Posts tagged Sexual Health

One 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/
5. NHS Choices. Balanitis [cited 7 February 2018]. Available at: https://www.nhs.uk/conditions/balanitis/

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 09/02/18

HIV (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)

Respect yourself and those around you - know your status

Follow these quick easy links to select your products:

HIV lab and home home-self test kits

Pre PrEP treatment test kit

PrEP Annual Test kit

Thinking of taking PrEP - read our informative blog to explain what you need to know.

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

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 11/01/18

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 11/01/18

Cialis has become popular as an erectile dysfunction (ED) prescription medication as it is effective for 36 hours. All other medications, Viagra, Sildenafil, Levitra and Spedra are active for 4-6 hours.

Cialis is the brand name for the medication created by Eli Lilly in 2003. The active ingredient in Cialis is Tadalafil and the composition couldn’t be recreated, by law, until Eli Lilly’s production patent ended on 14th November 2017. Now it can be produced and distributed by other drug manufacturers, in the generic form of 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.

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”.

Cialis (tadalafil) has been licensed in the UK for over a decade. It was the third erectile dysfunction (ED) prescription medication of its type to receive a UK license, after Viagra and Levitra.  Its prolonged duration of action and the option to take a low dose daily tablet have led to Cialis(tadalafil) becoming increasingly popular and being more widely prescribed.

How does tadalafil work?

Erections are primarily achieved through blood flow.Tadalafil works by helping to relax the blood vessels in your penis and the erectile tissue itself, allowing blood to flow into your penis when you get sexually excited. It does not have an effect on your sexual desire but can greatly improve your erection when you become sexually aroused.

Is tadalafil more effective than sildenafil (generic Viagra)?

Both medications have a high success rate, helping the majority of men to regain control over their erection and have an improved sex life. Clinical trials have indicated that both are equally effective.

Does tadalafil have fewer side effects than sildenafil?

As both drugs work in the same way, they share many of the same side effects. These include facial flushing, headaches and indigestion.  However, sildenafil has an effect on your vision that doesn’t seem to affect users of tadalafil to the same extent, as it may produce a green-blue visual tinge.  Headaches also occur more commonly with sildenafil but may last longer with tadalafil.  Any side-effects experienced may last longer with tadalafil.

Is tadalafil a safe medication?

Generally, tadalafil is a safe drug but is not recommended to be taken if you have certain conditions or are taking specific medications that might interact with tadalafil. This is the same for all other phosphodiesterase type 5 inhibitors like Spedra, Viagra, Cialis, Levitra and sildenafil.

Sildenafil and tadalafil should not be taken by men who take medicines or recreational drugs containing nitrates.

Nitrates interact very adversely with all phosphodiesterase type 5 inhibitors like Spedra, Viagra, Cialis, Levitra and sildenafil. They can cause a FATAL lowering of blood pressure and should NEVER be used together.

Nitrates include medications like GTN spray, isosorbide mononitrate, nitrate patches, gel or ointment and nicorandil. These are usually prescribed for heart conditions. If you take nitrates you should consult your GP for other options for your ED. Also, the recreational drugs called "poppers" should be avoided.

Tadalafil should not be taken by men who are on medicines called alpha blockers which are sometimes used to treat prostate problems or high blood pressure. Men who take alpha blockers can use Viagra, sildenafil, Levitra or Spedra but must allow at least a six hour gap between taking the alpha blocker and the ED medication.

There is a full list of the contra-indications and interactions on the website and on the medical questionnaire that is sent to our doctor for approval.

Can I drink alcohol with tadalafil?

Having just one or two drinks is unlikely to affect tadalafil (or any other similar ED medication) or cause any health risks. However, if you drink excessively while taking tadalafil you may experience some adverse effects and not achieve as firm an erection.

The main problem you may experience by drinking too much alcohol while you take tadalafil is orthostatic hypotension. This can cause a headache, dizziness, and fainting, which can lead to you injuring yourself. Hypotension may also make your heart beat at a faster rate which can lead to severe heart problems.

