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MESSAGES TO
Sexual Health Screening

Sexual Health Screening

A DxD Session with Dr Anthony Stanislaus


Ended on Thu Nov 15 2018
Ended

Top Answers


HIV and STD screening should be tailored to the type of sexual activity. If you had a high-risk exposure, HIV screening is still recommended even though the STD screening was negative.

The chances of a person getting HIV via oral sex with a HIV positive partner is extremely low. The type of oral sex that may be the riskiest is mouth-to-penis oral sex, but with that in mind the risk is still very low and is much lower than with vaginal or anal sex.

There are also several factors that may increase your risk of getting HIV via oral sex, such as:

  • Sores in the mouth or vagina or on the penis
  • Bleeding gums
  • oral contact with menstrual blood
  • presence of other sexually transmitted diseases (STDs).

There is no risk of HIV when it comes to mutual masturbation.

19 Oct 2018

Human immunodeficiency virus (HIV) is a form of retrovirus that causes HIV infection. Over time it leads to acquired immunodeficiency syndrome (AIDS).

AIDS is a condition where due to progressive failure of the immune system, allows life-threatening infections which don’t usually bother a healthy person and cancers to thrive in the body. This is why HIV is one of the infections we humans are most worried about after a sexual encounter.

There are a few ways to detect HIV in the blood and each method has different testing window periods.

Window period is basically the time between potential exposure to HIV infection and the point when the blood test will give an accurate result.

The most commonly ordered tests in Singapore for detecting HIV are:

  • HIV antibody test (3rd generation)
  • HIV antigen/antibody test (4th generation).

The HIV antigen, also known as p24, may become detectable in the blood 14 to 20 days after an infection and peaks at about day 30.

On the other hand, the HIV antibodies may become detectable as early as day 20 to 23 but in some cases, it may take longer.

With this in mind, the earliest you can undergo a HIV antigen/antibody (4th gen) test is 2 weeks after an exposure but a repeat test will need to be done at the 4-week mark where the p24 is at its peak and the test is deemed accurate.

The HIV antibody test (3rd generation) test is best performed at the 3-month mark for it to be deemed conclusive.

With these in mind, there are in fact other tests which may be able to detect HIV before the 4 week mark, however, it is very costly and the waiting time to get the results are long and therefore are not usually recommended.

It is therefore best to see a doctor with experience in HIV testing who will be able to tailor the tests to your history. Do note that there are rapid tests available in some clinics in Singapore, that will be able to give you a result in 30 minutes.

19 Oct 2018

All results are kept private & confidential between a patient and doctor. It will not be shared with anyone without the patient’s permission.

However, a positive HIV test needs to be notified to MOH under the Infectious Diseases Act.

19 Oct 2018

If you had non-protected intercourse, especially with a high-risk partner, your risk of being infected by STD is high.

You are at risk of all the STDs and HIV.

I would suggest a complete STD screening at the appropriate window periods to make sure you did not get infected.

This will include tests for:

  • HIV
  • Hepatitis
  • Syphilis
  • Herpes
  • Gonorrhoea
  • Chlamydia.

It is recommended to see a doctor trained in sexual health who will tailor the tests according to your sexual history.

19 Oct 2018

Yes. If the HIV tests are done at the appropriate window periods a negative test can be considered conclusive. In your case, a negative 4th gen test at 1 month and a negative 3rd gen test at 3 months are conclusive.

19 Oct 2018

Hi, Douching can disrupt the pH and balance of bacteria in the vagina. This leads to a change in the composition of the bacteria that is usually found within the vagina. This in turn, could increase the risk of vaginal infections such as yeast infections and bacterial vaginosis. Besides that, it can also cause the spread of harmful bacteria, already present in the vagina, further up into the uterus.

In reference to its impact on fertility, there are some studies that have shown that women who douche regularly take a longer time to become pregnant than women who do not douche.

I would recommend stopping douching as the vaginal tract produces mucus, which cleanses the vagina, washing away blood semen and discharge. Just wash the outside of the vagina with a mild soap and water for good hygiene.

Please see a doctor if you have any symptoms that you are concerned about.

21 Aug 2018

Yes, it is true that in a lot of instances, STI may not show any sign or symptom.

For example the most common STI in Singapore is Chlamydia, and up to 80 percent of women may not show any signs and symptoms of chlamydia infection.

This is why I usually recommend all my patients who had a potential exposure to an STI to test for them. It is important to detect these diseases so that treatment can be provided to prevent complications and transmission to your partner.

When STI do present with symptoms, it may include: 

  • Discharge from the Anus, urethra or vagina
  • Pain on passing urine 
  • Painful or painless Sores/ulcers in the genital region 
  • Blisters in the genital region 
  • Growths in the genital region  
  • Swollen or enlarged lymph glands in the groin or other parts of the body
  • Rash which may be localised to the genitals or distributed over other parts of the body
19 Oct 2018

If you think you’ve gotten an STI, I would recommend seeing a Sexual health doctor who is experienced in diagnosing and treating the different types of STI.

A detailed history and examination will be done. After that, we will recommend tests based on your exposure and in certain cases will provide treatment immediately based on what we think is the cause.

19 Oct 2018

STI tests are most accurate at the appropriate window periods. However, I do have patients who are very sexually active and come in for regular STI screening.

There are no guidelines for frequency of testing in such situations, but most clinicians recommend at least twice a year.

