To be labelled as having an “STD” is to be labelled as a moral or sexual deviant. But should this really be the case? Infections are caused by microorganisms invading our bodies and using our resources to make more of themselves. Drawing on resources around them to reproduce is hardcoded into the genetic material of all living things, humans being the best and worst examples. Microorganisms do not care how they are transmitted or where they infect as long as the environment they are in supports their reproduction. Microorganisms do not care about our textbooks and whether or not we call them STDs.


Consequently, some infections although predominantly transmitted by sex, can also be transmitted by other means. And some that can easily be caught via sex, are for some reason not given the label “STD”. I do hope we can eventually drop this label and treat infections for what they are – infections. Treat the patient, prevent reinfection, protect partners. Labels are useless. 

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

Speak to your doctor for more information or if you have any questions regarding Dengue Rapid Testing or other Dengue related topics: Dengue in the era of COVID, Dengue Fever Symptoms? Dengue Fever What You Need to Know, Why the recent resurgence in Dengue Fever?, ZIKA IS AN STD!! – Battling the STD Stigma


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What is Antibiotic Resistant Gonorrhea or Super Gonorrhea?

Gonorrhea is a sexually-transmitted infection caused by the bacteria called Neisseria gonorrhoeae. 

Antibiotic-resistant Gonorrhea refers to strains of Gonorrhea that are not killed by antibiotics that were previously effective in killing off these bacteria. 

In the 1980s, penicillins and tetracyclines could kill off Gonorrhea. By the 1990s, these drugs were no longer effective and Fluoroquinolones were recommended as the first line treatment. By the 2000s, Fluoroquinolones resistance was commonplace and only one group of antibiotics remains as an effective treatment for Gonorrhea – Cephalosporins. By now, certain strains of Gonorrhea that are resistant to cephalosporins have already been detected and that is worrisome because if these medications become useless, we might face a situation where we cannot clear gonorrhea from a person’s body. 

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What drugs are super gonorrhea resistant to?

Super Gonorrhea is the colloquial term for strains of Gonorrhea that are extensively drug-resistant, with high-level resistance to the current recommended treatment for gonorrhea (ceftriaxone and azithromycin) including resistance to penicillin, sulphonamides, tetracycline, fluoroquinolones, macrolides.


What causes super gonorrhea? 

Super Gonorrhea is a problem that we have created. 

The unrestricted access, inappropriate selection and overuse of antibiotics over many decades has allowed the strains of gonorrhea to genetically mutate in such a way that they are no longer affected by these antibiotics. Extra genital infections in the rectum and throat may also play an important role in the development of resistant strains as gonorrhea can interact and exchange genetic material with other co-infections in these places.


How common is Super Gonorrhea?

Super Gonorrhea has been reported by several countries including France, Japan, Spain, the UK and Australia. The American CDC has not received any reports of verified clinical treatment failures to any cephalosporin in the United States to date. 


How does Gonorrhea spread?

Gonorrhea can be spread through sexual contact with the penis, vagina, mouth, or anus of an infected partner. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Even if you have had gonorrhea in the past and was treated, you can still get reinfected again if you are exposed to it again. 


What are the symptoms of super gonorrhea?

The symptoms of super gonorrhea are the same as regular gonorrhea. Gonorrhea can infect different areas of the body. Most symptoms present within 1-2 weeks after exposure.

In males, the most commonly infected site is the genitourinary system. It can present with symptoms such as pain on passing urine, penile discharge, swelling at the tip of the penis and scrotal pain and swelling.

In females, the most commonly infected site is also the genitourinary system and and present with symptoms such as vaginal discharge, pain on passing urine, intermenstrual bleeding, painful intercourse, and mild lower abdominal pain

Gonorrhea can also infect other areas of the body such as the rectum, causing rectal pain, itching, discharge, or tenesmus. If gonorrhea infects the throat, you can get a persistent sore throat. Gonorrhea can also infect the eyes, causing conjunctivitis which may present with eye pain, discharge, and redness. If gonorrhea spreads by blood to the rest of the body including the brain, heart, bone, joints, skin and liver, this is termed Disseminated gonococcal infection (DGI). While rare, DGI can be deadly and have long term complications. 


Does Gonorrhea always have symptoms?

Gonorrhea can have little to no symptoms at all in some people. That is the reason why it is so important to screen for STIs with every sexual encounter. 

A study has reported that more than 80% of people (both males and females) with Gonorrhea can have no symptoms. Do not wait for symptoms to appear before you screen for STIs. Do it regularly with every new sexual encounter. 

Also read: Rapid STD Test for Chlamydia and Gonorrhoea PCR


What are other STDs that do not display symptoms and have serious complications if left untreated?

All STIs can have no symptoms at all. Because people do not experience any symptoms, they think that they do not have an STI and thus the spread of STIs continues. Other STIs we regularly test for include other urinary STIs such as Chlamydia, Ureaplasma urealyticum, Mycoplasma hominis and Trichomonas. What we can test for in the blood are STIs such as HIV, Syphilis, Herpes and Hepatitis B and C.


