HIV Elite Controllers and Long-term Non-progressors

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Elite controllers are defined as those individuals who have been infected with HIV but is able to achieve undetectable levels of virus (<50 copies/ml) without any medication. While long-term controllers are those who have been able to achieve low but detectable levels of HIV (<2000 copies/ml) without treatment.

There are many theories as to how these individuals are able to control the virus:

  • These individuals CD4 cells are less susceptible to infection by the HIV virus
  • Infected with defective strains of the HIV virus that makes the virus less able to produce copies of itself.
  • Individuals’ whose immune system is able to mount an effective response to the virus
  • Individuals’ immune system causes less inflammation when the HIV virus is encountered and thus limiting the exposure of the virus to CD4 cells.

There is a fair amount of evidence to suggest that perhaps the main mechanism that allows for control of the HIV virus is that an effective and potent immune response by an individual. Studies have shown that when only CD4 cells of elite controllers were isolated without CD8 cells, and then infected with HIV virus, the CD4 was just as easily infected as non-elite controllers thus giving evidence that the elite controllers CD4 cells were just as susceptible to HIV infection as non-elite individuals.
In recent months, researchers in Sydney, Australia has reported a case of a known HIV person who has spontaneously cleared HIV infection with no treatment. This patient was infected due to a blood transfusion back in 1981. The patient was able to suppress the HIV virus in his body through his own immune system and have undetectable levels of the virus since 1997. Most recently, they tried to look for traces of the HIV virus in his blood, intestines and lymph nodes but did not detect any traces of the virus, thus the researchers believe this is the first case of spontaneous clearance of HIV infection in humans.

So what factors may have contributed to this patient being able to clear the virus from his body?

  • The virus that originally infected that patient was lacking in a gene called nef. In HIV virus deficient in this gene, the virus replicates more slowly and thus is associated with lower viral loads.
  • The patient was born with 1 copy of a gene called CCR5. The gene is required for HIV to attach to human immune cells. Thus persons with only one copy of the gene would make it more difficult for the HIV virus to attach on to the immune cells. (See: CCR5 HIV Test)
  • It was also found that the patient’s immune cells were naturally more able to recognise a protein called gag made by the HIV virus. This protein is found on the surface of infected human cells. Thus allowing his immune system to better recognise cells that have been infected with HIV virus and aid in their destruction.
  • In addition, the patient was born with 2 specific immune-cell genes called HLA-B57 and HLA-DR13 and in combination allows his immune system to be more effective in responding to HIV infection.
  • As a result of his strong response by his CD4 cells as a result of the presence of the HLA-B57, he is able to mount a bigger immune response by his CD8 cells. CD8 cells are required to activate cytotoxic T cells which as the name suggests are immune cells that kills defective or infected human cells.

In essence, the combined effects of each of the above factors contributed to the clearance of the HIV virus from this particular patient. To replicate this combined effect artificially at this point in time is not possible. However, perhaps in the future with further development of gene therapy, we may be able to achieve this unique set of host factors to achieve clearance of HIV virus.

Other Interesting Reads:

  1. Weak Erection? Erectile Dysfunction? How to Improve Erection with Pills
  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. What are the Causes of Abnormal Penile Discharge?
  4. An Overview of STD – From an STD Doctor
  5. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  6. Anonymous HIV Testing – What You Need to Know
  7. Low HIV Risk Doesn’t Mean No HIV Risk
  8. What is HPV Vaccination (Gardasil 9)
  9. 10 Causes of abnormal Vaginal Lumps and Bumps
  10. An Overview of Gonorrhoea
  11. What is the Treatment for Cold Sores? What causes Cold Sores?
  12. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  13. Syphilis Symptoms (Painless STD Sores & STD Rashes)

Tag: hiv test

6 Common Causes of Penile Discolouration

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Most men tend to not pay regular attention to their general skin condition, but when it comes to matters of the penis, it is almost always a cause for immediate concern; after all, it is the source of our manhood. More often than not, any unusual appearance such as discolouration, dry skin, red spots or bumps may result in considerable anxiety.

It is not uncommon for men, especially those with darker skin, to have slight variations in the colour of the penis. In fact, for men of all races, it is normal for the penis to be slightly darker than the skin on the rest of the body. This applies also to the labia of women.

