Posts tagged Sexual Health

Today’s blog is written by Hanna, a 35 year old single female living in the city; but less Carrie Bradshaw and more Bridget Jones. Hanna will be writing for us from time to time on issues that arise in the modern world of dating, love and life in her 30s; and whilst many of us can relate to what Hanna has experienced, all views are her own.

Well festival season is upon us and those who attended Glastonbury this weekend got very lucky with the weather. Of course with scorching sunshine comes the inevitable festival issues; the stench of the toilets and ending up with your face in your dancing-neighbours sweaty armpit; all rounded off by being boiled alive in a tent at 6am with a killer hangover. Yet still we flock, in the thousands, to watch our favourite artists, create amazing memories and meet a range of new people. Mix this in with some alcohol and the laissez-faire environment created at a festival; it’s inevitable we’re going to want to hook up with that hot one we met at Silver Hayes.

This brings me to a topic I’ve discussed many times with my girlfriends and I can honestly say that the group is 50/50 divided; festival sex, yes or no? Stats show that, on average, 34% of Glastonbury attendees will have some sort of sexual encounter; it’s the most promiscuous music festival in the UK. These liaisons mainly happen in the tents but some brave souls get it on in crowds and I read that some even attempt it in the port-a-potties – I had to read that twice.

Those that are in the yes camp (pun intended) are my more free spirited friends that jump into the festival vibe with gusto from the moment we arrive. I, on the other hand, am firmly in the no camp and whilst that may make me seem uptight; you have not seen me at 7am when I’m sweaty, have no make up on and have scarecrow hair. I wish I could be free-loving and not care about intimate hygiene but as I shower at least once a day at home- you’re at Glasto for four days with only wet wipes. I know you’re thinking, “But surely it’s not that bad as you’d use a condom” and the great thing about Glastonbury is the availability of free condoms, the only single-use plastic that they did allow this year. So each to their own but I’ll abstain for four days, it’s not like I’m not used to it #singlelife

Just returned from Glastonbury and worried you may have contracted an STI? Get your home test kit here - delivered within 24 hours* in discrete packaging. Safe, secure, sorted.

*to mainland UK

The World Health Organization, WHO, has estimated that one million new sexually transmitted infections (STIs) occur every single day. (1)

Overall, in the UK the cases of sexually transmitted infections are increasing.

In England alone, in 2018, there were 447,694 new diagnoses of STIs, a 5% increase on the 422,147 in 2017. (2)

Gonorrhoea increased the most, by 26% to 56,259 cases, the largest number since 1978.

Where can I buy home treatment? Click here

The number of gonorrhoea cases has been increasing for years among both men and women, despite repeated warnings from public health doctors about the risks of unprotected sex.

Gonorrhoea, sometimes referred to as "The Clap", is a bacterial infection passed between people through unprotected sex.

About 50% of women and 10% of men are unaware that they’re infected as they don’t experience any obvious symptoms and this means that the infection can go untreated until the disease has progressed. This can lead to serious long-term health problems and infertility.

If symptoms are experienced, they usually occur about 10 days after being infected. Men and women are affected differently: (3)

Men may experience

• Burning sensation/pain when urinating

• Inflammation of the foreskin

• An unusual discharge from the tip of the penis that may be green, yellow or white.

• Tenderness or pain in the testicles

While women may experience

• Burning sensation/pain when urinating

• Bleeding between periods and/or heavier periods

• A change in vaginal discharge which may be thick and green or yellow in colour.

• Lower abdominal discomfort

• Bleeding after sex

Testing

If you have put yourself at risk and are concerned, then you should wait 14 days before taking a test as it may take this amount of time before the infection can be detected.

If you visit your GP you will probably be signposted to a genitourinary medicine, GUM, clinic which may also be called a Sexual Health Clinic.  If you find it difficult to either get an appointment at a clinic or are simply short of time or indeed too embarrassed to go to a clinic, you can choose to order a test from us at Webmed Pharmacy.

For test kits click here.

