What You Need to Know about Wuhan virus – 2019 novel coronavirus (2019-nCoV)

By now, we have all heard about the outbreak of a new virus in China that has infected more than 600 people and claimed at least 17 lives, while spreading to other countries around the world. As of today (24th Jan), Singapore has three confirmed cases of the 2019 novel coronavirus (2019-nCoV), also known as the Wuhan virus. Other countries which have confirmed cases include Japan, Korea, Thailand, the United States, Taiwan, Saudi Arabia and Vietnam. Disease modeling experts from Imperial College, London suggest that case numbers reported by China are conservative, issuing a report on Wednesday (22nd Jan) stating that 4000 people could currently be infected.

Its emergence on our shores has fueled fears of a deadly epidemic reminiscent of Severe Acute Respiratory Syndrome (SARS) in 2003, H1N1 influenza in 2009, and Middle East Respiratory Syndrome (MERS) in 2012. 

Here’s what you need to know about WuHan Virus:

What is the WuHan Virus and how did it happen?

The Wuhan virus belongs to a family of viruses known as coronavirus, which include SARS and MERS. These viruses, named for the crown-like spikes on their surfaces, infect mostly bats, pigs and small mammals. But they mutate easily and can spread from animals to humans, and from one human to another.

The outbreak is understood to have originated in December in Huanan Seafood Wholesale Market in Wuhan, the largest city in central China with a population of 11 million people. It is thought that wild animals are the source of the virus. Chinese scientists believe that the virus might have jumped from bats to snakes, which were then sold in the market, and subsequently transmitted to humans. 

How is the WuHan Virus spread?

The WuHan virus is believed to spread much like the common flu does – by droplet and contact, for example coughing, kissing or saliva contact. For now, virologists say that the Wuhan virus is likely not as infectious as the SARS virus, with a current reported 2% death rate. But there are concerns that the virus could further mutate to become more lethal.

What are the symptoms and when do you suspect that you have it?

Seek medical help or go to A&E immediately if:

  1. You have fever OR cough OR upper respiratory symptoms OR breathlessness, and
  2. You have travelled from mainland China within the past 14 days, or
  3. You have visited a hospital in mainland China 14 days before onset of illness, or
  4. You have had close contact with a confirmed or suspected case of Wuhan virus

Are there drugs or vaccines to treat or prevent Wuhan virus?

There is no vaccine to protect against coronaviruses. There is also no specific treatment to cure illnesses caused by coronaviruses. Patients receive supportive treatment at hospitals and generally recover on their own after some time. 

You should consider getting a flu vaccine if you are travelling to places where there are confirmed or suspected cases to prevent you from contracting influenza symptoms that may mislead screening authorities at temperature checkpoints.

What can I do to protect myself against the WuHan Virus?

  1. Wear a surgical mask if you have flu-like respiratory symptoms 
  2. Even if you have no symptoms, you can wear a surgical mask if you are going to be going out in public and having person-to-person contact
  3. It is advised that surgical masks will suffice and there is no need to use N95 masks
  4. Take the same protective measures you would take against the flu: wash your hands frequently with soap, cover your mouth with tissue paper or your hands when coughing or sneezing, and stay away from people who are sick
  5. See a doctor if you feel unwell

Should I cancel my trip to China?

According to the latest travel advisory issued on Thursday (23rd Jan) by the Ministry of Health (MOH), Singaporeans should avoid travelling to Wuhan. China has imposed a travel halt in Wuhan as all flights out of the city have been cancelled and trains, buses and ferries suspended.

MOH reminds the public to continue to exercise caution and pay close attention to personal hygiene when travelling to the rest of China. MOH advises that all travellers should monitor their health closely for two weeks upon return to Singapore and seek medical attention promptly if they feel unwell, and also inform their doctor of their travel history.

Lastly..

According to the World Health Organization, the Wuhan coronavirus is an emergency in China but is not yet a public health emergency of global concern. However, as the situation is rapidly evolving, all of us should continue to stay abreast with the latest updates and news reports. 

Stay safe!
[This article is written on 23rd January 2020]


武汉病毒知多少?- 新型冠状病毒
中文版: https://www.dtapclinic.com/articles/武汉病毒知多少?-新型冠状病毒/

What is Antibiotic Resistant Gonorrhea or Super Gonorrhea?