When an adolescent male or female undergoes puberty, the body produces the sex hormones, testosterone and oestrogen, which results in the development of secondary sexual characteristics. Excess levels of these hormones in the genitals respond to melanocytes, the skin cells that cause pigmentation. These physiological changes are responsible for darker genitalia in both men and women.

Mild penile discolouration is generally nothing to worry about. In fact, during sexual arousal, the penis can take on a reddish, sometimes almost purplish colour, due to increased blood flow to the organ. However, there are other causes of penile discolouration that may be more severe and require treatment.

 

6 Common Causes of Penile Discolouration

1. Contact Dermatitis

Contact dermatitis is a skin reaction to contact with an irritant. This can happen anywhere on the body, including the penis. When this happens, it is usually caused by latex condom usage. The skin of the penis can turn red and itchy. Sometimes the skin can break causing serous discharge, and bacterial infection can occur. Mild cases can be treated with a corticosteroid cream. Non-latex condoms can be used if you have a latex allergy.

 

2. Penile Injury

A penile injury can lead to rapid discolouration due to bruising, in the form of purple, dark brown or even greenish hues. Sometimes, a red patch with prominent blood vessels just under the surface of the skin can occur due to a hematoma. This usually fades after several days and treatment is typically not necessary.

However, if there is severe pain along with the discolouration after a traumatic episode, immediate medical attention is required as this could be due to a penile fracture, which is a more severe issue.

 

3. Lichen Sclerosus

Lichen sclerosus is a lifelong condition that can go through periods of remission and flare-ups, and is characterised by white patches on the penis. It is more common in those who are uncircumcised. In addition to blotchy white spots, the skin of the penis can also become itchy, fragile and tear or bleed easily. Other symptoms include painful sex and an inability to retract the foreskin fully.

The cause of lichen sclerosus is unknown, but an overactive immune system or an imbalance of hormones may play a role. It is not contagious and cannot be transmitted through sexual intercourse. Treatment usually includes a strong steroid ointment applied directly to the affected skin. If only the foreskin is affected, circumcision may be advised.

 

4. Penile Melanosis or Post Inflammatory Hyperpigmentation (PIH)

Penile melanosis, or PIH, is a benign condition simply caused by overproduction of melanin, in which the skin can appear in a wide variety of colors including different shades of brown, grey or even blue.

Overproduction usually occurs after an injury to the skin of the penis, the most common being excessive rubbing of the penis from vigorous sex or self-pleasuring. It will fade over time, or if a man is bothered by it, possible treatments such as topical retinol (vitamin A) every night before bed, laser therapy, or microdermabrasion can help to reduce the discolouration.

 

5. Sexually Transmitted Diseases (STDs)

Purple sores on the penis can occur as a result of genital herpes or syphilis. These STDs can be accompanied by other symptoms such as pain, fever, itchiness, burning, and fatigue. If STD is suspected, it is imperative to head to a clinic to see a physician as soon as possible to be tested and get treated.

Also Read

 

6. Penile Cancer

Penile cancer tends to start on the skin of the penis and spreads towards the deeper tissues. 95% are squamous cell carcinomas, while penile melanoma accounts for 0.7%. Penile cancer is rare and the cause is not entirely known, but risk factors include smoking, HIV and high risk strains of Human Papillomavirus (HPV) infection. Symptoms include changes in the colour and thickness of the skin of the penis, foul smelling discharge under the foreskin, and abnormal non-resolving growths or ulceration of the penis. A diagnosis of penile cancer requires an urgent biopsy.

 

There are other conditions that can cause penile discolouration. It is important to determine the exact cause as treatment varies according to the cause. It is always best to visit a doctor for a physical examination and proper evaluation.

If you need to speak to our doctors , please visit our DTAP Clinics.  Alternatively, you can email us hello@dtapclinic.com.sg or call us for an appointment.

 

Take Care.

 

Other Read:

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

What is Chronic Prostatitis Symptom & Treatment?

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What is Prostatitis?

Prostatitis refers to a group of conditions that usually cause inflammation of the prostate gland or surrounding structures in men, which results in pain or discomfort around the pelvis and a variety of urinary symptoms.
It can be classified into several categories which include:

  1. Acute Prostatitis,
  2. Chronic Bacterial Prostatitis,
  3. Chronic non-bacterial prostatitis, and
  4. Asymptomatic inflammatory prostatitis.

