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What is HPV infection?
Human Papillomavirus (HPV) is a type of virus most frequently transmitted through sexual contact. HPV can affect anyone who is sexually active, both women and men. It is estimated that 80% of sexually active individuals will get HPV infection at some point in their lifetime. Many people who have HPV may not show any signs or symptoms. They can transmit the virus to others without knowing it.
What type of diseases does HPV cause?
There are many types of HPV virus strains. Those considered as ‘High risk group’ include strain 16,18,31,33,45,52,58. They are responsible for causing >75% of cervical cancer and >50% of vaginal and vulvar cancer in women. In men, they can also cause anal and penile cancers. These high risk HPV strains do not cause genital warts.
Those in ‘Low risk group’ such as strain 6,11 cause >90% of anogenital warts in both genders. Anogenital warts can look like bumps. Sometimes, they’re shaped like cauliflower. These warts may not be visible immediately; they can show up weeks or months after someone has been infected. These low risk HPV strains are not responsible for causing cancers in the genitalia.
In some infected cases, the infection will clear on its own; but when it does not, genital warts, precancerous lesions or cancers can develop and progress. It is not known who will and who will not clear the HPV infection.
Human Papillomavirus (HPV) test is a screening test done for detection of the DNA (genetic materials) of the high risk HPV virus strains (e.g. 16 and 18) in one’s body. With the presence of high risk HPV strains, the risk of cervical cells turning abnormal in the future is higher, which means the patient should then be followed up at a closer interval.
According to MOH guidelines, Human Papillomavirus (HPV) testing is recommended as the primary screening test for women aged 30 years and above who have ever had sex, at a screening interval of 5 years.
For women aged 25-69 years, who have ever had sex, pap smear can be used as the primary screening test once every 3 years.
How is HPV test conducted? – HPV Test Singapore
Sample collection of HPV test is similar to the pap smear screening, where a speculum is inserted to the vagina then samples of the cervical cells will be taken using a soft brush.
It can be done in the clinic under an outpatient setting without any special preparation. It is important to try not to schedule the test during the menstrual period. After the test, one can proceed with normal daily activities.
Depending on the test result, the screening interval for future tests will be decided. If the test result comes back positive, patients will either be advised to go for a more regular follow up or referred for a colposcopy procedure if deemed necessary.
Benefits of early detection
Having a HPV test will allow for early detection of abnormal cervical cells and any early changes of precancerous or cancerous lesions can be picked up at earlier stages before they start progressing.
Early detection saves lives because treatment rendered at earlier stages for abnormal cells is more effective and has a better prognosis as compared to late stages.
Treatment methods for diseases caused by HPV infection
For genital warts, treatment can be either by application of topical imiquimod cream or by cryotherapy applied directly to the lesions.
For precancerous cervical lesions, removal of abnormal parts of the cervix can usually be done through laser excisional surgery (LEEP). Surgery, chemotherapy and/or radiotherapy may be needed for more advanced stages of cervical cancer.
Prevention of HPV infection
Barrier methods of contraception such as condoms lowers the risk of HPV transmission.
Other than early detection through HPV testing, the recommended way for HPV prevention is to go for HPV vaccination, which is usually given through injection in the muscle and can be completed in a 6 month interval.
In Singapore, there are various types of HPV vaccines available. Examples include Cervarix, Gardasil-4 and Gardasil-9 vaccines.
Cervarix vaccine offers protection against high risk cancer-causing HPV strains 16 and 18. It does not have protection against anogenital warts.
Gardasil offers protection against both high and low risk strains. Gardasil-4 protects against HPV strain 6,11,16,18 and Gardasil-9 offers additional protection of 5 extra strains 31,33,45,52,58 on top of the usual 4 strains. Both Gardasil vaccines are effective for prevention against both anogenital warts and cancers.
HPV vaccine works best when given before a person has any contact with the HPV strains. Gardasil-9 vaccine can be given to both males and females as young as aged 9, up to 45 year old. Even after being vaccinated, regular screening intervals as per MOH guidelines is still advisable.