Gonorrhea is a sexually-transmitted infection caused by the bacteria called Neisseria gonorrhoeae. 

Antibiotic-resistant Gonorrhea refers to strains of Gonorrhea that are not killed by antibiotics that were previously effective in killing off these bacteria. 

In the 1980s, penicillins and tetracyclines could kill off Gonorrhea. By the 1990s, these drugs were no longer effective and Fluoroquinolones were recommended as the first line treatment. By the 2000s, Fluoroquinolones resistance was commonplace and only one group of antibiotics remains as an effective treatment for Gonorrhea – Cephalosporins. By now, certain strains of Gonorrhea that are resistant to cephalosporins have already been detected and that is worrisome because if these medications become useless, we might face a situation where we cannot clear gonorrhea from a person’s body. 

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What drugs are super gonorrhea resistant to?

Super Gonorrhea is the colloquial term for strains of Gonorrhea that are extensively drug-resistant, with high-level resistance to the current recommended treatment for gonorrhea (ceftriaxone and azithromycin) including resistance to penicillin, sulphonamides, tetracycline, fluoroquinolones, macrolides.


What causes super gonorrhea? 

Super Gonorrhea is a problem that we have created. 

The unrestricted access, inappropriate selection and overuse of antibiotics over many decades has allowed the strains of gonorrhea to genetically mutate in such a way that they are no longer affected by these antibiotics. Extra genital infections in the rectum and throat may also play an important role in the development of resistant strains as gonorrhea can interact and exchange genetic material with other co-infections in these places.


How common is Super Gonorrhea?

Super Gonorrhea has been reported by several countries including France, Japan, Spain, the UK and Australia. The American CDC has not received any reports of verified clinical treatment failures to any cephalosporin in the United States to date. 


How does Gonorrhea spread?

Gonorrhea can be spread through sexual contact with the penis, vagina, mouth, or anus of an infected partner. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Even if you have had gonorrhea in the past and was treated, you can still get reinfected again if you are exposed to it again. 


What are the symptoms of super gonorrhea?

The symptoms of super gonorrhea are the same as regular gonorrhea. Gonorrhea can infect different areas of the body. Most symptoms present within 1-2 weeks after exposure.

In males, the most commonly infected site is the genitourinary system. It can present with symptoms such as pain on passing urine, penile discharge, swelling at the tip of the penis and scrotal pain and swelling.

In females, the most commonly infected site is also the genitourinary system and and present with symptoms such as vaginal discharge, pain on passing urine, intermenstrual bleeding, painful intercourse, and mild lower abdominal pain

Gonorrhea can also infect other areas of the body such as the rectum, causing rectal pain, itching, discharge, or tenesmus. If gonorrhea infects the throat, you can get a persistent sore throat. Gonorrhea can also infect the eyes, causing conjunctivitis which may present with eye pain, discharge, and redness. If gonorrhea spreads by blood to the rest of the body including the brain, heart, bone, joints, skin and liver, this is termed Disseminated gonococcal infection (DGI). While rare, DGI can be deadly and have long term complications. 


Does Gonorrhea always have symptoms?

Gonorrhea can have little to no symptoms at all in some people. That is the reason why it is so important to screen for STIs with every sexual encounter. 

A study has reported that more than 80% of people (both males and females) with Gonorrhea can have no symptoms. Do not wait for symptoms to appear before you screen for STIs. Do it regularly with every new sexual encounter. 

Also read: Rapid STD Test for Chlamydia and Gonorrhoea PCR


What are other STDs that do not display symptoms and have serious complications if left untreated?

All STIs can have no symptoms at all. Because people do not experience any symptoms, they think that they do not have an STI and thus the spread of STIs continues. Other STIs we regularly test for include other urinary STIs such as Chlamydia, Ureaplasma urealyticum, Mycoplasma hominis and Trichomonas. What we can test for in the blood are STIs such as HIV, Syphilis, Herpes and Hepatitis B and C.


What happens if gonorrhea is treated effectively?

If gonorrhea is treated effectively (with the proper antibiotics), your symptoms should clear up, and subsequent follow up tests to test for clearance should come back as negative for gonorrhea.


