Page 3 – DTAP Medical Clinic | GP STD HIV Testing Clinic Singapore

Risk of HIV Transmission Through Blowjob

5th March 2021/0 Comments/in infectious disease, STD & HIV, Syphilis /by Miri Yeo

A recent news report by Channel News Asia titled “HIV-positive man who donated blood during pandemic faces charge of lying about sexual history” may have caused some concern in the community with regards to the issue transmissibility of HIV through oral sex.

Based on the report, people may wonder just how transmissible is HIV via oral sex and how does it compare to other forms of sexual practices like vaginal sex.

Sexual Practice and HIV Transmission Risk

Based on the Department of STI Control Clinic in Singapore, the table below summarizes the risk of transmission of HIV based on the type of sexual practice.

Sexual Practice	Estimated risk of HIV transmission from a known HIV-positive individual not on effective HIV treatment
Receptive vaginal sex	10 per 10,000 persons
Insertive vaginal sex	About 8 per 10,0000 persons
Performing oral sex	< 1 per 10,000 persons
Receiving oral sex	< 1 per 10,000 persons

Can HIV be transmitted via oral sex yes, but the risk is roughly 10x less likely than vaginal sex.

So when is there no risk of HIV transmission?

Breathing the same air as someone.
Touching a toilet seat or door knob.
Drinking from a water fountain.
Hugging, kissing or shaking hands (although kissing may transfer fluids the level of virus in saliva is so low as to make the risk negligible).
Sharing food or utensils.
Sharing gym equipment.
Skin to skin contact with an HIV positive person even if they happen to have fluid of unknown origin on them (particularly applies to commercial sex workers).
Biting or scratching that does not break the skin or draw blood

How can we reduce risk of HIV transmission?

Monogomous relationship
Avoid casual sex or paid sex
Always use condoms
Regular testing if you are at risk – protect yourself and your loved ones

There are no way to know your HIV states unless you go for a HIV Test.

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Which STD Tests Should I Get In Singapore?

21st February 2021/in Diseases, Health Information, STD & HIV /by Miri Yeo

STD screening can be a confusing topic for many. For anyone who is sexually active, getting tested for STDs should be part of your regular health screening to protect yourself.

People often only get tested when they show symptoms, or if they have had recent new sexual partners whose health or infection status they are unsure about. However, individuals who are asymptomatic and with no specific sexual exposures of concern should still undergo routine STD screening.

Here are some of the screening recommendations suggested by the US Centers for Diseases Control and Prevention (CDC).

Who	Recommended testing	Recommended interval
All adults between ages 13-64	HIV screening	At least once in lifetime
All sexually active women under 25	Chlamydia and Gonorrhea testing	Annual
All sexually active women 25 and above	Chlamydia and Gonorrhea testing	If you have had new partners If you have had multiple partners If your partner has had an STD
All pregnant women	Syphilis, Hepatitis B and HIV testing Chlamydia and Gonorrhea testing if you may be at risk of these	Early in pregnancy and repeated as required
All sexually active MSM (men who have sexual intercourse with men)	Chlamydia, Gonorrhea and Syphilis testing	At least annually More frequent testing (e..g 3-6 monthly intervals) is recommended for individuals with multiple partners or partners whose infection status’ they are unsure of
	HIV testing	3 to 6 monthly
Anyone who has had unsafe/unprotected intercourse	HIV testing	At least annually

The above general recommendations detail the minimum sexual health testing that one should undertake as part of one’s routine screening. The types of tests recommended ultimately depend on your individual situation and symptoms.

If you have any reason to believe or be concerned about exposure to any STDs, or if you are having symptoms suggestive of an STD, a more thorough screen may be warranted. If you wish to find out more about STD screening, you can have an open conversation with your doctor about your sexual history and any possible concerns or symptoms you may have. Your doctor will then be able to best advise you on what relevant screening you can undergo.

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What Are Pubic Lice (Crabs) & How Do You Get Them?

14th February 2021/in STD & HIV /by Miri Yeo

Pediculosis Pubis is an infestation by the crab louse, Pthirus Pubis. Also known as “crabs”, pubic lice infestation is a relatively common but unreported sexually transmitted disease (STD) and it is estimated that 2% of the world population has had this infestation prior.

Pthirus Pubis

The crab louse is a small, translucent parasite around 1mm in length. It is one of the 3 species of lice that infects humankind and is differentiated by its almost round body. Crab Lice is exclusively found on human hosts and requires human blood to survive. As its name suggests, it is usually found in the hair at the pubic region but it can also be found in other coarse hair of the body, like eyebrows, armpits, beards for example.

Symptoms

The main symptom of a pubic lice infestation is intense scratching, typically at the pubis and the perineum. There can be also pale bluish discoloration of the skin following prolonged infestation as a result of injection of lice salivation during feeding.

When the eyelashes are involved, there can be crusting/matting of the eyelashes with eye irritation as well. Children might be seen continuously rubbing their eyes.

