July / August 2018

13th July ( Friday ) : Clinic is open from 8.30am to 2.30pm only. Night session is closed.

27th July ( Friday ) : Clinic is open from 8.30am to 12noon only. Night session is closed.

28th July to 29th July ( Saturday and Sunday ) : Clinic is closed.

9th August ( Thursday ) : Clinic is closed for National Day holiday.

22nd August ( Wednesday ) : Clinic is closed for Hari Raya Haji holiday.

NOTE: Patients who require HIV post-exposure prophylaxis or other urgent consultations – please SMS or call 9662 5512.

Thank you for your kind understanding.

A large number of other tests are available for add on, including ECG, Chest X rays and other radiological investigations, PAP smears, HPV tests, HIV and STD tests, and a large number of other blood or urine tests. Some genetic tests may also be available.

Our health screening packages can be tailored to your needs and concerns. Feel free to discuss your screening or testing needs with our doctor during your appointment and we will try out best to assist. Call us at 6251 5512.

A full range of HIV tests are available. Depending on time from exposure, you may wish to consider the following :

Most circumstances which may expose you to HIV may also expose you to other STIs. You may wish to consider testing for other STIs.

What is the risk of HIV?

This question may be one of the most common ones from patients coming for HIV counselling and testing. And yet this is probably one of the most difficult questions to answer. Do a search on the internet and you may find numerous websites, from official US CDC ( Centers for Disease Control & Prevention ) sites to Q&A websites, which give a range of figures pertaining to the risk of HIV transmission via various forms of sexual acts. Unfortunately, these figures may not always be the same. The reason for this includes :

• Patients or subjects of research often engage in multiple different sex acts in each sexual encounter.
• Patients or subjects of research may engage in multiple encounters ( either reported or unreported, involving different sex acts each time ) within a short period of time, in between getting their HIV tests done.
  
• There is inherent difficulty in doing research and getting precise statistics in a discipline which is very private and often still carries significant stigma. Much of the information on number of partners and types of sex acts depend on subjects’ self-reporting.
  

To simplify the issue, we have categorised the various sexual and non-sexual exposures based on their approximate risk level. Bear in mind that there can be several factors which increase or decrease the risk, even within each category. Where figures are available and likely to be reliable, we have quoted the lowest and highest estimated risk from various sources but we believe that the risk category is likely to be more relevant for patients trying to understand their chances of infection.

¹ Cohen MS, Chen YQ, McCauley M, et al; HPTN 052 Study Team. Prevention of HIV-1 Infection with early antiretroviral therapy. N Engl J Med 2011;365(6):493-505.

² Weller SC, Davis-Beaty K. Condom effectiveness in reducing heterosexual HIV transmission (Review). The Cochrane Collaboration. Wiley and Sons, 2011.
Below: Oraquick HIV rapid test – positive test

What do i do if the test turns out positve?

If the initial screening test is positive, a second blood sample will need to be sent for a confirmatory test called the Western Blot. This test typically takes about 2 weeks to be ready. No fasting or other special preparation is required.

The Western Blot may show:

• Negative ( good news! But consider repeating antibody test in 3 months if there has been risk of exposure )
• Indeterminate ( Consider repeating antibody test or P24 Combo test in 1 month if there has been risk of exposure )
• Positive ( Our doctor will discuss the subsequent options for treatment and follow up with you )
  

HIV is certainly a serious infection, but options now exist for patients to have the infection suppressed and controlled. This can help reduce or delay the late complications of HIV infection and help protect your sexual contacts from HIV. Therefore it is crucial to take the first step and be tested.

Some additional information is provided below, together with links to the original site / source.

1)  From the US CDC ( Centers for Disease Control and Prevention ) website

STD stands for sexually transmitted disease. STI stands for sexually transmissible infection.

Conceptually, there may be slight differences between the 2 terms but in most instances, the 2 terms can be used interchangeably. Both refer to infections which a patient catches from another through various forms of sexual contact, including oral, vaginal or anal sex. Sharing of sex toys does not carry a significant risk for HIV, but may constitute a risk for other STDs.

