Category Archives: Sexual Health

Why does it hurt to pee?

Burning sensation while peeing? Or maybe a sharp, stabbing pain as you pee? Whatever your symptoms, dysuria (painful urination) is not a pleasant experience.

Dysuria is usually caused by irritation and inflammation of the bladder trigone (neck of the bladder) or urethra (tube that drains urine from the bladder). If the irritation is affecting the trigone, it can cause bladder contraction, resulting in painful urination, as well as more frequent urination. Irritation in the urethra also causes pain while peeing, but generally doesn’t cause an increased frequency (1). Women can also suffer from dysuria due to inflammation in the vagina or in the region around the vaginal opening (2).

What can cause dysuria?
Dysuria is usually caused by an infection (2), such as:

  • Urinary tract infection (UTI). This is commonly uncomplicated cystitis (bladder infection), particularly in females. However, complicated UTIs can also occur and are associated with a higher risk of treatment failure, so must be diagnosed and treated appropriately (3).
  • Sexually transmitted infections (STIs). These can cause inflammation in various parts of the female and male reproductive tract.
  • Prostatitis (infection of the prostate in males). The prostate may feel tender during a digital rectal exam. Often accompanied by fever, difficulty starting urination, and frequent urination.
  • Yeast infection. Other symptoms can include a thick discharge, redness, and swelling.

Dysuria can also be caused by other health issues, including:

  • Connective tissue disorders that cause inflammation
  • An allergic reaction to a substance (e.g., spermicide or lubricant)
  • Interstitial cystitis (bladder inflammation that is not due to an infection)
  • Thinning of the tissues in the vagina or urethra (common in postmenopausal women)
  • Tumors in the bladder, prostate, or urethra. Your doctor may suggest a PSA test for the detection of prostate cancer. See our previous article here for more information about PSA. 

Which sexually transmitted infections can cause dysuria?
Chlamydia, gonorrhea, and trichomoniasis can all cause pain during urination. For more information about each of these STIs, please see our previous posts:

Each of these STIs may not cause any symptoms, or they may cause symptoms that are easily confused with a urinary tract infection. The only way to be sure of an accurate STI diagnosis is to get tested. We offer individual tests for each of these three STIs, as well as a combination test that detects all three STIs from one self-collected urine sample. See the Related Tests section below for links to each of these tests.

1. Maddukuri G. (Reviewed Jan 2021). Dysuria, Merck Manual Professional Version.
2. Maddukuri G. (Reviewed May 2021). Pain or Burning With Urination (Dysuria), Merck Manual Consumer Version.
3. Michels TC & Sands JE. (2015). Dysuria: Evaluation and Differential Diagnosis in Adults. Am Fam Physician. 92(9): 778-788.

Testing for HIV is quick and simple

At the end of 2019, an estimated 1,189,700 people in the United States were predicted to have HIV. However, it’s not possible to determine an exact figure as about 13% of HIV-positive people in the U.S. are unaware of their HIV status (1).

This lack of knowledge is because many people infected with HIV are unaware of the infection in the early stage (acute, stage 1), as they may not experience any symptoms or only mild symptoms (e.g. headache and sore throat) that can be easily confused with other illnesses (1).

Have you been at risk of catching HIV?
Maybe you have had unprotected sex recently or you have shared injectable drug equipment with someone else. You could unknowingly be carrying HIV and at risk of transmitting it to others too.

Get peace of mind and take an HIV test today. Testing is quick, relatively painless, and simple.
We offer a 4th generation HIV test that detects both the HIV p24 antigen and HIV antibodies. The HIV p24 antigen is a structural component of the viral particle and can usually be detected in the blood of an infected individual from 2-3 weeks after infection. However, p24 antigen levels in the blood begin to decrease 3-4 weeks post-exposure until no longer detectable. HIV antibodies are produced by an infected individual in response to the viral infection. They are usually not detectable until 4-6 weeks after exposure or up to 3-6 months in some cases, but then generally remain detectable (2).

Our test just requires a tiny blood sample self-collected from a finger-prick. This blood sample is then sent to our laboratory for analysis by a fully automated immunoassay–the same very accurate assay type that is used by doctors, clinics, and hospitals all over North America. But our test has one distinct advantage–there is no need to make a doctor’s appointment to get your sample collected. Collect the sample in privacy at home and receive your results online as soon as testing is complete.

HIV testing window period
It is important to note that there is a window period of 45-90 days, during which HIV diagnostic tests may produce a negative result, although infected individuals can still transmit the virus to others. This is because there are just not enough of the tested molecules (antigen and antibodies) present to be detected by laboratory assays. Follow-up testing is recommended for any individuals with a negative result who may have been exposed to HIV. An alternative test type that detects HIV nucleic acid in the very early stages of an infection is also an option (3).

