HIV Transmitted Risk – A quick overview

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

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

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

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

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

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

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

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

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


Other Reads:

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

 

10 Causes of Penile Pain – Ouch! Pain in the Penis

For men, the penis is one of the most, if not the most important organ. So if there are any signs of pain or discomfort, it usually causes a lot of worry and anxiety. However, pain in the penis can be due to many different conditions. Some are harmless, others may need immediate treatment.
So I have listed below some of the common causes of penile pain so that you can know when you need to rush to see the doctor or only come in the following Monday.

Top 10 Causes of Pain in the Penis:

Penile Infections

 1) Balanitis

Balanitis refers to inflammation of the foreskin which can be caused by fungal or bacterial infections, and irritants such as soaps, powders or creams that are applied over the foreskin. People that have diseases which compromise the immune system, such as Diabetes and HIV, may be more prone to this condition.
The pain caused by the inflammation is usually not severe but it can be throbbing, itchy and rather uncomfortable. This can be easily treated by treating the cause or avoiding the irritant.
See: Treatment for Penile Infection

2) Herpes

Herpes is one of the most common Sexually Transmitted Diseases STDs. This infection is transmitted through skin to skin contact and is usually caused by 2 different viruses called HSV 1 and HSV 2, which are usually known to cause lesions in the mouth and genital areas respectively. However, during oral sex, the virus can be passed on from the mouth to the penis causing genital herpes.
They usually present with painful blisters or ulcers over the skin and can be painful or at least very sensitive to touch. It can be treated with anti-viral tablets although it will keep recurring throughout a person’s life.
See: Everything You Need to Know about Herpes Simplex Virus

3) Chancroid

Chancroid is caused by a bacteria called Haemophilus Ducreyi and is transmitted through sexual intercourse. It commonly presents with a single large painful ulcer on the penis along with enlarged and tender lymph nodes in the groin region.
Chancroid is an infection that is usually caught via sexual contact. This can be treated with antibiotics once the diagnosis is established by your doctor.
See: The causes of Genital Blister and Ulcers

4) Urethritis

This is an infection of the urinary tract along the penis, through which the urine is passed out from the bladder. When an infection occurs along this tract it results in pain when urinating or discharges from the tip of the penis. Sometimes even when not urinating, one can feel the pain along the urethra itself.
Urethritis can be caused by Chlamydia, Gonorrhea, NSU or Herpes which are very common infections that can be transmitted through sexual intercourse. A simple urine test and sometimes a urethral swab can be performed to found out the exact cause and in most cases, it is easily cured with antibiotics.
See:  What are the causes of Abnormal Penile Discharge

5) Prostate Infections

When the prostate is involved during a urinary tract infection it can cause severe pain during urination and sometimes fever and shivering. This sometimes is difficult to diagnose and may involve the doctor placing a finger up the anus to feel for any tenderness in the prostate gland. Moreover, it usually requires a longer course of antibiotics.
See: The Causes, Testing and Treatment of Prostatitis (Prostate Inflammation)  

Trauma to the Penis

6) Penis Fracture

The penis is made out of erectile tissues and blood vessels. Although there is no bone in the penis, during an erection it can be as hard as bone. The term penis fracture is used when there is an injury to the erectile tissue inside the penis. It usually happens during sexual intercourse when the penis accidentally fully or partially slips out of the partner and the partner sits back down on the penis which injures it.
This will result in a sudden onset of pain and in certain cause you may even hear a snapping sound. When this occurs you should go to the emergency department immediately because it is a medical emergency.

