Responsible Drinking Over The Festive Season

It’s the most wonderful time of the year.. 

Happy holidays to one and all! While it is the season to be jolly, it is also the season where one may tend to consume too much alcohol. It is important to keep in mind not to drink too much. Excessive alcohol intake in one sitting can lead to intoxication, impaired judgement and negative physical behaviour such as drink driving and unsafe sex. Chronic alcohol overuse can lead to an increased risk of liver disease, some cancers, unintentional injury and social problems. 
 


How much is too much?

​​​​​​​If you drink alcoholic beverages, do so in moderation. According to Singapore’s Health Promotion Board (HPB), women should limit themselves to one standard drink a day and men to two standard drinks a day. A standard drink contains 10 grams of alcohol, and is equivalent to:

  • 330 ml (one can) of beer (158 kcal)
  • Or 100 ml of wine (140 kcal)
  • Or 30 ml of hard liquor (89 kcal)

 


Alcohol and Cardiovascular health

There is a paradox regarding alcohol and cardiovascular health. It is true that alcohol in low to moderate amounts has a cardioprotective effect. However, excessive alcohol intake can cause high cholesterol and high blood pressure, leading to an increased risk of heart attack, heart failure and stroke. In men, erectile dysfunction can sometimes be the first sign of impending cardiovascular problems.
 


The Asian flush

The dreaded Asian flush, the bane of many and frequently a source of embarrassment. To understand why some people turn tomato red after just a few alcoholic beverages, we first need to understand the basic chemistry of alcohol metabolism.
Alcohol or ethanol is broken down initially by the enzyme alcohol dehydrogenase into acetaldehyde, a highly toxic compound that contributes to the hungover feeling. In most people, acetaldehyde is subsequently converted by the enzyme aldehyde dehydrogenase into harmless acetate and water. 
Approximately 70% of East Asians (Han Chinese, Japanese and Korean descent) have a mutated or altered form of the aldehyde dehydrogenase 2 (ALDH2) gene. This causes reduced activity of aldehyde dehydrogenase, therefore such people take a much longer time to completely digest alcohol. As more toxic acetaldehyde circulates in the body, it leads to facial flushing and other symptoms such as headache, lightheadedness, nausea and palpitations. In other words, if a person experiences the Asian flush, it is the body’s way of signalling to stop drinking and start hydrating instead. 
 


3 common facts about drinking alcohol

Fact 1: Women have a tendency to get drunk faster than men.
 
This is true. A woman’s body typically takes longer to process alcohol. This is because women have a different fat-to-muscle ratio and a smaller blood volume than men. Women also have lower levels of the enzyme alcohol dehydrogenase, which begins the initial metabolism of alcohol in the stomach. Hormonal changes during a woman’s menstrual cycle can also affect alcohol absorption.
 
Fact 2: Alternating with non-alcoholic drinks will help to slow down alcohol absorption.
 
This is true. Drinking slowly or alternating with non-alcoholic drinks such as water, soda water or diet cordials will reduce the rate of alcohol consumption and also slow down alcohol absorption.
 
Fact 3: Drinking more non-alcoholic drinks after alcohol consumption will help to cure a hangover.
 
This is true. A person who is having a hangover is likely to be dehydrated and deficient in electrolytes such as sodium and potassium. Drinking plenty of water, sports drinks or coconut water can help to replenish the fluids and electrolytes, and helps to speed up the recovery from a hangover.
 


3 common myths about drinking alcohol

Myth 1: Mixing different types of alcoholic drinks gets you drunk quicker. 
 
This is false. The level of alcohol in one’s blood is what determines the likelihood of a person to get drunk. Therefore, the type of alcohol or mixing different types of alcohol does not make a difference. What is more important is the amount of alcohol being consumed. Drinking a lot of any type of alcohol can lead to dehydration, intoxication and a nasty hangover.
 
Myth 2: Eating oily food before consuming alcohol will help keep one sober.
 
This is false. Drinking on a full stomach only delays the rate of absorption of alcohol into the bloodstream, as the fat content in oily food helps to coat the stomach lining. However, it does not prevent one from eventually getting intoxicated if the alcohol intake is high.
 
Myth 3: Taking a cold bath or drinking hot coffee will help one to sober up.
 
This is false. While showers, fresh air and hot coffee or tea might feel a little refreshing, none of these things will help to sober a person up. Only time can help a person to sober up. It takes the body approximately one hour to eliminate the alcohol from one standard drink. 
Coffee contains caffeine, a stimulant that helps one feel more alert and awake. It does not speed up the process of alcohol metabolism. You may mistakenly think that the hangover has resolved, but when the effects of caffeine fade, extreme lethargy starts to kick in, which can result in potentially fatal consequences while driving or operating machinery.
 


