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Pulmonary arterial hypertension: breathing new life into research

Posted 19 April 2018 in Men's Health, Womens health

Decoding DNA. Source: medicalimages.comPulmonary arterial hypertension is a rare but serious disease which affects smaller branches of the pulmonary arteries, which are the blood vessels which carry oxygen-poor blood from the heart to the lungs to be re-oxygenated, ready to be pumped back around the body. Currently, half of people with the condition die within five years of it first appearing, but will a new genetic discovery lead to earlier diagnoses and therefore a more positive outlook for those affected? (1, 2, 3)

What is pulmonary arterial hypertension?

Pulmonary arterial hypertension (PAH) is raised blood pressure in the smaller branches of the pulmonary arteries, caused by the arterial walls stiffening and thickening. It is difficult for blood to be pumped through stiff, thick arteries as there is less ‘give’, therefore the right side of the heart, which supplies the pulmonary arteries, is forced to pump harder to make sure enough blood reaches the lungs, and blood pressure rises. This increased workload can weaken the right side of the heart over time and eventually cause heart failure. (1, 3)

What causes PAH?

A number of pre-existing conditions can be linked to PAH, including scleroderma (a condition associated with thickened skin, which can occur in blood vessels), HIV, thyroid problems, sickle cell disease, and particular medication. However, a cause cannot be established in around 20% of cases. (1, 2)

What are the symptoms of PAH?

PAH can cause you to experience shortness of breath, feel tired, faint or dizzy, experience palpitations (unusually fast or erratic heartbeat), experience pain in the chest, and develop swelling in the ankles, feet, legs or abdominal area. Usually, exercise worsens these symptoms. Unfortunately, contrary to other types of pulmonary hypertension, symptoms often do not occur until the later stages of the disease, when a lot of the damage is already done. (1)

How is PAH treated?

If a pre-existing condition has led to PAH, the first step is to treat this condition if possible. (4)

To treat PAH itself, a range of medicines can be taken including anticoagulants (such as warfarin), diuretics, inhaled oxygen therapy, digoxin (encourages the heart to pump more forcefully whilst lowering heart rate). Sildenafil and tadalafil are primarily used to treat erectile dysfunction but can be prescribed by specialists to treat PAH. (4)

In severe cases, PAH which is not sufficiently controlled by medication may call for surgery or a lung transplant. (4)

Unfortunately, PAH cannot be cured, but the treatments may help to slow, halt or even reverse the progression of the disease to an extent. (4)

The latest news

An exciting discovery has been made by researchers working on the 100,000 Genomes Project - four new genetic mutations have been found that are responsible for causing PAH. Previously, experts knew of only one mutation linked to the disease. These mutations code for faulty proteins which are incorporated into tissues including the pulmonary arteries. Knowing about these mutations opens up the opportunity for more targeted treatments to be produced in future, and if people with a family history of PAH can be genetically screened for the condition, it enables earlier diagnosis and earlier interventions. (2)

References

Prostate cancer - a growing problem

Posted 18 April 2018 in Men's Health

A worried manA recent review of prostate cancer diagnoses in the UK has led to the discovery that almost 40% of cases are diagnosed in the later stages of the disease. Furthermore, in February this year, the number of deaths from prostate cancer in men surpassed the number of deaths from breast cancer in women, which had never happened before in the UK. What is causing this startling rise in prostate cancer deaths and why isn’t the disease being picked up sooner? (1)

What is the prostate?

The prostate gland is a crucial part of the male reproductive system. It is responsible for the production of the white fluid, which along with sperm, makes up semen. It is found within the pelvis, enveloping the upper part of the urethra, which is the tube through which urine from the bladder flows out of the body. Prostate cancer develops when mutations (changes) in the DNA of cells in the prostate cause cells to proliferate uncontrollably. It is unclear why this happens, but a genetic link has been found, with men whose father or brother has/has had prostate cancer more likely to be affected by it themselves. (2)

Why the increase in prostate cancer, and why the late diagnoses?

The main reason for the increase in cases and deaths is thought to be our aging population. Prostate cancer is more likely to develop in men over 50, and the risk increases further with age. With life expectancy continually rising in the UK, this means more chance for prostate cancer cases to arise, and consequently more related deaths. (1, 2)

Also, prostate cancer symptoms can be difficult to recognise. In the earlier stages, people with prostate cancer may show few or no symptoms. This may last for decades, until the prostate enlarges to such an extent that it puts pressure on the urethra. Once this has occurred, changes in the pattern and ease of urination may become apparent. You may find it difficult to begin urinating, and you may need to forcefully push to achieve a normal urinary flow. It might also feel as if you can’t get the last drops of urine out of your bladder. Prostate cancer can also cause sudden urges to urinate, and waking up to urinate several times in the night. Erectile dysfunction is another symptom that can occur as a result of prostate cancer. (1, 2)

It is important to note that the above symptoms are not always caused by prostate cancer - other conditions such as benign prostatic hyperplasia (BPH) also cause these symptoms. But any men experiencing such changes in urination must see their GP to rule it out. (2)

How can prostate cancer be identified in the early stages?

There are a number of tests that can be carried out to assess prostate health. The most common is the prostate-specific antigen (PSA) blood test. PSA levels are increased in men with prostate cancer at any stage, but also in other conditions such as BPH, so raised PSA does not necessarily indicate presence of prostate cancer. Nevertheless, the PSA test is available free of charge on the NHS to men over the age of 50 if they ask their doctor for it. (1, 2)

A digital rectal examination (DRE) involves a doctor or nurse inserting a gloved, lubricated finger into the back passage to feel the shape and size of the prostate. It is not reliable enough to be used as a diagnostic test alone, but can be combined with a PSA test or biopsy. (3)

A biopsy involves taking a small sample of tissue from the prostate which is examined for any abnormalities. However, approximately 20% of cancerous samples are not identified, and the procedure can cause problems such as bleeding and infection of the prostate. (3)

What if I am diagnosed with prostate cancer?