What if I test positive?
Although an HIV diagnosis is still very unpleasant news, it is no longer the death sentence it once was. Even though there is no cure for HIV, antiretroviral therapy (ART) is a very effective treatment to prevent the progression of HIV and to prevent the transmission of HIV to others. It enables HIV-positive individuals to live relatively normal, healthy lives (3).

For more information about HIV treatment, please see our previous article “How is HIV treated?

1. HIV Basics. CDC.
2. Busch MP, et al. (1995) Time course of detection of viral and serologic markers preceding human immunodeficiency virus type 1 seroconversion: implications for screening of blood and tissue donors. Transfusion, 35 (2), 91-97.
3. HIV/AIDS. World Health Organization.

Posted in HIV

Are STDs during pregnancy dangerous?

Sexually transmitted diseases (STDs) can complicate pregnancy and may cause serious health complications for both a woman and her unborn child. Some STDs are curable, while others are not, but treatment and prevention options are still available. In this article, we will discuss the risks associated with various STDs and ways that these risks can be reduced.

Chlamydia and Gonorrhea:
Chlamydia and gonorrhea are both caused by bacterial infections. Most infected people do not show any symptoms, but there is still a health risk during pregnancy. Both of these STDs can cause ectopic pregnancy (1), which is when a fertilized egg implants itself outside of the womb, usually in one of the fallopian tubes. This egg will not develop into a baby and a woman’s health may be at risk if the pregnancy continues.

Untreated chlamydia and gonorrhea can also develop into pelvic inflammatory disease (PID). This is an infection of a female’s reproductive organs and can cause long-term pelvic/abdominal pain, infertility, and an increased risk of ectopic pregnancy (2). See our previous article for more information about the long-term complications of chlamydia.

Gonorrhea during pregnancy is also associated with premature birth and stillbirth (1).

Chlamydia and gonorrhea can transfer from the mother to the baby during delivery, which can lead to eye infections (both), as well as pneumonia (for chlamydia) (1).

Antibiotics are an effective treatment for chlamydia and gonorrhea for both mother and baby (1).

Trichomoniasis is caused by an infection with a protozoan parasite. The majority of infected people do not show any symptoms; however, an untreated infection can cause fallopian tube damage, as well as increase the risk of premature birth and low birth weight (1).

Antibiotics are an effective treatment for trichomoniasis for both mother and baby (1).

Syphilis is caused by a bacterial infection. It has four distinct stages, each with different symptoms. See our previous article here for more information about the four stages of syphilis.

Syphilis during pregnancy can result in miscarriage, stillbirth, or infant death shortly after delivery in up to 40% of cases (3). There is also about a 70% chance of an untreated woman passing syphilis to her fetus resulting in congenital syphilis (4). Congenital syphilis can result in serious health complications, including enlargement of the liver and spleen, rashes, fever, neurosyphilis, lung inflammation (5), developmental delays, seizures, and other fatal complications (6). See our previous article here for more information about congenital syphilis.

Penicillin is the most effective treatment for both mother and baby. Routine screening during pregnancy and prompt treatment is the preferred option to prevent transmission to the fetus. If a child is born with syphilis, treatment must begin immediately to prevent serious complications (6).

Human Papillomavirus (HPV)
HPV is a very common STD. Many people do not show any symptoms and effectively clear infection within 6–12 months (7). However, some HPV genotypes can lead to genital warts, while other genotypes can cause cell changes that lead to cervical cancer (8).

Genital warts that form in the birth canal can cause complications during delivery. In very rare cases, the virus may also be transmitted to the baby during delivery, and potentially cause warts in the newborn’s throat which will require surgery (1).

Wart treatment in the mother is possible during pregnancy (1). There is also a vaccine available for HPV, which is recommended at age 11 or 12 years, and for everyone through to 26 years, if not vaccinated already. Vaccination for individuals older than 26 years provides less benefit, as most sexually active adults have already been exposed to HPV (9).

Hepatitis B
Hepatitis B is caused by a viral infection that can spread from mother to child at birth (perinatal transmission), as well as through blood (e.g., sharing needles), and sexual contact. Many people with an acute (short-term) infection remain asymptomatic, while others can experience a range of symptoms, including yellowing of the skin or eyes, nausea, and fatigue. Chronic (long-term) infection is common in infants and young children, but rare in adults. Chronic infection can lead to liver cirrhosis and liver cancer (10).