Tips for responsible drinking and avoiding getting drunk

 

  • Learn to say no. Do not be influenced by your friends or social circumstances. Focus on socialising and conversing with friends instead of drinking.
  • If you must drink, drink slowly and do not treat alcohol as a thirst quencher.
  • Avoid engaging in drinking games.
  • Always stay hydrated and alternate your drinks with non-alcoholic drinks such as water, soda water or diet cordials.
  • Avoid pre-mixed drinks with added sugars, or mixing alcohol with energy drinks as they can be higher in calories.
  • Never drink on an empty stomach. A light and nutritious snack or meal before a drinking session can help slow down alcohol absorption.
  • Avoid salty food as they can make you thirsty and reach out for more drinks.
  • Light beer and wine spritzers have a lower alcohol and calorie content and are good ways to reduce overall alcohol intake.

Therefore, the next time you raise that wine glass during your round of merrymaking, please think about regulating your amount of alcohol consumption, and drink responsibly. 
Cheers!
 


 

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性传播感染 (STDs)

大家好,今天黄医生想谈的是性传播感染也有些人称之为性病。

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

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

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


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

如有必要,请去看医生进行定期筛查和治疗。和他谈谈接种肝炎和HPV疫苗。


如果您怀疑自己有任何高风险的艾滋病毒感染,请告诉我们的医生。

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艾滋病 (HIV) 的症状与治疗方法

大家好,今天黄医生谈谈艾滋病感染的症状。

HIV症状取决于个体和疾病阶段。

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


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

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


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

即使您遇到上述症状,除非您接受检测,否则无法确认HIV。


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

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HIV / AIDS: The Differences & Myths Surrounding Them

HIV & AIDS in Singapore

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

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


How does HIV progress to AIDS? 

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


Who should test for HIV?

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


Are you at risk?

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

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

What are some of the HIV tests available?

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

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

It is especially useful in the following situations:

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

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


Can you share the 4 most common myths about HIV? 

1. HIV is a death sentence. 

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

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

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

3. HIV can spread through mosquito bites. 

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

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

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


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

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

Speak to our doctors for professional advice or if you wish to find out more information on HIV and AIDS.
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Rectal Douching and Associated Infection Risks

Similar to vaginal douching, rectal douching or anal douching is not something that many people talk about it polite circles. It is commonly practiced by Men-Who-Have-Sex-With-Men (MSM) who receive anal sex. Let’s face it, generally we don’t want our loved ones to have to deal with our faeces while having anal sex. However there is a growing concern about the practice of performing anal douching and its associated risk of STI including HIV infection.
Other Read: Anal Pap Smear for Anal Cancer.
 

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A recently published systematic review (essentially this means that the study involves gathering all published studies on a subject and compiling the findings together) in the journal Sexually Transmitted Infections (May 2019), there is evidence to suggest that anal douching can potentially increase the risk of STI and HIV infection among MSM. In the systematic review, it included a total of 28 studies looking at anal douching and the risk of STI/ HIV in MSM population around the world (46% from US, 35% from Europe and the rest from South America, Asia and Africa). 
Also Read: STD Risk From Receptive Unprotected Anal Sex In Men
 


The findings show that men who perform anal douching compared to those who don’t have a 2.8 times higher risk of HIV and close to 2.5 times higher risk of any other types of STIs (Hepatitis B, Hepatitis C, chlamydia, gonorrhoea, syphilis and HPV). With respect to specific STIs, the study found that anal douching increases the risk of chlamydia and gonorrhoea by up to 3.25 times and 3.29 times for Hepatitis B Virus and Hepatitis C Virus.
It is theorised that possible reasons for the association of anal douching with increased risk of STIs and HIV may be due to:

  1. Water and/ or soap causes the delicate lining of the rectum and intestines to become damaged.
  2. Removal of normal flora (bacteria that normally is found in the rectum) due to the action of flushing
  3. Risk of transmission of STIs and HIV through the sharing of douching devices much sharing of needles for IVDU. 

 


The authors also noted that further studies will be needed to further elucidate this association between anal douching and STIs and HIV infection.
Speak to your doctor if you have any questions regarding the associated infection risks from rectal douching or anal douching.
 


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World AIDS Day 2019 Press Statement

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


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


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


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


Dr. Julian Ng

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

Cytomegalovirus (CMV): Risks, Symptoms & Treatment

What is Cytomegalovirus?