7) Torn Frenulum

The frenulum is a thin strip of skin connecting the head of the penis to the foreskin. This can break during intercourse, especially when it’s rough, and result in pain and a lot of bleeding. The pain can last up to a few days as the frenulum heals. The healing time varies and it may get repeatedly injured during subsequent intercourse. When it started to occur more frequently, a simple surgical procedure may be done to fix the frenulum.
Frenulum breve, or short frenulum, is a condition in which the frenulum of the penis is too short and thus restricts the movement of the foreskin.
See: Frenulum Breve Treatment or Penile Frenulectomy

Others Medical Condiction that Causes of Penile Pain

8) Peyronie’s Disease

Is your penis bent during an erection? At the point where it is bent, can you feel a painful lump?
If it is yes to both questions, you may have Peyronie’s Disease. This happens when a spot along the penis shaft becomes inflamed and as it heals, it leads to contraction of one side of the penis causing it to bend. The pain may arise from the area of inflammation or in certain cases when the curvature is so severe, it causes pain during sexual intercourse.
Please see a doctor if you think you have Peyronie’s disease, and once the diagnosis is established the doctor may suggest several treatment options ranging from shock wave therapy to surgery.

9) Paraphimosis

This is a condition where the foreskin is completely retracted to expose the head of the penis and cannot be pulled forward to cover the head of the penis again. When the foreskin get inflamed and forms a band around the penis, it may affect the blood flow to the tip of the penis and usually causes severe pain.
This is a medical emergency and patients with this issue should see a doctor immediately. Most of the time, the doctor can use special techniques to pull the foreskin back into place.
Learn more about Paraphimosis.

10) Chronic Pelvic Pain Syndrome

This is a condition where there are non-specific symptoms in the groin area including pain in the penis, testicles or even lower back pain. This is due to inflammation either in the prostate or any of the organs in the groin area.
Read more about CPPS here.
Next time you feel pain or discomfort, do consider the possible.
If you wish to speak to our doctor about penile pain, please visit our DTAP Clinics or you can call us, or email us for an appointment at hello@dtapclinic.com.sg.
Take Care!


Also, Read:

  1. Things to do to maintain your penis health
  2. 11 Causes of Penile Itching & Pubic Itch
  3. 10 Ways to Improve Sexual Performance for Men
  4. An Overview of STD by an STD Doctor
  5. Anal Warts! What You Need To Know
  6. Weak Erection: Does Size Matters?
  7. Sexual Health Advice for Travellers 
  8. What you need to Know about Erectile Dysfunction 
  9. What You Need to Know about Premature Ejaculation Treatment
  10. What you need to know about Testosterone Deficiency Syndrome
  11. What is HIV / AIDS Signs and Symptoms

 

HIV Window Period – Timelines for Accurate HIV Testing

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

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

The HIV window period is the time between viral transmission to be able to get a conclusively accurate test result. This time period depends on the type of HIV testing performed – different tests have different window periods, with newer generation testing allowing for earlier and more accurate diagnosis of HIV than what was available in the past.

As testing facilities vary from country to country, it is important to recognize local health authority guidelines and speak to the doctor if you have any uncertainties on your test.
If you are within 10 days from a possible HIV exposure, you are still in an eclipse period. This is the period of time where no current testing can detect the virus. HIV Testing in this time period will have no diagnostic utility.

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

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

Also Read: When to get HIV Test after HIV PEP

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

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

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

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

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

The HIV Pro-Viral DNA Test

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

It is especially useful in the following situations:

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

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

HIV PCR RNA Test – 12 days or more post-exposure

As the HIV RNA PCR test is more sensitive, the window period is shorter and it can be used 12 days after exposure, as compared to 28 days for conventional Antibody/Antigen Testing.

HIV is a retrovirus. Retroviruses are a type of RNA virus that invades cells, in this case a kind of immune cells known as CD4 cells by injecting its genome directly into it. RNA is slightly different and less chemical complicated than DNA, hence the virus also has a special enzyme known as Reverse Transcriptase that will encode the HIV RNA into HIV DNA which is then merged with the host cell’s genome. Hence, if we can detect the presence of HIV RNA in the blood, we can be certain that there is HIV infection even without symptoms.