Prostatitis is very common, with up to 2-10% of men affected at any time. The majority of these cases will fall under chronic non-bacterial prostatitis, also known now as chronic pelvic pain syndrome – these account for about 95% of prostatitis diagnoses.
Chronic Pelvic Pain Syndrome (CPPS) is due to inflammation of the prostate or inflammation in the organs and tissues in the pelvic region.

What are some of the Symptoms of Chronic Prostatitis?

Men with chronic pelvic pain syndrome can present with a number of symptoms, including pain at the perineum, testicles, penis, and lower back, pain while passing urine or after ejaculation, and urinary frequency or urgency.
They may also lead to erectile dysfunction or premature ejaculation.
These symptoms can wax and wane, lasting for weeks to months. Many men can suffer for months at a time with these symptoms without getting the correct diagnosis or treatment.
The exact causes of chronic pelvic pain syndrome are not well known, but it may be triggered by combinations of stress, anxiety, hypersensitive nerves, increased muscle tension, previous infection, or even changes in diet or climate.

What are the Treatments for Chronic Prostatitis?

Treatment options for chronic prostatitis can vary depending on the underlying cause but may include a combination of antibiotics, anti-inflammatory medications, and neuromodulators. There is also evidence that some patients can respond well to Electroshockwave Therapy or ESWT for Prostate Inflammation.
If you need to speak to a doctor in regards to Chronic Prostatitis, please visit our clinics. Alternatively, you can email us hello@dtapclinic.com.sg or call us for an appointment.
Take care.

Also Read,

  1. Erectile Dysfunction Treatment in Singapore
  2. Premature Ejaculation Treatment
  3. What is Prostatitis (Inflammation of the Prostate Gland)
  4. Andrology (Men’s Health Clinic) in Singapore
  5. Are All ESWT Machines for Erectile Dysfunction Treatment the Same
  6. What is Benign Prostatic Hyperplasia (Enlarged Prostate)
  7. What You Need to Know about Prostate Massage
  8. Weak Erection? – How to Treat Erectile Dysfunction without Pills
  9. 7 Ways Last Longer in Bed – Premature Ejaculation

水货九价HPV疫苗 – 到底能够采取什么措施来避免接受假药?

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选择正确就症方法   免遭问题疫苗困扰

 

近日新闻媒体关于“水货”九价HPV疫苗流入香港，中国游客“打飞的”远赴香港为其接种，且有病患者注射“水货”疫苗后，出现严重过敏反应的报道纷纷热议。目前就此问题疫苗事件已引起香港及中国民众的高度关注，应该提高警觉。

您可在以下的网站进一步了解报道详情：

 

什么是九价HPV疫苗? (视频)

9合1 加卫苗(Gardasil 9)疫苗可预防9种病毒株的人类乳头瘤病毒（HPV）所引起的癌症与疾病。
HPV是一种可分为两大类型的病毒，一组可致癌而另一组可致疣或乳头状瘤。
现今有超过一百种HPV病毒株并且每一株都有自己指定的数字，例如HPV16或HPV52。迄今为止，能致疣的HPV病毒株不会致癌而能致癌的病毒株并不会致疣！
HPV受诱惑于并仅活于体内的鳞状上皮细胞。这类细胞可存在于皮肤表面和潮湿的粘膜表面，例如：

  1. 阴道、肛门、子宫颈、外阴部（围绕阴道外）
  2. 阴茎的内包皮和尿道
  3. 内鼻、口、喉气管（主要呼吸管）和支气管（较小的呼吸管，分支于气管）
  4. 内眼睑

因此，这些表面的感染导致疣和癌细胞的形成。
9合1加卫苗有助于防止9种HPV病毒株的感染，因而适当的命名为9合1加卫苗。疫苗里的9种HPV病毒株当中，有2种用于预防疣（HPV16和18），而其余的7种用于预防癌症（HPV16、18、31、33、45、52与58）。
关于癌症，HPV是大多数宫颈癌、阴道癌、外阴癌、肛门癌、阴茎癌和口咽癌（咽喉癌和舌癌）病例的主要致癌病毒。

疫苗针竟然能会有假货？

这种惊人的新闻难免让大众感受到不少忧虑。这种事件能够发生在香港这样的大都市，同样的也能在新加坡发生。

人们到底能够采取什么措施来避免接受假药?