Cytomegalovirus (CMV) is an extremely common virus which is part of the herpesvirus family. There are various different strains of CMV. CMV infection seldom causes any symptoms in healthy individuals. Infected individuals carry the virus lifelong but it remains suppressed by the immune system in healthy individuals and they have no long term health complications. 
However, CMV can cause symptoms and potentially dangerous, even life-threatening illness and complications in individuals with weakened immune systems, such as infants whose immune systems are not fully developed, or individuals on immunosuppressive or chemotherapy and individuals with poorly controlled HIV. 


How common is CMV?

According to the US Centers for Diseases Control and Prevention, almost one third of children will be infected by CMV by age 5, and more than half of adults will have been infected by the time they reach age 40. 


How is CMV spread?

CMV is transmitted through body fluids like blood, semen, vaginal fluids, saliva, urine and breast milk. 
Transmission can occur when infected bodily fluid comes into contact with someone’s mucosa e.g. the eyes, lining of the mouth, or through sexual contact. An infected individual can transmit the virus during periods of activation- when it is not adequately suppressed by one’s immune system. Other modes of transmission include vertical transmission from mother to infant before or during birth, or through breastfeeding. One can also acquire CMV through blood transfusions or organ transplants. 


What are the symptoms and possible complications of CMV?

In most healthy individuals, CMV may not cause any symptoms at all. However, during the initial infection, some individuals may experience symptoms of fever, fatigue, myalgia (muscle ache), swollen lymph nodes and a sore throat. These symptoms are very similar to that of infectious mononucleosis or glandular fever. In healthy individuals, reactivation of the virus very rarely occurs as the immune system keeps it in check. 
In immunocompromised individuals, CMV can affect and cause symptoms involving various organs including the eye, liver (hepatitis), and the gastrointestinal tract (esophagus, stomach, intestines). 
CMV infection during pregnancy can lead to severe consequences for the unborn infant – infants who are infected during pregnancy (known as congenital CMV) may have problems affecting various organs including the brain, ears, liver, and lungs (see below for more on congenital CMV). 


What is congenital CMV? 

Congenital CMV occurs when CMV is transmitted from a pregnant mother to her unborn foetus during pregnancy. This can occur if a pregnant woman has a primary (new) CMV infection, or is reinfected with a new strain of CMV, or if she suffers a reactivation of a preexisting CMV infection. The risk of severe complications is highest if infection occurs during the first trimester of pregnancy.
Some of the effects of congenital CMV infection are apparent at birth. This includes possible jaundice, hepatosplenomegaly (enlargement of the liver and spleen), inflammation of the eye retina (retinitis), seizures, microcephaly (small head) and low birth weight. 
Some complications can be long term/life-long, including hearing and vision loss, intellectual disability and seizures. 


Who is at risk of CMV?

CMV can cause serious health problems in susceptible individuals: 
1) Infants who are infected during pregnancy (congenital CMV)
2) Infants born premature or with very low birth weight
3) Immunocompromised individuals e.g. organ transplant recipients or individuals with HIV. 


CMV and HIV

Not all individuals with HIV are at risk of CMV disease. Only individuals with a low CD4 (T cell – a form of immune cell) count are at risk. This usually occurs only if they are not on, or have failed to respond to antiretroviral therapy. Either re-infection with a new strain of CMV, or reactivation of an existing CMV infection can result in symptoms. 
The most common manifestation is CMV retinitis – inflammation of the retina of the eye, resulting in visual disturbances or visual loss. CMV can also cause inflammation of the esophagus (esophagitis), resulting in symptoms like pain on swallowing, and inflammation of the colon (colitis), causing diarrhoea, abdominal pain and weight loss. 
In rarer cases, CMV can affect the brain and nerves, causing symptoms like dementia, confusion, numbness and weakness. 


How does one test for CMV?

In symptomatic adults, antibody blood tests can be used to diagnose CMV infection. Other special tests may be necessary to determine organ involvement if there are symptoms to suggest this.
For infants with CMV, a urine or saliva sample is usually used to test for infection. Testing for congenital CMV has to be done within 3 weeks after birth. 


What is the treatment for CMV infection?

Healthy individuals with no symptoms do not require any treatment for CMV. However, in immunocompromised individuals who develop symptoms or in cases of congenital CMV infection, anti-viral medications can be used to treat and suppress the virus. In individuals with HIV, adherence to antiretroviral therapy and maintaining good CD4 counts is crucial. Treatment with anti-virals against CMV is not recommended unless there is evidence of CMV disease affecting an organ (end-organ disease). 
Speak to our doctors to find out more about Cytomegalovirus (CMV) and it’s available testing or treatment options.
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Common Causes Of Bumps & White Spots On Penis & Foreskin

This situation may be familiar to many men: while taking a shower one day, you happen to notice some white spots on your foreskin. You do a double take as you lean down to inspect your manhood. What could it be? How long have they been there? The questions are aplenty as you instinctively reach for your smartphone to begin a Google search.

