PAP smear Archives

Pap smear – Mengapakah anda perlu ketahui ujian ini?

9th October 2019/in Cancer, Women's Health /by Miri Yeo

Apakah itu barah cervix, HPV dan apakah pemeriksaan yang disyorkan?

Apakah itu ujian Pap smear?

Pap smear (atau ujian Papanicolaou) adalah ujian yang dijalankan oleh doktor untuk mengesan tanda-tanda kanser (barah) cervix. Cervix adalah bahagian antara vagina dan rahim di dalam badan wanita (bahagian bawah rahim).
Semasa ujian Pap smear, doktor tersebut akan memasuki sesuatu alat pemeriksaan bernama speculum yang digunakan untuk menolak tepi belah vagina. Setelah ditolak tepi, cervix dilihat dan sesuatu berus kecil digunakan untuk mengiris sel-sel di cervix secara perlahan-lahan.
Individu yang menjalani ujian Pap smear mungkin akan merasa kurang selesa tetapi biasanya tidak merasa sakit.
Setelah ujian lengkap, sampel akan dihantar ke makmal untuk diperiksa di bawah mikroskope.

Siapakah sesuai untuk menjalani ujian Pap smear?

Semua wanita yang berumur 25 tahun dan ke atas yang sudah aktif secara seksual sepatutnya menjalani ujian Pap smear.
Bagi mereka yang tidak pernah mempunyai keputusan Pap smear yang tidak normal, Pap smear perlu dijalankan sekurang-kurangnya setiap 3 tahun.

Apakah yang perlu disediakan sebelum wanita menjalani ujian Pap smear?

Tidak ada apa-apa yang spesifik yang perlu disediakan sebelum ujian Pap smear.
Wanita yang dalam haid juga boleh menjalani ujian ini. Jika haid terlalu berlebihan, individu tersebut boleh menghubungi klinik tersebeut untuk menukar tarikh temujanji.

Apakah itu barah atau kanser cervix?

Barah atau kanser cervix adalah barah ke-enam paling kerap antara wanita di Singapore. Barah cervix terjadi apabila sel-sel yang normal bertukar kepada sel yang tidak normal yang tumbuh diluar kawalan. Kebanyakan wanita yang mempunyai kanser cervix yang dikesan semasa peringkat awal boleh dirawat dengan sepenuhnya.
Faktor risiko barah cervix yang paling penting adalah jangkitan human papilloma virus (HPV).
Simptom-simptom barah cervix termasuk lelehan berdarah dari vagina yang berlaku di antara waktu haid (bukan semasa haid), selepas hubungan seks atau selepas menopaus.
Penyakit barah ini terbelah kepada beberapa peringkat (awal ke peringkat akhir). Barah ini boleh dirawat dalam beberapa cara termasuk pembedahan. Pembedahan termasuk “radical hysterectomy” atau pengeluaran cervix, rahim dan bahagian atas vagina atau pembedahan pengeluaran semua atau sebahagian daripada cervix – pembedahan ini boleh dilakukan dalam keadaan tertentu sahaja.
Rawatan lain termasuk radiasi dan kemoterapi.

Apakah itu human papillomavirus (HPV)?

HPV adalah virus yang boleh dijangkiti melalui sentuhan kulit, melalui hubungan seks (sama ada melalui vagina, oral atau lubang dubur) atau melalui sentuhan kawasan genital (alat kelamin). Individu tidak boleh dijangkiti HPV melalui sentuhan objek contohnya tempat duduk tandas.
Disebabkan virus ini boleh dijangkiti melalui hubungan seks, jika individu mempunyai beberapa pasangan seksual, risikonya ditingkatkan. Tambahan pula, kondom hanya memberi perlindungan yang tidak sepenuhnya. Pengisapan rokok juga boleh meningkatkan risiko jangkitan HPV sebanyak 4 kali ganda, bersama juga jika individu mengambil ubat yang melemahkan sistem imun atau mempunyai penyakit yang melemahkan sistem imun.

Adakah semua jenis atau strain HPV berbahaya?