Since 2005, our women’s clinics have been treating both local and foreign patients with women’s sexual health and reproductive health-related issues. Our women’s health doctors are experienced in diagnosing, treating and managing a wide array of women’s health-related issue like contraception, emergency contraception, oral contraceptive pills, contraceptive patch, contraceptive implants, Intra Uterine Device (IUD), vaginal infections, bacterial vaginosis, vaginal odour, vaginal itch, vaginal lumps & bumps, Dyspareunia (Pain during sex), bleeding after sex, Vaginismus, Uriniary Tract Infections (UTI), Pap Smear, Premarital screening, fertility screening, preconception screening, breast screening, cervical cancer vaccination, period & menstrual issues and weight loss treatment.
Article by Dr Goh Lit Ching – anchor doctor at DTAP@DUO
HIV, or Human Immunodeficiency Virus, attacks and damages the human immune system. When left untreated, HIV kills a type of immune cell called a T-Cell.
As the condition progresses more T-Cells get attacked. This makes the body become increasingly susceptible to a range of illnesses and cancers.
HIV is not airborne, neither does it spread through water or casual, physical contact. Instead, HIV is transmitted via the following bodily fluids:
● Vaginal secretions
● Rectal fluids
● Breast milk
The virus does its work by inserting itself into the DNA of cells. Therefore, there is no known drug capable of removing it from the body, even as medical science strives for a cure.
At the moment, a treatment called antiretroviral therapy makes it possible for a person with HIV to live with the virus for many years. Without such therapy, a person infected with HIV is likely to develop the condition known as Acquired Immunodeficiency Syndrome, or AIDS.
AIDS is when the immune system is weakened to the point where it is unable to properly and sufficiently counteract infections. If left untreated, people with end-stage AIDS have about 3 years to live. This is why antiretroviral therapy is important for people who have HIV, as it enables them to live as long as people who do not have HIV.
A person can also be diagnosed with AIDS if they have HIV and develop an opportunistic infection or cancer.
When AIDS develops, a person is seriously susceptible to illnesses like:
These illnesses can become severe, and shorten the lifespan of a person.
While related, HIV and AIDS are different things. It takes a period of time for HIV to progress to AIDS, which means that when action is taken, there is a possibility of preventing HIV’s progress to AIDS.
HIV cases progress through 3 distinct stages:
First Stage: Acute stage – First few weeks after infection
Second Stage: Chronic Stage
Third Stage: Progress to AIDS
As HIV progresses, the CD4 cell count slowly goes down. While an uninfected adult’s CD4 cell count runs between 500 to 1500 per cubic millimeter, a person with AIDS has a CD4 cell count that is sub-200 count per cubic millimeter.
The speed of HIV progression from stage 2 to stage 3 depends on the person. Some people can stay in stage 2 for a decade without treatment. However, with treatment, they can stay in stage 2 indefinitely. As mentioned above, there is no cure for HIV. However, antiretroviral therapy can give a near-normal life expectancy.
Similarly, there is no way to cure AIDS. However, treatment that can increase the CD4 count above 200 per cubic millimeter of blood exists. This means that they can be considered to no longer have AIDS.
No one is immune to HIV, and anyone can contract the virus. Here are some ways that HIV can be transmitted between people:
● Unprotected vaginal or anal sex — This is the most common route of transmission
● Sharing drug paraphernalia
● Unsterilized tattoo equipment
● Pregnancy, labor, or delivery from a pregnant person to their baby
● Premastication – the act of chewing a baby’s food before feeding it to them
Very rarely, HIV is transmitted via blood transfusion or organ donation.
It is extremely rare for HIV to be transmitted through:
● Oral sex
● Being bitten by a person with HIV
● Contact between broken skin, wounds, or mucous membranes and the blood of someone living with HIV
HIV does NOT transmit through:
● Unbroken skin-to-skin contact
● Casual contact like shaking hands
● Air or water
● Sharing food or drinks, including drinking fountains
● Saliva, tears, or sweat (unless mixed with the blood of a person with HIV)
● Insect bites
It’s important to note that if a person living with HIV is being treated and has a persistently undetectable viral load, it’s virtually impossible to transmit the virus to another person.
In the acute infection stage, there can be symptoms. At this stage, the virus is reproducing rapidly. The person’s immune system responds by producing HIV antibodies, which are proteins that take measures to respond against infection.
During this acute infection stage, some people have no symptoms, while others might have the following symptoms:
● swollen lymph nodes
● general aches and pains
● skin rash
● sore throat
● upset stomach
These symptoms are similar to the common flu. This is why infected people might not think that they need to see a doctor.