About 90% of pregnant women with an acute hepatitis B infection and 10–20% of pregnant women with chronic infection will pass the virus to their babies. If the perinatal transmission is a risk, the baby must receive their first hepatitis B vaccine dose, along with a dose of HBIG (hepatitis B immune globulin), shortly after birth. HBIG provides immediate, short-term protection against hepatitis B (11).

There are treatments available for chronic infection to suppress the replication of the virus and slow disease progression. However, these medications do not cure hepatitis B, so must continue for life (10). The best defense against hepatitis B is to obtain the very safe and effective vaccine.

Hepatitis C
Hepatitis C is caused by a viral infection that is commonly spread through sharing needles but can also spread through sexual contact (rare) and from mother to child at birth (only ~6% of infants of infected mothers) (12). Hepatitis C often doesn’t cause any symptoms in both acutely infected and chronically infected people. However, chronic hepatitis C, which develops in more than 50% of cases (13), is associated with an increased risk of liver disease, including cirrhosis and liver cancer (14).

Hepatitis C is treated with antiviral medications to eliminate the virus from the body. However, these medications are not recommended during pregnancy due to the risks for the developing fetus. In addition, hepatitis C medications should be stopped at least 6 months before pregnancy, as the risk of birth defects persists for up to 6 months after taking the medication (15).

HIV is caused by a viral infection that can spread through contact with infected blood, semen, pre-ejaculate, and vaginal fluids, as well as from mother to child during pregnancy, at childbirth, or while breastfeeding. HIV targets cells in the immune system, and untreated HIV eventually leads to AIDS (16).

Effective antiretroviral therapy (ART) prevents the virus from multiplying, thereby reducing the amount of virus in the body (known as the viral load). When the viral load is very low (<200 copies per milliliter of blood), it is referred to as viral suppression. When viral suppression is achieved, there is a very low risk of transmission from mother to child (17). See our previous article here for more information about viral load and suppression.

1. Sexually Transmitted Diseases (STDs) during Pregnancy. American Pregnancy Association.
2. Pelvic Inflammatory Disease (PID) – CDC Fact Sheet. (Reviewed Nov 2020). CDC.
3. Syphilis – CDC Fact Sheet (Detailed). (2017, January). 
4. Sheffield JS, et al. (2002). Congenital syphilis after maternal treatment for syphilis during pregnancy. Am J Obstet Gynecol, 186(3), 569-573.
5. Woods CR. (2009). Congenital syphilis-persisting pestilence. Pediatr Infect Dis J, 28 (6), 536-537.
6. Sexually Transmitted Diseases Treatment Guidelines, 2015. (2015). MMWR, 64(RR-3).
7. Cuschieri KS, Whitley MJ, & Cubie HA. (2004). Human papillomavirus type-specific DNA and RNA persistence–implications for cervical disease progression and monitoring. J Med Virol, 73 (1), 65-70.
8. Cervical Cancer. WHO.
9. Genital HPV Infection – Fact Sheet. (2021, January). CDC. 
10. Hepatitis B, World Health Organization. July 2020.
11. Hepatitis B and Hepatitis C in Pregnancy. (Updated June 2021). ACOG
12. Viral Hepatitis – Q&As from the Public. (2020, July). CDC.
13. Liang TJ, Rehermann B, Seef LB, & Hoofnagle JH. (2000) Pathogenesis, natural history, treatment, and prevention of hepatitis C. Ann Intern Med,132(4), 296-305.
14. Thomas DL & Seef LB. (2005) Natural history of hepatitis C. Clin Liver Dis,9(3), 383-398.
15. HCV in Pregnancy. (Updated August 2020). AASLD
16. HIV/AIDS. World Health Organization.
17. HIV Treatment. Reviewed May 2021. CDC

What is secondary syphilis?

Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum subspecies pallidum. It has been called “The Great Pretender”, as symptoms can resemble other diseases. If syphilis is untreated, it can cause serious health complications. There are distinct stages of a syphilis infection, known as primary, secondary, latent, and tertiary.

What symptoms can occur in secondary syphilis?

  • Skin rashes of varying appearance (usually the first sign of secondary infection)
  • Sores in the mouth, vagina, or anus
  • Large, raised, gray, or white lesions in warm, moist areas (e.g., mouth, armpits, groin)
  • Fever
  • Swollen lymph glands
  • Sore throat
  • Patchy hair loss
  • Headaches
  • Weight loss
  • Muscle aches
  • Fatigue

Not everyone who has secondary syphilis will develop all of these symptoms, but skin rashes usually occur, although sometimes they may be so faint that they are unnoticed. The symptoms of secondary syphilis eventually disappear whether or not treatment is received. Untreated cases will progress to the tertiary stage, and possibly the potentially fatal tertiary stage. Treatment cures syphilis and prevents the progression of the disease (1).