Terdapat lebih daripada 100 strain atau jenis HPV tetapi kebanyakan jenis HPV tidak menyebabkan kanser. Lebih daripada 80% wanita akan terdedah kepada virus HPV dalam hidup mereka. Kebanyakannya, system imun badan akan menyingkirkan virus ini secara semula jadi sebelum virus ini menyebabkan penyakit teruk. Tetapi, peratusan kecil wanita akan menghidapi penyakit yang lebih serius seperti kanser.
Terdapat jenis HPV yang berisiko rendah iaitu HPV jenis 6 dan 11 yang boleh menyebabkan penyakit ketuat kelamin (genital warts). Jenis berisiko rendah ini jarang sekali boleh menyebabkan kanser.
Antara jenis HPV yang berisiko tinggi adalah jenis 16 dan 18 yang boleh menyebabkan kanser cervix. Jenis 31, 33, 45, 52 dan 58 juga boleh menyebabkan kanser.

Apakah ujian yang boleh dijalankan untuk mengesan HPV?

Ujian HPV boleh dilakukan pada masa yang sama dengan ujian Pap smear iaitu melalui pengunaan berus kecil yang digunakan untuk mengiris sel-sel di cervix secara perlahan-lahan.
Di clinic Dr Tan & Partners, kita dilengkapi dengan mesin yang boleh mendapatkan keputusan HPV secara cepat iaitu melalui Rapid HPV test. Keputusannya boleh dihasilkan dalam masa 24 jam.

Apakah cara yang boleh mengurangkan risiko seseorang dijangkiti HPV dan barah cervix yang disebabkan oleh HPV?

Vaksin adalah efektif untuk mengurangkan risiko ini dan boleh mengelakkan seseorang daripada dijangkiti 70-90% jenis HPV berisiko tinggi dan juga jenis HPV yang boleh menyebabkan penyakit genital warts. Vaksin tersebut dinamakan Gardasil 9.
Selepas individu menerima vaksin, individu tersebut masih lagi perlu menjalani ujian Pap smear sekurang-kurangnya setiap 3 tahun kerana vaksin tidak boleh mencegahkan seseorang daripada dijangkiti jenis HPV berisiko tinggi yang lain yang tidak dilindungi Gardasil 9.

Siapakah sesuai untuk menerima Gardasil 9?

Vaksin Gardasil 9 diluluskan untuk diberi kepada perempuan yang berumur 9 tahun ke 26 tahun. Bagi mereka yang berumur lebih daripada 26 tahun, penerimaan Gardasil 9 boleh dibincangkan bersama doktor.

Apakah beza Gardasil 9 dengan vaksin HPV yang lain?

Terdapat vaksin yang lain yang dinamakan Gardasil dan Cervarix. Gardasil hanya boleh mencegah jangkitan HPV jenis 6, 11, 16 dan 18 sahaja (16 dan 18 adalah jenis HPV yang berisiko tinggi) dan Cervarix hanya mencegah jangkitan jenis 16 dan 18 sahaja.
Gardasil 9 boleh mencegah jangkitan HPV jenis 6, 11, 16, 18 dan juga jenis 31, 33, 45, 52 dan 58 (31, 33, 45, 52 dan 58 juga boleh menyebabkan barah cervix).

____________________________________________________________________________
Jika anda mengalami simptom-simptom yang disebut di atas dan ingin berjumpa dengan doktor wanita, sila hubungi klinik kita di Dr. Tan & Partners cawangan:
Dr. Tan & Partners @ DUO Galleria
7 Fraser St,
#B3-18 DUO Galleria (Bugis MRT),
Singapore 189356
Nombor telefon +65 6976 5023
Dr. Tan & Partners @ Robertson
11 Unity St
#02-06/07 Robertson Walk
Singapore 237995
Nombor telefon +65 6238 7810
Klinik juga bersedia menerima pesakit tanpa membuat temu janji.

Cervical Cancer, Pap Smear & HPV Vaccination – What You Need To Know

30th November 2018/in Cancer, Genital Warts, STD & HIV, Women's Health /by Miri Yeo

What is Pap Smear?

Pap smear is a cervical cancer screening recommended every 3 years for all sexually active females starting from age 25 years old.

This is a quick, simple and painless procedure that can be done in the clinic and it only takes a few minutes. A brush will be used to collect some cells from the neck of the womb (cervix) and it will be sent to the lab to identify any precancerous and cancerous cells.