During this acute infection stage, the HIV viral load in the person is high, and this means that the virus can be easily passed on to another person during this period.
The acute stage symptoms resolve themselves within a few months as the person enters the chronic stage of HIV, which can last for decades with the appropriate treatment.
There are a few tests that can be used to diagnose HIV.
Antibody/antigen tests are the most commonly used tests. They can show positive results typically within 2 to 4 weeks after someone initially contracts HIV.
These tests check the blood for both HIV antibodies and antigens. An antibody is a type of protein the body makes to respond to an infection. An antigen, on the other hand, is the part of the virus that activates the immune system.
These tests check the blood solely for HIV antibodies. 3 weeks to 3 months after transmission, most people will develop detectable HIV antibodies, which can be found in the blood or saliva.
These tests are done using blood tests or mouth swabs, and there’s no preparation necessary. Some tests provide results in 30 minutes or less and can be performed in a clinic.
If someone suspects they’ve been exposed to HIV but tested negative in a home test, they should repeat the test in 3 months. If they have a positive result, they should follow up with their doctor to confirm.
HIV Viral RNA PCR or Nucleic acid test (NAT) – HIV Test
Viral PCR or NATs are expensive, and used for those who have early symptoms of HIV or have a known risk factor. This test looks for copies of the virus itself.
It takes from 5 to 21 days for HIV to be detectable in the blood. This test is usually accompanied or confirmed by an antibody test.
If you have queries, or think that you need a HIV screening test, please reach out to any of our DTAP clinics for a confidential and professional diagnosis. Anonymous HIV testing and rapid HIV test is also available.
Treatment should begin as soon as possible after a diagnosis of HIV, regardless of viral load.
The main treatment for HIV is antiretroviral therapy: a cocktail of daily medications that stop the virus from reproducing. Antiretroviral therapy protects CD4 cells, keeping the immune system strong enough to respond to disease.
Antiretroviral therapy also prevents HIV from progressing to AIDS, and reduces the risk of transmitting HIV to others.
When treatment is effective, the viral load will be “undetectable.” The person still has HIV, but the virus is not visible in viral PCR test results.
However, the virus is still in the body. And if that person stops taking antiretroviral therapy, the viral load will increase again, and the HIV can again start attacking CD4 cells.
HIV medications work to prevent reproduction of HIV, stopping it from destroying CD4 cells.
These antiretroviral medications are grouped into six classes:
● nucleoside reverse transcriptase inhibitors (NRTIs)
● non-nucleoside reverse transcriptase inhibitors (NNRTIs)
● protease inhibitors
● fusion inhibitors
● CCR5 antagonists, also known as entry inhibitors
● integrase strand transfer inhibitors
Antiretroviral therapy side effects differ, but may include nausea, headache, and dizziness. These side effects are not permanent, and will often get better over time.
However, serious side effects can include swelling of the mouth and tongue, as well as liver or kidney damage. If you encounter these side effects, speak to your doctor about adjusting medications.
There is no cure for HIV, or AIDS. That is why It is important to know how to prevent the transmission of HIV.
HIV is most commonly transmitted via unprotected vaginal or anal sex. Short of abstinence, the only other way to prevent transmission is through protection via condom or another barrier method.
If you are concerned about HIV risks:
● Get tested for HIV.
● Always use condoms. Be sure to know how to use them correctly, as incorrect usage can expose you to HIV risks.
● Take medication as directed if you have HIV. This lowers the risk of transmitting the virus to your sexual partner.
● Take medication called PrEP (Pre-Exposure Prophylaxis). This can be prescribed by your doctor.
There are a few other things you can do to prevent transmission of HIV:
● Do not share needles or other drug paraphernalia. Needle sharing can spread HIV through blood contact.
● Consider PEP. If you know that you have been exposed to HIV, talk to your doctor about getting post-exposure prophylaxis (PEP), which can reduce your risk of contracting HIV. It consists of three antiretroviral medications given for 28 days. PEP should be started as soon as possible after exposure. – HIV PEP Singapore
Currently, there are no vaccines to prevent or treat HIV.
HIV mutates quickly, and can often fend off immune system responses. Only a small number of people with HIV develop broadly neutralizing antibodies.