How long does syphilis take to progress to the secondary stage?
On average, it takes 21 days after exposure before an infected individual shows the first symptom of syphilis, which is one or more chancres (in the primary stage). However, some people may notice a chancre just 10 days after they become infected, while it can take up to 90 days for other people. The chancres of a primary infection typically last 3–6 weeks before they disappear (whether or not treatment is received) (1).

Some people develop symptoms of a secondary infection while the primary chancre is healing (1), but more typically the secondary stage doesn’t begin until 2–8 weeks after the chancre has disappeared (2).

 How can I prevent secondary syphilis?
A single dose of Benzathine penicillin G 2.4 administered intramuscularly is effective to treat and cure anyone with a primary infection to prevent it from progressing to the secondary stage. This treatment is also effective in the secondary and early latent stages, but three doses are required for the late latent stage (1).

The correct use of latex condoms does reduce the risk of syphilis, but only when the infected area (e.g., chancre) or site of potential exposure is covered (1).

How can I get tested for syphilis?
Lab testing from a simple, self-collected finger-prick blood sample can accurately diagnose a syphilis infection. There are two types of lab tests–nontreponemal and treponemal, which are both required for an accurate diagnosis. We offer a treponemal assay, which detects antibodies specific to syphilis, but these antibodies usually remain detectable for life even after successful treatment; hence this assay identifies both current and past (resolved) infections (3).

1. Syphilis – CDC Fact Sheet (Detailed). (2017, January).
2. Tudor ME, et al. (Updated October 2021). Syphilis. StatPearls [Internet].
3. Henao-Martinez AF & Johnson SC. (2014). Diagnostic tests for syphilis. Neurol Clin Pract. 4 (2), 114-122.

Is there a link between HIV and cancer?

Human immunodeficiency virus (HIV) is a sexually transmitted disease (STD), which targets the cells of the immune system, in particular, a type of white blood cell called a helper T cell (or CD4+ T cell) (1).

Helper T cells are probably the most important cell type in adaptive immunity. They release cytokines (messenger molecules) to activate B cells (antibody-producing immune cells) and activate cytotoxic T cells (white blood cells that kill infected target cells) (2). So, when there are not enough helper T cells, the whole immune system is affected, and this is exactly what happens in people with HIV, particularly untreated HIV that develops into AIDS.

HIV patients suffer from a range of symptoms, including very high susceptibility to various microbes, some of which are normally harmless in healthy people. HIV patients also have an increased risk of developing specific cancers, known as “HIV-associated cancers”. Three cancers, in particular, are termed “AIDS-defining cancers” or “AIDS-defining malignancies” (3).

What are the three “AIDS-defining cancers”?

  • Kaposi sarcoma (500x increased risk in HIV patients)
  • Aggressive B-cell non-Hodgkin lymphoma (12x increased risk)
  • Cervical cancer (3x increased risk)

If someone with HIV is diagnosed with one of these cancers, it confirms a diagnosis of AIDS (3).

What other cancers are most common in HIV patients?
Other cancers that are more common in HIV patients are collectively termed “non-AIDS-defining cancers” (3) and include:

  • Hodgkin lymphoma (8x increased risk)
  • Anal cancer (19x increased risk)
  • Liver cancer (3x increased risk)
  • Oral cavity/pharynx cancers (2x increased risk)
  • Lung cancer (2x increased risk)

HIV patients are not only at a greatly increased risk of developing one of these cancers, but they also are at a much higher likelihood of dying from cancer too (3).

Why are these cancers more common in HIV patients?
HIV severely weakens the immune system by killing off helper T cells that are so vital for a good immune response. This means HIV patients are a lot more susceptible to viral infections, including viruses that can lead to cancer (3). Examples of these viruses include:

  • Kaposi sarcoma-associated herpesvirus (KSHV) aka human herpesvirus 8 (HHV-8) – causes Kaposi sarcoma and some lymphoma subtypes
  • Epstein-Barr virus (EBV) – causes some non-Hodgkin and Hodgkin lymphoma subtypes
  • Human papillomavirus (HPV) – high-risk types can cause cervical, vaginal, and vulvar cancers, anal cancer, penile cancer, as well as mouth and throat cancer
  • Hepatitis B and hepatitis C viruses – cause liver cancer

There are also other reasons that cancer is more common in HIV patients, including:

  • Increased likelihood of other risk factors (e.g., smoking, heavy alcohol consumption)
  • Immunosuppression and inflammation may increase cancer risk

Does antiretroviral therapy decrease the cancer risk in treated HIV patients?
Antiretroviral therapy (ART) has reduced the number of people affected by certain cancers (e.g., Kaposi sarcoma) but the risk in HIV patients is still higher than in people not infected with HIV (3). In addition, effective ART significantly increases the lifespan of HIV patients, but this also means there are now more older people living with HIV (that prior to ART would have succumbed at a much younger age). This means that there is now an increased incidence of cancers common in older age in people with HIV (3).