Cervical Cancer

In Singapore, cervical cancer is the 3rd leading cause of cancer deaths in women age 15-44 years old.
Cervical cancer risk is increased with :

Multiple sexual partners
Human papillomavirus (HPV) infection
Smoking
Unprotected sex

What is Human papillomavirus (HPV)?

Human papillomavirus (HPV) is one of the commonest sexually transmitted infection. It can affect both men and women.
There are 2 types of HPV – the low risk and high-risk types.

Low-risk HPV can cause genital warts in both female and males. These are flesh coloured growths on the genitals, and they are infectious.
High-risk HPV plays a significant role in the increased risk of cancer, such as cancer of the cervix, vulva, and vagina in women as well as anal cancer in men who have sex with men (MSM)..

The American College Obstetrician and Gynaecologist (ACOG) strongly recommends co-testing using Pap smear and HPV DNA testing (high-risk HPV types) especially for women ages 30-65 years old.
Patients are advised to repeat these tests in 5 years if pap smear and HPV results are negative.
This allows patients to extend their screening interval.

However, for women who test positive for high-risk HPV types, this means their risk is increased and hence, may need to have Pap smear screening at a closer interval, i.e once a year and depending on the results of the pap smear, some may need a referral to a gynaecologist for early intervention.

Remember, women can have no symptoms with an abnormal pap smear and HPV infection. Hence, early detection and screening are crucial as early intervention can be life-saving. Symptoms such as bleeding and pain during sex (postcoital bleeding), bleeding in between periods, heavy vaginal bleeding, and bleeding after menopause are usually late signs of cervical cancer.

The good news is cervical cancer can be prevented through vaccination.

GARDASIL 9 is a vaccine that helps protect against Human Papillomavirus (HPV). Most people infected with HPV show no signs or symptoms, this means they can transmit the HPV virus to others without knowing it in any kind of sexual activity or skin to skin contact.

Gardasil 9 provides protection against 9 major strains of HPV, which includes HPV types 6,11,16,18,31,33,45, 52 and 58 which are responsible up to 90% of genital warts and cervical cancers or precancer changes.

The vaccine, however, does not treat the infection.

It can be given to both females and males from the age of 9 up to 45 years old.
From the age of 9-14 years, 2 doses 6 months apart is recommended while those age 15 onwards, 3 doses will be recommended according to the schedule of 0, 2 and 6 months.
The side effects post vaccination is usually mild and temporary including pain, swelling, bruising over injections site and very rarely may cause fever and nausea.
HPV vaccine reduces your risk significantly but it does not mean your risk becomes zero.

After the completion of HPV vaccination, all women who are sexually active and above the age of 25 should still undergo routine screening via pap smear.

Take Care!

Genital Warts: The Cauliflower-Like Lumps on the Genitals

17th April 2018/in HPV (Human Papilloma Virus), STD & HIV /by Miri Yeo

Genital warts are white or flesh-coloured, smooth, small bumps that can appear anywhere in the general area of the genitals. They can also grow larger and appear as fleshy, cauliflower-like lumps on the genitals. Neither of which are more dangerous than the other, it is merely a characteristic and the stage that the illness was noticed.
Genital warts is an STD symptom caused by the Human Papilloma Virus (HPV).

HPV can cause multiple illnesses in the body as there are multiple strains of the virus attributing to different diseases in humans. Out of the hundreds of known strains of HPV, about 30 strains of the virus cause diseases of the genital area. These include warts, or in more sinister cases, cancer of the anus, cervix, vagina, and penis. Read: Causes of Vaginal Lumps & Bumps & Perianal Warts (Peri-Anal Warts)

Most of the other strains have no known effect on humans.

How do I get infected by the Human Papilloma Virus (HPV)?

Human Papilloma Virus (HPV) is a contagious disease that is transmitted through genital skin contact or through direct contact with genital fluids of a person already infected with HPV.
For transmissible illness such as these, using barrier methods of protection for sexual intercourse such as condoms should be emphasised. However, condoms are not very effective against transmitting HPV just because the HPV virus does not require penetrative sex to transmit the virus.

It can also be transmitted from a mother to an unborn child if the mother has an active HPV infection during the course of the pregnancy.

How do I know I am infected with HPV? How can it be detected?

A majority of people infected with HPV do not realise they even have the virus as it does not present with any symptoms.