The good news is that in 2016, the first HIV vaccine efficacy study in 7 years was done in South Africa. This experimental vaccine is an updated version of one used in a 2009 trial that took place in Thailand. A follow-up after vaccination showed that the vaccine was 31.2 percent effective in preventing HIV transmission.
The study involved 5,400 men and women from South Africa.
Caused by the bacteria known as Treponema Pallidum, Syphilis is a sexually transmitted infection (STI) once thought to have been almost eradicated in the 1940’s and 50’s after the discovery of penicillin. In the past few decades, there has been a steady rise in rates of infection, especially in men who have sex with men, sex with commercial sex workers, and as a co-infection with HIV. The disease is mostly spread through penetrative sex (vaginal or anal) and oral sex. However, syphilis can potentially transmit through any other direct contact with an infected sore.
The Different Stages
Syphilis can be considered to have three main ‘active’ stages: Primary, Secondary, and Tertiary syphilis. During these active stages, symptoms such as an ulcer or chancre at the site of infection, body rashes, swollen glands, etc. may be present. In between these stages, the infection can be completely asymptomatic and be ‘latent’. The latent stage can last for months to years, or even decades. This is especially true after the secondary stage has passed. This is why syphilis should always be considered when doing a routine sexual health screen, even if someone feels perfectly well.
Syphilis is also known as The Great Imitator, as there are many symptoms which can mimic other more common conditions, possibly causing the diagnosis to be initially missed. For example, while the classical chancre in primary syphilis is usually solitary and painless, there are also cases of multiple painful sores which turn out to be syphilis. Rashes in secondary syphilis are typically spread evenly around the body and typically include lesions over the palms and soles. However, we sometimes see localized rashes over the scalp, trunk or limbs alone without any lesions on the hands or feet.
Screening can dependably detect syphilis, even if it is asymptomatic. A simple blood test is usually run for either treponemal antibodies (TPAb/TPPA) or non-treponemal antibody tests (RPR/VDRL). Even if someone is asymptomatic, there is still a risk that the infection can be spread.
Rapid point-of-care testing is also now available and will check for TPAb/TPPA antibodies. Testing only requires a finger prick blood sample, with results ready in 15-20 minutes. This test can be performed anonymously, along with other rapid STI tests for chlamydia and gonorrhea. Anonymous testing means no personal identifiers are required from the patient, and positive results do not need to be notified by name. Anonymous screening can reduce stigmatization of STI testing and improve accessibility to those who may not otherwise test. This means that infections may be picked up and treated at an earlier stage, helping to reduce the risk of ongoing transmission in the community.
If you think you need an anonymous syphilis test, please reach out to our DTAP clinics for a confidential, and professional diagnosis.
According to both the US CDC and statistics in Singapore, Chlamydia and Gonorrhoea are the top 2 STIs. Left untreated, these diseases can cause serious long-term consequences like infertility and complications during pregnancy which affect unborn children.
Using real-time PCR (polymerase chain reaction) technology, which means that the test is able to detect the DNA of both Chlamydia and Gonorrhoea in real-time, we can now get accurate and quick diagnosis of these 2 STIs.
The test is up to 99% accurate.
DTAP clinics now offer this rapid test, with results are available by the next working day. All that is required are samples from either urine, endocervical, throat or anus, depending on where the infection is likely to be present. This will be determined by your doctor after the assessment. The diagnostic rapidity will facilitate prompt and appropriate treatment.
Getting tested for STIs can be daunting, with plenty of social stigma attached to it. We understand your need for confidentiality, which is why DTAP clinic now offers anonymous Chlamydia and Gonorrhea that uses real-time PCR technology.
What does an anonymous rapid chlamydia and gonorrhoea PCR test mean?
DTAP now offers anonymous chlamydia and gonorrhoea PCR tests for those who think they may be at risk of getting infected, thereby removing fear of identification.
Practically, this means is that all you need to give us is your mobile number when you want to do an anonymous chlamydia and gonorrhoea test. For the purposes of this test, you are no longer identified by your identity card or passport number. A short questionnaire will be given to you to fill up, which will not ask for any identifiable information like your name, identity number or address. The short questionnaire will help us understand your risks so that the doctors can give you the appropriate advice.
A mobile number is required so that we can contact you about your results. You will be listed in our computer system as a random number with no identifiable information attached to it.
How do I know I need to be tested?
