How to Quit Smoking – Smoking Cessation in Singapore

“Tobacco is the legal product which, used in moderation and exactly as the manufacturer intended, causes harm to the consumer.” – Federation of European Cancer Societies

Smoking is bad for you. I think that fact has been scientifically proven beyond the shadow of a doubt. Even people who continue to smoke realize this. Smoking damages the lungs. In fact, it can damage the lungs permanently. This is called emphysema. Once a person develops emphysema he will have it forever even if he stops smoking. Smoking greatly increases the risk of developing strokes and heart attacks. Smoking greatly increases the risk of developing not only lung cancer but also a variety of other cancers like stomach cancer, colon cancer, pancreatic cancer and prostate cancer.
Smoking not only harms the smoker. It has also been proven beyond a doubt that second-hand smoke damages health as much as actual smoking. According to the World Health Organisation every year almost 1 million people die as a result of exposure to secondhand smoke.
But to quit smoking is hard. This is due to the highly addictive nature of nicotine and also the fact that smokers get used to the ritual and social aspects of smoking. So while it is easy for non-smokers to say “Why is it so hard? It harms you and your family. It is expensive. It stinks! Why don’t you just stop?!” They, unfortunately, do not take into account the addictive nature of smoking. It is also difficult for non-smokers to empathize with smokers partly contributed by our health authorities’ extremely effective campaign to denormalize smoking in Singapore.
Also Read: Why Can’t Singapore Just Ban Cigarettes?
Also Read: Tobacco Past & Present

 

How to Quit Smoking (Smoking Cessation)?

It is difficult to get a smoker to quit smoking. In fact, most of them do not even think about it. So when a smoker is contemplating quitting smoking or better yet, has made the decision to want to quit, it is imperative to provide them with as much support as we can. Here in Singapore, there are multiple avenues to access such support.

If you are a friend or family of someone who is trying to quit smoking, learn more about what you can do for them by downloading this easy to read e-guide published by Singapore’s Health Promotion Board.

If you are a smoker reading this and have decided you want to quit, there are many ways you can reach out for support.

1) Join the I Quit Program

I Quit is Singapore’s National Smoking Cessation Program. It provides support for smokers who have the intention to quit smoking. There are many ways to sign up for the I Quit program. The easiest way is probably filling up an online form. I Quit is currently running a program that aims to get smokers to stop smoking in 28 days.
Smokers intending to quit have access to free counselling from trained and certified smoking cessation counsellors just by picking up the phone and calling the I Quit hotline known as Quitline. In fact, while signing up for the program, smokers can opt to have counsellors from Quitline call them instead.
Also, smokers on this program will receive daily SMS to keep them motivated to refrain from smoking. Smokers can also go online to the Health Promotion Board’s website and download self-help material like the Quit Fix Booklet and the I Quit Calendar. There is also community support that smokers intending to quit can reach out to via a Facebook Group known as the I Quit Club.
Just to add a little cherry on top of the Sundae, smokers who manage to remain smoke-free for 28 days will receive a $50 voucher from HPB. If he can remain smoke-free for 3 months, he will receive an additional $30 voucher. If he can make it to 6 months smoke-free there is yet another $20 voucher to be had.

Go down to I Quit Roadshow

Singapore’s Health Promotion Board holds regular smoking cessation roadshows. Go down to any of these road shows to see what they have to offer. You can sign up for a smoking cessation program on the spot.
Details on upcoming roadshows can be found in the I Quit Club page on Facebook.

2) Speak to a Pharmacist

Go to any retail pharmacy like Guardian or Watsons or Unity. Pharmacists are trained to provide smoking cessation counselling. They can also counsel you on the use of Nicotine Replacement Therapy. If the pharmacist feels that you require more intensive behavioural therapy or counselling or that you need to see a Doctor, they can point you in the right direction.