Some people will notice bumps or warts around the genital area, otherwise known as genital warts. These usually occur one to three months after initial infection with HPV.

The most sinister manifestation of the HPV disease is cervical cancer affecting women in their 30s or 40s. The simplest way to detect cervical cancer is by identifying if an individual is an active risk of getting the disease and doing regular PAP smears. MOH guidelines are also apparent on the timing and interval for PAP smears for women in the reproductive age group. Sometimes a biopsy of unhealthy cervical looking tissue may be needed.

For men-who-have-sex-with-men (MSM), it is recommended that they do an anal PAP smear to investigate for HPV.

We also provide Rapid HPV Testing (next day result) in all our clinics in Singapore.

How can HPV & Genital Warts be treated?

In most cases, the HPV infection is self-limiting therefore no treatment is deemed necessary.

Unless an individual has issues with antibodies or a weak immune system in general, the body should be able to contain and eradicate the virus from the body in due time.
If an individual has an impaired immune system or a weak immune response, a lingering infection or a co-infection with another sexually transmitted illness can occur.

In cases of genital warts, the treatment options are largely dependent on the severity of the infection. The most common treatment options include creams and paint-on ointments. These induce a state of cell death so warts around the genital will eventually wither and fall off the skin.

Some patients may be offered cryotherapy where the wart is frozen then removed. The wart is frozen prior to that so that there will be no transmission of the wart after.
Apart from the above surgical options for wart removal also exist. This is where a surgeon uses electrocautery or a scalpel and surgically excise warts. See: Genital Warts Removal

Unfortunately, the majority of genital warts or other warts can recur very frequently and is rather common to have warts recur post removal. Sometimes, repeated treatments are required for complete remission, but patients should be aware of the recurrence rates in such an infection.

HPV and Cervical cancer

Some HPV viruses are known as high-risk viruses. This is particularly true in virus strains 16 and 18. This is because it induces changes in the cells in the cervix of a woman and causes cervical if not detected early.

It is in this light that it is recommended that all sexually active women are advised to go for regular PAP smear tests, screen for HPV infections and visit your doctor for HPV vaccination in Singapore.

HPV and PAP Smear

Pap smear is a relatively painless test that can be quickly done. It involves inserting a speculum into the vagina of the patient to allow for inspection then a tool is inserted to obtain scraping. The patient should go back to resume activities of daily living with no hindrance once after the procedure completed by our female doctor.
These scrapings and obtained cells are then examined under a microscope to look for abnormal cells.

We also provide Rapid HPV Testing & Pap Smear in all our clinics in Singapore.

HPV and HPV Vaccination

Human Papilloma Virus (HPV) is a group of virus that can cause:

Vaginal Cancers
Vulvar Cancers
Anal Cancers
Penile Cancers
Oropharyngeal Cancers (cancers of the throat and tongue)
Genital warts or Papillomas

HPV vaccination is used to protect against HPV-related diseases and cancers.
To complete the HPV vaccination, 3 doses of injections will be given. The recommended HPV vaccine schedules are:
First dose: During your doctor visit.
Second dose: 1 – 2 months after the first dose
Third dose: 4-5 months after the second dose

Get More protection with New 9-valent HPV vaccine (Gardasil 9)

There are over a hundred strains of HPV and they are each given a designated number e.g. HPV 6 or HPV 16 or HPV52.
HPV strains that cause warts will NOT cause cancers and HPV strains that cause Cancer will NOT cause warts.

Compared to the older Gardasil, the new GARDASIL 9 offers a wider range of protection against HPV strains.
Both Gardasil and Gardasil 9 give you protection against the cancer-causing HPV 16 and 18 and the wart-causing HPV 6 and 11.
Gardasil 9 protects additional 5 other high-risk types: 31, 33, 45, 52 and 58.
Together these types cause about 90% of cervical cancers.

Another HPV vaccine Cervarix, on the other hand, protects only against the commonest cancer-causing HPV 16 and 18. There is no wart protection with Cervarix.
If you are interested in getting the HPV testing & PAP smear, genital warts treatment or HPV vaccine, please visit our STD clinics and speak to our male and female doctors.
If you or your partner are experiencing any possible signs or symptoms of infection, or have had any potential risk exposures, please see our STD doctors today.
Take Care. Be Safe!

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