Quite often, there is no urgent action required after a diagnosis, other than looking out for the aforementioned symptoms, sometimes called ‘watchful waiting’. If treatment is started in the early stages, it usually comprises hormone therapy, radiotherapy and possible surgery. In the latter stages, when the cancer has often spread to other areas of the body, treatment is supportive (prolonging life and easing pain and discomfort). (2)

Since the symptoms of urinary incontinence and erectile dysfunction can be embarrassing and debilitating, men with prostate cancer may develop depression or anxiety. Prostate Cancer UK has a wealth of information on living with prostate cancer as well as links to support groups, a helpline and advice from nurses specialising in the condition. (2)

References

  1. BBC News. Prostate cancer: Four in 10 cases diagnosed late, charity says [cited 12 April 2018]. Available at: http://www.bbc.co.uk/news/health-43669439

  2. NHS Choices. Prostate cancer [cited 12 April 2018]. Available at: https://www.nhs.uk/conditions/prostate-cancer/

  3. NHS Choices. Should I have a PSA test? [cited 12 April 2018]. Available at: https://www.nhs.uk/Livewell/Prostatehealth/Pages/psa-test.aspx

Tired of obstructive sleep apnoea?

Posted 9 April 2018 in Men's Health, Womens health

Alarm clock. Picture courtesy of pexels.comDo you often feel on waking that you haven’t had a good night’s sleep, despite going to bed early enough? Do you feel tired and catch yourself yawning throughout the day, although you seemingly slept for a reasonable time the night before? Or do you find you wake several times in the night, sometimes with a ‘snort’? You may be experiencing a condition known as obstructive sleep apnoea (OSA).

What is OSA?

OSA is a condition characterised by interrupted breathing while sleeping. The word ‘apnoea’ means absence of breathing and occurs when the muscles of the throat relax and the tissues slump to such an extent that the airway closes up. An episode of halted breathing is medically defined as apnoea if it lasts for at least ten seconds. Another type of breathing impairment associated with OSA is hypopnoea, meaning reduced breathing, which is when the airway is only partially obstructed by the relaxation of muscles and slumping of tissues in the throat, and functions at half capacity or less for at least ten seconds. (1)

What are the symptoms of OSA?

If you sleep alone, it is usually easier for OSA to go unnoticed, as the most obvious telltale signs occur during deep sleep. However, you may find that you wake up several times during the night, disrupting your sleep. Waking may be accompanied by a snorting or gasping sound as the brain tells the body to come out of deep sleep in response to the lack of oxygen in the blood, enabling a sudden, sharp intake of breath. You may also notice that you wake up in a sweat. (1, 2)

Another symptom is tiredness and sleepiness during the day. You may struggle to concentrate, leading to more mistakes at work. You may yawn excessively, or find yourself nodding off during quiet or dull parts of the day. If you wake several times at night you will be able to trace the tiredness back to this, but the brain sometimes tells the body to switch from deep to lighter sleep, rather than fully waking, to restore normal breathing. Deep sleep is more restful for the body, so fewer hours of deep sleep per night will increase tiredness during the day. (1, 2)

The deep sleep symptoms are often identified by another person, such as a partner, friend or relative, when you sleep in their presence. They may tell you that you snore loudly, or that it sounds like you’re struggling to take clear and complete breaths. Crucially, they can identify your episodes of apnoea, telling you that you stopped breathing for a prolonged period of time. (1)

Why does OSA happen?

Although most people experience some relaxation and slumping of the throat’s tissues and muscles during sleep, they can usually continue to breathe normally. Certain risk factors increase a person’s chance of developing OSA. (1)

Being overweight or obese is a major risk factor as excess weight carried on the neck can push the airway narrower or shut completely, and make it harder for the muscles to resist the slumping and keep the airway open. Men are at greater risk than women, again mainly due to the fact that they are more inclined to carry excess weight on the neck. This risk is more pronounced with a collar size of 17 inches or greater. (1)

Over the age of 40, risk of OSA increases for both men and women, then again for women after they reach the menopause. (1)

Natural variations in the structure of the airway or nasal cavity can be responsible for OSA. Such variations include a narrower airway than normal, enlarged tonsils or tongue, a receding jaw, a deviated nasal septum, nasal polyps and enlarged adenoids in children. OSA can also run in families. (1)

External factors such as drinking alcohol before bed, smoking and taking sedatives including sleeping tablets and anxiety medication can also make OSA more likely. (1)

Can OSA be treated?

If you think or someone else thinks you may have OSA, visit your GP. They will rule out any other causes of your symptoms and can refer you to a sleep centre for a firm diagnosis. (1)

Once you are diagnosed with OSA, your GP will advise you to make lifestyle changes if needed, or maintain your current healthy lifestyle. Losing weight, stopping smoking or reducing alcohol intake may be all that is needed to reverse OSA. Other changes such as sleeping on your side instead of your back, keeping your mouth closed and your nasal passages clear should also help. There are various aids available to facilitate directing air through the nose instead of the mouth, such as chin straps, mouth guards, mandibular advancement devices (MADs), nasal strips and saline nasal sprays. If you find you often wake up lying on your back, pillows can be purchased which are designed to prevent you from rolling from your side onto your back while you sleep. (1, 2)

If your OSA is not relieved by these changes, it may be worth considering a week’s trial of a continuous positive airway pressure (CPAP) device. This device pumps air through a mask into your airway to stop it from closing throughout the night. The trial is expensive at £100, but if it is successful you may be put on an NHS waiting list for a free CPAP of your own. CPAPs are also available to buy. Click here for more information. (1, 2)

If a variation in structure of the airway is the cause, surgery can be performed to correct this. (1)

Can OSA cause any other problems?