3) See a Doctor

See your friendly neighbourhood GP. Or visit your nearest polyclinic. Or if you are already seeing a Doctor for some other unrelated medical issues, you can always mention to him during your next follow up visit that you wish to get some help to quit smoking. Believe me, your Doctor will be thrilled and will be most eager to help you.
This is arguably the easiest way to go about it. Most Doctors are knowledgeable in smoking cessation and can counsel you on what you need. Be it accessing the national smoking cessation program known as I Quit, or referring you to a trained and certified smoking cessation counsellor or even prescribing you medicines or nicotine replacement therapy to help you quit smoking.
There are 3 so-called “pharmaceutical aids” to help you quit smoking.
The most well known is probably NRT (Nicotine Replacement Therapy). This helps smokers reduce their cravings and side effects of quitting by supplying their bodies with nicotine. It usually comes in the form of chewing gum or lozenge. They are usually taken for a duration of 2 to 3 months.
The 2 other pharmaceutical aids are tablets. One is Bupropion (Zyban) and the other is Varenicline (Champix). Both of these are tablets and can have potential side effects. They are usually taken for 3 months. They help to reduce cravings by activating certain chemicals in the brain. Please discuss with your Doctor if you can benefit from these.

The MOST important thing to remember is that these pharmaceutical aids work much better with behavioural intervention. In other words, do not just take the medicines. You still have to have a quit plan in place. You still have to keep yourself motivated. You still have to receive daily reminders and support to quit. You will still benefit from talking to a smoking cessation counsellor.

Be Strong. Take Care.


 

What are the Sign​s & Symptoms of HIV / AIDS

Human Immunodeficiency Virus (HIV) is a virus that can be spread through sexual contact, contaminated needles, blood transfusions, and other infected body fluids. It targets the immune system, specifically CD4 cells, and if left undiagnosed and untreated, can overwhelm the immune system and cause life-threatening complications.
HIV symptoms can appear at different times for different people, and some may not recall having any symptoms at all until diagnosis (which can be many years after the initial infection).

What are the Different Stages of HIV Infection?

HIV infection occurs in three main stages:

  1. Acute HIV Infection,
  2. Chronic HIV Infection (Clinical Latency Stage),
  3. and Late-Stage HIV or AIDS (Acquired Immunodeficiency Syndrome).

HIV symptoms may vary depending on the individual and the stage of infection, and some people may not have any HIV symptoms at all.

1) Acute HIV Infection

Within the first 2-4 weeks after initial infection, the virus replicates very quickly and HIV viral load will reach a high level. People may experience flu-like symptoms, which they may describe as ‘the worst flu ever’.
This is known as Acute Retroviral Syndrome or ARS. These acute HIV symptoms may occur in about 70-80% of people.
Acute Retroviral Syndrome ARS / HIV Symptoms may include:

  • Fever
  • Night sweats
  • Swollen glands
  • Sore throat
  • Body rash
  • Fatigue
  • Body aches
  • Headache
  • Nausea and vomiting
  • Diarrhea

Acute HIV symptoms can last between several days to several weeks, until the body can develop HIV antibodies to fight the virus. This is also the stage of the greatest infectious risk to others as the HIV viral load is very high. However, do remember that these symptoms are seen in other common conditions as well, and you shouldn’t assume you have HIV just because you experienced them.
If you are concerned about any symptoms or potential exposure, it is best to see a doctor to have them evaluated and consider HIV testing.

Different HIV tests are able to detect the infection at different times

The earliest you may be able to detect the virus is with HIV DNA/RNA PCR testing, which can be accurate from 10-12 days post-exposure. Other more common tests would be the 4th Generation HIV p24 Antigen/Antibody test, which is considered conclusive from 28 days post-exposure.
If you have had a potentially risky exposure within the last 72 hours, you can consider a course of medication called HIV Post-Exposure Prophylaxis (HIV PEP). This works to prevent the virus from replicating and taking hold in the body, and can reduce risk of transmission by more than 90%. It is only effective if started within 72 hours.

2) Chronic HIV Infection

After the early stage of acute HIV infection, the disease enters into a clinical latency stage, where the virus is developing in the body, but no symptoms are seen. During this time, the virus is still active but will replicate slowly inside the cells – it can still be transmitted to others, but the risks of transmission are lower than during the acute phase.
If you have been diagnosed with HIV and are on HIV antiretroviral treatment (HAART), the virus is often kept under control and you may experience a symptom-free period that can last decades. If the virus can be suppressed to undetectable viral load levels, we would deem the risk of transmission extremely low. This stage of HIV infection can last for 5-10 years.
If you have HIV but are not on treatment, then it will eventually progress to late stage infection, known as AIDS.