What happens if gonorrhea is treated effectively?

If gonorrhea is treated effectively (with the proper antibiotics), your symptoms should clear up, and subsequent follow up tests to test for clearance should come back as negative for gonorrhea.


What are the complications of Gonorrhea?

In females, untreated gonorrhea may lead to pelvic inflammatory disease (PID). This is an infection of the fallopian tubes, uterus, and cervix. If left untreated, PID may cause permanent damage to the reproductive tract, which may lead to infertility. It may also lead to long-term pelvic pain.

Males with untreated gonorrhea may develop a condition called epididymitis. This condition is characterized by inflammation of the tubes near the testicles that carry semen. It can also lead to infertility. 

DGI is another complication of gonorrhea as well. 


What happens if you have drug resistant gonorrhea? Can I get rid of Antibiotic Resistant Gonorrhea?

If you have drug resistant gonorrhea, your doctor may opt to treat you with antibiotics that hopefully are effective against this strain of gonorrhea. Antibiotic sensitivity testing for that strain should be done. If it is truly multi-drug resistant, a referral to an infectious diseases specialist is appropriate, and they may have to treat you with antibiotics that are reserved for the worst kinds of infections. 


How do you reduce your risk of contracting these STIs?

Abstinence is the only way to reduce your risk to zero.

If you are sexually active, use barrier protection such as condoms, the right way. You can also speak to your partner to get tested for STIs before engaging in sexual activity.  A mutually monogamous relationship also carries a lower risk of STIs than having multiple sexual partners.

If you are sexually active with multiple sexual partners, get yourself tested regularly and treated. The presence of one STI can increase your risk of contracting another one more easily. Most STIs can easily be detected through swabs, urine or blood tests at your doctors. These are rather pain free and minimally invasive, so there should be no fear to get tested!

There are some STIs that are preventable through vaccinations. Vaccines are available against certain strains of HPV that may cause warts, cervical, anal and penile cancer. Effective vaccines against Hepatitis B are available as well.

Also read: What is HPV (Human Papilloma Virus)?


How do I find out if I have been infected with Super Gonorrhea?

Gonorrhea is often diagnosed using a PCR test. This test can give results very fast and determine if a person is infected with Gonorrhea or not. However, this test cannot differentiate between regular Gonorrhea and Super Gonorrhea.

For that, a test called Gonorrhea Culture and Sensitivity has to be conducted. This test takes a longer time as the Gonorrhea bacteria has to be grown on a plate and tested against various antibiotics. This test is also less sensitive as for various reasons, sometimes the Gonorrhea bacteria cannot grow.

Also read: What Is Rapid Chlamydia & Gonorrhea PCR STD Testing?

If you think you may have been exposed to Super Gonorrhea, you have to see your Doctor immediately. DTAP clinics focus on STD screening and STD treatment. We offer rapid PCR testing for Gonorrhea (next day results) as well as culture tests to detect multi-drug resistant (Super) Gonorrhea. 

Speak to your doctor if you have any questions regarding Gonorrhea or other STDs.


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People Living With HIV In Singapore

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


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


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


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


READ: WORLD AIDS DAY PRESS STATEMENT

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


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性传播感染 (STDs)

大家好,今天黄医生想谈的是性传播感染也有些人称之为性病。

性传播感染是由病毒,细菌和其他微生物引起的,如果你与携带这些感染的人发生性关系,你可以捕获它们。

性病症状可分为泌尿系统症状,皮肤症状和一般症状,可在性生活后3天开始出现,也可能需要数周至数月。有些人受到感染但从未出现任何症状。

性病治疗取决于您所拥有的性传播感染的类型。一些可以通过抗生素治疗,一些如疱疹和艾滋病毒是必须管理的终身感染。人类乳頭瘤狀病毒 (HPV) 和肝炎等性传播疾病可通过疫苗预防


请记住,只要你发生性行为,你就可以患有性病。如果不及时治疗,大多数性传播感染会导致严重的并发症。

如有必要,请去看医生进行定期筛查和治疗。和他谈谈接种肝炎和HPV疫苗。


如果您怀疑自己有任何高风险的艾滋病毒感染,请告诉我们的医生。

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艾滋病 (HIV) 的症状与治疗方法

大家好,今天黄医生谈谈艾滋病感染的症状。

HIV症状取决于个体和疾病阶段。

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


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

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


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

即使您遇到上述症状,除非您接受检测,否则无法确认HIV。


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

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HIV / AIDS: The Differences & Myths Surrounding Them

HIV & AIDS in Singapore

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

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


How does HIV progress to AIDS? 

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


Who should test for HIV?

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


Are you at risk?

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

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

What are some of the HIV tests available?

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

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

It is especially useful in the following situations:

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

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


Can you share the 4 most common myths about HIV? 

1. HIV is a death sentence. 

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

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

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

3. HIV can spread through mosquito bites. 

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

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

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


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

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

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

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


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


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


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


Dr. Julian Ng

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