This effect can occur because tadalafil and alcohol both act as vasodilators. Vasodilators are substances that lower your blood pressure by relaxing the walls of your blood vessels, which allow the blood vessels to open wider.

Orthostatic hypotension can be even more likely with tadalafil than with the other erectile dysfunction drugs as it stays in your system longer than the other ED drugs.

Does tadalafil have any advantages over other ED medications of a similar type?

The main differences between tadalafil and other ED medications of a similar type is three-fold.

1) Tadalafil’s long duration of action - 36 hours. Where other Ed products only last for 4 to 6 hours.

2)  Low dose tadalafil can be taken on a daily basis, called Tadalafil Daily, so that you don’t have to plan ahead and can be ready for any sexual activity at any time.

3) It's not affected by food.

Conclusion

Tadalafil is unique in that it can either be taken when required or on a daily basis so that no planning ahead is needed and enables spontaneity. It’s also not affected by food and since it’s now off patent it can be bought at a much lower price than Cialis.

Due to all of these advantages, tadalafil will probably knock sildenafil off the number one spot as the drug of choice for men with erectile dysfunction.

Medically reviewed by: Superintendent Pharmacist Margaret Hudson BSc(Hons)MRPharmS 19/12/17

The urinary tract is composed of the urethra, bladder, ureters and kidneys. The blood is filtered through the kidneys to remove waste products and excess water, forming urine. This then travels along the ureters to the bladder, where it is stored until the person passes the urine out of their body via the urethra.

Urinary tract infections (UTIs) can occur in any of these four areas. Depending on the location, the infection may be labelled as urethritis (urethra), cystitis (bladder), ureteritis (one or both ureters) or a kidney infection. (1)

Classic symptoms include a frequent, urgent need to pass urine (often in small amounts), a stinging or burning pain when passing urine, and lower abdominal pain. However, the urine may also contain blood and may have an unpleasant smell and/or a cloudy appearance. The person affected may feel generally unwell, and elderly sufferers sometimes even experience confusion. (1)

What causes UTIs?

The most common cause of a UTI is when faecal bacteria such as E. coli from the back passage get into the urethra. This happens more frequently in women than men, because there is a shorter distance between the openings of the urethra and back passage. Furthermore, the urethra itself is shorter in women, meaning the bacteria don’t have as far to travel to reach the bladder and higher portions of the urinary tract, leading to infection. (1) The urinary tract is usually a sterile (bacteria free) environment, so it can be quickly overwhelmed by invasive bacteria which have no competition for space and nutrition.

Other causes include conditions in which block part of the urinary tract, such as kidney stones; an enlarged prostate in men, which can make complete emptying of the bladder hard; a poorly functioning immune system, which increases a person’s susceptibility to bacterial infections; using a catheter; and pregnancy. (1)

How are UTIs treated?

For women, sodium or potassium citrate sachets are available that can be used at the first sign of a UTI. They help to reduce the acidity of the urine, therefore easing symptoms while the body fights the infection. One sachet is dissolved in a glass of water and taken three times a day for two days. If the symptoms persist or recur after this course, a GP appointment must be made as antibiotics may be needed to clear up the infection.

Men, pregnant women and children must be booked in to visit their GP upon the development of any UTI symptoms. Anyone with lower back or side pain, a raised temperature, chills, nausea, vomiting or diarrhoea related to a UTI should make an emergency appointment with their GP, as the infection may have spread up the urinary tract to the kidneys, which will need urgent treatment. (1)

Trimethoprim is the antibiotic of first choice for simple UTIs affecting the urethra and/or bladder. Nitrofurantoin, cephalosporins or norfloxacin can be used as an alternative if the former is unsuitable, or the higher portions of the urinary tract are affected. Courses of antibiotics must always be completed, even if symptoms have ceased, otherwise the infection may not be fully treated and may recur.

Paracetamol may also be taken for pain relief. (1)

Can UTIs be prevented?