This is achieved through a technology known as polymerase chain reaction (PCR). In PCR, an automated device will process the patient’s sample with various chemicals. The polymerase enzyme and reaction will multiple any HIV RNA material into easily readable genetic information.

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

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

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

The 3rd generation Antibody-only test is accepted as conclusive from 3 months or more post-exposure. If testing is done within these respective window periods, there is a chance of a false negative result.
For extremely rare cases where people do not mount an appropriate HIV-antibody response (known as seronegative infections), the 4th generation test will still be able to detect the p24 antigen, which is why it is considered the most accurate first-line test for HIV diagnosis.

You may also have heard of a test called the Western Blot; this is just another type of HIV antibody test that is usually used for confirmation testing, once a preliminary test has shown a positive result. As HIV is a serious and life-changing diagnosis, it’s important we get it right – most diagnostic algorithms require two separate tests showing a positive result before we confirm it to the patient. As the HIV window period may differ with these separate tests, it is important that your doctor chooses the right tests for you.

The last test type we’ll be looking at is the HIV RNA/DNA PCR test, also known as Nucleic Acid Amplification Testing (NAAT). This test has significantly improved HIV screening, especially for people at high risk. This test directly measures the amount of virus in a person’s blood and can detect conclusively from as early as 12 days post-exposure. It is also used to monitor viral load in people with a known HIV infection. Although this test is able to pick up HIV infection at the earliest stage, it is not widely available due largely to costs and turnaround time in Singapore. There is a slightly higher risk of false positive results with the HIV RNA/DNA PCR test.

In Summary

In summary, here are the tests you can do at the appropriate time:
Day 1-3: Consider Post-Exposure Prophylaxis (PEP)
Day 1-9: Eclipse period (no HIV testing available)
Day 10: HIV Proviral DNA Test
Day 12 onwards: HIV RNA/DNA PCR testing (may have false positives)
Day 14 onwards: 4th Generation Combo testing can start to pick up the infection (may have a false negative)
Day 28 onwards: 4th Generation Combo testing is deemed conclusive
Day 90 onwards: 3rd Generation Ab-only testing is deemed conclusive
At the end of the day, it is important to speak to your doctor and inform them accurately about any potential exposure risks, so they can decide on which test is appropriate. And remember, 4th Generation Combo testing is the first line test recommended by most guidelines today. Ask for this test if you have any doubts!

Do come to see us for any further advice on HIV testing, window periods, or other STD Testing, STD Screening & Treatment and sexual health-related matters.

We accept both walk-ins and appointment for all our clinics, please call us or email us at hello@dtapclinic.com.sg.
Take Care!


Other Reads:

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

 

Also on Dtapclinic.com: HIV Test SingaporeSTD Test SingaporeAnonymous HIV Testing

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

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

Acute HIV Seroconversion HIV Rash

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

Other Infections

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

Syphilis

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

Herpes Simplex Virus

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

Kaposi Sarcoma

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

Candidiasis

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


Other Interesting Reads:

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

 

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

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

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

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

HIV Infection

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

HIV-infection

What is AIDS (Acquired Immuno-Deficiency Syndrome)?

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

HIV mode of transmission

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

How Would I Know if I Picked Up the Virus?

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

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

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

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

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

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

Descovy As New HIV Medication For HIV PrEP

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

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

Can Anyone Take HIV PrEP?

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

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

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

  • nausea
  • dizziness
  • headaches
  • fatigue
  • stomach cramps

More serious side effects include:

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

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

Frequently Asked Questions of HIV PrEP

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

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

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

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

3. Do I need regular HIV testing?

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

4. When can I stop PrEP?

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

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

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

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

Now what is HIV Post-Exposure Prophylaxis (PEP)

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

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

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

How do I take PEP?

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

How does PEP work?

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

How would I know if PEP worked?

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

Side effects of PEP?

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

Can HIV PEP fail?

