HIV PrEP for Travel – Things You Need to Know

What is HIV PrEP?

Use of oral anti-retroviral drugs by HIV-uninfected people to block the acquisition of HIV before exposure to HIV.

Why HIV PrEP?

Many trials have been conducted to determine the effectiveness of oral HIV PrEP across couples of all orientations. When patients follow the treatment and prevention strategies closely, significant prevention of HIV levels was achieved
In 2014, WHO (World Health Organisation) developed consolidated HIV guidelines for key populations, including men who have sex with men, sex workers, transgender people. In those guidelines, HIV PrEP was strongly recommended for men who have sex with men (MSM).6
During travel, the risk of acquiring HIV is the result of a change of HIV prevalence at the destination, and more importantly the change of sexual behaviour abroad and the increase of risk-taking behaviour. Studies have shown that amongst the MSM community, awareness of a special form of PrEP use, often described as “holiday PrEP” is becoming increasingly popular. This holds true even for MSM who do not consider themselves to be at high risk for HIV.7

How?

Prior to starting PrEP, your doctor will do blood tests to monitor your kidney and liver function, a full STI screen if you have not had one recently and also an HIV test.
Subsequently when on PrEP, your renal function will be monitored every quarter. Long-term PrEP use will also require monitoring of your bone density.

When?

How you take your PrEP depends on10:

  • how far in advance you plan on having sex
  • how regularly you have sex.

It does not necessarily depend on how much sex you have.

There are 4 Different Ways to Use HIV PrEP

There are 4 different ways to take PrEP, we discuss this further below:

1. 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.

2. On-Demand PrEP (Event-Based 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.


The regime requires the patient to take 2 tablets of the HIV PrEP medicine between 2 to 24 hours prior to the event followed by 1 tablet 24 hours after the initial dose and a final tablet 48 hours after the initial dose. Medical studies show that the protection provided against HIV for this regime is not as good as if the medicine is taken daily.
Furthermore, thus the regime is more complex and therefore increases the risk of the patient taking the wrong amount of medicine at the wrong time.

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 PrEP can cause viral flare-ups and liver inflammation.

3. 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.

4. 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 and these should have subsided within a week.

Worry Less, Worry Free!
PrEP is an ‘opt-in’ treatment – it is not meant to be taken forever.
Trying to stay HIV negative during the holiday or trip result in an anxious and stressful experience.
Your peace of mind and release from this stress and anxiety is important so that you can enjoy the moments that matter with your partner!
Safe Trip and Have Fun!
This article was written by Dr Tan & Partners, in collaboration with Oogachaga.


References

  1. Vivancos R, Abubakar I, Hunter PR. Foreign travel, casual sex, and sexually transmitted infections: systematic review and meta-analysis. International Journal of Infectious Diseases. 2010;14(10):e842–51.
  2. Svensson P.,et al. A meta-analysis and systematic literature review of factors associated with sexual risk-taking during international travel. Travel Medicine and Infectious Disease. 2018; Jul – Aug;24:65-88
  3. https://wwwnc.cdc.gov/travel/page/std
  4. https://www.fitfortravel.nhs.uk/advice/general-travel-health-advice/sexual-health-risks
  5. Riddell Jt, Amico KR, Mayer KH. HIV Preexposure Prophylaxis: A Review. Jama. 2018;319(12):1261-8.
  6. WHO Guidelines Approved by the Guidelines Review Committee. Guideline on When to Start Antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV. Geneva: World Health Organization Copyright (c) World Health Organization 2015.; 2015.
  7. Elsesser SA, Oldenburg CE, Biello KB, Mimiaga MJ, Safren SA, Egan JE, et al. Seasons of Risk: Anticipated Behavior on Vacation and Interest in Episodic Antiretroviral Pre-exposure Prophylaxis (PrEP) Among a Large National Sample of U.S. Men Who have Sex with Men (MSM). AIDS and behavior. 2016;20(7):1400-7.
  8. Brett-Major DM, Scott PT, Crowell TA, Polyak CS, Modjarrad K, Robb ML, et al. Are you PEPped and PrEPped for travel? Risk mitigation of HIV infection for travelers. Tropical diseases, travel medicine and vaccines. 2016;2:25
  9. Hampel B, Reinacher M, Fehr JS, HIV pre-exposure prophylaxis (PrEP): Is it time to rethink HIV prevention in travelers?, Travel Medicine and Infectious Disease (2018), doi: 10.1016/j.tmaid.2018.06.008
  10. https://www.iwantprepnow.co.uk/how-to-take-prep/

Sexual Health Advice for Traveller

Passport, Phone, Plane tickets and….. PrEP!

Planning your next trip – for business or pleasure, or both? Apart from the usual, do you make plans for your own sexual health?