首先，可以向新加坡卫生科学局 (Health Sciences Authority) 的医疗保健产品管理组 (Health Products Regulation Group) 寻求确认。

该组织确保新加坡的药品、创新疗法、医疗器械和健康相关产品受到监管，以满足安全、质量和功效方面的必要标准。其次，可以去有良好信誉的诊所就诊。

 

在新加坡DTAP诊所，我们非常关心病患者的安全与健康，因此只采用百分百真价实的疫苗。

我们的九价HPV疫苗是从美国默沙东 (MSD, or Merck & Co) 药厂引进，疫苗经过严格、专业的监管和测试，疫苗包装上面附有中英文说明，也有“MSD”字样，并且包装盒子上面会有一串防伪码以保证患者放心、安全的接受注射。

我怎么知道是否是原版的九价HPV疫苗产品


如果您在考虑进行HPV筛查或接种九价HPV疫苗，即可到我们DTAP诊所咨询。

若读者想深入了解HPV，可以参考以下资料：

 

HPV到底是什么？

人乳头瘤病毒 （HPV）是最常见的性传播感染，估计多达百分之七十的人在生命中某个时候会感染到HPV。HPV具有很强的传染能力，可通过与受感染的皮肤或粘膜直接接触而传播。HPV最常感染的身体部位包括阴茎、阴道、肛门、咽喉和阴部。

目前已经确认的HPV病毒有一百余种。其中，至少有十三种与癌症有密切联系，而被称为高风险性类型。其次，十六型和十八型加起来已占子宫颈癌的百分之七十。HPV除了会导致子宫颈癌之外，还会增加外阴、阴茎、肛门和咽喉的癌症风险。

其他的HPV类型被称为低风险性类型，反而会导致疣。疣(尤其是生殖器部位)是皮肤上难看的肉色肿块，经常被描述为椰菜花的形状。

 并非所有感染HPV的人都会患上癌症或疣。事实上，绝大多数感染HPV病患者根本不会出现任何症状，并且病毒会在不知不觉的传染给其他人。这就是HPV如此流行的主要原因之一。

HPV感染有治疗方法吗?

HPV如今是没有特效药物可以清除，只能靠提高机体免疫力，产生抵抗力清除病毒达到自愈。幸运的是，这种情况经常发生。一项研究成果报告估计，高达百分之八十的HPV感染者能够在两年内自然将病毒从体内清除。然而，有些患者无法清除体内的病毒，因此可能患上癌症或生殖器疣。

 

是否有HPV筛查测试?

我们可以通过医学测试来筛查与HPV相关的子宫颈、咽喉和肛门癌变或癌前病变。通过这种方法，医生可以确定哪些病人有可能患上癌症，并在他们真正患上癌症之前对他们进行治疗。此外，还有一些测试可以在宫颈、肛门和喉咙中寻找某些高危HPV类型。患有十六型或十八型等高风险类型的患者需要较积极的观察或治疗，以防止他们患上癌症。

 

接种HPV疫苗 (Gardasil 9)

预防HPV感染最有效的方法就是接种HPV疫苗。最新的HPV疫苗可预防九价HPV (Gardasil 9)，但也可交叉预防许多其他病毒类型。由于大多数与HPV相关的癌症仅由少数类型引起，因此HPV疫苗可将罹患HPV相关癌症的风险降低百分之九十以上。

 

谁适合接种人类乳头瘤病毒疫苗?

该疫苗适用于男性和女性。九岁以上的男孩和女孩都可以接种疫苗。美国食品和药物管理局最新报告报道显示，只要是四十五岁以下的男性和女性都可以从中受益。疫苗通常是在六个月内注射三次，较年轻的患者只需要注射两次。

如果你想了解更多接种HPV疫苗 (Gardasil 9), 请发邮件给我们 hello@dtapclinic.com.sg。我们所有的诊所都提供HPV筛查或接种九价HPV疫苗医疗服务。

 

What are the Common Misconceptions that People have about HIV?