You will need to be tested:
• If you possess symptoms suggesting you may have been infected with Chlamydia (link to article on symptoms of Chlamydia) or Gonorrhoea (link to article on gonorrhoea)
• If your partner was tested positive for either one of those infections
• If you had a recent change in partner
• If you have multiple sex partners
• If you recently had unprotected sex
How long does it take for the results to be available?
Generally, results will be available next working day.
How accurate is the test?
In general, the test can be up to 99% accurate.
Which areas of the body can the test be used for?
Urine, endocervical, throat and anus
Do I need to prepare anything for the test?
For urine samples, it is best if you avoid passing urine 2 hours before the test. Otherwise, no additional preparation needs to be done before the test.
Is it painful?
There are no needles involved.
If you think that you may have been exposed to these 2 STIs, or if you have symptoms like penile/ vaginal discharges, burning sensations, and/or discomfort when you pass urine, you should get tested anonymously. Please visit our DTAP clinic and consult with our doctors to get tested with the Anonymous Rapid Chlamydia and Gonorrhoea test and get treated.
On the 10th Jun 2021, Singapore’s Ministry of Health (MOH) announced that DIY COVID ANTIGEN Testing kits would be available for public to buy off the shelf for self-testing purposes from 16th Jun 2021.
Imagine that the COVID virus is a person wearing a coat. This coat is called the antigen, while the nuclei acid if the person’s body. Antigen tests work by detecting the presence of the coat, while PCR tests work by detecting the presence of the body. Vaccines and our own immune systems also taget the antigen. Interestingly, just as we don’t wear the same coats every day, viruses might also change their antigens when they become a new strain of the same virus.
Currently, most of the COVID Antigen tests offered in clinics and done by health professionals or trained personnel, takes a sample from all the way to the back of the inside of the nose. While it is largely painless, this procedure may cause some some discomfort like watering eyes, or a feeling that you need to sneeze.
Conversely, some of the DIY COVID Antigen kits that can be used by the public only requires the person to take sample from the front part of the nostrils. This makes it easier for untrained members of the public to take a sample. However, this might mean that the test may not be as sensitive as those done by clinics or trained personnel.
COVID PCR test also takes samples from the back of the nose. However, it detects the “body” of the virus. In the COVID virus’ case, the test detects the RNA of the virus. This means that this test is the most accurate and sensitive to detect whether a person has the infection or not as it only needs a small amount of the “body” of the virus to be present.
COVID Antigen tests are known to be less sensitive than the COVID PCR tests. This means that they have a higher chance to giving a negative result, even when the person being tested has been infected. It comes down to the fact that the COVID PCR only needs a tiny amount of the “body” of the virus will give a positive result as the PCR technology is able to multiply the tiny amount of the “body” of the virus millions of times, even if the person may have very small amount of the virus.
The main reason is that COVID antigen tests give quick results. It requires roughly about 15-20 mins to give an idea of whether someone is infected or not. In contrast, COVID PCR tests take from a few hours to 24 hours for results. Thus, if the aim is to try to identify and isolate people quickly to reduce the chance of spreading it further, then using the antigen test may be more appropriate.
As mentioned previously, many of these DIY covid test kits used only require samples from the front of the nostrils. Ahe amount of virus antigen may be lesser than if the samples were taken from the back of the nose. Thus, there is a potential that it is less sensitive than the ones collected by professionals.
However, these DIY kits may have a role to play. If you think that you may have been exposed to COVID, you may want to do your own testing first. If the DIY test kit turns positive, then you should go to a health professional for further advice.
Please make sure that you buy from reputable sources if you do wish to use these DIY COVID test kits. You may be tempted to buy these online, but in some cases, these kits are fake, not properly manufactured, or poorly stored. This can result in the purchase of a malfunctioning test kit.
Additionally, please follow the instructions of the kit strictly. If you don’t, you may cause the result to be falsely negative even though you might actually be infected.
Lastly, if you do test positive using these DIY test kits, please visit the nearest medical professional to seek further advice and testing. Please do not brush off a positive result, even if you are asymptomatic, as you might be endangering the lives of your loved ones at home, as well as your colleagues and friends. You might not be lucky enough to win the lottery, but you certainly don’t want to take any chances when it comes to a COVID-19 infection.
If you would like to know more about COVID testing, or need to get tested for COVID-19, please visit us at DTAP CLINICS.
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