3) AIDS (Acquired Immunodeficiency Syndrome)

Late Stage HIV / AIDS (Acquired Immunodeficiency Syndrome)
If you have HIV but are not on antiretroviral treatment, it will eventually weaken your immune system and progress to AIDS, or Acquired Immunodeficiency Syndrome.
Symptoms or signs of late stage HIV / AIDS may include:

  • Rapid weight loss
  • Recurring fever
  • Profuse night sweats
  • Extreme tiredness
  • Swollen glands
  • Persistent diarrhea
  • Mouth or genital sores and ulcers
  • Fungal infections, especially oral thrush
  • Shortness of breath, lung infections (e.g. PCP)
  • Memory loss, limb weakness and other neurological disorders
  • Mucous membrane and skin rashes and lesions (patches of reddish-purplish lesions may be characteristic of Kaposi sarcoma)

Many of these signs and symptoms in AIDS are due to Opportunistic Infections (OI’s), which are organisms that usually only cause infections in people with a weak immune system. People with normal functioning immune systems will typically be able to fight these types of infections off, or suppress them so they do not manifest with significant symptoms.
Common types of OI’s include candidiasis (thrush), pneumocystis carinii pneumonia (PCP), tuberculosis (TB), and salmonella colitis infection, among many others.
In someone who is diagnosed with late-stage HIV and whose CD4 cell count is found to be very low, doctors will usually start on certain medications such as antifungals or antibiotics to prevent these OI’s; they will be kept on these medications as prophylaxis, while they are taking their regular HIV medications, until their CD4 count is high enough (indicating their immune system is strong enough to fight off these infections by itself).
Even if you experience the previously mentioned symptoms, it is impossible to confirm HIV infection unless you get tested. If you are concerned about a possible exposure, please visit our clinics for a consultation and evaluation.
Take Care!


Other Interesting Reads:

  1. Weak Erection? Erectile Dysfunction? How to Improve Erection with Pills
  2. The HIV Provirus DNA Test can be done 10 days post exposure.
  3. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  4. What are the Causes of Abnormal Penile Discharge?
  5. An Overview of STD – From an STD Doctor
  6. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  7. Anonymous HIV Testing – What You Need to Know
  8. Low HIV Risk Doesn’t Mean No HIV Risk
  9. What is HPV Vaccination (Gardasil 9)
  10. 10 Causes of abnormal Vaginal Lumps and Bumps
  11. An Overview of Gonorrhoea
  12. What is the Treatment for Cold Sores? What causes Cold Sores?
  13. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  14. Syphilis Symptoms (Painless STD Sores & STD Rashes)

Syphilis Symptoms & Treatment (Painless STD Sores and Rashes)

What is syphilis?

Syphilis is a sexually transmitted infection (STD) with many different manifestations and potentially serious complications. It is caused by a bacteria called “Treponema pallidum”.
In the past, before the advent of antibiotics, syphilis was considered a dangerous illness with long-term, devastating consequences which could even affect the brain and nerves.
Thankfully, with the development of penicillin antibiotics and lab tests to detect syphilis infection early, modern medicine is now well equipped to diagnose, treat and cure syphilis well before complications can set in.

Syphilis – Still a Real and Relevant Infection Today

As of recent years though, there has been a rise in syphilis cases amongst both heterosexuals as well as homosexual couples, as reported by the Centers for Diseases Control (CDC), a reminder that syphilis remains a very real infection concern that any sexually active individual should be aware of.
Syphilis is transmitted by direct contact with a syphilis sore, which is a painless ulcer known as a “chancre”. These chancres can occur both in the mouth/oral cavity or in the genital region and the rectum. Sexual contact in the form or oral, vaginal or anal intercourse can all spread syphilis. If a pregnant mother has syphilis, she can also transmit it to her unborn child.

What are the symptoms and different stages of syphilis?

Reading about syphilis can be confusing because it is an infection with different stages and a multitude of varied symptoms.
But to simplify things, there are three stages of syphilis: primary, secondary and tertiary.

Primary Syphilis Symptoms

(usually begins a few weeks up to 3 months from infection)

a.) Syphilis Symptoms: Chancres
  • Painless, round ulcer
  • usually single – occurring at the site where the infection enters the body which is usually in the genital, anal or oral region
  • lasts between 3 – 8 weeks

Note that chancres will heal by themselves and disappearance of the chancre does not mean the infection is gone!