Our test kits are sent to The Doctors Laboratory (TDL) in London. They are the largest independent providers of clinical laboratory diagnostic services in the UK. Once the lab has received your sample, your results will be available 2-3 days later.

The kits are posted in discreet plain unmarked packaging with no indication of their contents or who it‘s from.

Treatment

If your test is positive for gonorrhoea we can refer you to a GUM clinic for treatment. The first line treatment, as recommended by the British Association for Health and HIV, BASHH, is an injection of a single antibiotic.

If you can’t get to a GUM clinic, unable to get an appointment or have a needle phobia then our doctor can prescribe second line treatment that comprises of two different antibiotics that you take orally. As our treatment is second line, and therefore not considered to be as effective as the first line treatment, we provide a free “test of cure” that you can send to the lab 14 days after treatment to make sure you are clear of infection.

We will ask that you complete a simple medical questionnaire that our Doctor can assess for your suitability and, if approved, be prescribed the oral antibiotics to treat the infection.

Your treatment will be delivered in discreet, unmarked packaging with no mention of the contents or who it’s from. You can have your parcel delivered to your home or work address and, if in an area where we use DPD, you can have it diverted to a local pickup shop where you can collect it at your convenience.

The symptoms for all STIs are very similar and it’s better to get tested to find out which STI you may have rather than trying to guess from your symptoms. Then you can receive the most appropriate treatment and be sure of treating the infection successfully.

This is especially important for gonorrhoea as there is evidence of a resistant strain of gonorrhoea emerging in the UK and unnecessary prescribing of antibiotics can contribute to this.

For Gonorrhoea and Chlamydia treatments, click here. 

References

1. https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)

2. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/806118/hpr1919_stis-ncsp_ann18.pdf

3. https://www.nhs.uk/conditions/gonorrhoea/symptoms/

Medically reviewed by
Superintendent pharmacist Margaret Hudson BSc(Hons) MRPharmS
11th June 2019

Gonorrhoea is a sexually transmitted infection and can be caught by having unprotected sex with an infected person. It can affect both men and women. Symptoms do not appear until about 10 – 12 days after infection and some 50% of women and 10% of men are unaware that they have it, because there may be no obvious symptoms. This can lead to long term health problems and infertility. (1)

Symptoms in men are a burning sensation when urinating, pain in the testicles, a discharge from the penis that may be white, yellow, or green, and inflammation of the foreskin if present. In women there will also be a burning sensation when urinating, vaginal discharge which may be green or yellow, lower abdominal discomfort, bleeding after sex, and bleeding between periods. (1)

If you are concerned that you may have been at risk, you need to wait 14 days before taking a test because it may not be detected earlier.

At Webmed Pharmacy we can supply test kits  and treatment for both men and women.  Click here for test kits.

In all mainland UK except the Scottish Highlands and islands, the kits will be delivered the next working day by DPD in unmarked packaging. All other areas will receive their discreet parcels by Royal Mail special delivery the next working day. (2)

You then take your sample using the test kit and send it in a pre-paid envelope to The Doctors Laboratory in London. Results will be available 2 – 3 days later, and we will contact you by email or SMS to tell you that there is a message waiting for you in your secure inbox at Webmed Pharmacy.

If your test proves positive for gonorrhoea or chlamydia we will then ask you to complete a simple medical questionnaire online so that our doctor can assess you for your suitability and, if approved, can prescribe the oral antibiotics that you need to cure the infection. (3)

For Chlamydia and Gonorrhoea treatments, click here

If you have already tested positive using a home test kit from another site or a clinic, you can still complete the online questionnaire and if approved our doctor can prescribe the oral antibiotics. You should then take another test in order to ensure that you are free of infection 14 days after gonorrhoea treatment online, and we supply a FREE test kit to you for this purpose.  

References

1. https://www.nhs.uk/conditions/gonorrhoea/symptoms/

2. https://www.nhs.uk/conditions/gonorrhoea/diagnosis/

3. https://webmedpharmacy.co.uk/buy/gonorrhoea-treatment-kit

Medically reviewed by

Superintendent pharmacist Margaret Hudson BSc(Hons) MRPharmS

 14 May 2019

Can you tell which STI you have from symptoms only?