If not treated, OSA will continue to cause constant tiredness, poor concentration and irritability, negatively affecting your quality of life. Furthermore, it may lead to other health problems including high blood pressure, heart attacks and strokes, changes in heart rhythm, and even type 2 diabetes. (1)

If you receive a diagnosis of OSA and you drive, you’re legally obliged to inform the DVLA, as is the case with all conditions which may impair your driving. It’s possible that you’ll be asked not to drive until your symptoms are under control. (1)

Visit the Sleep Apnoea Trust website for further support.

References

  1. NHS Choices. Obstructive sleep apnoea [cited 28 March 2018]. Available at: https://www.nhs.uk/conditions/obstructive-sleep-apnoea/
  2. The Guardian. Seven ways to… prevent snoring [cited 28 March 2018]. Available at: https://www.theguardian.com/lifeandstyle/2018/mar/26/seven-ways-to-prevent-snoring

Itching for information about genital herpes?

Posted 6 April 2018 in Men's Health, Sexual Health, Womens health

Taking a pillAffecting approximately 10% of UK people by the age of 25, herpes simplex type 2 (HSV-2), or genital herpes, is one of the most common sexually transmitted infections (STIs) in the country. Once a person is infected with HSV-2, their body will contain the virus for life. For some people, this may cause no further symptoms once the initial infection has cleared, but for others is it a nuisance as recurrent outbreaks can occur. Although there is no cure, HSV-2 symptoms can be managed with the right medication and self-care, allowing you to get on with your life. (1)

What is HSV-2?

HSV-2 is the main virus which causes genital herpes and is a strain of the herpes family of viruses. Other strains include HSV-1 which is responsible for cold sores but can also cause genital herpes, varicella-zoster virus which causes chickenpox and shingles, and Epstein Barr virus which is implicated in glandular fever.

Once it has found a way into the body and has caused an initial infection, HSV-2 remains within the body indefinitely. For most of this time it is in a dormant (inactivated) state within a nerve close to the initial point of infection, but outbreaks of genital herpes can occur and often have a trigger such as ill health, cuts or friction to the area, periods or UV light. (2)

What are the symptoms of genital herpes?

The earliest symptoms of genital herpes are usually a tingling or itching sensation in the genital area, followed by the formation of blisters on the area of the groin that was in contact with the infected area of the other person. This may be the penis, vulva, anus, thighs or buttocks. These blisters burst, leaving sores which scab then heal. Under the foreskin of the penis and on the inside of the labia, ulcers will form as opposed to blisters. As part of the initial infection there may be associated general malaise - aches and pains, fever and slightly swollen glands in the neck, armpits and groin. Discomfort when urinating and unusual discharge from the vagina are also possible symptoms. Symptoms of initial infection should clear within three weeks. (1, 2)

Subsequent outbreaks of genital herpes generally involve milder symptoms and clear up in a matter of days. (1)

How can I be tested?

If you have blisters in your genital area and think you may have genital herpes, you can attend a sexual health clinic to be tested. One of the blisters will be swabbed to obtain a sample to send off for testing. The sample can only be taken if there are blisters present. (2)

If your result comes back positive, anyone with whom you’ve been sexually active also needs to be tested. This is because symptoms of genital herpes can, in some cases, take years to appear after initial infection. If you don’t want to or can’t contact the partners yourself, the sexual health clinic may be able to contact them on your behalf. They will not reveal your identity while doing so. (2)

How is genital herpes treated?

There is no cure for genital herpes, so the aim of treatment is to ease symptoms and sometimes shorten the duration of an outbreak. Aciclovir, an antiviral drug, is the first line treatment. It is taken in tablet form three or five times a day, depending on the tablet strength, for five days. The course may be extended if blisters appear after the course is started or if they have not healed sufficiently. Outbreaks can be treated with shorter courses if higher strength tablets are taken. An oral suspension and topical cream are also available. Alternative antivirals famciclovir and valaciclovir can be used orally in a similar way. (3)

For people who suffer from frequent outbreaks, antivirals can also be used for suppression to keep viral levels under control and prevent outbreaks from happening in the first place. Instead of being taken as a course, they are taken every day for up to a year, after which treatment is halted to determine whether outbreaks return. If they do, treatment may be started again. If outbreaks keep happening despite taking suppressive treatment, your GP may consider referral to a specialist. (3)

Is there anything else I can do to ease the discomfort of an outbreak?

During an outbreak, you may benefit from the following self-care steps:

  • An ice pack covered with a flannel pressed against the area can help to ease the pain of the blisters. Do this for as long as is needed or comfortable.

  • You may want to try pouring water onto the groin as you urinate to reduce pain and discomfort.

  • Petroleum jelly or anaesthetic cream applied to the blisters may also help with discomfort during urination. Always make sure you wash your hands thoroughly before and after touching blisters.

  • Open sores are a potential site of a secondary bacterial infection. To avoid this, bathe regularly using plain or salt water.

  • Wear loose-fitting underwear and clothing to avoid rubbing of the area and therefore pain and potential bacterial infection. (2)

How can I reduce the spread of genital herpes?

The most effective way to prevent infection of partners is to abstain from any sexual contact while symptoms are present, from the tingling or itching until blisters and ulcers have completely healed. This includes sexual activity involving hands, as not only does this mean the virus can be transferred to a partner’s genitals, but it is possible for it to enter the body via the hands. (1, 2)

Additionally, always use condoms for vaginal or anal sex and dams for oral sex or vulval contact between partners, even when there is no outbreak. (2)

Avoid sharing sex toys. If you do, wash the toy thoroughly and cover with a fresh condom before each use. (1)

The antiviral drug valaciclovir can also be prescribed to help make HSV-2 less transmissible to partners. (3)

Is genital herpes a threat to other aspects of my health?