What? Why?
Whether you’re straight, gay, lesbian, bisexual, transgender or just curious and questioning, lots of people have casual sex when they travel, so you’re not alone.
However, lots of research and experience show that the risk of developing a sexually transmitted infection (STI) – like HIV, syphilis or others – is increased when you travel. 1
This could be due to increased risk-taking behaviour when we travel abroad. The reasons may include increased freedom, alcohol and drug use, loneliness, peer pressure or a general sexual lifestyle when you’re abroad.2
Of course, there are those who travel abroad specifically for sex, in what some call “Sex Tourism”, which is the intention of travel overseas to purchase sex. This usually involves travelling to neighbouring countries to purchase sex from commercial sex workers.
Whatever your reasons for travel, if you’re unprepared for sex you may be putting yourself at risk and participate in behaviours that you wouldn’t consider at home.3
 

So how? Top tips for your Sexual Health Risk Reduction  (T.R.A.V.E.L)

T for Testing & treatment of STIs

  • Please get tested prior to travel as blisters, ulcers, bumps provide an entry point for STIs into the body. Having an STI increases the risk of HIV transmission by 10 fold!
  • Periodic STD Screening & Anonymous HIV Testing can keep your status in check
  • Don’t assume your partner is STD-free because s/he doesn’t mention it and, STDs are often asymptomatic. Talk openly with him or her about your STD and HIV status and date of the last testing3

R for Rubbers & Lube

  • Unprotected (without a condom) sex with a new/casual partner carries a risk of contracting STIs or blood-borne viruses.
  • Stock up on condoms and lube, keep them in a cool place, practice using them and get confident in talking about using them before you go.

A for Alcohol & Drug Use

  • Be careful when having sex after alcohol use. With alcohol or other drugs, one is more likely to take risks: not using a condom, having sex with someone you normally wouldn’t have sex with. We encourage condoms to be used for all forms of sexual activity especially with new/casual partners.

*Note: We do not support illicit drug use and urge our readers to abide by the host country’s drug laws. Singapore has strict anti-drug laws. Any citizen or permanent resident found to have abused controlled drugs overseas will be treated as if he or she had abused drugs in Singapore. Furthermore,  possession, consumption, manufacturing, import, export, or trafficking of controlled drugs in any amount are illegal.

V for Vaccinations

  • Discuss with our DTAP team the risk of infections, STIs and Blood Borne Viruses and any vaccines that are available (plan ahead as some vaccinations may take up to 6 months for full immunity). The vaccines that we recommend are the HPV (human papillomavirus) vaccine, also known as Gardasil 9, Hepatitis A and Hepatitis B vaccination.

E for Education

  • Empower yourself with information where sex may be available, at your travel destination.4
  • Ensure you are vaccinated against Hepatitis B, carry and use kite-marked condoms, consider taking oral HIV PrEP (Pre-exposure Prophylaxis) prior.

L for Living and travelling with HIV

 
Get tested after you return and last but not least, consider PrEP before you travel!  Learn more about Travelling with HIV PrEP (Pre-Exposure Prophylaxis)

Safe Trip and Have Fun!
This article was written by Dr Tan & Partners, in collaboration with Oogachaga.


References

  1. Vivancos R, Abubakar I, Hunter PR. Foreign travel, casual sex, and sexually transmitted infections: systematic review and meta-analysis. International Journal of Infectious Diseases. 2010;14(10):e842–51.
  2. Svensson P.,et al. A meta-analysis and systematic literature review of factors associated with sexual risk-taking during international travel. Travel Medicine and Infectious Disease. 2018; Jul – Aug;24:65-88
  3. https://wwwnc.cdc.gov/travel/page/std
  4. https://www.fitfortravel.nhs.uk/advice/general-travel-health-advice/sexual-health-risks
  5. Riddell Jt, Amico KR, Mayer KH. HIV Preexposure Prophylaxis: A Review. Jama. 2018;319(12):1261-8.
  6. WHO Guidelines Approved by the Guidelines Review Committee. Guideline on When to Start Antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV. Geneva: World Health Organization Copyright (c) World Health Organization 2015.; 2015.
  7. Elsesser SA, Oldenburg CE, Biello KB, Mimiaga MJ, Safren SA, Egan JE, et al. Seasons of Risk: Anticipated Behavior on Vacation and Interest in Episodic Antiretroviral Pre-exposure Prophylaxis (PrEP) Among a Large National Sample of U.S. Men Who have Sex with Men (MSM). AIDS and behavior. 2016;20(7):1400-7.
  8. Brett-Major DM, Scott PT, Crowell TA, Polyak CS, Modjarrad K, Robb ML, et al. Are you PEPped and PrEPped for travel? Risk mitigation of HIV infection for travelers. Tropical diseases, travel medicine and vaccines. 2016;2:25
  9. Hampel B, Reinacher M, Fehr JS, HIV pre-exposure prophylaxis (PrEP): Is it time to rethink HIV prevention in travelers?, Travel Medicine and Infectious Disease (2018), doi: 10.1016/j.tmaid.2018.06.008
  10. https://www.iwantprepnow.co.uk/how-to-take-prep/