No, at least in most cases. Many symptoms of different STIs overlap, such as unusual discharge, pain when urinating and soreness and swelling of the vulva in women or the head of the penis in men. (1) Some STIs do have their own specific symptoms, such as black powder in underwear with pubic lice, but it is also important to remember that not everyone with a particular STI will experience all of the symptoms, and some may have no symptoms at all! Furthermore, HIV and Hepatitis B don’t cause symptoms, other than a flu-like illness which may occur a few weeks after infection. All of this is why it’s important to get tested! (1, 2)

Is there a single treatment for all STI's?

No. There are certain STIs that are caused by bacteria, some are caused by viruses, and others are caused by parasites, so the same treatment won’t work for them all. Also, different STIs need to be treated for different lengths of time, ranging from just a week long course of doxycycline (an antibiotic) for some cases of chlamydia to lifelong treatment with a daily cocktail of antiviral drugs for HIV.

Can all STI's be cured?

No. As previously mentioned, people living with HIV need ongoing treatment with many different antiviral drugs to keep the level of the virus in their body as low as possible. Genital herpes, as with any other herpes virus, remains dormant in the body once contracted, undetectable by the immune system – and can flare up at any time, particularly during times of stress or ill health. Genital warts are caused by one of several human papilloma viruses (HPVs) which tend to remain in the skin, even if there are no visible warts present, and can cause flare ups – although in some people, the immune system may eliminate the virus eventually. (3)

Conversely, some STIs can be cured very easily with a simple course of antibiotics, such as chlamydia, gonorrhoea and trichomoniasis.

Can I catch an STI from kissing?

No. Still, beware of cold sores, which are caused by a type of herpes virus (usually a different strain to the genital herpes virus) – these can be passed on through kissing.

Can I catch an STI from a toilet seat?

No. STIs can’t survive outside of the body for more than a few seconds (an exception to this rule is Hepatitis B, which can survive outside the body for at least seven days - but it is not strictly classed as an STI due to there being several other ways to contract it). (4)

Can I get an STI again even if I’ve been treated before?

Yes. Courses of treatment for curable STIs are to treat the current infection and offer no protection against future infections. Likewise, your body cannot develop immunity to STIs.

Do I need a “test of cure” for all treatments?

No – only for gonorrhoea. For pubic lice, the affected area should be checked to ensure there are no live lice one week after treatment ends. However, for any STI that can be cured with a course of treatment, see your GP if symptoms persist after you have completed the course. (5, 6)

Are men or women more likely to catch an STI?

The proportions of men and women being diagnosed with the various different STIs vary based on the STI in question and also year by year. Several factors can affect how many men and women are diagnosed with STI's, including women tending to show fewer symptoms due to most of their genitals being internal and therefore less visible, and women being more likely than men to attend an STI test. STI's seem to disproportionately affect homosexual men, possibly due to less frequent condom use compared with the heterosexual population. (7)

I’m pregnant, will my baby be affected?

Many STIs can affect unborn babies during pregnancy or be passed to the baby during birth.

• Chlamydia can cause premature birth or low birth weight. Transfer from mother to baby during birth can lead to conjunctivitis and pneumonia. (8)

• Gonorrhoea can cause miscarriage or premature labour. The baby may contract the infection during birth and develop conjunctivitis (an eye infection). If this is left untreated or treatment is delayed, the child may suffer from permanent impaired vision or even blindness. (9)

• Trichomoniasis may cause low birth weight and premature birth. (10)

• Genital warts can occasionally infect babies during birth, leading to infection in either the throat or genitals. (3)

• Genital herpes can cause neonatal herpes in the baby. This is a very serious infection and is potentially fatal, but it usually only develops if the mother contracts genital herpes while she is pregnant. (11)

• Syphilis can cause serious complications during pregnancy, including miscarriage, stillbirth and syphilis infection in the baby (congenital syphilis). Routine testing for syphilis is available to all pregnant women in this country for this reason. (12)

If you are pregnant and are in doubt as to whether you may have an STI, consult your midwife or see your GP.