There are many conditions that can cause white spots to develop on the penis and foreskin. Some men may be born with them, while others may develop them as a result of poor hygiene practices or sexually transmitted infections (STIs). It is important to know what the white spots are due to, as not all conditions require treatment. Listed below are some common causes of white spots on the foreskin and penis.


Pearly Penile Papules

Pearly penile papules (PPP) are small, dome-shaped or projection-like bumps that are located just below the head of the penis, usually arranged in a neat row. They can be white, flesh-coloured, yellow or translucent in colour. They do not cause any pain or itch. PPP is considered as a normal variant of the male penile anatomy, and are harmless bumps. It is not cancerous and there is no cancer risk. It is not a sexually transmitted infection and is not contagious. It is common and can occur in up to 38% of young men up to age 25.

PPP can be left alone and does not require treatment. However, for men who find them unsightly, they can be removed. Treatment options include laser therapy, cryotherapy and electrosurgery. 

READ: What are Pearly Penile Papules?


Fordyce Spots

Also known as Fordyce glands, these are harmless, small white or yellow bumps that are found on the foreskin. They are basically enlarged sebaceous glands, and can occur alone or in clusters. They do not cause any pain or itch. Fordyce spots can also commonly occur on the edges of your lips or on the inside of your cheeks.

Just like PPP, Fordyce spots are not cancerous and infectious, and also does not require treatment. Similarly, they can be removed if men find them unsightly. Treatment options include topical retinoid cream, oral isotretinoin, laser therapy and electrosurgery. 


Tyson’s Glands

Also known as preputial glands, Tyson’s glands are modified sebaceous glands that are found on the inner surface of the foreskin. They occur in pairs and are located on either side of the frenulum. These glands are also present on the hood of the clitoris in females. Tyson’s glands are normal structures and do not require treatment.  


Skin Tags

Skin tags are small, soft, flesh-coloured growths on the skin. They usually have a stalk and hang off the skin, and can vary in size from a few millimetres up to several centimetres. They tend not to grow on the penis itself, but rather, around the groin and scrotum. They often grow in areas where the skin folds and rubs against itself, and as such they are often also found on the neck, armpits, eyelids and under the breast. They affect men and women equally. Obesity, diabetes and pregnancy can increase the chances of occurrence.

Skin tags are benign tumours of the skin and do not require treatment. Occasionally, they may fall off on their own. People often wish to get them removed for aesthetic reasons, or if the skin tags are large and get in the way. Treatment options include cryosurgery, electrosurgery, ligation and excision.  

READ: Skin


Balanitis

Balanitis is inflammation of the foreskin and head of the penis. Spots can appear on the penile head or foreskin, and can be white or reddish. Other symptoms include redness, pain, itching, discharge, swelling and difficulty with retraction of the foreskin, and sometimes pain when passing urine. 

Balanitis can affect as many as 1 in 10 males, and can occur at any age. It is more likely to occur in uncircumcised men. The most common cause of Balanitis is a bacteria or fungal infection, or a combination of both. This can result from inadequate personal hygiene and/or phimosis (tight foreskin). There are non-infectious causes for balanitis as well. Risk factors for recurrent balanitis include diabetes, HIV and other sexually transmitted infections. 

To investigate balanitis, your doctor may perform swab tests to identify the responsible organism. Treatment involves topical and/or oral anti-fungal and antibiotics. The long term solution to balanitis is a circumcision.

READ: Causes, symptoms and treatment of Balanitis.

Pimples

Pimples develop as a result of the pores of our skin being blocked by dead skin cells, sebum and other debris. The sebaceous gland continues to produce sebum and build up under the blockage, allowing bacteria to grow in the area, resulting in inflammation, infection and pain. They can occur anywhere on the body, including the penis.

Pimples can be left alone and usually resolve on their own without treatment. It is important to resist the urge to pop the pimples as this may lead to superimposed infection, scarring and hyperpigmentation. However, they may end up self erupting and discharge small amounts of pus. Treatments for pimples include topical over-the-counter creams such as benzoyl peroxide, antibiotic creams and, if more severe, oral antibiotics.