Top Travel Tips for Persons Living With HIV (PLHIV)

Planning for a long Vacation or Preparing for a Business trip? The travel preparation can sometimes be challenging for People Living with HIV (PLHIV).
Making sure there is enough medication. Making sure you get the correct travel vaccine or visiting the doctor to get prescription (just in case you might be questioned during immigration check)

Travel Tips For Travelling with HIV (B.R.A.V.E)

B for Board, Bottle

Carry Your HIV Medication with You on Board
Carry your HIV medications with you on Board rather than checking them in and have a memo from the prescribing doctor’s memo with you.

Carry Your Doctor’s Memo with You
The contents of the memo should confirm that the medication is necessary during the trip. It does not need to discuss HIV and can state the medications are for a chronic medical condition and for personal use.

Use Medication’s Original Packet or Bottle
It is also advisable to have the medication’s original packet/ Bottle, showing the name of the person carrying the medication and medication details.

R for Reveal, Reiterate

You Don’t Need to Discuss Your HIV Status!
When crossing international borders, one might be questioned on the medication carried. Preparing for these questions can facilitate an easier border crossing experience. HIV need not be discussed or Revealed and that these medications are for a chronic health problem can be Reiterated.

A for Adjust, Avoid,  Anonymous Testing, Advice

Adjusting Your Dose Timing
Discuss with your doctor dose timing adjustments when travelling across different time zones. Medication can usually be taken one or two hours later for a number of days until the timing fits with the destination country. The process should be reversed on return.

Avoid Missing Your Medication Dose
Missing medication doses should be avoided at all cost. Treatment breaks should be avoided unless discussed with your doctor.
 
 Advice, Anonymous testing
If you are travelling in and out of Singapore and need advice on HIV treatment or testing, At Dr. Tan & Partners, we provide a safe and discreet environment for testing. You can find out more about Anonymous HIV Testing.

V for Vaccinations

General principles for vaccination of PLHIV as follows:

  • Killed or inactivated vaccines do not represent a danger to immunocompromised people and generally should be administered as recommended for other people.
  • Live-virus or live-bacteria vaccines such as BCG, oral poliovirus, typhoid (Ty21a), varicella, Yellow fever should be avoided unless the benefits outweigh the cons

The main vaccinations we recommend for PLHIV besides the country-specific vaccinations are.

  1. HPV Vaccination
  2. Hepatitis A
  3. Hepatitis B
  4. Influenza
  5. Pneumococcal
  6. Meningococcal

E for Extra Medication

Bring Extra Medication
It is imperative to bring enough medication and slightly more for a few days as getting a prescription or purchasing your medications in a foreign country may not always be possible. Furthermore, there is no way to ascertain whether the purchased medication might be of the same quality, type and efficacy.

If you are travelling with a partner/s who are not HIV positive, you can find out more information on getting PrEP (Pre Exposure Prophylaxis) for their protection as well – Non-HIV partners for HIV PrEP.

Here are some further resources you can explore to find out more about the country you are travelling to and its restrictions if any:
1.) www.aidsmap.com – HIV-related services worldwide and access country-specific information and news 
2.) www.hivtravel.org – International database on HIV related travel and occupation

Safe Trip and Have Fun!
This article was written by Dr Tan & Partners, in collaboration with Oogachaga.

Top 10 Anonymous HIV Testing (AHT) Clinics in Singapore

10 Anonymous HIV Testing (AHT) Clinics in Singapore
Anonymous HIV testing (“AHT”) offers a level of privacy and confidentiality as your personal particulars are not required. Rapid HIV test kits are used in anonymous HIV testing. The results of rapid HIV tests can be available within 20 minutes.
In Singapore Anonymous HIV testing is only offered at the following ten AHT clinics:

No.AHT Clinic Name Address and Opening Hours
1Dr Tan & Partners (DTAP) @ Robertson
 
11 Unity Street, Robertson Walk #02-07 Singapore 237995
Mon to Fri: 8am to 9pm
Sat and Sun: 9am to 2pm
Public Holidays: Closed
Website: https://www.dtapclinic.com
2Action for Aids
 
31 Kelantan Lane #01-16 Singapore 200031
Tues and Wed: 6.30pm to 8.15pm
Sat: 1.30pm to 3.15pm
Public Holidays and eve of Public Holidays: Closed
Website: www.afa.org.sg
 