However, if you are regularly involved in high risk sexual behaviours, more frequent testing may be required.

The type of tests that needs to be done will depend on your sexual activity. It is best to discuss this with the doctor so that the type of tests and frequency can be tailored to you.

19 Oct 2018

After a detailed history, the sexual health doctor will examine the area of concern based on any sign or symptoms that you have.

Based on your sexual history, the doctor will also decide on which tests are suitable based on the window periods.

For gonorrhoea and chlamydia, a urine collection or swab of the area of concern (Pharynx, Anal, Urethral, Vagina) will be obtained.

These days a Polymerase Chain Reaction (PCR) test is done as it is more accurate and sensitive than the blood test which looks for antibodies to those bacterias. The issue with the blood test is that, if positive, we are unable to tell if it’s a new infection or an old one.

Besides that, from the same vaginal or urethral swab and urine collected, tests for other bacteria’s such as Ureaplasma Urealyticum, Mycoplasma Hominis and Trichomoniasis may also be done.

For the other STI such as Hepatitis A, B & C, Syphilis, and Herpes Simplex Virus, a blood test will be done. HIV test may also be done from the same blood sample.

Patients who present with symptoms suggestive of Herpes, a PCR swab of the lesion may be done to get a confirmation. 

19 Oct 2018

The only vaccine available in Singapore to help prevent a form of STI is the Cervical cancer vaccine. It protects you from certain strains of the Human Papilloma Virus (HPV) which can be transmitted sexually. Most HPV strains do not cause any symptoms and go away on their own.

However, there are certain strains that cause cervical cancer in women. Besides that, certain strains can also cause less common cancers in both men and women such as cancer of the anus, penis, vagina or vulva and oropharynx. Moreover, some strains can cause warts in the genital area of men and women.

It is important to note that the vaccines are designed to only cover certain strains (not all) which cause cancers and warts. There are different versions of this vaccine with the latest called Gardasil 9 which protects you from 9 different strains of HPV. The other versions are called Gardasil 4 which protects you against 4 different strains and Cevarix which only protects you against 2 strains.

In Singapore, females aged 9 to 26-year-old can use their Medisave to subsidise the Cevarix and Gardasil 4 vaccinations. Although these vaccines were approved for males and females between the ages of 9 and 26, patients older than 26 may still consider getting it but it is best to discuss this with the doctor to find out if you are suitable for it.

19 Oct 2018

I feel every couple should have this conversation before engaging in sexual activity for the first time. STI are more common than what is reported and a lot of them may not show any symptoms.

The last thing you want is to transmit a disease to your partner. Talking about STI in this decade has become less of a taboo compared to the past and more people are getting tested these days.

This topic should be brought up in a private discussion before engaging in any form of sexual activity to prevent STI. Besides that, it is totally normal for the conversation to feel a little awkward but once you get it over with, the awkwardness disappears. You never know, your partner may be glad you brought it up.

Also, if you are found to be positive for a STI, it is very important that you tell your partner so he/she can get tested or treated. This is because your partner would have more likely gotten infected and if untreated, it can cause complications to your partner if untreated and potentially re-infect you even if you have been treated.

19 Oct 2018

Only a few suppliers are registered in Singapore to distribute test kits and they are only allowed to supply to medical clinics. This is based on the approval of Health Sciences Authority (HSA) and Ministry of Health (MOH).

The quality and accuracy of the test kits sold online cannot be guaranteed. Moreover, there is no way to ensure the patients are conducting the tests properly and that their results are accurate.

In Singapore, doctors have to undergo training in order to perform these rapid tests in the clinic. This is to ensure that the results are accurate and also treatment can be provided as soon as possible.

19 Oct 2018

Below are high risk behaviours that would put you at a higher risk of getting STI and HIV:

  • Unprotected vaginal or anal intercourse
  • Unprotected oral intercourse. 
  • Engaging in sexual activity from a young age.  
  • Sexually active with multiple partners 
  • Sexually active with a high-risk partner (one who is engaged in these high risk behaviours)  
  • Working in the sex trade industry 
  • Having intercourse with a partner who engages in injected illicit drug use. 
  • Men who have Sex with Men (MSM) 
19 Oct 2018

Top Questions


Dear Doctors, I am currently 22 years old. I noticed that my penis is quite small in size as compared to my peers. My penis is 2.5 inch when fully erected, and about 0.5 inches when not erected. I would like to know whether there are any available treatments that can help to enlarge my penis? Thanks.

A friend of mine (22F) suspects she has PID. She had bad pelvic pain at one point in time, but the pain has since subsided without any treatment. Can PID heal or go away by itself without treatment? Will leaving PID untreated worsen the condition?

I’m a 22 year old female. 3 days back, I realised that I've been peeing more than usual. There was also little droplets of blood. Even though I have peed just a few minutes back, I still have that sensation that I have to still go. And right after I’m done, there’s a tingling feel. I don’t feel any pain or such, just the tingle and frequent visits to the toilet even though I just peed previously. Do let me know what is wrong with me because it’s quite worrying. Thank you!

Hi Docs, I’m male, 25. 4 months ago, I received an unprotected handjob from a local massage parlour. I ejaculated on her hand after 5 mins, and she used a towel to wipe my genital area up. I don't have any symptoms like discharge or pain while peeing. However, I would like to check whether there are any STI risks of an unprotected handjob? Which STI tests are required, if any? Thanks!!