READ: Skin


Folliculitis

Folliculitis is an inflammation or infection of the hair follicles. It can occur anywhere on the body, including the penis, where it is frequently seen at the shaft or base of the penis, or the pubic area. Folliculitis tends to result from shaving, waxing or chafing of the hair follicles. The damage to the hair follicles allows bacteria to enter. Sometimes, ingrown hairs can also occur from hair removal treatments, eventually leading to folliculitis as well. Folliculitis can be painful and/or itchy. Treatment options include topical and/or oral antibiotics. 

READ: Common causes of penile itching and pubic itching


Genital Warts

Genital warts are caused by the Human Papillomavirus (HPV). HPV is the most common sexually transmitted infection and can be spread via vaginal, oral or anal sex. They appear as flesh-coloured growths over the genitals that can cluster and resemble a cauliflower. Most of the time they do not have any symptoms but can sometimes itch. Bleeding can also occur during sexual intercourse. 

READ: Causes, symptoms and treatment for Genital Warts
READ: How to get rid of Genital Warts

Left alone, the warts can remain the same or increase in size and number. They will disappear once the body has shed the virus completely, typically over a course of 1 to 2 years. Treatment options include topical medications such as imiquimod, cryotherapy and electrosurgery. Vaccines are available to help prevent HPV infection, consider getting a HPV vaccination. 

READ: HPV Vaccination For Men
READ: Rapid HPV Testing

Genital Herpes

Genital herpes is caused by the Herpes Simplex Virus (HSV) and is a sexually transmitted infection. Itching of the penis is usually the first symptom, and can occur in other areas such as the scrotum, groin, buttocks and anus. Shortly after, tiny clusters of painful blisters develop, which can then rupture and form shallow ulcers with crusts. Other symptoms include painful urination, enlarged groin lymph nodes, fever and body aches. The virus can lie dormant in the body for years without causing any symptoms, therefore some people may not even be aware that they are infected. 

Genital herpes can be diagnosed via swab testing of the lesions. When there are no symptoms, no treatment is required. Flares can be treated with oral and topical antiviral medications. There is unfortunately no cure for genital herpes, as the virus will permanently remain in the body.

READ: Rapid Herpes Testing

Molluscum Contagiosum

This is a benign infection of the skin caused by the Molluscum Contagiosum virus, resulting in painless, small, shiny pearl-shaped lesions. They can happen anywhere on the body as a result of physical contact, but when they occur on the genital area, it is usually as a result of sexual contact. The virus is thus spread via sexual contact, or even to another part of the person’s own body, from scratching the lesions and touching another part of the body. They can appear alone, or in clusters. They usually do not cause any symptoms, but can sometimes itch. 

Left alone, the lesions will eventually disappear once the body has shed the virus completely, typically over a course of several months to a year. Treatment options include topical medications such as salicylic acid, cryotherapy, laser therapy and curettage.

READ: Everything you need to know about Molluscum Contagiosum

In conclusion, do not panic if you notice white spots on your penis, as not all white spots require treatment.  Speak to your doctor for advice on white spots or bumps and request for an examination. 

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Movember: 13 FAQs On Mental Health And More For The Community.

Mental Health Don’t Discriminate.

As part of the Movember series on Mental Health & Suicide Prevention awareness, Dr Tan & Partners (DTAP Clinic) has team-up with the counsellors in Oogachaga to come out with 13 FAQs on Mental health and other health concerns for all the Men in the community!

The Questions are from Counsellors of Oogachaga. The Answers are from Doctors in DTAP Clinic in Singapore & Malaysia.


Q1: What can I do to maintain a good mental health status?

Dr Taufiq: There are many ways one can do this. Let me list a few and elaborate a bit on them.

  • Share your feelings – talking about how you feel is a good form of release and prevents you from bottling up your feelings only for it to affect you negatively later on.
  • Be physically active – Exercising and being active improves blood flow and release endorphins which helps to promote a positive mood.
  • Eat healthy – Clean and healthy food keeps your body healthy. With a healthy body, you can stay mentally healthy too.
  • Ask for help – if you have come to a point where you are not sure of what to do or how to control your emotions, seek help. Oogachaga has professional counsellors that can help you with your issues.

Q2: My anxiety often keeps me awake at night and I find myself irritable and moody the next day. How can I work on my sleeping schedule?

Dr Taufiq: To improve sleeping schedule you need to practice good sleep hygiene. Here are some tips:

  1. Have a regular routine that you do before sleep like brushing your teeth, drinking water etc.
  2. Avoid watching tv in bed. The bedroom should be reserved for sleep and sex only.
  3. Don’t take caffeinated drinks before you go to bed.
  4. Fix a time at which you go to bed.

#DidYouKnow: In generalised anxiety disorder, feelings of anxiety overwhelm and affect one’s daily functioning and life….