3Anteh Dispensary
 
1 Lorong 22 Geylang #01-02 Singapore 398664
Mon to Fri: 9am to 12noon, 2pm to 5pm, 7pm to 11pm
Sat: 9am to 12noon, 1pm to 6pm, 7pm to 11pm
Sun and Public Holiday: 1pm to 6pm, 7pm to 11pm
Website: https://anteh-dispensary-pte-ltd.business.site
4Doctor Jay Medical Centre115 Killiney Road Singapore 239553
Mon to Fri: 9.30am to 4pm, 6pm to 8.30pm
Sat: 9.30am to 12noon
Sun: 6.30pm to 8.30pm | Public Holidays: Closed
Website: http://www.drjay.clinic/
5Dr Soh Family ClinicBlk 966 Jurong West Street 93 #01-221 Singapore 640966
Mon and Tue: 8.30am to 1pm, 2pm to 4.30pm, 7pm to 9pm
Wed to Sun and Public Holidays: Closed
Website: NA
6M Lam Clinic739 Geylang Road Singapore 389649
Mon to Fri: 9am to 12.30pm, 2pm to 5.30pm
Sat: 9am to 12.30pm
Sun and Public Holidays: Closed
 
7Doctors Clinic & Surgery
 
305 Woodlands St 31, #01-91, Singapore 730305
Mon to Fri: 8.30am to 12pm, 2pm to 4.30pm, 6.30pm to 8.30pm
Sat/Sun: 8.30am to 12pm | Public Holidays: Closed
Website: https://www.doctorsclinicandsurgery.net/
8Kensington Family Clinic14D Kensington Park Road, Serangoon Garden Estate, Singapore 557265
Mon to Sun: 8am to 3pm, 6pm to 10pm
Public Holidays: Closed
Website: www.kensingtonfamilyclinic.com
9Q&M Medical & Aesthetic Clinic (Tampines Central)10 Tampines Central 1, #04-18/19, Tampines One, Singapore 529536
Mon to Fri: 9am to 1pm, 2pm to 9pm
Sat and Sun: 9am to 1pm
Public Holidays: Closed
Website: http://www.qandmmedical.com.sg
10Tanjong Pagar Medical Clinic1 Tanjong Pagar Plaza, #01-06 Singapore 082001
Mon, Wed and Fri: 9am to 6pm
Tues and Thur: 9am to 9pm
Sat and Sun: 9am to 2pm | Public Holidays: Closed
Website: www.tanjongpagarclinic.com/

 
For individuals who suspect that they are at risk or not sure if they show symptoms of HIV, please make a visit to any of the nearest 10 Anonymous HIV Testing clinics in Singapore to be tested by the doctors today.

What is Rapid Chlamydia & Gonorrhea PCR STD Testing?

Chlamydia and gonorrhoea are 2 common Sexually Transmitted Infections (STIs) which can infections in various parts of the body such as penis, vaginal, anus, throat and eyes.
Most commonly you will experience discharges from the penis/ vaginal or discomfort when passing urine.
However, the majority of men may not have any symptoms and for women, 50% may also not have symptoms.
The infection will stay in the body for a few weeks after the symptoms have been treated.
In rare instances, Gonorrhoea and Chlamydia can continue to cause damage to the body, specifically the urethra and testicles. Pain may also spread to the rectum. An overview of Gonorrhoea

At Dr Tan and Partners, we recognize that symptoms like abnormal vaginal discharges, penile discharge or discharge from the rectum can cause quite a bit of worry.
Thus, we have introduced a Rapid STD testing (next day results) that can detect these 2 infections within a day.
Which means that you can get the necessary treatment quickly as well.
All it requires is a urine sample or swab from the vaginal/ throat/ anal

This Rapid STD Testing detects for the presence of the DNA of the 2 organisms, making the test very sensitive

If you think you may have symptoms suggestive of chlamydia or gonorrhoea infection or if you think you may have been exposed and you are interested in an STD Screening, please visit a doctor for further evaluation.

Take Care!


Other Reads:

  1. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  2. Weak Erection? Erectile Dysfunction? How to Improve Erection with Pills
  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

11 Causes of Dyspareunia in Women (Pain During Intercourse)

Dyspareunia or Pain During Intercourse is a condition whereby people experience pain during sexual intercourse. Both men and women can experience pain during sex sometime during their lives. However, it is much more common for women. Particularly in young women who are inexperienced or women who are in the perimenopause or menopause stages.
 
There is not much awareness about this topic as there is still a stigma surrounding it. Consequently, women are not speaking to their sexual partner, friends, close family or doctor when faced with this issue. If the situation is not dealt with, it may lead to other problems. Besides not being able to enjoy sex, the pain will progressively worsen due to the muscles tightening up.
Dyspareunia will have a negative physical impact on you, as well as being able to emotionally affect you and your partner’s relationship.
 

Pain During Intercourse can be classified into either deep or superficial pain during sex.