What are the complications of Gonorrhea?

In females, untreated gonorrhea may lead to pelvic inflammatory disease (PID). This is an infection of the fallopian tubes, uterus, and cervix. If left untreated, PID may cause permanent damage to the reproductive tract, which may lead to infertility. It may also lead to long-term pelvic pain.

Males with untreated gonorrhea may develop a condition called epididymitis. This condition is characterized by inflammation of the tubes near the testicles that carry semen. It can also lead to infertility. 

DGI is another complication of gonorrhea as well. 


What happens if you have drug resistant gonorrhea? Can I get rid of Antibiotic Resistant Gonorrhea?

If you have drug resistant gonorrhea, your doctor may opt to treat you with antibiotics that hopefully are effective against this strain of gonorrhea. Antibiotic sensitivity testing for that strain should be done. If it is truly multi-drug resistant, a referral to an infectious diseases specialist is appropriate, and they may have to treat you with antibiotics that are reserved for the worst kinds of infections. 


How do you reduce your risk of contracting these STIs?

Abstinence is the only way to reduce your risk to zero.

If you are sexually active, use barrier protection such as condoms, the right way. You can also speak to your partner to get tested for STIs before engaging in sexual activity.  A mutually monogamous relationship also carries a lower risk of STIs than having multiple sexual partners.

If you are sexually active with multiple sexual partners, get yourself tested regularly and treated. The presence of one STI can increase your risk of contracting another one more easily. Most STIs can easily be detected through swabs, urine or blood tests at your doctors. These are rather pain free and minimally invasive, so there should be no fear to get tested!

There are some STIs that are preventable through vaccinations. Vaccines are available against certain strains of HPV that may cause warts, cervical, anal and penile cancer. Effective vaccines against Hepatitis B are available as well.

Also read: What is HPV (Human Papilloma Virus)?


How do I find out if I have been infected with Super Gonorrhea?

Gonorrhea is often diagnosed using a PCR test. This test can give results very fast and determine if a person is infected with Gonorrhea or not. However, this test cannot differentiate between regular Gonorrhea and Super Gonorrhea.

For that, a test called Gonorrhea Culture and Sensitivity has to be conducted. This test takes a longer time as the Gonorrhea bacteria has to be grown on a plate and tested against various antibiotics. This test is also less sensitive as for various reasons, sometimes the Gonorrhea bacteria cannot grow.

Also read: What Is Rapid Chlamydia & Gonorrhea PCR STD Testing?

If you think you may have been exposed to Super Gonorrhea, you have to see your Doctor immediately. DTAP clinics focus on STD screening and STD treatment. We offer rapid PCR testing for Gonorrhea (next day results) as well as culture tests to detect multi-drug resistant (Super) Gonorrhea. 

Speak to your doctor if you have any questions regarding Gonorrhea or other STDs.


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Movember: Testicular Cancer

Testicular Cancer & Self-Examination

It is November this month, which is also the month of Movember! Movember is an annual event which to most people, involves the growing of moustaches and beards. But the true meaning behind Movember is to raise awareness of men’s health issues, such as prostate cancer, testicular cancer, and men’s suicide. 

In the same vein, today we will be talking more about testicular cancer and self-examination. Testicular cancer is the most common cancer in men aged 15 to 34 years.

The testicles are the sex organs located inside the scrotum. They produce the male sex hormones and sperm for reproduction. Testicular cancer is a cancer that arises from the cells that make up the testicle. Testicular cancer is comparatively rare when put side by side with other cancers, but testicular cancer is the most common cancer in males between the ages of 15 and 35.

Signs & Symptoms Of Testicular Cancer

  • A lump or enlargement of the testicle (cancer usually affects one testicle in most cases)
  • A feeling of discomfort, pain or heaviness in the testicle or scrotum
  • A dull ache in the lower abdomen or groin
  • Fluid in the scrotum
  • Groin lymph node swellings 
  • Breast swelling or tenderness

Know Your Risk!

Are you between 15-35 years old, of certain ethnicity, have an undescended testicle or a personal or family history of testicular cancer? Consider a testicular cancer screening.