Secondary syphilis

(months or more after initial infection)

b.) Syphilis Symptoms: Rashes
  • Syphilis is known in the medical world as “the Great Mimicker” – so keep in mind that the rash it causes may look very different from what you see in photos!
  • The classic rash is a brownish rash over the palms and soles but syphilis can also cause a rash anywhere over the body
  • May range from very faint rashes to obvious reddish patches
  • Generally not itchy
  • Can occur anytime from when the initial chancre is healing to weeks after
  • May come and go
c.) Snail track ulcers
  • Raw reddish ulcers in the mouth and genital region
d.) Condylomata Lata
  • Raised, greyish patches that occur in moist regions of the body like the groin, armpits
e.) Nonspecific symptoms
  • Fever
  • Enlarged lymph nodes
  • A sore throat

Tertiary syphilis

(occurs decades after initial infection)

  • Tertiary syphilis is now fairly rare as most cases are detected and treated before they progress to this. Symptoms depend on the organs affected by syphilis

NOTES:
Someone with syphilis can also feel entirely well and not have any symptoms- this is known as latent syphilis. If the infection was acquired within the last year, it is considered early latent syphilis, but if it occurred more than a year ago, then it is considered late latent syphilis.
Syphilis can affect the eyes and nerves during any stage of infection. This can result in a variety of symptoms including vision problems, abnormal body movements and even early dementia or memory problems.

What Does a Syphilis Test Do

Who should test for syphilis and what tests are done to diagnose syphilis?

You should test for syphilis…

  • If you have had sexual contact with someone with known syphilis
  • If you have symptoms suspicious for syphilis
  • As part of your regular STD screening if you have an active sex life and have had partners whose infection status you are unsure of

Diagnosis of a syphilis infection is done through a blood test which looks for antibodies to syphilis. Syphilis blood tests can be a little complex and your doctor will be able to explain more to you about the interpretation of results and what to look out for.

What Treatment is Available for Syphilis?

Syphilis infections are treated with penicillin which is administered as an injection. The dosage or number of injections required depends on the stage of the infection.
In unfortunate cases where the infection fails to clear up with initial treatment (which is known as treatment failure), then additional antibiotics may be required for a longer duration of time.
In order to determine if treatment is successful, as well as to monitor for recurrence of the syphilis infection, regular blood tests at intervals of a few months may be required. Until one is clear of syphilis, it is best to abstain from the sexual activity so as to minimise the risk of transmitting the infection to others.
Syphilis remains a problem in the present day, but while it is a potentially serious infection, the good news is that with early diagnosis, the frightening complications that occur with untreated syphilis can very easily be prevented.

Take Care!

Other Interesting Reads:

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

What is the Treatment for Cold Sores? What Causes Cold Sores?

What exactly is a cold sore?
You have probably heard of cold sores or even have had one at some point in your life. But perhaps you’re not entirely sure of what it is caused by and what else you may need to be concerned about.
A cold sore is a small, painful, fluid-filled blister that most commonly occurs near the mouth or on the face, although it may infrequently appear elsewhere on the body. Cold sores tend to occur in clusters.  The appearance of a cold sore is sometimes preceded by an unusual tingling or itching sensation over the same area.
The blisters then form and eventually burst, leaving shallow ulcers/open sores which scab over, forming a crusty lesion. They may come and go, with each flare lasting up to a few weeks.

What Causes Cold Sores?


Cold sores are caused by the Herpes Simplex Virus

There are two types of Herpes Simplex Viruses (HSV) – Type 1 and Type 2.
Cold sores are caused by the Herpes Simplex Virus (Type 1), and genital sores are caused by the Herpes Simplex Virus (Type 2).

genital-herpes

Herpes Simplex Viruses (Type 1)

HSV-1 usually causes cold sores, while HSV-2 tends to be responsible for genital sores. HSV-1 is extremely common in the general population, with the World Health Organisation (WHO) estimating 3.7 billion people under the age of 50 have HSV-1 globally.
Herpes Simplex Viruses (HSV) is transmitted through body secretions.
HSV-1 can be transmitted through saliva via kissing, or sharing of utensils (oral-to-oral transmission), but oral-to-genital secretion can also occur through oral intercourse. This means that someone with cold sores can transmit HSV-1 to their partner’s genitals, resulting in genital sores. An STD Screening can screen for both herpes simplex viruses.
Individuals with HSV are most contagious when they have cold sores, but can still be infectious even when they have no sores or blisters.
Here’s a video about Herpes