What are ways for HIV patients to reduce their cancer risk?

  • Start on ART as early as possible and continue to take ART medications as instructed
  • Abstain from smoking
  • Limit alcohol intake
  • Get tested for Hepatitis B and Hepatitis C and obtain treatment if required
  • Regular screening for cervical cancer (HPV high-risk test available here)
  • Get the HPV vaccine (if less than 26 years of age)

1. Al-Jabri AA. (2003) How does HIV-1 infect a susceptible human cell? J Sci Res Med Sci. 5(1-2): 31-44.
2. Alberts B, et al. (2002) Molecular Biology of the Cell. 4th edition. New York: Garland Science; 2002. Helper T Cells and Lymphocyte Activation.
3. HIV Infection and Cancer Risk. NIH, National Cancer Institute. Reviewed Sept 2017.

Posted in HIV

HIV and AIDS: Debunking the myths

At the end of 2020, there were an estimated 37.7 million people living with HIV around the world, with over two-thirds of the cases occurring in the WHO African Region (1). In the United States, 36,801 new cases of HIV were diagnosed in 2019, with an estimated 1,189,700 people predicted to have HIV at the end of 2019. Yet, about 13% of HIV-positive people in the U.S. are unaware of their HIV status (2).

Major medical advances have drastically improved life for people with HIV, but there is still a lot of misinformation about HIV and AIDS. In this article, we debunk 10 common myths about HIV and provide you with the facts instead.

#1 Touching someone with HIV puts me at risk of catching HIV
This is one of the biggest misconceptions about HIV. HIV can only be passed from one person to another via specific bodily fluids:

  • Blood
  • Semen (including pre-cum)
  • Vaginal fluid
  • Rectal fluid
  • Breastmilk

And it is necessary for the infected bodily fluid to enter the blood of another person for transmission to occur. This can be through:

  • Unprotected sex (both rectal and vaginal, but only very rarely through oral sex)
  • From mother to child during pregnancy, childbirth, or breastfeeding
  • Sharing needles, syringes, or other drug-injection equipment

This means that it is usually not possible to catch HIV from kissing and hugging, sharing food, insect bites, toilet seats and bathing, sneezes and coughs, or sweat.

Nowadays with thorough testing of donated organs and tissues, it is also very unlikely that HIV will be transmitted from blood transfusions, blood products, or organ and tissue transplants.

#2 Washing after sex will prevent me from catching HIV
No, washing immediately after sex will not prevent the transmission of HIV if bodily fluids have already been exchanged. Other common myths about HIV prevention include a belief that pulling out prior to ejaculation or being on the contraceptive pill will prevent HIV transmission. Pre-ejaculate (pre-cum) can also contain the HIV virus so transmission can still occur. The contraceptive pill in no way protects against HIV (or any other STD for that matter!). It is for preventing pregnancy, but not for preventing infectious disease transmission.

The only ways to really protect yourself from catching HIV through sex are by using condoms or taking pre-exposure prophylaxis (PrEP). PrEP is a prescription medication that is very effective at preventing HIV when taken exactly as prescribed. It is also important to get tested and treated for other STDs, as if you have another STD it can increase your chance of catching HIV.

#3 HIV has very distinct symptoms
Some people believe that it is easy to spot those with HIV as they have distinct disease symptoms. Or they think that they will know if they have caught HIV by experiencing the symptoms themselves.

However, the early symptoms of HIV are actually not at all easy to spot. Some people may not even show any symptoms at all in the early stages. While others just display general symptoms typical of many other types of infections, e.g., fever, fatigue, general malaise.

The only way to accurately determine if you have caught HIV is to get tested. Saliva testing is an option but testing of blood is more accurate and detects an HIV infection at a much earlier time point post-exposure. We offer a 4th generation HIV test that detects both HIV antigen and HIV antibodies from just a simple finger-prick blood sample.