Thankfully, pubic lice are not known to be any vectors of any harmful diseases, unlike the body lice.

Diagnosis

Diagnosis is usually made by direct visualization of the lice or nits (lice eggs) by the patient or the doctor. No other blood tests or swabs are required.

Transmission

Transmission is usually during sexual contact with skin to skin contact.

Transmission via the environment, for example through clothing, towels or linen may also occur but are less common.

One is unlikely to catch pubic lice from a toilet seat as the organism gravitates towards a warm environment and is not adapted to crawl on smooth surfaces.

Treatment

Topical medication is available for treatment of pubic lice and a few applications might be required for complete eradication.

Shaving of the affected area is not required but the manual removal of nits with a nit comb or tweezers is recommended.

It is also important for close sexual contacts of the affected patient to be screened for pubic lice infestation as well. Abstinence is also recommended until re-examination to rule out persistent infection.

Bedding and clothing of the affected patient should also be machine washed in hot water and dried. There is no need for fumigation of the entire room.

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How to Test for Oral STDs

7th February 2021/0 Comments/in Diseases, Health Information, infectious disease, STD & HIV, Syphilis /by Miri Yeo

It is a common misconception amongst both men and women that oral sex (i.e. fellatio, cunnilingus, and analingus) is completely risk-free when it comes to infections. While oral intercourse is often thought to be a safer option compared to penetrative intercourse or conventional sex, the reality is that a variety of STDs can still be transmitted through direct contact with the mouth, lips, tongue or throat.

As such, it is important to monitor for symptoms of these infections as well as proactively test if there is a potential exposure risk, especially as a large proportion of these infections can be asymptomatic, or have symptoms that develop much later.

The most common infections transmissible through oral sex are Chlamydia, Gonorrhea, Herpes Simplex Virus (HSV), and Human Papillomavirus (HPV), and Syphilis. In this article, we will be outlining some of the common symptoms seen with these infections as well as how they can be tested.

Chlamydia and Gonorrhea

These are two of the most common STDs seen globally, and are caused by the bacteria Chlamydia Trachomatis and Neisseria Gonorrhea respectively. They will usually infect the genital region, urinary tract, anus, and oral cavity, although other sites of infection have been noted as well. While symptoms such as sore throat and throat discharge may be present in some individuals, up to 70-80% of throat infections with chlamydia and gonorrhea may be asymptomatic and a large portion will remain undiagnosed and untreated.

The most accurate method of testing for throat chlamydia and gonorrhea infections will be with Polymerase Chain Reaction, or PCR testing – this looks for specific genetic sequences from the DNA of these bacteria. Standard bacterial cultures are usually insufficient to pick up these infections.

Herpes Simplex Virus

There are two main types of HSV infection. Type 1 HSV is more commonly seen, and can be spread through both oral-to-oral transmission such as kissing, as well as oral-to-genital transmission. Type 2 HSV is more typically seen through genital-to-genital transmission, although it can also be spread to the mouth, tongue, and throat through oral sex. These viral infections can cause outbreaks of painful ulcers or cold sores at the site of transmission, and infection is carried lifelong. There is risk of transmission of these infections even without symptoms.

Testing for herpes infections can be performed either with blood serology testing or via PCR testing if there are symptomatic lesions. Serology or antibody testing will only be able to detect possible past exposure 1-3 months after transmission, and is not useful to detect new or acute infections.

Human Papillomavirus

HPV infections are one of the most common prevalent STDs worldwide. There are many subtypes of HPV, usually divided into low-risk and high-risk categories. Low-risk types include type 6 and 11, which are responsible for about 90% of genital warts or papillomas – these are benign, cauliflower-like growths on the skin and mucous membranes that can develop weeks to months after initial transmission. High-risk types include type 16, 18, 31, 33, 45 etc. and are more related to cancer risk, including cancers of the cervix, anus, penis, and mouth/throat. It is estimated that approximately 20,000 HPV-associated oral cancers are diagnosed per year in the US alone.

Warts from HPV are usually diagnosed clinically and do not require any specific testing; however, high-risk HPV infections are usually asymptomatic and would require PCR testing to be detected. Guidelines currently recommend women over the age of 30 to do regular HPV PCR testing together with their pap smears, and for men who have receptive anal sex to screen for rectal HPV if they are HIV positive. While oral HPV testing can be performed with the same type of test, there are no specific recommendations to do so, with the costs and benefits of the test to be determined by the individual and their doctor. HPV infections can be prevented with the HPV vaccine, which is now available for both males and females 9 years of age and older.