Posted by Dr Tan & Partners on Tuesday, May 28, 2019
8 Ways to Cope with Anxiety

Q3: Do I have to come out as bisexual if I don’t have a partner of the same gender?

Dr Taufiq: Try not to be too worried about labels. If you are not partnered right now, it’s a good time to focus on yourself. Pick up a new hobby, learn a new skill, socialize, make new friends. When the right person comes along then it is good, if not you will still be able to live the best life that you can.


Q4: It’s stressful to hear my colleagues say nasty remarks about the queer community. How can I manage to work in a homophobic environment and maintain good relationships with my colleagues?

Dr Taufiq: You need to establish whether your superior and your company is LGBTQ friendly and open to all sexuality. If they are, then speak to your superior to share how you feel about the situation. See if he or she can find a way to make the work environment more comfortable for all. Your superior may also be able to mediate the discussion between you and your colleagues to talk about this issue and clear up misconceptions and unhappiness.

However, if the workplace or your superior is not LGBTQ friendly or open to discussion, then it might not be wise to approach them to talk about this. I suggest speaking to a counsellor from Oogachaga to find out how best to deal with such situations.

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Q5: Is being gay a mental illness or an emotional problem?

Dr Julian Ng: Being gay is NOT a mental illness or an emotional problem. A gay person is simply a male who has a romantic interest in another male, just like heterosexuals who have a romantic interest in the opposite sex.

Just like how someone may like someone with long hair or a great smile or a good sense of humour while another person may prefer other characteristics, being gay is NOT something that one can change or have control. It is simply a difference in interest.


Q6: Why do people attempt suicide when they appear to feel better?

Dr Julian Ng: Some people attempt suicide because they have lost hope while others simply want to stop the pain. Sometimes they hide away their pain so that their loved ones would not worry. We have also heard of cases where someone has already made up their mind but just wants to spend their final hours with their loved ones with the thinking that at least their loved ones will have that final happy memory to remember them by. 

In addition, some may feel better when they are in the company of their loved ones/ friends but when they are alone, the sense of loneliness/ hopefulness comes back.


Q7: I am currently in a heterosexual relationship, can I still identify as bisexual?

Dr Julian Ng: Definitely! Just because you are in a heterosexual relationship, it doesn’t change your sexuality. Sexuality is the emotional, romantic, and/or sexual attractions with whom you build your relationship with.


Q8: How do I know if I am feeling depressed and need to seek help?

Dr Guna: It’s common for one to feel down at times but if you feel hopeless and it just won’t go away, you may have depression. Depression symptoms vary from one to another but in general, you will be able to identify some of them.

Common symptoms of depression are:

  • Loss of interest in daily activities – You have stopped feeling joyful and do not find pleasure in things you used to.
  • Feelings of helplessness and hopelessness – you will start thinking that nothing is going to make anything better, in fact, you might not even try.
  • Anger or irritability – your usual threshold level is no longer high. Anything and everything will make you agitated.
  • Appetite or weight changes. Significant weight loss or weight gain
    Self-loathing. You harshly criticize yourself and blame every mistake on you.
  • Sleep changes. Either insomnia, with frequent early awakenings, or oversleeping.
  • Loss of energy– You would feel you body has been glued to the ground. Too tired even for small activities such as having breakfast or even bathing.
  • Reckless behaviour – You will want to live life dangerously or they would say YOLO!
  • Concentration problems– Trouble focusing, making decisions, or remembering things.
  • Unexplained aches and pains. 

You will need to seek help when you think something is definitely off in your lifestyle. No one will know better about you other than yourself. Despite trying some life modifications, meditations and everything in the book, if you still notice things are not getting better, then it is time to seek professional help. 

Depression is an illness that falls under the category of mood disorders. Unlike the normal mood changes or occasional…

Posted by Dr Tan & Partners on Friday, May 3, 2019
5 Ways to Fight Depression

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Q9: What can I say to medical professionals who have misgendered me?

Dr Guna: Misgendering is on the rise. Whilst some are on an adventure figuring out themselves, they too have to deal with the public that may unknowingly misgender them. So what should you do? Should you just lash out and scream, ITS MA’AM or just let it slide? Here are some tips for you!

You may consider the following if you would like to correct them:

  • Is it going to be a one-off meeting? If it is, it might be better to save your saliva. Think about it, why waste your time with one person. 
  • How are they going to react? To be honest, there are still some aggro dude bro doctors out there. They might react in the weirdest way possible. So, save yourself some trouble.
  • Your emotional capacity. This is the most important step. If you have reached your BS level for the day, just go with it. If you can rectify the mistake, why not! Make them understand that you have found yourself and you will be pleased if they can stop misgendering you!. 