Unfortunately, HSV infections are lifelong – meaning there is no cure for HSV and once infected a person carries the virus for life.
This is the reason why cold sores can flare up from time to time. There are certain triggers that can set off an outbreak of cold sores- for instance, environmental factors such as sunlight and cold temperatures, or anything which weakens your immune system, such as an illness, or medications which suppress your immunity.

cause-of-cold-sore

What is the Treatment for Cold Sores?

Antivirals can help clear up and keep cold sores away.
While there is no cure for HSV, the good news is that anti-viral medications (treatment for cold sores) are extremely effective in suppressing the virus and can be used to treat an outbreak of cold sores, and even prevent or minimise future outbreaks.
Some people may not be significantly bothered by their cold sores, which flare up only occasionally and go away by themselves. However, if you are troubled by your symptoms and worried about transmission of the virus to people around you during a flare, anti-virals such as acyclovir or valacyclovir are available as both oral tablets and topical creams.
Sometimes, just the topical cream (treatment for cold sores) may be enough to address your cold sores but if they fail to respond or if your flare is particularly bad, your doctor may prescribe a short course of tablets on top of the cream.
If you are someone who experiences frequent and painful outbreaks of cold sores, or if you are concerned about transmitting the virus to your loved ones, then suppressive anti-viral therapy may be a good option for you. This is when you take the anti-viral medication on a daily basis in order to achieve continued suppression of the virus just like HIV treatment. This not only stops flares from occurring but also reduces your infectivity and the risk of transmitting HSV to others.
Now that you know a little more about, the cause of and, the treatment for cold sores, hopefully, this has helped you realise that you do not need to live with intermittent painful outbreaks. There are treatment options available in our clinics, so if this is an issue which has been troubling you, then it’s time to make that a thing of the past.
Take Care!

Other Interesting Reads:

  1. An Overview of STD – From an STD Doctor
  2. What are the Symptoms of HIV Infection and AIDS?
  3. Weak Erection? Erectile Dysfunction? How to Improve Erection with Pills
  4. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  5. What are the Causes of Abnormal Penile Discharge?
  6. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  7. 11 Causes of Dyspareunia (Pain During Intercourse)
  8. 10 Common HIV-related Opportunistic Infections
  9. What is HPV Vaccination (Gardasil 9)
  10. 10 Causes of abnormal Vaginal Lumps and Bumps
  11. An Overview of Gonorrhoea
  12. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  13. How Do I Get an Anonymous HIV Testing?
  14. Syphilis Symptoms (Painless STD Sores & STD Rashes) 

 

Why Do I Have Abnormal Vaginal Discharge?

Let’s talk a little about normal vaginal discharge first.

The vagina is a muscular passage which leads from the vaginal opening to the cervix, which is the entrance to the womb. There are naturally occurring “good” lactobacillus and other bacteria which are part of the normal vaginal flora. The walls of the vagina have glands which produce secretions for the cleansing of the vaginal canal. Normal vaginal discharge is a result of these secretions. It is usually clear or whitish and largely odourless and may change slightly throughout your menstrual cycle.
 

via GIPHY
 

How to identify abnormal vaginal discharge and what you should be worried about?

However, when you notice a major change from your usual vaginal discharge, this abnormal vaginal discharge may indicate that something is wrong.
Signs that your vaginal discharge may be abnormal include different coloured discharge – greenish, yellowish, greyish or even brownish discharge, the presence of a bad vaginal odour, changes in discharge consistency such as thicker, clumpy discharge or large amounts of watery discharge.
If this discharge is accompanied by abdominal pain, fever, or spotting/bleeding after sexual intercourse or bleeding when your period is not due yet, then these are all alarming features that should Fprompt you to consult a doctor.
Abnormal vaginal discharge is one of the most common female health problems and it should not be something you feel you have to suffer in silence about. Most ladies will experience this at some point in their life and while it can be an extremely distressing and uncomfortable problem, it is very treatable.
 