#4 I will definitely catch HIV if I have sex with someone with HIV
This is another false belief. Correct condom use and PrEP prevent HIV transmission. In addition, antiretroviral (ART) medication is very effective at controlling the viral replication of HIV. Although ART does not cure HIV, it can ensure that the amount of virus in the blood (viral load) is very low. HIV viral suppression is defined as less than 200 copies of HIV per milliliter of blood and ensures that HIV transmission through sex does not occur (2).

#5 HIV always leads to AIDS and death
In the past, this statement was true, as untreated HIV typically develops into AIDS after about 10 years. AIDS patients often display the symptoms that many people associate with HIV, including rapid weight loss and skin discoloration, and are very susceptible to other health complications, including pneumonia, tuberculosis, and certain cancers. And it is these opportunistic infections and cancers that lead to the death of most untreated AIDS patients within three years.

Nowadays, effective ART medication can reduce the replication of HIV in the blood to an undetectable level, meaning that HIV patients can live relatively normal lives and their HIV never develops into AIDS.

#6 Only men who have sex with men can catch HIV
False. Although men who have sex with men account for the most cases of HIV in the U.S. (65% in 2019), HIV can also be transmitted through heterosexual contact (23% of cases in 2019) (2).

During anal sex, the risk of catching HIV is much higher in the receptive partner, but transmission to the insertive partner is still possible. During vaginal sex, either partner can get HIV.

Oral sex is also a potential transmission pathway but the risk is a lot lower than anal or vaginal sex. Generally other factors must also be present for transmissions to occur, such as mouth ulcers, bleeding gums, and the presence of another STD (2).

#7 If myself and my partner are both HIV-positive, there is no need to use protection
This statement only holds true if both partners are on ART and maintaining viral suppression and have an undetectable viral load, which prevents HIV transmission. If both partners do not have viral suppression, it is very important to use condoms during every sexual encounter. This is because there are different strains of HIV. If you each are infected with a different strain, it is possible that you (or your partner) could become infected with two different strains. This is known as HIV superinfection and may cause problems with treatment and cause some people to get a lot sicker a lot faster, particularly if the new strain is resistant to the ART medicine that was controlling the original HIV strain (2).

#8 HIV can be cured
Unfortunately, there is still no cure for HIV. Although ART significantly reduces the amount of HIV in the blood and can achieve viral suppression in most people, it does not eliminate the virus completely. ART medications must be taken as prescribed for life otherwise the viral load will increase and can eventually lead to AIDS.

Some people choose to take alternative medicines (e.g., herbal medicines) with the misconception that they will provide a cure for HIV. However, herbal remedies do not work, and can even interfere with the effectiveness of ART medicines if taken concurrently.

#9 An HIV diagnosis means that I can never safely have a child
Thankfully an HIV diagnosis is not the death sentence it used to be, nor does it prevent most people from making a family.

If an HIV-positive mother-to-be maintains viral suppression throughout her entire pregnancy (including labor and delivery), as well as giving HIV medications to the baby for the first 4-6 weeks, it can reduce the risk of HIV transmission to less than 1% (2).

In addition, an HIV-positive man can still safely father a child, by ensuring that the HIV is not transmitted to his female partner. This is through keeping an undetectable viral load with ART medication. The female partner may also opt to take PrEP to further reduce the risk of catching HIV during sex.

#10 A negative HIV test result means that I definitely don’t have HIV
Unfortunately, this is not always the case. Even with advanced laboratory testing techniques, there is still a “window period” post-exposure where an HIV-positive person will still test negative on an HIV test. This is because a certain level of the virus is required in the blood before it is detectable by HIV tests.

The 4th generation HIV test that we offer can usually detect the p24 antigen from HIV within 18–45 days weeks post-exposure. However, in some cases, an HIV infection may not be detected from a finger-prick blood sample until 90 days post-exposure. Therefore, a false-negative test result may occur within the first three months. Retesting after three months is recommended.

If a potential exposure is suspected, post-exposure prophylaxis (PEP) is available as an emergency medication to reduce the risk of infection. This must be started within 72 hours of exposure to be effective.

Although there are still many common misconceptions about HIV, the good news is that it is now a very treatable disease, and most infected people can live long, productive lives using adequate antiretroviral medication.

1. HIV/AIDS Fact Sheet. WHO Reviewed July 2021.
2. HIV Basics. CDC Reviewed 2021.

Posted in HIV

What is oral gonorrhea?

Firstly, let’s go over a few quick facts about gonorrhea:

  • It is a common sexually transmitted disease (STD) or sexually transmitted infection (STI).
  • It is spread through sexual contact with the penis, vagina, mouth, or anus of an infected individual.
  • It can also spread from a mother to her newborn during childbirth.
  • It is caused by infection with the bacterium Neisseria gonorrhoeae.
  • 85–90% of males show symptoms of a urogenital infection but only <20% of females. Urogenital refers to the urinary tract, vagina, or penis.