References

1. NHS. Sexually transmitted infections (STIs) [cited 1 May 2019]. Available at: https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/

2. NHS. Pubic lice [cited 1 May 2019]. Available at: https://www.nhs.uk/conditions/pubic-lice/

3. NHS. Genital warts [cited 1 May 2019]. Available at: https://www.nhs.uk/conditions/genital-warts/

4. CDC.Hepatitis B Questions and Answers for the Public [cited 1 May 2019]. Available at: https://www.cdc.gov/hepatitis/hbv/bfaq.htm

5. NICE CKS. Gonorrhoea [cited 1 May 2019]. Available at: https://cks.nice.org.uk/gonorrhoea#!scenario

6. NICE CKS. Pubic lice [cited 1 May 2019]. Available at: https://cks.nice.org.uk/pubic-lice#!scenario

7. FPA. Sexually transmitted infections factsheet [cited 1 May 2019]. Available at: https://www.fpa.org.uk/factsheets/sexually-transmitted-infections

8. NHS. Complications: Chlamydia [cited 1 May 2019]. Available at: https://www.nhs.uk/conditions/chlamydia/complications/

9. NHS. Complications: Gonorrhoea [cited 1 May 2019]. Available at: https://www.nhs.uk/conditions/gonorrhoea/complications/

10. NHS. Trichomoniasis [cited 1 May 2019]. Available at: https://www.nhs.uk/conditions/trichomoniasis/

11. NHS. Genital herpes [cited 1 May 2019]. Available at: https://www.nhs.uk/conditions/genital-herpes/

12. NHS. Syphilis [cited 1 May 2019]. Available at: https://www.nhs.uk/conditions/syphilis/

Author
Gabby Gallaher MPharm

Medically reviewed by
Superintendent pharmacist Margaret Hudson BSc(Hons) MRPharmS
7 May 2019

National HIV Testing Week begins on Saturday 17th November 2018 and World AIDS Day on December 1st, so now is the best time to look over some of the most commonly asked questions about HIV (human immunodeficiency virus) testing and treatment!

How soon can HIV be detected by a blood test after contracting the virus?

Generally, it is one month after exposure to HIV that the virus is easily detectable in the blood. Tests done less than one month after exposure are considered unreliable. (1)

What is the window period for HIV testing?

The window period is the one-to-three month time frame following possible exposure to HIV, depending which test you use. The window period for the lab test is 28 days but is 90 days for the “Home” test. If you test before the recommended time frames then the HIV test may need to be repeated. This applies whether an earlier test came back positive or negative, as results from tests conducted earlier than the recommended “window period” for HIV can be unreliable, as previously mentioned. (1)

However, you shouldn’t wait until you may be in the window period before seeking medical help - you should do this as soon as you can if you believe you may have come into contact with HIV. Within the first 72 hours after suspected exposure, a type of medication called post-exposure prophylaxis (PEP) can be taken, which may prevent the infection from taking hold altogether. (1)

Can you receive instant results from an HIV Test?

Tests which provide instant results are available to use. Some genitourinary medicine (GUM) clinics and sexual health clinics offer finger prick testing, and home testing kits can be purchased from some online or high street pharmacies. (1)

How can I test for HIV at home?

There are a number of tests available from Webmed Pharmacy which allow you to test or take a sample in the comfort of your own home.

How accurate are HIV Tests?

• The latest 5th generation HIV lab test kit is 99.8% effective at detecting HIV at least 28 days after potential exposure. It contains a sterile lancet and a test tube. A blood sample is collected by pricking the little finger with the lancet and massaging a small amount of blood into the tube. This is then sealed (further instructions are found in the kit) and sent off to a lab for testing using the pre-paid envelope included. Results should be available two to three days after the sample is received by the lab – you will be able to access these via your secure account.

• The 3rd generation INSTI HIV Home self test allows you to sample and test for HIV yourself, all within just 60 seconds. It is only reliable if used at least 90 days after potential exposure. Like the lab test, blood is collected by pricking the finger (full instructions supplied in the kit). The result is clearly shown as one dot for HIV negative, two dots for HIV positive. Negative results are at least 99.5% accurate and positive results are at least 99.8% accurate.