 

You probably have a vaginal infection.

The top cause of abnormal vaginal discharge is a vaginal infection, also known as vaginitis. Other rare causes of abnormal vaginal discharge include cervical abnormalities such as cervical cancer.
The next question, then, would be what sort of infections you have to worry about if you are experiencing abnormal vaginal discharge. These can broadly be divided into Sexually Transmitted Infections (STIs) and non-Sexually Transmitted Infections (STIs).
The most common causes of abnormal vaginal discharge are non-sexually transmitted infections- Bacterial Vaginosis and yeast infections. These all occur when there is disruption to the delicate balance of your healthy vaginal flora and can be triggered by a multitude of factors.
However, if you have had unprotected sexual intercourse, particularly if you are unsure of your partner’s infection status (whether this be a casual partner or a long-term partner), then your abnormal vaginal discharge may very well be due to a Sexually Transmitted Disease (STD) such as Chlamydia, Gonorrhoea, Trichomonas, and various types of Mycoplasma and Ureaplasma bacteria.
Regardless of the underlying cause of your abnormal vaginal discharge, proper evaluation is crucial as it allows you to receive the appropriate treatment, which is important not just in relieving your discomfort but also in preventing more serious, long-term complications (like Pelvic Inflammatory Disease) that can occur with certain infections.
 
 

Why does the abnormal vaginal discharge keep coming back?

This is a very common question and recurrent abnormal vaginal discharge can be an extremely frustrating and distressing issue.
Recurrent yeast infections and bacterial vaginosis tend to be responsible for the above phenomenon and can be triggered by a variety of factors which upset the balance of your vaginal flora.
 

1) Hormonal Fluctuations

  • For some ladies, they may find that the hormonal fluctuations during their peri-menstrual period (before or after menses), may cause them to be prone to recurrent yeast infections.
  • Pregnancy

 

2) Weakened Immune System

  • If you have diabetes or are undergoing any other sort of medical treatment that affects your immunity, you may be more prone to recurrent yeast infections.

 

3) Sexual Lifestyle

  • Sexual intercourse can trigger off bacterial vaginosis – in fact, the number of sexual partners which one has had is actually a risk factor for bacterial vaginosis, with every new partner that a lady has increased the risk of Bacterial Vaginosis infections.
  • Other habits like using spermicide may also kill off the good lactobacilli in the vagina and lead to increased susceptibility to infection

 

4) Medications

  • Being on the combined oral contraceptive pill does increase your risk of recurrent yeast infections
  • Antibiotic usage (for instance, taking something for a bacterial throat infection) can also (ironically) upset the delicate balance down there

 

5) Hygiene Habits

  • Use of vaginal douche washes or feminine washes with harsh chemicals can disrupt your natural vaginal balance and lead to increased yeast and BV infections
  • Tight underwear, pantyliners or menstrual pads which trap humidity and moisture may also place you at increased risk for a yeast infection

 
As can be seen, not all triggers may be entirely avoidable but good habits- like avoiding feminine douche washes, wearing breathable cotton underwear, minimising antibiotic use unless medically indicated, and using condoms- do play a part in helping you maintain a healthy vagina.
If you keep having abnormal vaginal discharge that comes back with a vengeance after the initial episode, do speak to your doctor about additional treatment that may be suitable for you.
 
Remember that you are not alone – abnormal vaginal discharge is common – and treatable!
Don’t let your discomfort about the topic keep you from treatment.
 
Take Care!

Other Interesting Reads:

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

 
 

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

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 :

  1. Multiple sexual partners
  2. Human papillomavirus (HPV) infection
  3. Smoking
  4. 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.

  1. Low-risk HPV can cause genital warts in both female and males. These are flesh coloured growths on the genitals, and they are infectious.
  2. 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.

If you are due for your routine PAP smear or if you have questions about cervical cancer screening & HPV vaccination and wish to find out more, please call or visit any of our clinics or drop us an email at hello@dtapclinic.com.sg
We have Female doctors at our Robertson Walk, & Kovan Location. Call our clinics DTAP @ Kovan +6569627191 & DTAP @ Robertson +6562387810

Take Care! 

