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Department of STI Control Singapore
MSM @ the DSC clinic
Department of STI Control Singapore
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HIV notifications
300 250 200 150 100 50 0
200 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 0
Heterosexual 190 181 181 177 188 186 222 255 248 284 228 210 220 181 Homosexual 12 22 30 40 72 87 95 130 151 139 163 195 210 209 Bisexual
16
16
12
14
22
14
14
15
34
27
41
42
27
38
Uncertain
4
10
3
6
18
23
12
13
3
7
3
10
10
22
Ministry of Health statistics
Department of STI Control Singapore
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Why are STIs important • Some STIs are asymptomatic • STIs have similar mode of acquisition as HIV • Multiple infections with a few STIs are possible • STIs increase the risk of acquisition of HIV • Same behavioural change / safer sex can lead to decrease of both
Department of STI Control Singapore
STI infections
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Total STI rates (n = total no. of MSM attending DSC by year) %
1000
100
928
900
90
850
84.4%
800
77.8%
73.1%
71.1%
700
80
758
70
66.9%
66.2%
591
600
525
60
512
500
50
400
40
300
30
200
20
100
10
0
2008
2009
2010
2011
2012
2013
Total MSM attendees
525
512
591
758
928
850
% STI
84.4
71.1
77.8
73.1
66.9
66.2
554
621
563
Total STI diagnosed:
443
364
460
0
Department of STI Control Singapore
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Table 1- DSC Diagnoses 2013 Diagnosis
2008
2009
2010
2011
2012
2013
Warts (Penis)
28
20
29
31
21
32
Warts (Perianal/Anal canal)
85
79
90
87
92
102
Herpes simplex infection
10
9
-
13
12
7
Early Syphilis
36
25
35
45
55
73
Late Syphilis
39
34
36
42
58
54
GC Urethritis
59
46
76
66
78
55
GC Proctitis
25
17
25
36
37
32
GC Pharynitis
21
11
15
28
13
20
NGU
46
42
51
39
56
39
Chlamydia Urethritis
34
38
48
53
81
45
Chlamydia Throat
1
-
-
-
-
-
Chlamydia Rectal
8
1
10
68
62
61
HIV screened at DSC
40 (new)
27 (new)
28 (new)
30 (new)
43 (new)
26 (new)
HIV referred by GP/others
11
15
17
16
13
17
Total STI
443
364
460
554
621
563
Other Diagnoses
25
15
-
-
-
-
NA
58
213
229
357
467
406
Total MSM
525
512
591
758
928
850
STI %
84.4
71.1
77.8
73.1
66.9
66.2
Department of STI Control Singapore
Sexual behaviour
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Last recorded sexual exposure 2013 – category of partner & condom use 70 60
257 (62.5%)
125 (51.7%)
50 40
1 (25%)
30 20 10
7 (3%)
15 (3%)
0
0
n=244
n=492
n=242
n=411
n=4
n=10
condom use for oral sex
condom use for anal sex
% MSM condom use regular
3
51.7
% MSM condom use casual
3
62.5
% MSM condom use sex worker
0
25
Department of STI Control Singapore
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STI infections
Diagnoses (Viral STIs) 120
100
80
60
40
20
0
2008
Wart (Penis)
2009
2010
Wart (Perianal / Anal canal)
2011
2012
Herpes simplex infection
2013
HIV (new)
Department of STI Control Singapore
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STI infections
Diagnoses (Bacterial STIs) 90 80 70 60 50 40 30 20 10 0
2008
2009
2010
2011
2012
2013
Syphilis infectious
Syphilis non-infectious
Gonococcal urine pcr
Gonococcal proctitis
Gonococcal pharyngitis
Non Gonococcal Urethretis
Chlamydia urine pcr
Chlamydia throat pcr
Chlamydia rectal pcr
Department of STI Control Singapore
STI infections
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Infection rates (In % MSM attended & MSM Tested) 30
24.7%
25
14.9%
20
18.6%
20.8%
15
9.5%
10
7.2%
8.4%
6.5%
6.9%
5.3%
5
0
4.6%
3.8%
5.8% 4.3% 3%
2.3%
Syphilis
Chlamydia Rectal
GC Urethritis
Chlamydia Urethritis
NGU
GC Proctitis
HIV
GC Pharyngitis
Chlamydia Throat
% +ve among MSM attendees n=850
14.9
7.2
6.5
5.3
4.6
3.8
3
2.3
0
% +ve among MSM tested
20.8
18.6
8.4
6.9
24.7
9.5
5.8
4.3
0
71.8
38.5
76.6
76.7
18.6
39.4
53
54.6
0.7
Percentage of MSM attendees: that tested
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Department of STI Control Singapore
STI screening
Department of STI Control Singapore
• • • • •
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@ DSC clinic (July 2014) Consult fees: $30 HIV rapid test: $8.50 Syphilis screening test: $11.50 Hepatitis B screening tests: $30 Chlamydia & Gonorrhoea screening tests: $30 per site • Maximum cost for tests: $120
Serology
• • • • • HIV Syphilis Hepatitis A Hepatitis B Hepatitis C
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Department of STI Control Singapore
Department of STI Control Singapore
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Swabs/urine
Gonorrhoea & Chlamydia • Pharyngeal (oral) • Penile • Rectal (anal)
Department of STI Control Singapore
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Vaccinations
• Hepatitis B
• Hepatitis A
• HPV – genital wart virus
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Department Departmentof ofSTI STIControl ControlSingapore Singapore
Web resources
CDC: www.cdc.gov
DSC website: www.dsc-clinic.sg