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

All in All

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


Other Reads:

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

 

STD Risk from Receptive Unprotected Anal Sex in Men

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

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

1. Chlamydia and Gonorrhea

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

Anal Discharge

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

Anal Discomfort

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

Anal Bleeding

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

Lower Urinary Tract Symptoms

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

2. Human papillomavirus (HPV)

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

Read: Is HPV Vaccine Necessary for Males?

3. Herpes

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

4. Molluscum Contagiosum

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

5. Syphilis

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

6. HIV

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


Other Reads:

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

 

7 FAQs HIV Pre-Exposure prophylaxis (HIV PrEP)

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

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

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

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

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

a. Event-Based HIV Dosing

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

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

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

Type: 

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

Considerations:

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

b. Daily PrEP

Daily PrEP Regimen: 

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

Type:

  • Anal, Vaginal/Frontal sex

Considerations:

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

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

Ts and Ss Regimen:

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

Type: 

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

Considerations:

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

d. Holiday PrEP

Holiday PrEP Regimen:

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

Type: 

  • Anal, Vaginal/Frontal sex

Considerations:

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

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

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

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

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

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

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

6. How can I purchase PrEP?

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

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

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

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

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

Take Care!


Other Reads:

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

 

HPV Infection & HPV Vaccination for Men who have sex with Men

About 40 types of HPV are passed on through sexual contact. The virus can be spread through skin-to-skin contact that doesn’t involve penetrative sex. Condoms will not necessarily fully protect people from coming into contact with it. Also Read: Anal Pap smear for men

What you need to know about Gardasil 9 HPV Vaccine and HPV in Men who have sex with Men

 

What is Human papillomavirus (HPV)?

The Human Papilloma Virus (HPV) is not one virus, but a family of about 200 different strains that cause common warts, genital warts and some cancers.
Sexually active adults mostly acquire at least one variety of HPV and it’s a near-universal infection in people with HIV. Even people with a one-lifetime partner can get HPV if their partner has it.
About 40 types of HPV are passed on through sexual contact. The virus can be spread through skin-to-skin contact that doesn’t involve penetrative sex. Condoms will not necessarily fully protect people from coming into contact with it.
For most people, HPV will not cause any harm. Only some varieties of HPV can cause cancer and even if you do come in contact with these strains, the chances of developing cancer are very small.
However, some people do not clear the virus from their bodies, and this can cause:

  • Genital warts on the penis and anus. It is also possible to have these types of warts on the lips and in the mouth.
  • Cancer of the anus, penis and oropharynx (back of the throat, including the base of the tongue and tonsils).

Although some other strains of HPV are associated with cancers, two main strains of HPV – HPV 16 and HPV 18 – cause 70% of cervical cancers in women and over 80% of anal cancers worldwide.
It is estimated that HPV is responsible for about 5% of cancers worldwide. However, anal cancer is one of the most common cancers for people living with HIV.

Learn more about Rapid HPV Testing (Next Day Result)

HPV & Men Who Have Sex With Men (MSM)

Every year anal cancer is diagnosed in about two people per 100,000 in the general population.
Men who have sex with men are about 20 times more likely than heterosexual men to develop anal cancer, and men-who-have-sex-with-men who are living with HIV are even more likely (up to 100 times more than the general community).

What is the new Gardasil 9 (HPV Vaccine)?

GARDASIL 9 is a vaccine (injection/shot) given to individuals 9 through 26 years of age to help protect against diseases caused by some types of Human Papillomavirus (HPV).
In boys and men 9 through 26 years of age, GARDASIL 9 helps protect against:

  • Anal cancer
  • Precancerous anal lesions
  • Genital warts – Penile warts, Anal Warts and other areas

These diseases have many causes. Most of the time, these diseases are caused by nine types of HPV: HPV Types 6, 11, 16, 18, 31, 33, 45, 52, and 58. GARDASIL 9 protects against diseases caused by these nine types of HPV.