 

Causes of superficial pain include:

1.) Vaginismus

Vaginismus is the spasms of vaginal muscles which arises from the fear of being hurt. This can cause both deep and superficial pain, making sex extremely painful and sometimes even impossible. As a result of fear of vaginal examinations, women with vaginismus may never be able to use tampons or have a pap smear test.
The causes of vaginismus can be attributed to a restrictive upbringing, a history of rape or sexual abuse as a child, or past painful vaginal infections such as genital herpes.
 

2.) Lack of Vaginal Lubrication

This is arguably the most common cause of dyspareunia. Lack of vaginal lubrication can be due to nervousness, failure to relax, not having enough foreplay, or having unskilled foreplay performed by the male partner. Dyspareunia because of this can be resolved through increased foreplay, using lubricants by both counterparts, or if the female can become more relaxed.
One feature of menopause is the fall in production of the female hormone oestrogen, this causes vaginal dryness in perimenopausal or menopausal women. In this case, using lubricants during sex should reduce the pain substantially. Other treatment options available for these women are hormone replacement therapy (HRT) or vaginal hormone creams with the purpose to actively boost oestrogen production.
 

3.) Vaginitis (Inflammation of the Vagina)

Vaginitis is essentially the inflammation of the vagina which is caused by infections from thrush (candida), trichomonas or bacterial vaginosis (BV).
Common symptoms of this condition would be abnormal vaginal discharge, as well as itchiness and a burning sensation in the vagina and vulva (opening of the vagina).
 
Another type of causes, especially if associated with an infection, can also cause pain.
This includes:

  • Genital herpes
  • Foreign body in the vagina
  • Forgotten tampon

Generally, treating the infection will simultaneously clear dyspareunia.
 

4.) Vulvitis (Inflammation of the Vulva)

Vulvitis is the inflammation of the vulva (opening of the vagina) that can progressively lead to cracks in the skin of the vulva. It can also cause pain (including dyspareunia), itching and a burning sensation in the vulva.
Contact dermatitis is a common skin disorder that can also lead to inflammation of the surrounding skin of the vulva either due to an allergic reaction or direct exposure to agents like perfumed soaps, douches or lubricants.
 

5. Injury

Injuries to the vulva commonly stem from labour. During labour, episiotomy cuts or tears can occur. If unattended to, it may cause pain during sex for an extended period of time. Otherwise, badly healed stitches can cause pain too.
If you are experiencing any of these problems, it is advised to see a doctor sooner.
 

Causes for deep pain include:

6. Problems with the Cervix

During sex, the penis is able to come into contact with the cervix (opening of the womb). This can cause pain due to deep penetration, also known as ‘collision dyspareunia’. This open contact can also cause STDs such as gonorrhoea, chlamydia, trichomoniasis, genital herpes and others.
Additionally, if an intrauterine contraceptive device (IUD) or ‘coil’ planted at the cervical canal becomes displaced during sex, this can also cause pain.
 

7. Problems with the Uterus (womb) or Ovaries

Womb disorders or other problems in this region can cause deep pain during sex, such as:

  • Fibroids
  • Fixed retroverted uterus
  • Ovarian cysts

 

8. Endometriosis

Endometriosis is a disorder in which the tissues intended to line the uterus start growing outside the uterus. The location where endometriosis occurs will determine how much pain you experience during sex. The pain is expected to be more intense if endometriosis occurs behind the vagina and lower part of the uterus.
 

9. Pelvic inflammatory disease (PID)

PID is caused by a sexually-transmitted infection in the upper female genital tract (pelvis). During sex, pressure on these badly inflamed tissues in the affected region can cause deep pain.
 

10. Pelvic Adhesions

Pelvic adhesions are when the tissues in the upper female genital tract (pelvis) become stuck together. This development is usually due to the aftermath of surgery, injury (trauma), radiation treatment or infection, like a complication of pelvic inflammatory disease (PID). These adhesions can cause pain, including dyspareunia.
 

11. Ectopic Pregnancy

An ectopic pregnancy is when the pregnancy is located outside the womb, like in the fallopian tubes, cervix or ovary. As this type of pregnancy develops, it will stretch out the surrounding tissue, creating discomfort. Pressure on this region during sex will cause more pain.
If you are experiencing repeated pain during or after sex, do not hesitate to see a doctor or visit our clinic as dyspareunia is not normal and often the underlying cause is curable. The longer you leave it, the more issues it may cause to yourself and also may lead to a detrimental effect on your relationship with your partner.
 
If you are experiencing Pain During Intercourse, it is highly recommended to visit our doctor at our Women Clinics as soon as possible, especially if the pain becomes persistent. Most causes of dyspareunia are not serious. However, there is a few that can be severely detrimental to your health and well-being.
 
Take Care!

Other Interesting Reads:

    1. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
    2. 11 Causes of Dyspareunia (Pain During Intercourse)
    3. What is HPV Vaccination (Gardasil 9)
    4. 10 Causes of abnormal Vaginal Lumps and Bumps
    5. An Overview of Gonorrhoea
    6. What is the Treatment for Cold Sores? What causes Cold Sores?
    7. Sex During Period (Sex & Menstruation) What To Know

 
 

10 Causes of Abnormal Vaginal Lumps and Bumps

Some women may develop lumps or bumps in the vaginal area sometime during their lives.