There is no failsafe way to prevent UTIs, but there are steps that can be taken to make developing a UTI less likely. Always wipe from the front to the back after using the toilet, to prevent transfer of faecal bacteria to the urinary tract. Wear loose fitting, breathable underwear and try to use fragrance free body washes and soaps in the intimate area. Drink plenty of water, try not to hold in urine for too long and be sure to completely empty the bladder when you go to the toilet. Also, pass urine as soon as possible after sex to flush out any bacteria that have entered the urethra. (1)

If, despite following these steps, you still suffer with recurrent UTIs, your doctor may prescribe low dose antibiotics to help keep them at bay, or refer you to a specialist for further investigation.

National Health Service. Urinary tract infections (UTIs) [cited 24 September 2017]. Available from: https://www.nhs.uk/conditions/urinary-tract-infections-utis/

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 26/09/17

What is PrEP?

PrEP (Pre- exposure prophylaxis) can be taken by people who are negative for HIV before sex to prevent them from contracting HIV (Human Immunodeficiency Virus). (1)

The results of clinical trials have been very successful, reporting that PrEP significantly lowers the risk of becoming HIV positive. (2)(3)

The medication used for PrEP is a tablet called Truvada which contains tenofovir and emtricitabine. These are drugs commonly used to treat HIV in the UK.

PrEP has been shown to be highly effective at preventing HIV as long as it’s taken as directed but it is important to note that it will not protect you from other STIs (sexually transmitted infections) and so it’s still vital to practise safe sex by using a condom. It is also important to go for regular STI screening every three months so you can get tested and treated if necessary.

Before PrEP

It is essential to have an HIV test before you start taking PrEP as it can only be used if you are HIV negative. If you take PrEP without being tested and find out later that you are HIV positive then you could develop resistance to the drugs that you will need for successful treatment.

You should also be tested for the Hepatitis B virus before you start PrEP, as although you can still take the medication, its use needs to be monitored more carefully and medical advice is needed, particularly if you decide to stop taking it at any point.

It is also important to check your kidney function both before starting the medication and every 3 months thereafter. Initially to assess your kidney function, a blood test is used to measure the level of creatinine in the blood as this is an indicator of how well your kidneys are working. If the kidneys become impaired for any reason, the creatinine level in the blood rises due to poor clearance of creatinine by the kidneys. Doctors routinely use creatinine levels to check kidney function and this is one of the most accurate ways of monitoring them.

During PrEP

Whilst taking PrEP, you should have a HIV test and a urine protein dipstick test every 3-4 months to reaffirm that you are still HIV negative and to ensure that the PrEP medication is not having an adverse effect on your kidney function. The urine test is an alternate way to measuring kidney function that is not as specific as the creatinine blood test needed before starting the medication, however it is a reliable and simple way to quickly determine if there are signs of kidney injury. 

If the dipstick test detects any protein in your urine then it’s a sign that your kidneys might be affected by taking PrEP and you should make an appointment with your GP or other healthcare provider or attend a local sexual health clinic. They will perform further tests that are able to determine the exact cause of the result and can inform you as to whether the medication is still safe to take. You can buy a urine protein dipstick test kit at your local pharmacy.

Also, every 12 months you should repeat the HIV test along with the creatinine blood test for accurate kidney function levels to ensure that there has been no change since commencing the medication.

Therefore, before taking PrEP, you should be tested for HIV and Hepatitis B (HBV) and have your kidney function checked.

Click for: PrEP pre treatment test kit

While taking PrEP, you should have a HIV test and a urine protein dipstick test every 3-4 months.

Click for: HIV lab or home self-check test kit

Every 12 months, a HIV test and a kidney function check should be carried out again to ensure that there has been no change since commencing the medication.

Click for: PrEP Annual test kit 

Since these health checks are of such importance both before taking PrEP and while you are taking it, we at WebMed Pharmacy have introduced the following three tests;

Medically reviewed by: Super intendent pharmacist Margaret Hudson BSc(Hons)MRPharmS

1) PrEP pre-treatment test kit :- tests for HIV, Hepatitis B (HBV) and measures your baseline kidney function.