How does oral gonorrhea occur?
Oral gonorrhea is also known as pharyngeal gonorrhea. It refers to a gonorrhea infection in the throat and can occur by giving oral sex to a partner with an infected penis, urinary tract, vagina, or rectum (1). Basically, the Neisseria gonorrhoeae bacterium isn’t too fussy about which mucus membranes it infects, so it is quite happy to spread to the mucus membranes in the throat. Gonorrhea transmission can occur even when an infected person is not showing any symptoms.

What are the symptoms of oral gonorrhea?
Most people with an oral gonorrhea infection do not experience any symptoms. And if they do, it is going to feel like any other sore throat (1). Other symptoms can include redness in the throat, throat inflammation, and swollen glands (2).

Can untreated oral gonorrhea cause any serious complications?
Despite an often absence of symptoms from oral gonorrhea (or urogenital gonorrhea for that matter), serious health complications are rare but possible. The gonorrhea infection can spread throughout the body causing a condition called disseminated gonococcal infection (1). The symptoms can include fever, joint pain and swelling, and skin lesions. The joints that are most commonly affected are wrists, ankles, hands, and feet. In rare cases, the infection can also affect the liver, brain, and heart tissue (2). Disseminated gonococcal infection can be caused by both untreated oral gonorrhea and untreated urogenital gonorrhea (3).

How to test for oral gonorrhea?
Oral gonorrhea can be detected by culture and nucleic acid amplification tests (NAATs) of pharyngeal (throat) swabs (4).

At least annual screening for oral gonorrhea is recommended for men who have sex with men (MSM), with increased screening (every 3–6 months) for MSM at high risk (e.g., substance abuse or multiple partners) or those at high risk of HIV acquisition (4).

How is oral gonorrhea treated?
Increased antibiotic resistance previously raised concerns about gonorrhea treatment and dual antibiotic therapy was recommended. However, due to other health concerns, only ceftriaxone is now recommended by the CDC. This is administered via a shot in the muscle (4).

1. STD Risk and Oral Sex, Sexually Transmitted Diseases (STDs). Reviewed Feb 2020. CDC.
2. Mayor MT, Roett MA, Uduhiri KA. (2012). Diagnosis and Management of Gonococcal Infections. Am Fam Physician, 86(10):931-938.
3. Morris SR. (2020). Gonorrhea. Merck Manual Professional Version.
4. Gonococcal Infections Among Adolescents and Adults. Sexually Transmitted Infections Treatment Guidelines, 2021. (Reviewed July 2021). CDC.

HIV Quick Facts

What is HIV?
Human immunodeficiency virus (HIV) is a sexually transmitted disease (STD), which occurs by contact or transfer of blood, semen, pre-ejaculate, and vaginal fluids. HIV can also be transmitted from an infected mother to her infant during pregnancy, childbirth, or through breast milk. HIV targets the cells of the immune system and in the absence of effective treatment, it can develop into acquired immunodeficiency syndrome (AIDS) (1).

What causes HIV?
HIV is caused by infection with one of two types of HIV. HIV-1 is the most common and most contagious. HIV-2 is less infectious and is predominantly confined to infections in West Africa.

What are the symptoms of HIV?
Many people infected with HIV are unaware of the infection in the early stage (acute, stage 1), as they may not experience any symptoms or only mild symptoms (e.g. headache and sore throat) that can be easily confused with other illnesses (2). Other people experience more serious symptoms, including:

  • High fever
  • Swollen lymph nodes
  • Skin rashes
  • Diarrhea
  • Mouth ulcers
  • Muscle aches
  • Sore throat with persistent coughing
  • Chills
  • Night sweats

The second stage is called chronic HIV infection or clinical latency and generally doesn’t cause any symptoms.

AIDS is the third stage of an HIV infection when the virus has destroyed so many of the host’s immune system cells (2). The symptoms can include:

  • Rapid weight loss
  • Extreme fatigue
  • Pneumonia
  • Skin discoloration
  • Memory loss
  • Depression
  • Increased susceptibility to other infections such as tuberculosis, severe bacterial infections, and certain cancers

Who is at risk of HIV?
Populations that have an increased risk of HIV include men who have sex with men, injecting drug users, individuals in correctional facilities, sex workers (and their clients), and transgender individuals (3).