 
The severity of the condition, indicated by these lumps and bumps, can be classified into three categories:

  • Harmless
  • Infection or sexually-transmitted disease
  • Malignancy

 
For the most part, these lumps or bumps are harmless. The following conditions fall under this group.
 

1.) Cysts

Cysts can occur anywhere in the body. They are sacs, that range in size, filled with liquid or other substances. In the vaginal area, these cysts are usually benign and painless unless infected. It would feel like a small pebble just underneath the skin of the vulva.
 

There are two kinds of cysts:

Sebaceous Cysts

Sebaceous cysts result from the blocked hair follicles and ingrown hair when shaving or waxing. Most of these cysts do not require treatment and can be ignored if it does not cause any problems. However, some may need a small incision if they enlarge or become infected.
 

Bartholin Cysts

When the Bartholin gland (a gland in the vaginal and vulva region) becomes blocked and swells, this will cause a Bartholin cyst to form. The cyst is also harmless unless it becomes infected and turns into an abscess (a swollen area containing pus). In such cases, a trial of antibiotics usually is effective. In some cases, minor surgery may be necessary.
 

2.) Molluscum Contagiosum

A virus called pox virus causes molluscum contagiosum. It is a skin infection which causes multiple tiny bumps to spread across the area of infected skin. These harmless bumps or raised lesions are pearly white to skin-coloured and will eventually vanish after 1-2 years.
Molluscum contagiosum commonly appears in children and other parts of their bodies. However, it may pose as a sign of an STD when it occurs in adults. It is then advised for these people to get tested for other STDs.
Effective treatment options available to cure this particular type of molluscum contagiosum include:

  • Electrosurgery
  • Freezing (liquid nitrogen)
  • Topical cream

 

3.) Vestibular Papillomatosis

VP is a skin condition whereby multiple shiny small papules appear over the skin of the inner labia and vaginal opening. Similar to pearly penile papules (PPP) in men, VP is a normal variant of female genitalia; therefore treatment is not necessary.
It should be noted that Vestibular Papillomatosis is commonly mistaken for genital warts because of their similar appearance. Genital wart is a type of Sexually Transmitted Disease (STD). Therefore it is essential to have a correct diagnosis of the condition as a measure to prevent undue stress or prolonged deterioration. Our doctors are able to distinguish between both conditions.
 

4.) Fordyce Spots

Fordyce spots are enlarged oil glands materialising as small white to yellow lumps over the inner labia. These spots can also appear on the lining of the mouth and occasionally on the penis in men. They are completely painless and harmless.
The condition where lumps and bumps associated with an infection is folliculitis. Other conditions that are STD-related include genital warts, syphilis and herpes.
 

What are some of the causes of Bleeding after Sex (Post Coital Bleeding)?

5. Folliculitis

Folliculitis is the skin condition where the hair follicles in the labia region become inflamed and infected, causing tender red spots containing pus to surface. The hair follicles become inflamed from bacterial, fungal or even viral infection (e.g. herpes), due to situations that irritate ingrown hair, like shaving or waxing. The treatment is dependent on the type of infection.
 

6. Genital Warts

Genital wart is a Sexually Transmitted Disease (STD) caused by the Human Papilloma Virus (HPV), usually, type 6 and 11. Genital warts present as small, skin-coloured cauliflower-like bumps that can either develop into one single lump or more commonly into multiple lumps. Genital warts are highly contagious through skin-to-skin contact.
Depending on the individual, the HPV warts may go away, remain present or spread and increase in amount. Even without developing these warts, the individual can still be a carrier of the HPV virus.
There are HPV vaccinations now available to protect you from certain strains of HPV including type 6 and 11.
(The new Gardasil 9 HPV Vaccination is available in all our clinics in Singapore and Malaysia)
 

7. Syphilis

Syphilis is a sexually-transmitted disease that is caused by a bacterial infection. From this, a chancre, a painless sore, will appear in the genital or mouth area. The sore can eventually go away untreated in a few weeks. However, this will lead to the development of severe complications because the infection remains.
Please click here to find out more about syphilis, including treatment options.
 

8. Genital Herpes

Genital herpes is a contagious sexually-transmitted disease appearing as multiple painful blisters or ulcers clustered in the genital area. The infection can spread quickly to sexual partners, even with the use of condoms.
Although there is currently no cure for the infection, there are different treatments, like antiviral medications, to prevent and control recurring outbreaks of blisters.
 

Lumps and bumps can also be a malignant growth, and potentially a sign of cancer.