Despite being in the future, some still go through hard times in the doctor’s office, especially when they are being called with their “dead” names. 

It’s vitally important for trans people to get the healthcare they need while being treated fairly and with respect. Discrimination against trans people in medical offices and hospitals occurs on a daily basis and not many know this. However, many of these people are standing up for themselves and taking action so other trans patients don’t have to suffer through the same ordeal in the future. 

In the end, the choice is always up to you. Some would love to guard their mental health and emotional capacity very carefully. For others, it might be the opposite. It’s really a personal choice and it’ll have to be your decision. Good luck!

For a  better counselling on how to handle such situations, you may look for Oogachaga. This 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. 

Oogachaga

Q10: Is it possible for me to get pregnant even though I am on hormone replacement therapy (HRT)?

Dr Guna: HRT generally means taking medications to stimulate certain types of hormones. One of them being testosterone. Testosterone greatly reduces your ability to become pregnant but it does not completely eliminate the risk of pregnancy. Transgender men can become pregnant even while on testosterone. Being said that, if you are sexually active, you do have chances of getting pregnant.  If you think you may have become pregnant, stop your hormone therapy and see a doctor soon as testosterone can endanger the fetus. 

If you do want to have a pregnancy, you’ll have to stop testosterone treatment and wait until your doctor tells you that it’s okay to start trying for a little one.

You should bear in mind that taking testosterone will definitely reduce the chances of one to get pregnant. So, do plan ahead. There are a variety of options from IVF to surrogacy. You also have the option of egg freezing which you can consider prior to starting the hormone therapy. All these options have a high price range, so always plan ahead! 

You can also visit any fertility centres for a better explanation regarding your fertility status. 


Q11: I identify as a transgender man and have not gone for gender-affirming surgery. I find it hard to use male toilets in public and in work for fear of being outed. What can I do?

Dr Guna: This is a very tricky question as many opinions and suggestions are made available out there. To be very honest with you, no one should ever tell what should you do. You first must be comfortable with yourself for you to be comfortable in public. It’s not going to be easy to be out of your comfort zone whilst the public is continuously judging you. 

In Malaysia, back in 2018, Deputy Minister in the Prime Minister’s Department Fuziah Salleh, has urged the transgender community to use the disabled toilets if no unisex toilets are available nearby. This is something to ponder on. Let’s face it, some transgender male, are afraid of using the males toilet as they are worried they might be physically abused, which has happened many times. If they have decided to use the female toilets, the female users might fear for their safety. What much can the transgender community do if they are not given a chance to even breathe properly? 

Another option that I would suggest is, get in touch with your local support group. Discussing matters such as this will help you figure out some better and brilliant ideas as most of them would have pretty much gone through similar things in their life.


Q12: How can I deal with my mental health without the use of medication?

Dr Julian Hong: Top 5 Tips!

  1. Speak to your doctor, get a thorough assessment, sometimes some conditions require medications for treatment and sometimes you can work with your trusted healthcare professional to aim to wean down the medications.
  2. Speak to a counsellor/psychologist.
  3. Get support from your close friends or family, do not be afraid to reach out!
  4. Pick up a new hobby or create an exercise plan – exercise is known to prevent and also help reduce the occurrence of mental health conditions.
  5. Always remember you are not alone and help is but a phone call away!

Q13: Is talking about suicide a bad idea and might be interpreted as an encouragement?

Dr Guna: This question is one of the most famous myths around. People who take their lives don’t want to die, they just want to stop hurting. Most suicidal individuals give ample warning signs or signals of their intentions. Recognizing these warning signs and knowing how to respond when you spot them is the best way of prevention. You can always play a role in suicide prevention by pointing out the alternatives. Showing that you care will help them immensely. If all else fails, getting a doctor or psychologist involved will the best option. 

Suicide warning signs include:

  • Feelings of helplessness, hopelessness, and being trapped. The belief that things will never get better or change
  • Talking about suicide – such as “I wish I hadn’t been born,” “If I see you again…” and “I’d be better off dead.”
  • Seeking access to objects that could be used in a suicide attempt
  • Unusual focus on death, dying, or violence.
  • Feelings of worthlessness, guilt, shame, and self-hatred.
  • Desire to be left alone.
  • Saying goodbye to people as if they won’t be seen again.
  • A sudden sense of calm and happiness after being extremely depressed can mean that the person has made a decision to attempt suicide.
  • Taking unnecessary risks as if they have a “death wish.”