The chances of a cure and full recovery increases when the cancer is detected EARLY.


The vast majority of testicular cancers are from germ cells (the cells that produce immature sperm). They can be either a seminoma or nonseminoma tumour. What causes germ cells to become abnormal and develop into cancer isn’t known, but factors that may increase your risk of testicular cancer include:

  • An undescended testicle
  • Personal history of testicular cancer (e.g. in other testicle)
  • Abnormal testicle development
  • Syndromes such as Klinefelter syndrome
  • Family history of testicular cancer
  • Being ages 15-35, however, testicular cancer can occur at any age too

However, many men with testicular cancer have no known risk factors

Cancer can also arise from the stromal (connective) tissues. These are often benign but sometimes can be malignant. These grow in the tissues that produce hormones inside the testicles. Testicular cancers can also be secondary (spread to the testicles from other organs), or lymphomas. 

Treatment For Testicular Cancer

Testicular cancer is highly treatable as they are very sensitive to chemotherapy, even when the cancer has spread outside of the testicle. Cure rates can reach as high as 90%-95%. However, patients cured of testicular cancer have about a 2% risk of developing a cancer in the contralateral testicle. 

If testicular cancer is found early when it is small and has not spread, the chances of a cure is much higher. Early testicular cancers may cause symptoms listed above that lead men to seek medical attention. The most common presenting symptom is a lump on the testicle. Having said that, testicular cancers in other people may not cause symptoms until the later stages.

There are doctors that recommend all men examine their testicles monthly after puberty, but because testicular self-exams have not been studied enough to know if they reduce the death rates from testicular cancer, no clear guidelines exist on whether or not they should be recommended to everyone. Each man has to decide for himself if he wants to examine himself. This might be more important if you have any of the risk factors listed above. Seek medical attention immediately if you do find a lump. Your doctor will advise as appropriate.

Testicular Self-Exam (TSE)

The testicles are easiest to examine when the skin of the scrotum is relaxed. The skin is usually relaxed when you are relaxed, or after a warm shower or bath. You can examine yourself lying down or standing up. Most doctors will examine you standing up. 

  1. Hold your penis away.
  2. Hold your testicle one at a time between your thumb and fingers.
  3. Roll it gently between your fingers.
  4. Feel for any lumps, bumps or fluid.
  5. If you do examine your testicles regularly, you will eventually know what is normal for you and what is different. Feel for any change in the size, shape, or consistency of your testicles. Seek medical attention if you notice any difference.

What’s Normal?

  • One testes may be slightly larger than the other
  • One side may hang lower than the other
  • Part of the testicle is known as the epididymis where sperm is stored. This may be felt as a bump at the posterior upper or posterior middle aspect of the testicles
  • Above the testicles you may feel a cord like structure – this is the spermatic cord where sperm is carried.

What’s Abnormal?

  • An abnormally large testes compared to the other side
  • A hard lump
  • Fluid around the testicle 
  • Dilated veins above the testicles which may feel like worms 
  • Tender lumps

Not all the above abnormalities are related to cancer. But if you do find such abnormalities, please visit your doctor for a consultation. One of the easiest ways to characterize a lump is with an ultrasound, which is completely painless.

Happy Movember everyone!

Speak To Our Male Doctor Today!

If you are experiencing any symptoms, or have any concerns or questions about prostate cancer and prostate cancer screening, please make an appointment with our clinics today or visit any of our Men’s Health Clinics or drop us an email at hello@dtapclinic.com for an appointment.

Circumcision Reduces Bacteria And Risk Of STDs

What is Circumcision?

Circumcision is a procedure where the excess foreskin is removed. This ritual has been performed on boys for thousands of years. It is currently practised by many faiths and culture. In the states, it is usually done within the first few days of life. Among Muslims and Jews, it is highly encouraged for boys to be circumcised. In fact, it is highly encouraged because it promotes better hygiene among other benefits. 

Male circumcision reduces the abundance of bacteria living on the penis and might help explain why circumcision offers men some protection against HIV, according to a study led by the Translational Genomics Research Institute (TGen).

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Are circumcised men less likely to contract HIV?