Fortunately, for healthy people, genital herpes is nothing more than an annoyance. It doesn’t predispose you to other diseases, affect fertility or alter your lifespan. Nevertheless, it can cause problems for people with HIV, so people with HIV who catch herpes will be managed by a specialist. If you need any further information or support, click here or consult your GP, pharmacist or sexual health clinic. (1, 2)

References

  1. Herpes Viruses Association. About herpes simplex virus [cited 16 March 2018]. Available at: https://herpes.org.uk/frequently-asked-questions/herpes-simplex-virus/
  2. NHS Choices. Genital herpes [cited 16 March 2018]. Available at: https://www.nhs.uk/conditions/Genital-herpes/
  3. British National Formulary (version 1.3.7) [Mobile application software]. Retrieved from: www.bnf.org

Viagra Connect soon to be available over the counter

Posted 3 April 2018 in Erectile Dysfunction, Men's Health, Sexual Health

Viagra GenericOccurring in almost a third of men over the age of 40, erectile dysfunction is a widespread condition that can cause embarrassment, frustration and even depression for those affected. Some men are so ashamed about having erectile dysfunction that they choose not to seek help from their GP, and since treatment is currently only available on prescription, they just continue to put up with the condition, or more worryingly, opt to purchase treatment from illegal vendors online. Purchasing any medicines in this way poses risks, as there is no guarantee that they have been produced following the stringent quality and safety procedures and testing that medicines from UK registered and regulated online pharmacies undergo. The good news is that this has impelled the Medicines and Healthcare products Regulatory Agency (MHRA) to reclassify Viagra Connect (sildenafil 50mg) from a prescription-only medicine (POM) to a pharmacy (P) medicine, meaning that it will be available to purchase over the counter without a prescription in the UK. It is expected to be on sale in the spring this year. (1, 2)

Viagra Connect should be taken around one hour before sexual activity, ideally on an empty stomach as food can slow absorption. No more than a single tablet per day should be taken. Although the majority of men will be successful first time, it may take a few doses (therefore a few separate attempts) to reach the desired effect of a penile erection sufficient for satisfactory sexual activity. If this fails, you will need to see your GP. (3)

Men wishing to purchase Viagra Connect over the counter in a pharmacy will need to have a quick discussion surrounding symptoms, medical conditions and other medicines with the pharmacist, so that it can be determined whether the medicine is suitable or safe to take. If buying from an online pharmacy, a short medical questionnaire will need to be completed to assess suitability. Certain medical conditions, such as cardiovascular diseases, high cardiovascular risk, and liver or kidney failure, may mean that the medicine cannot be sold and a GP appointment is needed. (2)

Viagra Connect will be available to order from Webmed Pharmacy by selecting the medicine after clicking the ‘Treatments’ tab on the homepage. You will need to complete a short confidential online consultation, and then, like in any other pharmacy, the pharmacist will review the information you’ve given and assess whether the medicine is safe for you to take.

This regulatory change will benefit millions of UK men. For many, a trip to the pharmacy seems much more informal and is often more convenient than an appointment with the GP. The patient can even visit a pharmacy they don’t usually go to, or use a General Pharmaceutical Council (GPhC) registered online pharmacy such as Webmed if they fear embarrassment. The danger to health of obtaining medicine from illegal, unregulated and unregistered websites will also be reduced. It may even help other underlying conditions to be diagnosed, since pharmacists will inform men buying Viagra Connect that they should make a follow-up appointment with their GP within 6 months so that such conditions can be tested for. (1)

Watch this space to find out as soon as Viagra Connect becomes available to buy!

References

  1. You’ll be able to buy Viagra for the first time ever- in the UK [cited 20 February 2018]. Viagra Connect to be available over the counter from Spring 2018. Available at: http://fortune.com/2017/11/28/viagra-over-the-counter-uk/

  2. GOV.UK. MHRA reclassifies Viagra Connect tablets to a Pharmacy medicine [cited 20 February 2018]. Available at: https://www.gov.uk/government/news/mhra-reclassifies-viagra-connect-tablets-to-a-pharmacy-medicine

  3. emc. Viagra Connect [cited 20 February 2018]. Available at: https://www.medicines.org.uk/emc/product/8725

The concerning link between STIs and infertility

Posted 19 February 2018 in Men's Health, Sexual Health, Womens health

A couple in a romantic sunsetInfertility affects around 3.5 million UK people, but did you know that as many as one in four cases of infertility are caused by sexually transmitted infections (STIs)? The longer STIs are left untreated, the greater the risk of infertility, which is why it’s crucial to diagnose and treat STIs promptly to maintain the health and wellbeing of individuals and couples wishing to conceive. (1)

Which STIs can cause infertility?

Chlamydia and gonorrhoea are the two most common STIs in the UK, and also happen to be potential causes of infertility if left untreated.

Chlamydia

Chlamydia is the most common STI in the UK, with approximately 70% of cases being under 25 years of age. It is caused by a type of bacteria called Chlamydia trachomatis. Worryingly, it usually doesn’t cause any symptoms, meaning that people don’t know they’re infected unless they have a test. For under 25s it is recommended to have a test for chlamydia yearly or upon getting a new sexual partner. (2)

If a person with chlamydia does experience symptoms, they may include painful urination, unexpected or discoloured discharge from the vagina, penis or back passage, abdominal pain or unusual vaginal bleeding (after sex or when not on your period) in women, and painful inflamed testicles in men. (2)

If you catch chlamydia and it is left untreated, it could eventually cause infertility. In women, this is because the infection can lead to pelvic inflammatory disease (PID), a condition in which the higher portion of the reproductive system becomes inflamed, including the ovaries, fallopian tubes and uterus. PID can cause scarring of these areas, which can make it hard or sometimes impossible for an egg to be released and to reach the uterus. In men, a condition called epididymo-orchitis can develop, which is inflammation of the testicles and sperm ducts. If left untreated, it can damage these areas to the extent of causing infertility. (3)

Gonorrhoea

Gonorrhoea is another very common STI in the UK caused by the bacterium Neisseria gonorrhoeae. Symptoms are usually a thick, yellow or green, unpleasant-smelling discharge from the vagina or penis, painful urination and unusual vaginal bleeding. But, as with chlamydia, some people don’t get symptoms – this is the case for approximately 10% of men and 50% of women infected. (4)

Untreated gonorrhoea may also lead to PID in women, which in turn may lead to infertility. The infection may spread to the testicles and prostate gland in men, occasionally causing a drop in fertility or even infertility. (5)

If you think you may be at risk of having chlamydia or gonorrhoea, you have had any of the above symptoms, or you have had a recent change of sexual partner, you can arrange a test at your GP surgery, a genitourinary medicine (GUM) clinic or a sexual health clinic. Certain pharmacies, contraception clinics and young people’s services may also offer testing. (6, 7)

You can also order testing kits and treatments for a range of STIs including chlamydia and gonorrhoea from Webmed Pharmacy here.