 

9. Vaginal Cancer

Vaginal or vulvar cancer can be presented as a lump or bump in the vaginal region. Besides the lumps, this type of cancer is also accompanied by other symptoms, including:

  • Abnormal vaginal bleeding
  • Unusual vaginal discharge
  • Pain during intercourse

In such cases, a pelvic examination and pap smear are done to look for any red flags. A pelvic examination and a pap smear test is done to check for signs of early changes and cancer.
If the results are positive, the doctor will then discuss the next steps for treatment.
 

10. Vaginal Melanoma

Melanoma is a type of skin cancer arising from pigmented cells. 2% of melanoma are diagnosed in the vagina or vulva. This cancer is more prevalent in women older than 50.
Vaginal melanoma appears as a pigmented lump in the vaginal area. Other non-specific symptoms include itching, bleeding and pain.
 
If you are experiencing Abnormal Vaginal Lumps & Bumps, it is highly recommended to visit our female doctors at our Women Clinics as soon as possible.
 
Take Care!

Other Interesting Reads:

    1. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
    2. 11 Causes of Dyspareunia (Pain During Intercourse)
    3. What is HPV Vaccination (Gardasil 9)
    4. 10 Causes of abnormal Vaginal Lumps and Bumps
    5. An Overview of Gonorrhoea
    6. What is the Treatment for Cold Sores? What causes Cold Sores?

 
 
 

9合1 加卫苗(Gardasil 9)疫苗

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。

了解更多: 水货九价hpv疫苗-到底能够采取什么措施来避免接受

这个疫苗与旧款疫苗希瑞适(卉妍康 Cervarix)和4合1加卫苗(Gardasil 4)有什么区别?

与4合1加卫苗相比,9合1加卫苗对于HPV可提供更广泛的保护,它不仅能预防4合1加卫苗所预防的4种病毒株,它还能预防另外5种高危型的病毒株:HPV31、33、45、52合58。这几种病毒株加起来就已经覆盖了能导致百分之九十的宫颈癌病例的病毒株。
两种加卫苗都可预防致癌的HPV16、18,以及致疣的HPV6与11。
另一方面,希瑞适只针最常致癌的HPV16与18,而且并不能预防疣。

男女性都能接种9合1加卫苗吗?

是的,男女行都能接种9合1加卫苗,反观,希瑞适只适用于女性。

适合接种9合1加卫苗的最小年龄是?

9合1加卫苗可接种的最小年龄是9岁。在发生任何HPV接触之前接种疫苗是最有效的。

对女性而言,9合1加卫苗有多重要?

宫颈癌是新加坡15-44岁女性因癌症死亡的第三大主要原因,每月有6名妇女因宫劲癌而死。
通过疫苗接种可轻易预防宫颈癌,因此在女性当中受到了极大的推荐。
请记住,接种疫苗预防宫颈癌、阴道癌、外阴癌、肛门癌或口咽癌并不是百分之一百的有效的,但至少它现今提供了最好的预防机会,更何况,这些癌症还有其他致癌的HPV病毒株和其他致病因素。

对男性而言,9合1加卫苗又是如何重要?

首先,我们将根据不同的性行为进行两大分类:进行穿插性肛门性交的男性和不进行该行为的男性。
进行穿插性肛门性交并是接受一方的男性一般患上HPV相关肛门癌的风险较高,因HPV将贮藏于肛门粘膜表面。
无论往后的性取向如何,男孩或年轻男性进行早期接种疫苗都有助于预防肛门癌。与女性不同的是,进行肛门性交的男性目前尚无类似宫颈抹片实验(PAP Smear)这类受批准的筛查检测方案可实行。
不接受肛门性交的男性依然可从接种疫苗中受益。该疫苗可降低其口腔癌和阴茎癌的风险,因为在进行阴道性交或口交期间HPV可贮存于阴茎上,同样地,HPV也可在口交时贮存于口腔内。
许多异性恋男人可能会问:“HPV一般常导致宫颈癌,似乎更是个女性的问题而非是男性的。”仔细想想,HPV相关癌症对于女性是致命的,只要接种疫苗的男性人数越多,免疫人群就越大,从而降低把HPV传播给女性的风险。这被称为”“群体免疫力”。
相反,随着更多的女性接种疫苗,更多的男性就被赋予“群体免疫力”的保护,HPV流行率下降从而降低了感染HPV相关疾病的风险。
因此,我们也应该鼓励男性接种9合1加卫苗以降低HPV相关癌症和疣的总体风险和发生率。以澳洲为例,HPV疫苗接种已被纳入其国家免疫计划赞助的以学校为基础的举措,广泛接种12至13岁的男孩。

疫苗的使用方式和计量方案是什么?