One of the most interesting benefits of circumcision is the finding that circumcised men are less likely to contract HIV, the virus that causes AIDS. In 2005, a study of South African men found that circumcised men who had sex with an HIV-positive woman were 63 percent less likely than uncircumcised men to contract the virus. Other than HIV, Circumcision has also been shown to reduce the risk of contracting HPV, or human papillomavirus. 

HPV is a virus that can cause cervical cancer in women. Another sexually transmitted virus is the herpes simplex virus type 2, better known as genital herpes. The risk of transmission of genital herpes is also reduced in men who were circumcised.


Bacteria and Sexually Transmitted Diseases (STDs)

Other than viruses, bacteria also are responsible for some of the common Sexually Transmitted Diseases (STDs). Circumcision has been proven to reduce incidence of Chlamydia Trachomatis infection. Interestingly, circumcision doesn’t just protect the men, but also protects the women as well.

In a study published in 2005 in American Journal of Epidemiology, there’s an 82% reduction of Chlamydia infection among women whose partners were circumcised as compared to women whose partners were uncircumcised.

A study of women in Kenya and Uganda enrolled in an RCT and followed up for 3 years found circumcision of their male partners was associated with a 59% reduction in incident syphilis among the women. A prospective study in Kenya by the same authors found that those with circumcised male partners had a 58% lower risk of incident Trachomatis vaginalis than did women with uncircumcised partners.

One of the main possible reasons behind lower risk of infection is the recent finding where there is a significant shift in the bacterial flora of the penis after circumcision. This was according to a study published by the online journal mBio. This international collaboration focused on 156 men in Rakai, Uganda — part of the world’s largest randomized-controlled trial on male circumcision.

Researchers showed that men who were circumcised as part of the study had 33.3 percent less bacteria on their penis than those who remained uncircumcised one year after the study began. Researchers further showed that the decrease was primarily found in 12 types of bacteria, most of which were intolerant to oxygen.

At the same time, understanding the mechanisms that underlie the benefits of male circumcision could help to identify new intervention strategies for decreasing HIV transmission, especially for populations with high HIV prevalence and in places where male circumcision is culturally less acceptable, the study says.

“We know that male circumcision can prevent HIV and other diseases in heterosexual men, but it is important to know why,” said Dr. Lance Price, the Director of TGen Center for Microbiomics and Human Health and the study’s senior author.

“We think that these dramatic changes in the penis microbiome may explain, at least in part, why male circumcision is protective, ” said Dr. Price, who is also a Professor of Environmental and Occupational Health in the School of Public Health and Health Services at the George Washington University.


HIV

In heterosexual transmission of HIV, the virus on the foreskin needs to reach its target cells, the CD4+ T-cells, which reside primarily in blood or the lymph nodes.

Researchers hypothesize that penis bacteria may facilitate this process in two ways: by both recruiting more HIV target cells to the foreskin and by triggering another set of immune cells, the Langerhans cells, to deliver the virus to susceptible T-cells. Without this trigger, the Langerhans cells will simply destroy the virus.

“Our findings are interesting from two perspectives. From a public health standpoint, we were finally able to detail the bacterial changes associated with male circumcision,” said Dr. Cindy Liu, Adjunct Professor at the Pathogen Genomics Division at TGen, and the study’s lead author.

“From an ecological perspective, our study shows how phenomena from the macro-world actually scale to the micro level. When you change a macro environment, such as clear cutting a forest, you affect the animals that live there. That’s intuitive. Here we show that changing the penis environment affects the microbes that live there as well.” said Dr. Liu, who also is a member of the Department of Pathology at the Johns Hopkins School of Medicine.


Currently circumcision among adults is carried out in Africa as a part of the campaign to fight HIV and AIDs. With increasing evidence of health benefits from circumcision, I am seeing more men coming forward to get circumcised voluntarily. These are men who have no medical problems that warrant a circumcision. They simply want to have better hygiene and reduce their risk of infection.

Also read: What Are The Top 7 Reason Men Undergo Circumcision?

At Dr Tan & Partners, we use the Shang Ring Method of circumcision. With this method, there is no need for injections and the procedure is very quick, simple and painless. Only numbing cream is used and after 30 minutes of application, the procedure can commence. The procedure itself takes only 10-15 minutes. Our patients are usually surprised at how painless and quick the procedure is. Most importantly they like how the results look at the end of the day.