Syphilis

Syphilis infection is caused by the bacterium Treponema Pallidum. While incidence of syphilis had initially decreased with the availability of penicillin treatment in the 1940’s, rates of infection have been rising steadily for the past two decades, and it is commonly seen as a co-infection with Human Immunodeficiency Virus (HIV). Syphilis infection can be spread through direct contact to mucous membranes and compromised skin from an infected sore or chancre, usually at the genital region, anus, and mouth; it is estimated that around 20% of syphilis infections are transmitted through oral sex alone. Symptoms will depend on stage of infection at presentation, and can include sores or ulcers in primary syphilis, and a diffuse rash in secondary syphilis. Many cases are not detected when symptomatic and may be considered in the latent stage when screened on blood testing, or may even reach the tertiary stage many years after initial infection – this can cause complications with the heart and blood vessels (cardiovascular system), or with the central nervous system (neurosyphilis).

Syphilis testing is mostly performed with serological tests, which look for certain antibodies in the blood that can be detected 2-5 weeks after infection. Other forms of testing include dark-field microscopy, direct fluorescent antibody, and PCR testing; however, these are rarely performed in the clinical setting due to cost and availability of equipment and experienced lab personnel.

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Symptoms of Sexually Transmitted Diseases in Women

31st January 2021/0 Comments/in STD & HIV, Women's Health /by Miri Yeo

Sexually transmitted diseases (STD) are a major issue amongst women of any age. They may lead to a variety of complications as they can affect the reproductive health of women if left untreated. Therefore, it is important to recognize their symptoms and the need for early medical review and treatment cannot be emphasized strongly enough.

Some of the STDs are caused by:

1) Human papillomavirus
2) Chlamydia trachomatis
3) Neisseria gonorrhoea
4) Genital herpes
5) Trichomonas
6) Mycoplasma genitalium
7) Syphilis
8) HIV
9) Hepatitis B
10) Hepatitis C

It is important to note however, that many people with STDs do not know that they carry the infection. This is called asymptomatic infection. Therefore, even if you have no symptoms and are concerned about an exposure that may have been high risk (e.g. unprotected sex, a recent STD diagnosis in a partner, substance or alcohol use during sex or having multiple sexual partners), then STD tests should be performed to rule out asymptomatic infection.

Symptoms that may suggest that you have STD are as follows:

1) Abnormal vaginal discharge

Any discharge that is unusual for the woman such as a change in quantity, consistency, colour (yellow to greenish) and if there is blood mixed in may indicate an infection.

2) Vaginal itch

This is usually felt externally in the vulva area and may indicate an infection within the vagina.

3) Abnormal vaginal odour

A malodorous discharge or odour without discharge may be abnormal and can be caused by STDs.

4) Vaginal discomfort, pain or burning sensation

This can range from a mild discomfort to full-blown pain or a burning and stinging sensation down below.

5) Painful urination

Burning or a painful sensation during peeing or sometimes just a “hot” sensation during the process though may indicate a urinary tract infection (UTI) but do note that it could also point to an STD.

6) Painful sexual intercourse

This is also called dyspareunia and if it feels deeper inside, it may indicate an infection involving deeper areas such as the cervix.

7) Lower abdominal discomfort or pain

This again may mean infection of the deeper structures such as in pelvic inflammatory disease.

8) Bleeding outside of menses

This may again indicate pelvic inflammatory disease but may also be due to sinister conditions like cancer of the cervix.

9) Vulva blisters, sores, ulcers or wart-like lumps that can also involve other areas such as anal and oral areas

STDs can manifest as rashes or ulcers in the vulva areas or other places as stated above. A blister-like rash is typical for genital herpes whereas a single ulcer (painless or painful) may be early syphilis. Genital warts are due to an infection with human papillomavirus.

10) Non-specific flu-like symptoms such as sore throat, mild fever, headache, tiredness and fatigue

Though these symptoms may not seem to indicate anything serious (apart from suspicion of covid-19), a recent infection with viruses such as HIV and hepatitis B and C may manifest with any of these symptoms. These symptoms are due to the body’s antibody production against these viruses, also called ‘acute seroconversion syndrome’. It is important to think about these conditions particularly after a high-risk sexual exposure event.

11) Swollen (painful or painless) lymph nodes either widespread or limited to the groin area

An STD may cause regional lymph nodes to swell up and may cause pain or discomfort.

12) Widespread rash mainly in the trunk or back which can involve palms and/or soles

Generalised rash involving the body which can involve the palms or soles or both is one of the common symptoms of syphilis.

Though you may feel that you are unlikely to have an STD as you don’t feel any symptoms at all, as mentioned earlier, a large proportion of people who have STDs may not exhibit any symptoms. Thus one should exercise caution when it comes to engaging in high-risk activities (e.g. 100% protection including during oral sex, reduce number of sexual partners, avoid alcohol or substance use etc) and to always seek medical attention should a partner is diagnosed with an STD.

The importance of early diagnosis and treatment of STDs cannot be emphasized enough and this is so that the risk of transmission to others is eliminated and to also reduce the risk of development of complications from STDs.

Should you have any concerns regarding STDs or are experiencing any of the above symptoms, do consider making an appointment with us at DTAP clinic.

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