South Korea is a great place to travel, and needless to say, Singaporeans travel in flocks to this wonderful country during the holiday season. South Korea is famous for kimchi, soju, plastic surgery, Namdaemun Market, ginseng roots, K-pop, movie stars, and of course, Korean dramas. But for the patient seeking HIV and STD tests in Singapore, a mummified Korean child might furnish more pertinent information concerning medical science and sexually transmitted diseases (STD).
In the journal Hepatology, a team of scientists documents the findings of liver biopsies and genetic analyses performed on an ancient, mummified Korean child who lived during the Joseon Dynasty. The genomic study furnished medical scientists with important information on the evolutionary genetics of the Hepatitis B virus (HBV). This most ancient viral genome of HBV allowed the tracing of its origin and migratory pathways from the Far East to other countries, and eventually to Asia and Australia. Scientists were then able to calculate the mutation rates of HBV, and subsequently acquire clinically relevant microbiological data for future HBV research.
Hepatitis B virus (HBV) can cause serious liver infection, chronic hepatitis, liver cirrhosis, liver failure and even liver cancer (hepatocellular carcinoma) in humans. It has been estimated that about 300 million are infected with Hepatitis B worldwide, and are carriers of HBV. According to the Health Promotion Board of Singapore, about 1 in 35 adult Singaporeans are Hepatitis B carriers. The worldwide prevalence of Hepatitis B carriers varies from about 2.0% in low prevalence regions like the United States, to as high as 20% in areas of high prevalence (for example, China, Southeast Asia, and sub-Saharan Africa). With the mandatory vaccinations of infants in Singapore, coupled with perinatal HBV screening of all pregnant mothers, there is a significant decline in the incidence of acute Hepatitis B cases in Singapore. Despite this, certain adults are persistently at risk for contracting the Hepatitis B virus, particularly through intravenous drug usage and sexual contact.
As Hepatitis B is a sexually transmitted disease (STD), STD clinic Singapore see their fair share of cases annually. Hepatitis B is transmitted via blood exposure, sexual intercourse, and also from mother to child (vertical transmission). This can occur during pregnancy (in utero), during childbirth, or after delivery. Elective Caesarean section has not been shown to reduce the risk of vertical transmission from mother to child. Sexual transmission is especially efficient through anal intercourse, and probably less so with vaginal intercourse. Transmission via oro-genital sexual contact is very rare.
When I speak with my patients, many are unaware that Hepatitis B is a sexually transmitted disease (STD), particularly in sexually active adults. As the prevalance of Hepatitis B carriers in Singaporeans is relatively high compared to low prevalence countries like the United States, Australia, and Canada, STD clinics in Singapore are usually vigilant with regard to the Hepatitis B status of patients.
HBV infection can result in an acute and self-limiting illness, serious fulminant hepatitis (life threatening liver inflammation), or a chronic carrier state. Incubation period is usually 6 to 12 weeks. The acute infection is symptomatic in up to 70% of patients. The major presenting complaints of a patient suffering from acute HBV infection are usually vague and non-specific, such as fever, malaise, anorexia, nausea, myalgias, and abdominal pain. The icteric phase follows this initial stage, and is characterized by jaundice, dark urine, light-colored stools, and a tender enlarged liver. This icteric stage typically lasts around 1 to 3 weeks. Finally, the convalescent stage, which persists for several weeks to months, is characterized by fatigue and malaise and can be debilitating. A serum sickness-like prodrome, characterized by polyarthritis, skin rash or cryoglobulinaemia can occur in up to 20 percent of cases.
Patients who become chronic HBV carriers can be absolutely asymptomatic, complete with normal physical examinations and laboratory tests results. But this asymptomatic carrier stage can be deceptively optimistic. HBV carriers are at significantly increased risk of liver cirrhosis, hepatocellular carcinoma, and impending death from long term liver disease. It is also important to note that HBV carriers can develop liver cancer without the presence of liver cirrhosis.
STD clinics in Singapore base their diagnoses of HBV primarily on serological blood tests for HBV surface antigen (HBsAg), the antibody to HBV surface antigen (anti-HBsAg), and antibody to HBV core antigen (anti-HBcAg).
The presence of HBsAg points to an acute HBV infection or chronic active hepatitis and potential infectivity. The presence of both anti-HBsAg and anti-HBcAg is indicative of resolved or inactive infection. The presence of anti-HBsAg, without a positive anti-HBcAg, suggests prior immunization with the Hepatitis B vaccine (Engerix B). The presence of Hepatitis B e antigen indicates that the patient is very infectious and that there is a higher probability of transmission.
STD clinics in Singapore would encourage all adults who have not received a complete course of Hepatitis B vaccination to seek clinical advice. Immunization is the cornerstone of HBV prevention. Adult vaccination typically consists of 3 doses of vaccine at 0, 1, and 6 months. Our clinic would also advise all sexually active patients to check their Hepatitis B status.
Post-exposure prophylaxis of Hepatitis B is usually recommended for all non-vaccinated patients who had a high-risk exposure to HBV-infected body fluids or blood. If the HBV status of the source is unknown, vaccination with Engerix B alone is the recommended prophylactic treatment. It should be administered within 12 hours post-exposure, and the remaining 2 doses of vaccine are completed according to the recommended schedule. If the source is HBsAg positive, both a vaccine and hepatitis B immunoglobulin are administered as post-exposure prophylaxis.
Coming back to the Korean mummy child who served as the proverbial guinea pig posthumously. How did the child contract Hepatitis B? Logically speaking, a child could not have acquired it sexually. It is most probable that the child had contracted it from the mother. This serves to remind all parents and parents-to-be to be vigilant with regard to their HBV status.
Get yourself tested today at an STD clinic Singapore. Our clinic also furnishes rapid HIV testing as well as confidential, discreet STD test Singapore. Speak to our board accredited Family Physician for more information on Hepatitis B and other infectious diseases.