Also read: How Does Sutureless Circumcision​ Technique (Shang Ring) Work

Next read: How Is The Adult Circumcision (Foreskin Removal) Procedure Done?

Speak to your doctor if you have any questions regarding circumcision.


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People Living With HIV In Singapore

The alarm chimes to life. As the incessant ringing crescendos the clock face starts to flash an LED blue. Mr. J stretches a slim arm out from under the blankets and pushes down on the snooze button. It was 6:00am on another nice balmy morning in Singapore. Because it was approaching the year end it was a cool 24°C. Jumping out of bed, Mr. J prepares for his morning run on the Park Connector, a network of roads and paths linking the various parks and gardens in Singapore.
A quick shower follows his run and he slips into his shite cotton shirt and blue cotton pants, all ready for a 20 minutes ride on the MRT to Raffles Place and his office in the financial hub of Singapore. After a hard day’s work a 10 minute walk takes him to Fullerton One where he enjoys a well earned dinner and drinks with his friends while the sun sets behind the Marina Bay Sands integrated resort. Another most typical day for a typical Singaporean in Singapore. Except for one difference. Mr. J is one of the almost 7000 people living with HIV in Singapore. 
I set up our first clinic at Robertson Walk in 2005 and in 2008 was awarded the mandate to conduct anonymous HIV tests. Mr. J saw me in 2009. He was recently married. His wife had to spend a few days out of town and he saw no harm in engaging the services of a sex worker. He did not use a condom. As the positive line slowly materialized on the test strip, I turned to Mr. J and said “It looks like the test is positive.”
He screamed and he screamed. He could not stop screaming. He grabbed the pillow on my examination couch and screamed into that. Even in the state he was in, he was considerate enough not to scare the other patients in the waiting room. He finally picked up his phone and called his brother. Soon after, his mother and his brother arrived. They spoke and they cried. I told him it was going to be OK but I knew nothing I said was getting through. A few days later Mr. J came back to the clinic, this time with his wife. She tested negative. She had forgiven him and they were going to have a family together. He would be strong, he would take his medicines and he would live what I promised was a long healthy and meaningful life. 


Since 2008 our clinic at Robertson Walk has conducted more than thirty thousand anonymous HIV tests. We have given good news most of the time and bad news more often than we would like. We have diagnosed people from all walks of life, all orientations, all genders, all vocations and a huge variety of nationalities with HIV. It is a virus that does not discriminate. Some took the news with stoic calm, some crumbled mentally, emotionally and physically. We tell everyone the same thing: it is going to be OK. HIV is not a death sentence. HIV is a chronic disease. It is no different from diabetes. You just have to take a single pill a day. You just have to see the doctor a couple of times a year. It is not so bad. It is not so bad. It is not so bad. It is going to be OK. We have held hands, wiped tears and held people together as they mended. 
After the initial shock comes acceptance and the relatively mundane work of getting the virus under control. We walk with them every step of the way from their first blood tests to their first pills. We link them up with emotional support services, we counsel them on their medical finances and step by step, piece by piece their lives reassemble and are made whole again.


On the 1st of April 2015, Singapore lifted its travel ban on people living with HIV. We opened our arms to all in the region who wished for our brand of care. We started seeing people living with HIV come from Malaysia, Vietnam, Indonesia and many other countries in the region. We provided the best care we knew how and watched like a proud parent as their viral loads dropped and the CD4 counts rose. 
2 to 3 out of every 1000 people in Singapore is living with HIV. Did you walk past a thousand people today? On the bus, on the train, in the mall, at your office? Then you have walked past a few people living with HIV. They are no different from anyone else. In fact, I often tell my patients that the people living with HIV I know are frequently in much better shape. Perhaps they appreciate their health more. It is also a myth that once a person is diagnosed with HIV in Singapore the authorities will come flying in and inform his family and his employer and every time he goes past immigration the officers will look at their screens and give him a dirty knowing look.
None of these happens. In fact, laws in Singapore protect the anonymity of people living with HIV and punish people who share someone’s status unnecessarily. Another myth is that HIV treatment in Singapore is unaffordable costing thousands of dollars a month. There are now many schemes in place to make treatment extremely affordable. What still needs a lot of work is the stigma and discrimination. That is why almost every person living with HIV in Singapore keeps their status a secret. That is also why we salute Mr. Avin Tan who went public with his HIV status and now works tirelessly to help others.