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

Read: HIV, AIDS & Opportunistic Infection

2) HIV is a death sentence. This may have been the case several decades ago, where without prompt and adequate treatment, the infection progresses and causes the immune system to weaken, leading to AIDS. However, thanks to advances in modern medicine, most HIV infected patients today may never develop AIDS. This is why it is imperative to be on treatment, ideally as soon as possible after a diagnosis of HIV is made. It is also important to undergo regular HIV screening.

READ: HIV Treatment & Management

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

READ: How Long Can HIV Survived Outside The Body

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

With or without treatment, a person infected with HIV may not appear any different from that of an uninfected person.
HIV infection undergoes 3 stages. The first stage (Acute Stage) may present with flu-like symptoms, fever and a rash. The second stage may present with lymph node swelling, but most patients do not have any symptoms at all. The second stage (Clinical Latency) can last anywhere from a few years to over 20 years. Thus, many HIV infected patients, especially during this stage, may not even know that they have contracted HIV. Lastly, the third stage is the presentation of AIDS symptoms.
HIV infected patients should receive prompt long term treatment and undergo regular follow up blood tests in order to reduce the viral load in their bodies to low levels. This allows their immune system to continue to function well and minimizes the risk of progression to AIDS. By doing so, they can essentially live very normal lives not any different from that of an uninfected person.

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

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

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

Without adequate treatment, up to 50% of HIV infected patients develop AIDS within 10 years. Elevated levels of HIV affect the patient’s immune system and prevent it from functioning properly, eventually leading to AIDS. This may result in the individual being more prone to infections. Patients may develop symptoms such as prolonged fever, tiredness, swollen lymph nodes, weight loss and night sweats. HIV Related Opportunistic infections such as tuberculosis, recurrent pneumonia and esophageal candidiasis,  may occur as well. AIDS patients could also develop various viral-induced cancers.
The leading causes of death worldwide in patients with AIDS are, as mentioned, opportunistic infections and cancer.

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

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

READ: HIV CCR5 Mutation & CCR5 Testing

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

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

Other Interesting Reads:

  1. HIV Elite Controllers And Long-Term Non-Progressors
  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. What are the Causes of Abnormal Penile Discharge?
  4. An Overview of STD – From an STD Doctor
  5. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  6. Anonymous HIV Testing – What You Need to Know
  7. Low HIV Risk Doesn’t Mean No HIV Risk
  8. What is HPV Vaccination (Gardasil 9)
  9. 10 Causes of abnormal Vaginal Lumps and Bumps
  10. An Overview of Gonorrhoea
  11. What is the Treatment for Cold Sores? What causes Cold Sores?
  12. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  13. Syphilis Symptoms (Painless STD Sores & STD Rashes)

  14. HIV Pro-Viral DNA Test

 

Mycoplasma Genitalium (MG) – STD Screening, Testing & Treatment

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Mycoplasma Genitalium (MG) is a type of bacteria that can be sexually transmitted: what it is and why you should be concerned.

  • Women tend to experience vaginal itching, burning on urination, pain during intercourse & etc.
  • Men, on the other hand, may experience urethral discharge, burning on urination, pain or swelling of the testicles & etc.

 

Mycoplasma Genitalium (MG): What It Is & Why You Should Be Concerned.

What is Mycoplasma Genitalium (MG)?

You may have heard of sexually transmitted infections (STIs) like Chlamydia or Syphilis or the feared HIV. But Mycoplasma genitalium (M.gen) may be unfamiliar to most of you, even if you are fairly conscientious in looking after your own sexual health. This is partly because of difficulty in testing for the infection. Up until recently; testing for M.gen was not available in Singapore.
Furthermore, a good proportion of people infected with M.gen may feel completely fine but are still able to spread the infection. So if you’ve done a full STI screen and think you are completely safe because it came back clear, think again- there might just be something else you need to be concerned about.
Mycoplasma genitalium is a tiny, slow-growing bacterium which was first identified in the 1980s. Testing for M.gen has traditionally been very difficult because of the nature of the bacteria. The M.gen bacterium also does not have a cell wall, which means certain classes of antibiotics which are commonly used are unfortunately ineffective against the bacteria. This, coupled with recent increasing antibiotic resistance, makes treatment of M.gen potentially challenging as well.
It is only in more recent years that it is now being recognised as a significant and increasingly more common STI which can cause symptoms in both males and females with potentially more serious consequences.
To put things in perspective as to exactly how prevalent M.gen is, the Centers for Diseases Control (CDC) data indicates that it is more common than Gonorrhea, coming in a close second to Chlamydia.