What happens if I test positive for chlamydia or gonorrhoea?

If you have chlamydia, you’ll receive antibiotic treatment. The antibiotics usually used are azithromycin, taken as a single dose, or doxycycline, taken for a week. Other antibiotics can be used if you are allergic to the usual choices, pregnant or breastfeeding. Don’t have sex until you’ve finished the course, or for a week after taking the azithromycin single dose, as the infection may not have fully cleared up within this time. If you take the antibiotics as directed and follow the aforementioned advice, you probably won’t need to have another test to confirm whether the treatment has worked, unless your symptoms persist. (8)

For gonorrhoea, the usual choice of antibiotic treatment is a single dose of azithromycin alongside a ceftriaxone injection. You’ll most likely have a repeat test a couple of weeks later to make sure the infection has cleared – avoid sex until you’ve had a negative result from this test. (9, 10)

If you’ve tested positive for chlamydia or gonorrhoea, then any sexual partners you’ve had within the last 6 months will need to be tested and potentially treated too. If you don’t want to or can’t contact them yourself, you can seek the help of a GUM or sexual health clinic who may be able to find their details and send them a letter advising them to be tested. The letter won’t contain your name. (8, 10)

How can I protect myself from STIs?

Condoms are widely available and highly effective at protecting against STIs. Free male or female condoms are available from contraception clinics, young people’s services and sexual health clinics. Certain GUM clinics and GP surgeries may also supply free condoms. They can be used for vaginal or anal sex, or to cover the penis during oral sex. (11, 12)

Dams are square-shaped barriers made from latex or polyurethane (also used to make condoms). They can be used during oral sex to cover the vagina or anus, or to cover the vulva during skin-to-skin contact with a partner’s vulva. (12)

Avoid sharing sex toys, or wash and cover them with a fresh condom after each use. (12)

Forms of contraception such as the oral contraceptive pill, copper intrauterine devices (IUDs) and spermicides are designed to protect against pregnancy only and will not offer protection from STIs.

References

  1. NHS Choices. Infertility – Overview [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/infertility/

  2. NHS Choices. Chlamydia – Overview [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/chlamydia/

  3. NHS Choices. Chlamydia – Complications [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/chlamydia/complications/

  4. NHS Choices. Gonorrhoea – Overview [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/gonorrhoea/

  5. NHS Choices. Gonorrhoea – Complications [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/gonorrhoea/complications/

  6. NHS Choices. Sexually transmitted infections (STIs) [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/

  7. FPA. Sexually transmitted infections (STIs) help [cited 2 February 2018]. Available at: https://www.fpa.org.uk/help-and-advice/sexually-transmitted-infections-stis-help

  8. NHS Choices. Chlamydia – Treatment [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/chlamydia/treatment/

  9. British National Formulary (version 1.3.4) [Mobile application software]. Retrieved from: www.bnf.org

  10. NHS Choices. Gonorrhoea – Treatment [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/gonorrhoea/treatment/

  11. FPA. Condoms (male and female) [cited 2 February 2018]. Available at: https://www.fpa.org.uk/contraception-help/condoms-male-and-female

  12. Central Manchester Foundation Trust. Chlamydia [cited 2 February 2018]. Available at: http://www.cmft.nhs.uk/health-a-to-z?letter=C&path=articles/chlamydia/introduction

Itching to hush irritating thrush?

Posted 9 February 2018 in Men's Health, Sexual Health, Womens health

A man and woman itching with thrushOne of the numerous infections that can be caused by a type of yeast known as Candida, thrush affects around 75% of women at some point in their life, and can affect men too. It can be a nuisance, causing discharge, discomfort and irritation, but if you find it’s a common occurrence it may be a sign of an underlying problem. (1)

What is thrush?

Thrush, also known as candidiasis, is the name given to a number of skin and mucous membrane infections involving Candida, which is a group of several species of yeast (fungus). In society, ‘thrush’ is generally defined as vaginal or penile candidiasis, so the same definition applies to the term ‘thrush’ in this blog hereafter. (2)

Symptoms of thrush in women include an odourless vaginal discharge with the appearance of cottage cheese, irritation and itching of the vagina and vulva, and pain or stinging on urination or during sex. For men, thrush can cause irritation and burning of the head of the penis and beneath the foreskin, pain on retraction of the foreskin, a cottage cheese-like discharge and odour. But not everyone with thrush will have all of the according symptoms listed - in fact, it is possible to have thrush without any symptoms. (2)

What causes thrush?

Candida and certain species of bacteria, known collectively as flora, live naturally in the vagina and are beneficial in that they keep the acidity of the vagina at a healthy level. However, particular factors can upset the balance of the flora and allow Candida to proliferate, leading to thrush. Such factors include antibiotics, pregnancy, being post-menopausal, poorly controlled diabetes, a compromised immune system or broken or irritated skin in the vagina. Sometimes, having sex or even periods can bring on an episode of thrush. (2)

Men may develop penile thrush through sex with a female partner who has vaginal thrush. (2)

How is thrush treated?