• The PrEP annual test kit can be used if you are taking pre-exposure prophylaxis (PrEP) – this medicine is used by HIV negative people to prevent infection with HIV. This test can be performed yearly to check HIV status and also kidney function, which can be affected by taking PrEP.

• The pre-treatment PrEP test kit is suitable if you are thinking of starting PrEP. It checks your HIV status, kidney function and also whether you have hepatitis B.

What should I do if I test positive for HIV?

If you get a positive result, seek medical help. You will need to have regular blood tests to monitor the levels of a type of cell called CD4 lymphocytes. CD4 lymphocytes are one of the types of cells that make up the immune system and are also the cells that are targeted by HIV. HIV particles ‘hijack’ the CD4 lymphocytes, replicate themselves within the cells, and are then released in greater numbers when the cell dies, going on to infect further cells. You will need to start treatment to keep your CD4 levels high enough to keep you in good health - if someone with HIV does not start treatment, their CD4 levels will eventually fall so low that they will be at risk of serious infections such as flu, pneumonia and tuberculosis, which their immune system will not be able to cope with (this is known as AIDS  - see below). (2)

Even if your CD4 levels are high, you will still need to start medication to limit the progression of the disease. The aim of treatment is to achieve an undetectable viral load (levels of HIV in the blood being so low that they do not show up on blood tests).

What medications are available for HIV?

There is a wide range of HIV medications available, which are grouped into the following categories:

Other HIV medications outside these categories include enfuvirtide and maraviroc, which work in different ways to the medications listed above. (3)

Taking HIV treatment correctly should allow you to stay in good health, free from symptoms and to achieve a normal lifespan.

What is the difference between HIV and AIDS?

We often hear the abbreviations ‘HIV’ and ‘AIDS’ used interchangeably, but they are not the same! AIDS, or acquired immunodeficiency syndrome, is the most severe stage of HIV. It is characterised by CD4 levels falling so low that the body is very susceptible to opportunistic infections and cancers. Without treatment, AIDS will lead to death, usually within around three years. Fortunately, it is rare in the present day for people in the UK with HIV to progress to AIDS thanks to the thorough prevention, testing, monitoring and treatment strategies. (4)

References

1. NHS Choices. HIV and AIDS: Diagnosis [cited 16 Nov. 18] Available at: https://www.nhs.uk/conditions/hiv-and-aids/diagnosis/

2. NAM Aidsmap. Factsheet CD4 cell counts [cited 16 Nov. 18] Available at: https://www.aidsmap.com/

3. British National Formulary (version 2.1.6) [Mobile application software]. Retrieved from: www.bnf.org

4. CDC. What is HIV? [cited 16 Nov. 18] Available at: https://www.cdc.gov/hiv/basics/whatishiv.html

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 28/11/18

The Falsified Medicines Directive (FMD) is to be implemented in all member states of the European Union (including the UK) and the European Free Trade Area on 9th February 2019. This is a response to the growing number of falsified medicines entering the pharmaceutical supply chain, which can have serious consequences for patient health and safety. But how will it work? (1)

What is FMD?

FMD stands for Falsified Medicines Directive, a term used both to describe the process by which pharmacies will identify the medicines they receive from wholesalers as legitimate or falsified, and to refer to the European Directive on Falsified Medicinal Products, the piece of legislation concerning this process. (2)

What are falsified medicines?

Falsified medicines are illegitimate copies of legitimate medicines, from unlicensed manufacturers. Despite tight controls, some find their way into the supply chain, allowing them to reach patients. They have not been produced in the same highly regulated way in which legitimate medicines are produced by licensed pharmaceutical companies, but are often passed off as coming from such companies due to identical or stolen packaging. Falsified medicines can contain too much or too little of the active ingredient(s), no active ingredients at all, different active ingredients to what is stated on the packaging, and potentially harmful, banned or dangerously concentrated excipients (excipients are all ingredients of a medicine other than active ingredients). Clearly, there is a risk posed to patients, with overdose, drug interactions, poisoning or a condition being left untreated all possible outcomes of taking falsified medicines. (1)

How can you tell if you are buying falsified medicines?