How is Mycoplasma Genitalium Transmitted?

Mycoplasma genitalium infects the cells in the genital and urinary tracts and can be transmitted through sexual contact including vaginal intercourse, anal intercourse and oral intercourse.

What are the symptoms of Mycoplasma Genitalium?

M.gen can affect both males and females. Both males and females may often be asymptomatic/feel completely well, but can continue to spread the infection to their sexual partners. M.gen is thus a silent but dangerous STI.
In males who do develop symptoms, it can cause urethritis, which manifests dysuria (painful or uncomfortable urination), which may be associated with penile discharge. These symptoms are non-specific and similar to urethritis caused by other STDs like Chlamydia. As of now, M.gen is not yet well linked to more serious symptoms like pain or swelling of the testicles or epididymis (a gland near the testicles), but it is important to remember that data on M.gen is still lacking right now. Learn more about STD Risk From Receptive Anal Sex in Men

10 Causes Of Penile Pain – Ouch! Pain In The Penis

In females, it can cause cervicitis, inflammation of the cervix, resulting in abnormal vaginal discharge, painful intercourse, or bleeding after intercourse (post-coital bleeding) or spotting when one is not having one’s menses (intermenstrual bleeding). If the infection spreads to deeper organs like the uterus and fallopian tubes or ovaries, a condition known as pelvic inflammatory disease (PID) with potentially devastating long-term complications like infertility, one may also experience pelvic pain.

Common STD Symtopms in Women

Anal intercourse can result in M.gen in the rectum and anal canal, but this is generally asymptomatic in another word, does not display symptoms.

Can Mycoplasma Genitalium cause serious infections?

M.gen may very well be one of the next major STIs that the world needs to worry about. While there is a paucity of existing data, emerging research links M.gen to more serious infections with long term health consequences.
There is data to suggest that M.gen can cause Pelvic Inflammatory Disease (PID) in females- the bacterium was detected in women suffering from PID more frequently. Women with tubal factor infertility (infertility due to scarring of the fallopian tubes) were also found to have antibodies to M.gen, suggesting the bacterium could again be responsible or linked to increased risk of infertility. Learn more about Women’s Fertility Screening 
Some studies have also shown that in pregnant women, M.gen is associated with increased risk of pre-term delivery.
It is still uncertain as to whether M.gen can cause infertility in males, but it is important to note that there have been cases where M.gen was detected in men with epididymitis (inflammation of the epididymis).
All in all, we currently still lack robust data about M.gen and the consequences of infection, but overall data does suggest that there may be more to worry about than previously thought.

How is Mycoplasma Genitalium diagnosed?

M.gen was classically known to be notoriously difficult to diagnose because of difficulty in getting the bacterium to grow in laboratory conditions. Testing is done by nucleic acid amplification testing (NAAT) and is not as widely available as testing for other more well-known STIs is.
Until recently, testing for M.gen was not available in Singapore. But you will be glad to know that at DTAP clinic, we now offer testing for M.genitalium.
For males, testing is done using a urine sample. A high vaginal or endocervical swab is performed in females.
If you are a male who is troubled by persistent or recurrent symptoms of urethritis despite antibiotic treatment, and your urine STI screen is persistently “clear” of infection, this is a diagnostic test you should consider.
M.gen is an established cause of urethritis in males. If you may have potentially been exposed to M.gen from a sexual partner, you may also wish to consider getting tested, particularly in light of the above potential complications.
Diagnosis of M.gen is particularly important because of potential antibiotic resistance amongst various M.gen strains. This means that treatment of M.gen may not be so straightforward.

We provide Comprehensive STD screening for Men & Women in all our clinics.

 

Can Mycoplasma genitalium infection be treated?