What is the difference between Gardasil and new Gardasil 9?

Gardasil only covers 4 strains of HPV: 6, 11, 16, 18.
Gardasil 9 covers that and 5 more strains, 31,33,45,52.

HPV-4 types
(6, 11,16,18)
HPV-9 types
(6,11,16,18,31,33,45,52,58)
Cervical cancer cases 70% 90%
High-grade cervical lesions 50% 75-85%
Low-grade cervical lesions 30-35% 50-60%
HPV-related vulvar cancer cases 70-75% 85-90%
HPV-related vaginal cancer cases 65% 80-85%
HPV-related anal cancers 85-90% 90-95%
Genital wart cases 90% 90%

As you can see, Gardasil 9 has a broader HPV coverage compared to Gardasil.

Frequent Asked Questions (FAQs)

1.) Can I get Gardasil 9 if I am above 26 years old?

Gardasil 9 in Singapore is indicated for boys and men from ages 9 to 26. That does NOT mean that men above the age of 26 years cannot get the vaccine.
If you are above 26 years old, the best thing to do is to have a discussion with our doctor about the pros and cons of the vaccine then make a decision on whether or not you will benefit from it.

 

2.) Can I get Gardasil 9 even if I have had genital warts?

There are 200 different strains of HPV. Even if you have been infected with 1 strain, the vaccine can help protect you against other strains.
Also, there is data to show that people who have received treatment for HPV related cancers and had the HPV vaccine were less likely to get recurrences of their cancers.
So even if you have had or currently have genital warts, you should still have a frank conversation with our doctor about how Gardasil 9 can benefit you.

3.) Can I get Gardasil 9 even though I have already had the older version of Gardasil?

Yes, you certainly can. Scientific data has proven that it is absolutely safe to receive the full dose of Gardasil 9 even though you have already completed the vaccination using the older version of Gardasil.
If you have any concern about HPV infection treatment or you are interested in getting HPV vaccination, please contact us for more information.

Gardasil 9 vaccination is avilable in all our clinics in Malaysia and Singapore.
You can call any of our clinics or email us 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. Everything You Need to Know about Herpes Simplex Virus
  7. How Do I Treat Oral Herpes (Cold Sores)
  8. Syphilis Symptoms – Painless Sore & Ulcers
  9. HIV Symptoms – What You Need to Know
  10. 10 Common HIV related Opportunistic Infections

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

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

How is it Even Possible to Get HIV Tested Anonymously?

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

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

Step 2:

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

Step 3:

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

Who Should Get HIV Tested?

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

How Is HIV Testing Done? I am Scared of Needles

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

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

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

How Much Does the Anonymous HIV Test cost?

Rapid Fingerprick HIV (3rdGen Test) – (90 days after exposure)
$54.00
Rapid Fingerprick HIV Combo Test (4thGeneration) – (28 days after exposure)
$162.00
All results take 20 mins. Consultation charge is from $22.00

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

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


Other Reads:

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

 

Low HIV Risk Does Not Mean NO HIV Risk

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

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

Prof Chan told TNP.

What are the odds?

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

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

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

So What about Tattoos or Piercings?

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

What is the take-home message?

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

Low HIV Risk Doesn’t Mean NO Risk

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

Other Interesting Reads:

  1. An Overview of STD – From an STD Doctor
  2. The HIV Pro-Virus DNA Test can be done 10 days post exposure.
  3. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  4. What are the Causes of Abnormal Penile Discharge?
  5. What are the Symptoms of HIV Infection and AIDS?
  6. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  7. 11 Causes of Dyspareunia (Pain During Intercourse)
  8. What is HPV Vaccination (Gardasil 9)
  9. 10 Causes of abnormal Vaginal Lumps and Bumps
  10. An Overview of Gonorrhoea
  11. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  12. Syphilis Symptoms (Painless STD Sores & STD Rashes) 

 


References

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