Legitimate online pharmacies such as Webmed are approved and accredited by official regulatory bodies including the  MHRA, GPhC and CQC. The independence and unbiased nature of these bodies provide regulation, monitoring and inspection to ensure we and our peers are held to the highest standards.

You can rest assured that when you purchase treatments from Webmed (from erectile dysfunction medication all the way to Hair Loss Treatments) you are purchasing legitimate, official medicines.

How will FMD be implemented in pharmacies?

From 9th February 2019, two new features will be present on all prescription medicines supplied to pharmacies (bar a handful of specialist medications):

• A unique identifier (UI) – a 2D data matrix, or barcode, unique to each pack of medication

• An anti-tampering device (ATD) – an addition to the packaging that will make it evident whether or not it has been tampered with, such as adhesive seals, shrink wrap, or perforated sections of boxes that must be broken to open the pack. (2)

It is expected that electronic patient medication record (PMR) systems in pharmacies will be updated to incorporate a medicines verification feature that can be used to scan the UIs on packs and identify the medicine as genuine or falsified. By law, stock will not need to be verified until it is being prepared for a patient, but optional verification will most likely be performed when stock is received into the pharmacy, allowing suppliers to be alerted as soon as possible when a suspected falsified medicine is found. (2)

The safest way to verify medicines before supply to patients will be using aggregated codes, if PMR systems allow. During the dispensing process, each pack of medicine will be scanned and codes for all packs to be bagged up for the patient will be ‘aggregated’ and printed on a label to attach to the outside of the bag. Then, when the patient comes in to collect the bagged prescription items (or before handover to delivery drivers), the aggregated codes will be scanned and, if verified as legitimate, all packs inside the bag will be decommissioned, meaning that their UI codes become inactive. Since UIs will be unique by name and nature, the same UI showing up on a further pack will be flagged, highlighting the pack as potentially falsified and unsuitable for supply to the patient. Aggregated codes will be preferable to scanning each item individually as it will mean that the bag does not need to be reopened on handing over to the patient or delivery driver, which will uphold patient confidentiality, save time and lower the risk of a dispensing error. (2)

Once packs are decommissioned, they can be recommissioned (the UI reactivated and the pack put back to stock as long as it hasn’t left the pharmacy) within 10 days. This may happen if a patient no longer requires the item(s) or if a pack is decommissioned in error. (2)

Scanning will also flag up any recalled, discontinued or out of date medicines, further minimising the impact of human error on patient safety. It is hoped that eventually it will even be used to ensure the correct medicine has been picked against the prescription! (2)

Will Brexit have an impact on FMD?

Since FMD is part of EU law, there has been confusion over whether FMD in the UK will be continued after the UK leaves the EU on 29th March 2019. The Department of Health and Social Care (DHSC) and the Medicines and Healthcare products Regulatory Agency (MHRA) have assured “high regulatory alignment” with the EU, meaning FMD will be here to stay. It is also believed that the UK will still be considered part of the EU for the purposes of FMD after Brexit, so the process should remain unchanged – this is the best outcome for ease of operation in pharmacies and for patient safety. (2)

References

1. UKFMD Working Group for Community Pharmacy. FMD (1): What is the Falsified Medicines Directive? [cited 31 October 2018].

2. UKFMD Working Group for Community Pharmacy. The way forward for FMD in community pharmacy [cited 31 October 2018]. Available at: https://www.communitypharmacyni.co.uk/wp-content/uploads/2018/02/fmd-cp-working-group-way-forward-paper-jan-18-public-v1-0-final.pdf

Author: Gabby Gallagher MPharm

There are a number of things to consider when deciding on a treatment for erectile dysfunction (ED) - how long will the effect last, how often do I need to take it, how much does it cost? But did you know that tadalafil, once only available as the Cialis brand, is now available to buy online as a generic (unbranded) version?

What is Generic Cialis (Tadalafil)?