In Singapore, the more commonly encountered STIs include:

Bacteria

• Gonorrhoea ( sometimes spelled ‘gonorrhea’ )
• Chlamydia ( not all types of chlamydia are considered STIs )
• NSU ( non-specific urethritis ), which may be caused by Mycoplasma hominis or Ureaplasma urealyticum, amongst others.
• Syphilis / Venereal disease

Viruses

• Herpes / Genital herpes
• Genital warts ( caused by HPV, human papillomavirus )
• Molluscum contagiosum
• Hepatitis B
• Hepatitis C
• HIV

Parasites / Protozoa

• Trichomonas
• Pubic lice ( ‘Crabs’ )

Other conditions sometimes associated with sex or intimate contact ( but are not necessarily considered STDs ):

• Oral Herpes / Cold Sores
• Urinary tract infections
• Candidiasis / Thrush
  
• Bacterial vaginosis ( female )
• Prostatitis ( male ) – inflammation or infection in the prostate
  
• Epididymo-orchitis ( male ) – inflammation in the testes and male tubes
• PID / pelvic inflammmatory disease ( female ) – inflammation in the Fallopian ( female ) tubes
• Scabies

Some infections, such as HIV, Hepatitis B, Hepatitis C and syphilis, may also be transmitted through non-sexual routes. These may include mother-to-child ( vertical ) transmission, occupational exposures from contact with blood ( eg. laboratory personnel, police or prison officers, healthcare workers ), infections in recipients of blood transfusions or organ transplants and infections amongst intravenous drug users who share needles.

So, how would I know if I have an STD or STI?

Symptoms of STDs, such as painful urination or discharge from the urethra or vagina, may alert you to the presence of infection. However, many patients with STDs do not have any symptoms. These carriers are still capable of passing the infection on to their partners.

Getting a screening test done will be a more reliable way to tell if you have been infected after sexual exposure. The list of available tests can be found here.

Of course, preventing yourself from getting an STD or STI is still the best plan. Here’s what we suggest.

What happens if I have an STD?

Majority of STDs can be treated. It is important to get treated early to reduce the chances of spreading the infection and to minimise the risk of complications and long term problems. A write up on available treatments can be found here.

Common symptoms which are caused by STDs may include:

For men
– discharge from the penis / urethra / anus
– pain when passing urine
– blisters or sores on the penis / pubic region / anus
– rash on the penis / pubic region
– itch or pain in the urethra
– aching, pain or swelling in the testicles
– blood in the semen / ejaculate
– growths or lumps around the penis / anus
– swellings at the groin

For women
– discharge from the vagina / urethra / anus.
– pain when passing urine
– blisters or sores on the vagina / pubic region / anus
– rash on the vagina / pubic region
– itch or pain in the urethra or vagina
– pain during sex
– bleeding during sex
– growths or lumps around the genitalia / anus
– swellings at the groin

Occasionally, symptoms which are non-specific, such as fever, tiredness, bodyaches, rash over the body, including the palms and soles or neck swellings, may be present. These symptoms may happen 1 or several weeks after the sexual encounter. 

However, we believe the most important message on this issue is that most STDs can be totally asymptomatic or symptom-less for a long period of time. 

STDs can be passed on to sexual partners even when they are not causing any symptoms. The consequences of sexually transmissible infections can include cancer, problems with fertility, prostate irritation and inflammation ( in men ), pelvic inflammatory disease ( in women ) and damage to other organs such as the liver, kidney, heart, spinal cord and brain.

This is why preventive strategies and going through screening tests ( with timely treatment of any infection detected ) are crucial in protecting your loved ones from infection.

If you experience persistent or increased vaginal discharge, or if you suspect that you may have an infection , call us now at 9662 5512 for appointment.

If you suspect or believe you have urethral discharge, do make an appointment with us now at 9662 5512.

• genital warts
• molluscum contagiosum ( MC )
• condylomata lata ( syphilis )

• skin tags
• skin malignancies ( cancers )
• actinic keratosis
• seborrheic keratosis
• lichen planus
• benign skin tumours and cysts ( eg. keratoacanthoma )

• Fordyce spots
• Pearly Penile Papules
• Sebaceous hyperplasia

• Hymenal remnants
• Micropapillomatosis labialis