If you think you’ve got thrush for the first time, you’ll need to visit your GP for a diagnosis and to rule out anything else. Treatment comes in various forms, namely external and vaginal creams, pessaries and oral capsules. (2, 3)

The mainstay of treatment of thrush in women is a pessary or vaginal cream containing clotrimazole, an antifungal. The pessary or cream usually only needs to be inserted into the vagina once, as long as the high strength is used. Lower strengths are available, but they will need to be used more than once. Other, less common antifungals used in this way include econazole and miconazole. (3)

If the vaginal forms of treatment are unsuitable, fluconazole and itraconazole antifungal capsules are available. Again, fluconazole can be taken as a single dose. (3)

To ease itching and irritation of the vulva while the above treatment takes effect, creams containing antifungals such as clotrimazole can be applied to the area several times a day. (3)

To treat thrush in men, a cream containing an antifungal such as clotrimazole may be applied to the penis, or oral fluconazole can be taken as a single dose. As for women, the cream can be used alongside the capsule to ease symptoms while the capsule works. (3, 4)

If you’ve already had a diagnosis of thrush in the past, you can visit a pharmacy instead of the GP where you can buy clotrimazole-containing external and vaginal creams, clotrimazole pessaries and fluconazole capsules over the counter.

When else will I need to see the GP?

As well as experiencing symptoms for the first time, there are several other instances when you will need to see your GP or visit a sexual health clinic when you develop thrush:

If you fall into one or more of these groups, the healthcare professional you see may need to look at the area to gauge whether it’s thrush or a different infection. If they’re unsure, they may take a sample of the discharge using a cotton swab to send off for testing. If you get recurrent thrush, your GP may run tests to check if there is an underlying problem with your immune system. (2)

In men, thrush can develop into a condition called balanitis. The head of the penis and the foreskin can become red, painful and inflamed, with associated foul-smelling discharge and painful urination. If you think you have balanitis you should visit your GP. (5)

Can I prevent thrush?

There are certain steps you can take to try to prevent bouts of thrush in the future. Opt for showers as opposed to baths, use non-perfumed intimate washes or emollients rather than soap on the groin area, and dry thoroughly afterwards. Wear loose-fitting cotton underwear where possible and don’t douche or use deodorants on your intimate area. (2)

References

  1. raTrust. Vaginal Thrush Overview [cited 7 February 2018]. Available at: https://ratrust.org.uk/sexual-health/stis/vaginal-thrush/overview
  2. NHS Choices. Thrush in men and women [cited 7 February 2018]. Available at: https://www.nhs.uk/conditions/thrush-in-men-and-women/
  3. British National Formulary (version 1.3.4) [Mobile application software]. Retrieved from: www.bnf.org
  4. Canesten. Thrush in Men [cited 7 February 2018]. Available at: https://www.canesten.co.uk/en/female/female-knowledge/thrush-in-men/
  5. NHS Choices. Balanitis [cited 7 February 2018]. Available at: https://www.nhs.uk/conditions/balanitis/

Cervical screening - a vital test in decline

Posted 5 February 2018 in Womens health

Cervical screening is a quick but potentially life-saving procedure. However, a quarter of women invited annually don’t attend. In light of recent survey results, it seems that embarrassment and fear of judgement are among common reasons not to show up. (1)

Ladies for cervical screening. Picture courtesy pixabay.com

What is cervical screening?

Once referred to as a ‘smear test’, cervical screening is a procedure during which a sample of cells is taken from the cervix, which is located at the upper end of the vagina and is deemed the opening to the uterus (womb). The cell sample is then examined for any abnormalities. For 95% of women, no abnormalities will be present. But for the remaining 5%, further testing will need to be done. Abnormal cells are sometimes at risk of becoming cancerous, in which case they need to be extracted from the cervix. But usually these cells resolve by themselves and cause no problems, therefore it is important to note that cervical screening is not a test for cancer. (1, 2)

Cervical screening exists to lower the number of cervical cancer cases and cervical cancer-related deaths. (2)

What happens during cervical screening?

Firstly, as long as you’re registered with a GP, you’ll have a letter posted to you inviting you to attend cervical screening. It will tell you who you need to make your appointment with, usually your GP surgery. If you don’t respond to the letter initially, you’ll be sent reminder letters at later dates. All women should have received a letter by the time they turn 25, and may be as early as 6 months before this. You may book the appointment as soon as you receive the letter. (2, 3)

It’s best to schedule your appointment for the middle of your menstrual cycle if you can, as this is when the clearest samples can be taken. If not, at least make sure you don’t book it for when you’re on your period as this will almost certainly make the sample unreadable. (2)

When you book, you are welcome to request a female doctor or nurse to carry out the procedure. (2)

In the 24 hours before your appointment, make sure you don’t use any spermicides, barrier contraceptives (e.g. condoms) or personal lubricant as this may interfere with the quality of the sample. (2)

At the appointment, which usually lasts about 5 minutes, the doctor or nurse will allow you some privacy to remove clothing from the waist down, although if you’re wearing a loose skirt or dress you should be able to keep it on. You’ll then need to lie on a couch for the procedure to be carried out. The doctor or nurse will then return and carefully insert a speculum into your vagina. A speculum is a piece of equipment designed to keep the vagina open, allowing easy access to the cervix. A sample of cells is then taken from the cervix using a small soft brush. It shouldn’t hurt, but if it does, let the person carrying out the procedure know so they can try to reduce the pain. Once the sample is taken, the procedure is done. The sample will be sent for testing and you should receive a letter in the post informing you of your results within 14 days. (2)

After this, you’ll be called back for cervical screening every three years up to the age of 50, unless you have an unclear result, in which case you’ll need to arrange another appointment after 3 months. Abnormal results may also require the procedure to be repeated. After your 50th birthday, you’ll be invited every five years up until the age of 65, when testing is no longer offered unless you haven’t had screening since you were 50 or your last result was abnormal. (2, 4)

Abnormal results may call for a repeat screening or a colposcopy (cervical examination). Occasionally, abnormal cells may need to be removed before they have the chance to develop into cancer. (2)