Generic forms of any medication are medically identical to the branded originals and are quality controlled to the same standards as the brand name versions; they are just as safe and effective but generally cost much less.

Generic tadalafil contains exactly the same active ingredient as Cialis, but at a fraction of the price. This may be of benefit if you’ve thought about trying Cialis in the past but were put off by the cost. However, cost isn’t the only factor to take into account, and the information below aims to help you decide on the best erectile dysfunction (ED) treatment for you.

Which erectile dysfunction (ED) treatment should I choose: Sildenafil or Tadalafil?

Sildenafil and tadalafil are the two most popular treatments for erectile dysfunction (ED), with sildenafil, brand name Viagra, being the oldest and most well known of the two. But which is better?

Sildenafil is taken an hour before sexual activity, and it will help you get an erection up to at least four hours after taking it, sometimes up to six hours (this doesn’t mean you’ll have an erection that lasts for this length of time - just that you’ll have the potential to have an erection if sexually aroused within the four to six hours after taking). Tadalafil, on the other hand, can be taken 30 minutes before sexual activity and will help you to get an erection up to 36 hours later, so it allows for more sexual spontaneity and has been dubbed “The weekend pill”. Both sildenafil and tadalafil should not be taken more frequently than once a day.

The effect of sildenafil can be impaired if taken with or after food, but tadalafil works just as well taken after a meal as it does on an empty stomach.

Which erectile dysfunction (ED) treatment is best for lactose intolerant people?

If you are lactose intolerant, sildenafil may be the best option as it is available as a lactose free formulation. You can buy the Mylan brand of sildenafil at Webmed, which is lactose free.

Tadalafil can also be taken as a daily dose if you are sexually active at least twice a week. This means you don’t need to worry at all about waiting for the effects to kick in - you’ll be ready for sexual activity at any time.

Other erectile dysfunction (ED) medicines are available besides sildenafil and tadalafil - avanafil, available only as the brand Spedra, is the fastest acting, taking effect in just 15 minutes. Vardenafil, marketed as Levitra, may work more quickly and last slightly longer than sildenafil and tadalafil and may be the most suitable ED medication for people with diabetes.

What’s the best erectile dysfunction (ED) treatment?

Overall, it appears that tadalafil comes out on top when compared with sildenafil, with the notably longer duration of action, slightly faster onset of effectiveness, compatibility with food and the option to take it as a once daily dose. But everyone has different needs, and what works for one person may not work for the next. Hopefully, this information will have helped you to decide on which erectile dysfunction (ED) treatment will be best for you.

To see the full list of erectile disfunction (ED) medication available from Webmed, click here.

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 24/08/18

Viagra Connect is available to buy NOW!

Around 50% of men over the age of 40 suffer some form of erectile dysfunction.

This widespread condition 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. 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 is available to purchase over the counter without a prescription in the UK from the spring of 2018. (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 is 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)

Other options include:-

Viagra is the most well-known treatment for erectile dysfunction, often referred to as “the blue pill”.
The active ingredient in Viagra is sildenafil which dilates the blood vessels leading to the penis to enable a firm, long lasting erection when a man is sexually aroused or stimulated.

Viagra and Sildenafil both contain exactly the same active ingredient. They are both equally effective, but sildenafil is much cheaper.

Tadalafil, the generic form of Cialis, became available in November 2017 when the patent expired and has become very popular.

Tadalafil on demand is known as “the weekend pill” as, due to it's 36 hour duration of action, it can be taken on a Friday night and still be active on Sunday morning.

There is also a low dose tadalafil option taken on a daily basis, called Tadalafil daily, so you don’t have to plan ahead and can be ready for action “anytime, anyplace, anywhere”.

Worried about buying fake medicines online?  Then read our blog on what to look for to prove that it is a fully approved and Regulated pharmacy only supplying genuine UK sourced medication.

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

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 09/07/18

Affecting 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)

You can also test for genital herpes with our 7-in-1 test kit which tests for the 7 most common STI's.

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

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 06/04/18

Infertility 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)

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.

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

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

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 19/02/18