The theme of this year’s World AIDS Day is “Communities make the difference. Communities are the lifeblood of an effective AIDS response and an important pillar of support.” Because HIV/AIDS is not “their problem”, it is our problem. Less stigma means a lower barrier to testing which leads to earlier diagnosis and decreasing the risk to others. Less discrimination means more willingness to seek help and treatment which leads to earlier viral load control and less contagion. More support means people living with HIV staying on treatment and remaining physically, mentally and emotionally healthy and contributing to society.


READ: WORLD AIDS DAY PRESS STATEMENT

My Facebook just got updated. There’s a picture of Mr. J with his wife and 2 lovely twin daughters at the Singapore Barrage. They look like they are flying kites or at least trying to. His girls must be 6 years old by now. 6 years since I tested both of them to be negative for HIV. They look like a really happy family. A typical Singaporean family.
Speak to your doctor if you have any questions regarding HIV, Anonymous HIV Testing, HIV Screening and HIV Treatment & Management.


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Where To Buy Nicorette Gum In Singapore

Quitting smoking can be very difficult. This is because the nicotine found in cigarettes is highly addictive.

When smokers stop smoking, their bodies crave the nicotine and this leads to many uncomfortable symptoms including:

  1. Irritability and/or depression
  2. Tingling in hands and feet
  3. Nausea and tummy cramping
  4. Cold sweats
  5. Sore throat and coughing
  6. Difficulty sleeping
  7. Difficulty concentrating
  8. Anxiety
  9. Weight gain

READ: Tobacco Past & Present


Nicotine replacement therapy (NRT)

Nicotine replacement therapy (NRT) has been shown to be an effective adjunct to help people quit smoking. NRT is a safe way to deliver nicotine to the body in place of smoking cigarettes. It therefore reduces the severity of nicotine withdrawal symptoms making the quit journey more tolerable.

In Singapore, NRT is available as chewing gum and patches.

The only brand of NRT available in Singapore is Nicorette. Nicorette chewing gum comes in an Icy Mint flavour. It also comes in 2 strengths – 2mg and 4mg.

READ: Why Can’t Singapore Just Ban Cigarettes?


How do I choose which strength to use?

If you smoke one or more packs of cigarettes (20 cigarettes) per day – use the 4mg strength

If you smoke less than one pack of cigarettes (20 cigarettes) per day – use the 2mg strength


How many gums can I chew in a day?

You should chew a gum each time you have the urge to smoke. As time goes by, you should need fewer and fewer gums.

A recommended weaning program is:

First 12 weeks – 8 to 12 gums per day

Then reduce to 4 to 6 gums per day over 2 weeks

Then reduce to 1 to 3 gums per day over another 2 weeks

Then gradually reduce to zero gums


How do I chew Nicorette gum? Do I just chew it non-stop?

Chew the gum until you the flavour becomes strong. Then place the gum between your teeth and cheek. The nicotine from the gum will be absorbed through your cheek. When the flavour fades, chew the gum again. Keep repeating these steps for 30 minutes. After which the gum can be disposed of. When you have the urge to smoke again, chew another new gum.


What is the price of Nicorette gums?

The price of Nicorette Icy Mint gums at our clinics in Singapore are:

  • 2mg
    • 30 pcs – $28.50
    • 105 pcs – $82.00
  • 4mg
    • 30 pcs – $42.00
    • 105 pcs – $119.00

Prices inclusive of GST.

Nicorette is also available for delivery via our medication delivery service. 


Need more help to quit?

Join the Singapore’s Health Promotion Board I Quit program.

Call 1800 438 2000 to talk to trained consultants to help you through your quit journey. Sign up for the 28 days quit program and get rewarded for staying smoke free: https://www.healthhub.sg/programmes/88/IQuit

Speak to your doctor today for more information regarding Nicotine replacement therapy (NRT).

Next read: How To Quit Smoking – Smoking Cessation In Singapore


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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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