The link between HPV and cervical cell abnormalities

A common cause of abnormalities in cervical cells is the human papilloma virus (HPV). HPV is a group of viruses that can infect the skin and mucous membranes including the cervix. It is very easily transmitted, with 80% of all people catching it at some stage in their life. Most strains are harmless and resolve of their own accord. But some of the strains which infect the cervix can lead to possible pre-cancerous changes in the cells. These strains are passed from one person to the other via sexual contact, such as penetrative sex, genital skin to skin contact, and sharing sex toys. Using condoms may lower the chance of catching HPV from a sexual partner, but will not eliminate it entirely since they only cover part of the genital area. (5)

The alarming fact that the strains of HPV which cause abnormalities don’t actually cause any symptoms demonstrates the importance of keeping up to date with cervical screening. (5)

Since 2008, vaccines have been available in the UK that protect against at least two of the HPV strains that can cause abnormal changes in cervical cells. Girls aged 12 and above can be given a vaccine for free on the NHS. However, even with the vaccine, you’re not completely immune to HPV and there are other strains which can cause abnormalities, so cervical screening remains crucial. (5)

Why is attendance falling for cervical screening?

Since 2011, attendance at cervical screening appointments has dropped year by year. By 2016-2017, just 72% of women invited for an appointment attended, a 3.7% drop on 2011 figures. Many of the non-attending women were those in the youngest age bracket of 25-29 - a third of women this age do not show up year on year. The startling figure drop led Jo’s Cervical Cancer Trust to carry out a survey on over 2000 women in Britain, to try to discover the reasons why cervical screening is being shunned. The overwhelming message was that embarrassment over the appearance and odour of their genital area or of their body overall was the main factor in preventing women from taking up the offer. Younger women in particular seemed to fear judgement from the person carrying out the screening, giving reasons for missing appointments such as the appearance of their vulva or vagina giving away how much sex they’d had (this is a common misconception - there is in fact no link) and not having removed pubic hair beforehand. (1)

It’s understandable that having such an intimate part of your body visible to a person unfamiliar to you might seem embarrassing, but you must remember that doctors and nurses are healthcare professionals who carry out such procedures day in, day out and are there not to judge, but to safeguard your health and wellbeing. They will listen to your concerns and try to make the procedure as comfortable as possible for you. Now is the time for women to recognise this, take control of their health and get the attendance figures on the rise again!

For further information and support, visit www.nhs.uk/conditions/cervical-screening or www.jostrust.org.uk.

References

  1. Silver K (2018). ‘Embarrassment makes women avoid smear tests, charity says’, BBC News. Available at: http://www.bbc.co.uk/news/health-42747892
  2. NHS Choices. Overview [cited 26 January 2018]. Available at: https://www.nhs.uk/conditions/cervical-screening/
  3. NHS Choices. When it’s offered [cited 26 January 2018]. Available at: https://www.nhs.uk/conditions/cervical-screening/when-its-offered/
  4. NHS Choices. Results [cited 26 January 2018]. Available at: https://www.nhs.uk/conditions/cervical-screening/results/
  5. NHS Choices. Why it’s offered [cited 26 January 2018]. Available at: https://www.nhs.uk/conditions/cervical-screening/why-its-offered/

Peptic ulcers - the gut wrenching facts

Posted 22 January 2018 in Men's Health, Womens health

A man clutching his stomach due to the pain of a peptic ulcer. Picture pixabay.comPeptic ulcers are a condition that will affect around 10% of people at some stage in their life, more often than not when they are elderly, but it is possible for anyone of any age to be affected. Most peptic ulcers cause no more than abdominal discomfort, pain and indigestion, resolving within a couple of months of starting treatment. However, in certain cases they can have grave consequences, which is why it is important to know the signs and when to visit your GP. (1)

What are peptic ulcers?

‘Peptic ulcers’ is a collective term for gastric (stomach) and duodenal (upper small intestinal) ulcers. They are sores that occur on the lining of these areas, caused by stomach acid coming into contact with the lining. Usually, the lining is shielded from the acid by mucus, but certain factors can deplete this mucus layer. One is Helicobacter pylori, a type of bacteria which lives in the stomach lining of around half of all people. Some of these people don’t know that they’re infected because the bacteria cause no problems. For others, ulceration develops because H. pylori degrades the protective mucus, leaving the lining exposed. Another factor which can lead to peptic ulcers is taking a type of medicine called non-steroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen, aspirin, naproxen, diclofenac and etoricoxib amongst others. It is thought that this happens because the same pain and inflammation-causing compounds which NSAIDs reduce levels of are also responsible for protecting the lining of the stomach and upper section of the small intestine. Taking high doses of NSAIDs, or taking them for a prolonged period of time, increases the chances of developing peptic ulcers in this way. Smoking can also make peptic ulceration more likely. (1, 2, 3)

How do I know if I have a peptic ulcer?

Generally, a peptic ulcer will cause a burning or gnawing-type pain that can be pinpointed to the middle of the abdomen. It may sometimes spread to other areas such as the back, neck or belly button. This pain usually occurs on an empty stomach and may be temporarily relieved by eating. Indigestion, heartburn, reduced appetite, nausea and vomiting can also occur. (1, 4)

How are peptic ulcers treated?

The first-line treatment for peptic ulcers is a drug known as a proton pump inhibitor (PPI). They work by inactivating a channel called the proton pump, which is found in the acid-producing cells of the stomach. This reduces the level of stomach acid, allowing the ulcer to heal. Commonly prescribed PPIs include omeprazole, esomeprazole, lansoprazole and pantoprazole. (5)

If the ulcer is found to have been caused by H. pylori, a course of antibiotics will need to be taken alongside a PPI, usually clarithromycin with amoxicillin or metronidazole. If successful, the H. pylori are eradicated after 7 days of treatment. (5)

If PPIs are unsuitable, a type of drug that works in a different way to reduce stomach acid may be given, namely an H2-receptor antagonist. These drugs work by binding to the H2-receptor in the stomach which also plays a part in stomach acid production. The most commonly used H2-receptor antagonist is ranitidine. (5)

When do I need to seek medical help?