M.gen is inherently resistant to some classes of antibiotics and there are concerns about increasing antibiotic resistance. It is therefore important that you are treated properly with the correct antibiotic and for an appropriate duration – this makes testing and treatment more crucial than ever.
As always, safe sexual practices including using barrier protection, reducing your number of sexual partners and knowing your partners’ infection status remains crucial in keeping yourself safe and healthy.
If you would like to find out more about Mycoplasma Genitalium testing and treatment, come down to any of our clinics for a consultation.

Other Reads:

  1. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  2. Is HPV Vaccine Necessary for Males?
  3. Weak Erection? Erectile Dysfunction? How to Improve Erection with Pills
  4. 11 Causes of Penile Itching & Pubic Itch
  5. HPV Infection & HPV Vaccination for Men who have sex with Men
  6. STD Risk for Receptive Unprotected Anal Sex in Men
  7. Is HPV Vaccine Necessary for Males?
  8. Low HIV Risk Doesn’t Mean No HIV Risk
  9. HIV PrEP for Travel – How You Need to Know
  10. An Overview on STD from an STD Doctor
  11. Everything You Need to Know about Herpes Simplex Virus
  12. How Do I Treat Oral Herpes (Cold Sores)
  13. Syphilis Symptoms – Painless Sore & Ulcers
  14. HIV Symptoms – What You Need to Know
  15. Sex During Period (Sex & Menstruation) What To Know
  16. 10 Common HIV Related to Opportunistic Infections

 

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

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

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

 

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

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

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

 

Addendum 1: Singapore Infectious Diseases Act

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

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

(a) with the consent of the other person;

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

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

[10/2008 wef 10/06/2008]

[15/2010 wef 02/01/2011]

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

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

[10/2008 wef 10/06/2008]

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

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

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

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

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

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

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

[5/92; 13/99]

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

Bumps on Vaginal Area – Vaginal Lumps & Vaginal Bumps

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Lumps and bumps over the external genitalia (the vulva) or vagina are a fairly common concern that ladies may have. These can be normal or benign, or due to infections, sexually transmitted diseases, and less commonly, due to cancers (malignancy).

Here are some of the Causes of Vaginal Lumps & Bumps:

1) Benign bumps

Causes of benign bumps in the genital region include vestibular papillomatosis, Fordyce spots, ingrown hairs and folliculitis, various cysts (sebaceous cysts, Bartholin cysts).

Vestibular papillomatosis

This is a variation of normal anatomy. Vestibular papillomatosis appears as multiple, symmetrical, tiny bumps or finger-like projections over the labia minora and vestibule (vaginal opening). This can often be mistaken for warts and may thus be an undue cause for worry but there are features which help differentiate it from warts. No treatment is required for vestibular papillomatosis. It is harmless and it is NOT due to infection and cannot be spread to your sexual partners.

Fordyce spots

These are due to enlarged oil glands, which appear as tiny (1-3mm) whitish or yellowish bumps over the labia minora. These can also occur in other parts of the body, for instance around the edges of the lips or on the penis in men. They are completely harmless and painless and are part of normal anatomy. There is no need for any treatment or worry.

Folliculitis and ingrown hairs

Ingrown hairs may manifest as bumps, particularly in someone who shaves. Both ingrown hairs, as well as hair follicles, can get infected (known as folliculitis), resulting in small, red, tender bumps. Usually, topical creams will suffice for treatment.  Good hygiene, particularly relating to hair removal, is helpful in reducing the risk of folliculitis.

Cysts

Cysts are small round bumps that can be felt underneath the skin. These may arise from structures in the skin layer itself e.g. sebaceous cysts, or from glands which are found in the genital region near the labia minora (Bartholin’s glands).

Sebaceous Cysts

Sebaceous cysts are the result of oil glands which get blocked. They are painless unless they become infected. Most of the time, they can be left alone—but in the event of infection or if they become too large, incision and drainage or removal may be necessary.

Bartholin Cysts

Bartholin cysts are the result of Bartholin’s glands which are blocked. These cysts can enlarge, become infected and tender. They also have a tendency to recur and a minor surgery to remove them may be required.