How is HIV diagnosed?
HIV infections are usually diagnosed by the detection of HIV antigens and antibodies in a blood sample. It is important to note that there is a window period of 45-90 days, during which HIV diagnostic tests may produce a negative result, although infected individuals can still transmit the virus to others. Follow-up testing is recommended for any individuals with a negative result who may have been exposed to HIV (3).

How is HIV treated?
Although there is no cure for HIV, effective antiretroviral therapy (ART) ensures that infected individuals can live relatively normal lives and prevents the transmission of HIV. Individuals at risk for HIV can also take HIV medication called pre-exposure prophylaxis (PrEP), which is highly effective for preventing HIV (3).

1. Weiss RA. (1993) How does HIV cause AIDS? Science, 260 (5112), 1273-1279.
2. Symptoms of HIV. Clinical Info July 2020.
3. HIV/AIDS. World Health Organization.

Posted in HIV

I just had unsafe sex. Should I take an STD test immediately?

There is no harm in taking an STD test shortly after a potential exposure. However, it is very likely that the test result will come back negative, even if you have been infected. This is because the molecules detected by laboratory assays must reach a specific level to actually be detectable.

This time between exposure and when a laboratory test can detect the infectious agent is called the window period.

Note: The window period differs from the incubation period, which is the time from exposure to the development of symptoms.

Window periods vary for different STDs and also for the laboratory test that is being used. We screen for chlamydiagonorrhea, and trichomoniasis using nucleic acid amplification tests. The window period for these STDs is predicted to be around 5 days, but may be up to two weeks.

Our hepatitis B test detects the hepatitis B surface antigen (HBsAg) and antibodies to the hepatitis B core (anti-HBc), which can take 30 to 60 days to become detectable.

Antibodies to hepatitis C may be detected with our test as early as two weeks post-exposure, but are generally not detected until 8-11 weeks post-exposure, and can be longer in individuals that lack an adequate immune response.

We use a 4th generation test for HIV that can detect an HIV infection within 18 – 45 days, or sometimes as early as two weeks post-exposure. Individuals who have been potentially exposed to HIV should be tested immediately, and then tested again at six weeks, three months, and six months. In addition, if an individual is concerned about being exposed to HIV in the last 72 hours, they should be referred to a health care provider immediately for post-exposure prophylaxis (PEP) evaluation.

Syphilis can usually be detected with our laboratory assays around one month post-exposure but may take up to three months.

I tested positive for an STD. Should my partner get tested too?

Many sexually transmitted diseases (STDs) are more common than you may realize, particularly in sexually active youth aged 15 – 24 years. Thankfully most STDs are easily treated and there are no long-term health complications.

Discussing a positive STD test result with your sexual partner can be very intimidating. There is quite a lot of stigma associated with STDs, despite the fact that many of them are quite common. Unfortunately, if you test positive for an STD, that is a conversation that really needs to take place.

Who should get tested?
All of your recent and current sexual partners should be tested, even if you consistently use condoms and your partner is not experiencing any symptoms. Although correct condom use does reduce the risk of transmitting STDs, it does not eliminate the risk, and many STDs are asymptomatic, meaning that there are no obvious symptoms, yet they can still be transmitted to others.

In addition, if you are successfully treated for an STD, but your partner is not tested and treated, you are at risk of your partner passing the STD to you again. Recurrent infections are associated with an increased risk of serious health complications.

For example, an initial chlamydia infection may only cause mild symptoms or no symptoms at all, and it is easily treated with oral antibiotics. However, untreated and recurrent chlamydia infections are associated with an increased risk of pelvic inflammatory disease in females. This can lead to chronic pelvic pain, pregnancy complications, and even infertility.

Tips for having the uncomfortable STD conversation

  • Choose the right timing. Ideally not just before or during sex! Make sure you are in a private setting with no distractions.
  • Know some of the facts. Examples:
    • Let them know how common the STD is: There are an estimated 2.86 million chlamydia cases in the United States every year (1)
    • Explain how the STD can be treated: Oral antibiotics for chlamydia are simple and effective (2). Early treatment reduces the risk of any long-term health complications.
    • Discuss how easy the test is. Our at-home test kits are ideal for this situation! No need to make a doctor’s appointment for sample collection or laboratory analysis. A blood sample is not even required for chlamydia and gonorrhea testing – just a self-collected urine sample.
  • Reiterate how many STDs may not cause any symptoms in some people, but testing is still important.
  • Consider your safety. Is your partner going to react angrily if this STD test result may indicate dishonesty?

1. Sexually Transmitted Infections Prevalence, Incidence, and Cost Estimates in the United States. Jan 25 2021.
2. Workowski KA & Bolan GA (2015) Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR Recomm Rep, 64 (RR-03), 1-137.