If you find you are frequently experiencing the symptoms listed above, visit your GP who can assess your condition and get you started on the necessary treatment.

If you vomit blood (this can appear fresh in some cases, but dark brown and grainy in others), pass black tarry stools, or experience a piercing abdominal pain that progressively intensifies, you need to seek urgent medical help as you may have a bleeding ulcer or peritonitis, an abdominal infection caused by a ruptured lining. Make an emergency appointment with your GP or ring NHS Direct on 111. If this is not possible, visit A&E. (6)

Is there anything I can do to ease the symptoms?

Peptic ulcers take weeks to heal, so in the meantime, you can ease pain and discomfort by avoiding alcoholic drinks, smoking, and spicy, fatty or acidic foods. You may find taking an over the counter antacid suspension such as Gaviscon after meals and at bedtime helps. Also, make sure you avoid taking NSAIDs for pain relief, instead opting for paracetamol. (5)

References

For further information, click here or ask your pharmacist.

  1. NHS Choices. Overview [cited 19 January 2018]. Available at: https://www.nhs.uk/conditions/stomach-ulcer/

  2. NHS Choices. Causes [cited 19 January 2018]. Available at: https://www.nhs.uk/conditions/stomach-ulcer/causes/

  3. UpToDate. NSAIDs (including aspirin): Pathogenesis of gastroduodenal toxicity [cited 19 January 2018]. Available at: https://www.uptodate.com/contents/nsaids-including-aspirin-pathogenesis-of-gastroduodenal-toxicity

  4. NHS Choices. Symptoms [cited 19 January 2018]. Available at: https://www.nhs.uk/conditions/stomach-ulcer/symptoms/

  5. NHS Choices. Treatment [cited 19 January 2018]. Available at: https://www.nhs.uk/conditions/stomach-ulcer/treatment/

  6. NHS Choices. Complications [cited 19 January 2018]. Available at: https://www.nhs.uk/conditions/stomach-ulcer/complications/

HIV: is a life-changing formulation in the pipeline?

Posted 11 January 2018 in Men's Health, Sexual Health, Womens health

Daily Pills. Picture courtesy of pixabay.comHIV (human immunodeficiency virus) is no longer the death sentence it once was, thanks to the development of numerous tests and treatments over the years. However, the cocktail of drugs that those diagnosed with HIV must take daily, just to keep the virus at a low enough level to maintain a functional immune system, could be considered a life sentence. Understandably, a way to reduce this frequency of dosing is greatly desired – and recent research shows that in the future it may become reality. (1)

HIV is primarily a sexually transmitted infection, but it may also be passed from one person to another via sharing needles or sex toys, accidentally pricking oneself with a contaminated needle or via blood transfusion. It can also be passed to a baby during birth or breastfeeding if the mother is infected. People at greatest risk include homosexual men, heterosexual black African people of any gender, and anyone who shares needles or syringes with others. (2, 3)

Once HIV has found its way into the body, it hijacks specific cells in the immune system known as CD4 lymphocytes, forcing them to abandon their intended function and instead produce thousands more copies of the virus. The CD4 cells then die, releasing the newly made viruses, which go on to repeat the process again and again over a timespan of up to 10 years until CD4 levels are critically low and the immune system fails. (2)

If HIV is diagnosed early, a course of HIV medication known as post-exposure prophylaxis (PEP) can prevent the virus from taking hold, as long as it is taken within three days of first contact with the virus. If this is unsuccessful, or more than three days have elapsed, medication will need to be started as soon as possible to keep the virus under control. (2)

There is a wide range of HIV medication, also known as antiretroviral medication, available and people with HIV must take a combination of medicines daily to halt the progression of the disease and maintain health. Antiretrovirals are grouped into the following categories:

  • nucleoside reverse transcriptase inhibitors (NRTIs), which include zidovudine, abacavir and lamuvidine, and work by preventing the virus’s genetic material from being copied

  • non-nucleoside reverse transcriptase inhibitors (NNRTIs), including efavirenz, etravirine and rilpivirine, which work in the same way as NRTIs

  • protease inhibitors, such as ritonavir, saquinavir and atazanavir, which prevent formation of new copies of the virus

  • integrase inhibitors, including dolutegravir and raltegravir, which prevent the hijacking of CD4 cells by the virus. (4)

Other antiretroviral medications outside these categories include enfuvirtide and maraviroc, which work in different ways to the medications listed above. (4)

The promising news

Recent research by the Massachusetts Institute of Technology has demonstrated that in the future it may be possible to reduce the frequency of HIV medication dosing from daily to weekly by adopting a new formulation. Pigs were administered various drugs in the form of a capsule containing a star-shaped structure, which broke down much more slowly than a tablet or standard capsule, releasing the medicine gradually over as long as two weeks. Biotechnology company Lyndra is now planning to bring this success forward to human trials over the next year. Such a formulation would be life-changing for millions of people worldwide, making it easier to remember to take medication as well as freeing them of the inconvenience of taking numerous drugs daily. It is too early to know how long it may be before weekly HIV medication becomes mainstream, but this is very exciting news indeed. (1)

References

  1. BBC News (2018). ‘Once-a-week pill for HIV shows promise in animals’. Available at: http://www.bbc.co.uk/news/health-42610315

  2. NHS Choices. Causes [cited 9 January 2018]. Available at: https://www.nhs.uk/conditions/hiv-and-aids/causes/

  3. NHS Choices. Overview [cited 9 January 2018]. Available at: https://www.nhs.uk/conditions/hiv-and-aids/#causes-of-hiv-infection

  4. British National Formulary (version 4.2) [Mobile application software]. Retrieved from: www.bnf.org

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