2) Infections and Sexually Transmitted Diseases (STDs)

Warts

These are caused by certain strains (type 6, 11) of the Human Papilloma Virus (HPV). They appear as small skin-coloured bumps or irregular, cauliflower-like skin growths. They and can occur in isolation but are usually multiple. Genital warts usually appear anytime between weeks to 8 months (average 3 months) from the time of HPV infection and are highly infectious. The clinical course of warts can vary – in some individuals, genital warts may spontaneously resolve, while in others they may stay the same or increase in size and number.
The treatment of genital warts does not remove the underlying HPV infection and the only medication available against this is the HPV vaccine. The HPV vaccine protects against future infection but does not get rid of existing strains, so it is best to get vaccinated as soon as possible before one is exposed to more strains of HPV.
Read: Cervical Cancer, PAP SMEAR & HPV Vaccination – What you need to know

Molluscum contagiosum

This is skin infection caused by the Molluscum contagiosum virus which causes multiple small, pearly white or skin coloured bumps, sometimes with a central dimple (“central umbilication”). These are painless, non-itchy and can occur not just in the genital region but elsewhere on the body as well. The virus is spread through direct skin contact, or through contaminated clothing and towels. These lesions are harmless and will generally resolve within 6 months to a year (occasionally longer). Treatments available to address these bumps include topical medications like imiquimoid cream, freezing, and electrosurgery (laser).

Herpes

One of the stages of genital herpes is painful genital blisters – red bumps which eventually become fluid filled and later burst to form ulcers. Genital herpes is caused by the Herpes Simplex Virus which can be transmitted through secretions such as saliva or genital fluids. There is no cure for herpes, but antiviral medications are prescribed when an individual has a painful flare of blisters and ulcers.

Read: Genital Warts, Genital Blister & Genital Ulcer – Causes and Treatments
Read: Syphilis Symptoms – Painless Sores & Rashes

3) Malignancy

Vaginal cancer

Vulval or vaginal cancer are rare but serious causes of a vaginal lump or bump. These may be accompanied by other features such as persistent itching, pain, a persistent ulcer, and abnormal vaginal bleeding or discharge.

Melanoma

Vaginal melanoma (a type of cancer of the skin) can appear as a pigmented lump which may be associated with itching, bleeding and pain.

Malignancies tend to occur in older women but as their symptoms can be rather nonspecific, it is best to get any abnormal lump/bump checked.

If you wish to speak to female doctors if you have experienced the above signs and symptoms, call us or email us for an appointment at hello@dtapclinic.com.sg.

Take Care!

Other Reads:

  1. What Is the Cause & Treatment For Oral Herpes (Cold Sores)
  2. How Late Can a Period Be (Delayed Menstrual Cycle)
  3. 10 Causes of Abnormal Vaginal Lumps and Bumps
  4. 11 Causes of Dyspareunia (Pain During Intercourse)
  5. What You Need to Know about HPV Vaccination, Cervical Cancer & Pap Smear
  6. Why Do I Have Abnormal Vaginal Discharge
  7. What is HPV Vaccination – Gardasil 9
  8. Sex During Period (Sex & Menstruation) What To Know

 

When To Test For HIV During or After Completing HIV PEP

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

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

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

When can I test for HIV after I finish PEP?

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

Immediately After Completing PEP

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

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

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

Read: How to Get An Anonymous HIV Test in Singapore

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

Other Reads:

  1. Low HIV Risk Doesn’t Mean No HIV Risk
  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. What are the Causes of Abnormal Penile Discharge?
  4. HIV PrEP for Travel – How You Need to Know
  5. An Overview on STD from an STD Doctor
  6. Why Do I Have AbnormalVaginal Discharge
  7. How Late Can a Period Be (Delayed Menstrual Cycle)
  8. Everything You Need to Know about Herpes Simplex Virus
  9. How Do I Treat Oral Herpes (Cold Sores)
  10. Syphilis Symptoms – Painless Sore & Ulcers
  11. HIV Symptoms – What You Need to Know
  12. 10 Common HIV related Opportunistic Infections

  13. HIV Pro-Viral DNA Test

How Long Can HIV Survive Outside the Body?

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

How Long Can HIV Survive Outside the Body?

So what does the evidence say so far?

1) Temperatures

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

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

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

2) pH Level

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

DID YOU KNOW:

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

Semen or vaginal fluids outside the body

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

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

Survivability ≠ Infectivity

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

In a Nutshell

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

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

Take Care!

Other Reads:
Other Reads:

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

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