医师将在您的胳膊、大腿或臀部肌肉上进行9合1加卫苗注射。
计量方案一共是3剂,在理想情况下,这3剂应在6个月内分散注射,例如:如果您今天已注射了第一剂,那么您的第二剂量将在2个月后注射,而第三剂将在第一剂的6个月后。
即使您忘记或延迟您的后续剂量,只要您在12个月以内完成所有3次剂量注射仍然可以实现有效的免疫力。

注射了9合1加卫苗后女性还需要进行宫颈抹片检查(PAP Smear)吗?

是的。虽然9合1加卫苗比旧款疫苗更覆盖了更多的HPV病毒株,但它仍然不能覆盖所有致癌的病毒株,而这其中就有7种。请记住,已知晓能导致癌症的HPV病毒株有15种,或许还有更多是我们还不知道的呢!
宫颈抹片检查应至少每三年进行一次,若您的检验异常,您的医师可能会建议您每6-12个月复查一次以便进行更密切的监测。
若您有意注射HPV疫苗或想了解更多相关信息,请联系我们在新加坡与马来西亚的诊所。
新加坡诊所
马来西亚诊所

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

What is HIV PrEP?

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

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

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

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

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

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

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

What is Event Driven Based HIV PrEP Strategy?

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

Descovy As New HIV Medication For HIV PrEP

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

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

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


Other Reads:

  1. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  2. The HIV Proviral DNA Test can be done 10 days post exposure.
  3. Weak Erection? Erectile Dysfunction? How to Improve Erection with Pills
  4. HPV Infection & HPV Vaccination for Men who have sex with Men
  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

Anonymous HIV Testing + Emotional Support + Community Outreach

Getting an HIV test can be a scary affair for most people in the community.
Besides the stigma that is associated with HIV & AIDS, there is also the anxiety that comes along with knowing your HIV-status. This is definitely overwhelming for many of us.
Not forgetting the 20 minutes agonising wait for your HIV test result that seems forever.
Dr. Tan & Partners & Oogachaga have teamed up to provide Anonymous HIV testing & emotional support for the community in a discreet and confidential environment in our Robertson branch every first Friday evening of the month.

Dr. Tan & Partners  @Robertson is a Minister of Health of Singapore approved HIV test site for Anonymous HIV Testing.

Oogachaga is a community-based, non-profit, professional organisation working with lesbian, gay, bisexual, transgender, questioning and queer (LGBTQ+) individuals, couples and families in Singapore since 1999

Anonymous HIV Testing

Anonymous HIV testing is for local or foreign individuals who would like to get their HIV test done, but prefer not be identified.
Hence, we do not collect your NRIC or passport numbers, address or contact numbers during registration.
Both negative and positive HIV result is kept anonymous and confidential.
If you suspect that you have any HIV signs & symptoms or have questions in regards to HIV window periods, you can chat with our open – friendly doctors on all STD/HIV related medical concerns.
All HIV tests are administered by our doctors in our STD clinic.

Emotional Support

While waiting to see our doctor, or after the doctor has administered the Anonymous HIV test, you (or your partner) may request to talk in private with the professional counsellor from Oogachaga for free. No additional charges will be added to your medical bill.
The counsellor can offer you guidance on other non-medical issues related to your sexual health concerns or other personal problems. Oogachaga has been working with (LGBTQ+) individuals, couples and families in Singapore since 1999.
Sometimes, it helps to be able to chat with someone to take your mind off the HIV test.

How to go about it?

Step 1: Reception

Let our friendly staffs know you need an “AHT test”.  No appointment required.

Step 2: See a Doctor

A doctor will have a private consultation with you & administer the HIV test.

Step 2-A: Chat with Counsellor

Instead of waiting alone, you can choose to speak to the counsellor, who is LGBTQ-friendly before or after you see our doctors.

You can ask the counsellor questions about HIV/ STIs, or have a chat about coming out, relationships, sexuality, safer sex…..

(The session will be kept confidential, even from the doctor, if you wish)

Step 3: HIV Test Result & Review

After 20 mins, your HIV test result will be ready & the doctor will review the result with you.

When is it available?

If you wish to speak to the counsellor please visit us Every first Friday evening (6 pm – 9 pm) of the month at out Robertson Branch
Anonymous HIV Testing is available daily from 8 am – 9 pm on weekdays and 9 am to 2 pm on weekends at our Robertson branch.
There are no additional medical charges for speaking to the counsellor from Oogachaga. The medical bill only includes your HIV test and doctor consultations.
No appointment is required.

X.O.X.O
Dr Jonathon Ti


Other Interesting Reads:

  1. An Overview of STD – From an STD Doctor
  2. Top Travel Tips for People Living with HIV
  3. 4 Penile Health Tips
  4. An Overview of Gonorrhoea
  5. What is the Treatment for Cold Sores? What causes Cold Sores?
  6. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  7. Syphilis Symptoms (Painless STD Sores & STD Rashes)
  8. What You Need to Know about Prostate Massage
  9. 10 Ways to Improve Sexual Performace for Men
  10. HIV PrEP for Travel