If you are advising a friend that is suicidal, always remember to never say things like: “You have so much to live for,” “Your suicide will hurt your family,” or “Look on the bright side.” Although these are the statements you would want to tell, but there is no point in arguing with them. Always listen to them, and let them speak. Do not interrupt them. Never say suicide is wrong. They know it’s wrong and that’s why they are seeking help. If you think you have no idea how to handle such a situation, help by directing them to a support group. 

Dr Julian Hong: Talking about suicide does not cause suicide. In fact, when it is out in the open, you get to find support and even address the root cause of the suicidal thoughts which more often than not needs a medical evaluation.

Figures from Samaritans of Singapore – In Singapore, Suicide is the leading cause of death for those aged 10-29. There are 2.5 times more deaths from suicide than transport accidents in 2017. 361 lives were lost to suicide in 2017. Males account for more than 66.2% of all suicides in 2017

If you are a loved one who knows of a young person struggling with their mental health, these are some warning signs to look out for (adapted from SOS Singapore)

Talk

  • “My family will be better off without me”
  • “My life is meaningless anyway”
  • “If you don’t love me, I’ll kill myself”

Actions

  • Giving away treasured possessions and saying goodbye
  • Researching suicide methods
  • Writing suicide notes (including emails/diaries/blogs)

Mood

  • Emotional outbursts
    (anger, sadness, irritability, recklessness)
  • Loss of interest
  • Anxiousness or feelings of shame

For immediate help – Call 999 or the Samaritans of Singapore (SOS) at 1800-221-4444 (Both operate 24/7). Stay on the phone with them until someone comes to you. Or, head down to the Accident & Emergency (A&E) Department of the nearest hospital for someone to attend to you.

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Speak To A Professional Counsellor

Speaking to a professional counsellor is helpful as counselling therapy allows the individual to talk about their personal issues and feelings in a confidential, non-judgemental and safe environment.

The counsellor works together with the individual on their issues to help them achieve greater insight into self-understanding, improved relationship with self and others and better control over their life. Counselling provides the individual with different perspectives on their current issues, make sense of past experiences and help them understand how it affects the present, the person they are today.


Oogachaga

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.

They strive forward with a mission to enable lesbian, gay, bisexual, transgender, questioning and queer (LGBTQ+) individuals to make informed decisions that strengthen them and to help them achieve a fulfilling life.

Oogachaga’s team of professional counsellors come from diverse backgrounds, all of whom adopt an LGBTQ-friendly approach that is guided by gay-affirmative practice.

Their services:

  • Hotline, WhatsApp and Email Counselling
  • Professional Counselling
  • Professional Training
  • Corporate Engagement
  • Support Groups

For professional help or counselling, speak to the counsellors at Oogachaga!

For other resources, please see www.congregaytion.com

X.O.X.O



ESWT Treatment For Plantar Fasciitis

Watch as Dr Edwin Ong, Resident Doctor, Dr Tan & Partners (DTAP clinic) talks about ESWT, Extracorporeal Shock Wave Therapy, as an effective treatment for Plantar Fasciitis. Shock Wave therapy is a safe, quick and non-invasive treatment using energy from sound waves to activate the self healing properties of the body and accelerate the recovery process.

What is Plantar Fasciitis?

If you have ever experienced intense pain over the bottom of your heel whenever you wake up in the morning and take your first few steps, chances are that you have had plantar fasciitis.

Plantar fasciitis is the most common cause of heel pain and affects approximately 1 in 10 people at some point during their lifetime. The pain is typically sharp and sudden and usually happens in only one foot, although both feet can be affected at the same time.

Shockwave Therapy: 

  1. Firstly, through a process known as cavitation, Shock Wave therapy stimulates the production of fibroblasts and tenocytes. These are the cells responsible for the healing of connective tissues such as tendons. The end result is tissue regeneration.
  2. Secondly, the Shock Waves stimulate microscopic circulation and therefore metabolism within the treatment area, which promotes healing and the breakdown of calcification deposits, also known as spurs.
  3. Lastly, Shock Wave therapy diminishes pain by over-stimulation of the nerves that send pain signals to the brain.

To conduct the treatment for plantar fasciitis, we place the treatment probe over the affected area and deliver the required number of shocks. The treatment for plantar fasciitis is tolerable. Most patients will need about 2 to 3 sessions each 2 weeks apart. If you are suffering from plantar fasciitis and require treatment for plantar fasciitis, speak to your Doctor and ask if Shock Wave therapy is right for you.

Please call or visit our Siglap Branch or drop us an email at hello@dtapclinic.com for an appointment.