Other Interesting Reads:

    1. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
    2. 11 Causes of Dyspareunia (Pain During Intercourse)
    3. What is HPV Vaccination (Gardasil 9)
    4. 10 Causes of abnormal Vaginal Lumps and Bumps
    5. An Overview of Gonorrhoea
    6. Herpes – What You Need to Know
    7. The Good Wrinkles, Bad Wrinkles & the Ugly Wrinkles

HIV PrEP for Travel – Things You Need to Know

What is HIV PrEP?

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

Why HIV PrEP?

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

How?

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

When?

How you take your PrEP depends on10:

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

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

There are 4 Different Ways to Use HIV PrEP

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

1. Daily PrEP

Daily PrEP Regimen: 

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

Type:

  • Anal, Vaginal/Frontal sex

Considerations:

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

2. On-Demand PrEP (Event-Based Dosing)

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

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

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

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

Type: 

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

Considerations:

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

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

Ts and Ss Regimen:

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

Type: 

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

Considerations:

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

4. Holiday PrEP

Holiday PrEP Regimen:

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

Type: 

  • Anal, Vaginal/Frontal sex

Considerations:

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

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


References

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

Top Travel Tips for Persons Living With HIV (PLHIV)

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

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

B for Board, Bottle

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

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

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

R for Reveal, Reiterate

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

A for Adjust, Avoid,  Anonymous Testing, Advice

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

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

V for Vaccinations

General principles for vaccination of PLHIV as follows:

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

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

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

E for Extra Medication

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

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

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

Safe Trip and Have Fun!
This article was written by DTAP, in collaboration with Oogachaga.

What is Rapid Chlamydia & Gonorrhea PCR STD Testing?

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

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

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

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

Take Care!


Other Reads:

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

11 Causes of Dyspareunia in Women (Pain During Intercourse)

Dyspareunia or Pain During Intercourse is a condition whereby people experience pain during sexual intercourse. Both men and women can experience pain during sex sometime during their lives. However, it is much more common for women. Particularly in young women who are inexperienced or women who are in the perimenopause or menopause stages.

There is not much awareness about this topic as there is still a stigma surrounding it. Consequently, women are not speaking to their sexual partner, friends, close family or doctor when faced with this issue. If the situation is not dealt with, it may lead to other problems. Besides not being able to enjoy sex, the pain will progressively worsen due to the muscles tightening up.
Dyspareunia will have a negative physical impact on you, as well as being able to emotionally affect you and your partner’s relationship.

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

 

Causes of superficial pain include:

1.) Vaginismus

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

2.) Lack of Vaginal Lubrication

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

3.) Vaginitis (Inflammation of the Vagina)

Vaginitis is essentially the inflammation of the vagina which is caused by infections from thrush (candida), trichomonas or bacterial vaginosis (BV).
Common symptoms of this condition would be abnormal vaginal discharge, as well as itchiness and a burning sensation in the vagina and vulva (opening of the vagina).

Another type of causes, especially if associated with an infection, can also cause pain.
This includes:

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

Generally, treating the infection will simultaneously clear dyspareunia.

4.) Vulvitis (Inflammation of the Vulva)

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

5. Injury

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

Causes for deep pain include:

6. Problems with the Cervix

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

7. Problems with the Uterus (womb) or Ovaries

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

  • Fibroids
  • Fixed retroverted uterus
  • Ovarian cysts

8. Endometriosis

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

9. Pelvic inflammatory disease (PID)

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

10. Pelvic Adhesions

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

11. Ectopic Pregnancy

An ectopic pregnancy is when the pregnancy is located outside the womb, like in the fallopian tubes, cervix or ovary. As this type of pregnancy develops, it will stretch out the surrounding tissue, creating discomfort. Pressure on this region during sex will cause more pain.
If you are experiencing repeated pain during or after sex, do not hesitate to see a doctor or visit our clinic as dyspareunia is not normal and often the underlying cause is curable. The longer you leave it, the more issues it may cause to yourself and also may lead to a detrimental effect on your relationship with your partner.

If you are experiencing Pain During Intercourse, it is highly recommended to visit our doctor at our DTAP Clinics as soon as possible, especially if the pain becomes persistent. Most causes of dyspareunia are not serious. However, there is a few that can be severely detrimental to your health and well-being.

Take Care!

Other Interesting Reads:

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