2) HIV test kit :- to be used every 3-4 months. 

3) Annual PrEP test kit :- this will check that you are still negative for HIV and measures your level of kidney function.

References;
(1) Terrence Higgins Trust. PrEP (Pre-exposure Prophylaxis) Terrence Higgins Trust [Internet]. Tht.org.uk. 2017 [cited 23 April 2017].
Available from: http://www.tht.org.uk/sexual-health/About-HIV/Pre-exposure-Prophylaxis

(2) Aids Map. PROUD PrEP study results published [Internet]. Aidsmap.com. 2017 [cited 23 April 2017].
 Available from: http://www.aidsmap.com/PROUD-PrEP-study-results-published/page/2998033/

(3)  BASHH. Updated BHIVA-BASHH Position Statement on PrEP in the UK [Internet]. 2017 [cited 23 April 2017]. Available from: https://www.bashh.org/documents/PreP_BHIVA_BASHH_Update_14June15_for%20consultation.pdf

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 23/04/17

Erectile dysfunction, or impotence as it’s sometimes called, is a very common condition that distresses men of all ages. It’s the inability to achieve or maintain an erection that is sufficient for satisfactory sexual activity.

Listen to our Superintendent Pharmacist, Margaret Hudson, discuss ED in a recent radio interview

In the UK erectile dysfunction, or ED, is thought to affect more than 50% of men over 40 years of age.¹

Most men are unaware that ED could be a symptom of a more serious underlying medical condition, and so if you suffer from ED you should get a health check from your GP. The most common of these conditions are high blood pressure, high cholesterol and diabetes.

ED can have a range of causes but the main culprits are physical problems, psychological factors and the side-effects of certain medications.

Physical problems include narrowing of the blood vessels going to the penis; commonly associated with high blood pressure (hypertension), high cholesterol or diabetes. Hormonal problems such as an over or under active thyroid gland and surgery or injury to the penis, pelvis or surrounding area can also cause it.

Some examples of causative neurological conditions are Parkinson’s disease and multiple sclerosis while the psychological causes of ED include stress, anxiety, depression and relationship problems.

Lifestyle can also cause ED and so if you’re overweight, smoke, drink excessively or take recreational drugs, you are more likely to suffer from these symptoms.

In younger men, it may be caused by anxiety, nervousness about having sex, inexperience in using a condom or even fear of causing an unwanted pregnancy.

The most common health conditions causing ED are cardiovascular disease and diabetes but the medications for high blood pressure, prostate problems, high cholesterol, depression and anxiety can also cause ED and therefore compound the situation. For example, you might have high blood pressure which causes ED, then you take a medication for your blood pressure which also causes ED making your symptoms even worse! ²

In fact, there is a long list of medications that may cause ED, including:

• Diuretics - “Water tablets”
• Beta-blockers - used to treat high blood pressure
• H2-antagonists - used to treat stomach ulcers
• Antihistamines - used to treat allergic health conditions, such as hay fever
• Antipsychotics - used to treat some mental health conditions, such as schizophrenia
• Anticonvulsants - used to treat epilepsy
• Corticosteroids - medication that contains steroids, which are a type of hormone

Speak to your GP if you are concerned that a prescribed medicine is causing erectile dysfunction as alternative medication may be available. However, it is important never to stop taking a prescribed medicine unless you are advised to do so by a qualified healthcare professional who is responsible for your care.

Most men blame themselves for having ED as they think it’s a reflection of their masculinity and don’t realise that it’s caused by a health problem that they may or may not be aware of.

It is believed that if more men were aware of this fact then they would be much more willing to go to their GP for a health check. Not only would the individual find out if they have an important health condition but they would also be more confident about seeking a solution to their ED.

Most men don’t talk about ED when they meet up with their friends for a drink or for any other social activity. It’s a topic that they would rather avoid at all costs!

In fact, most men even find it difficult to speak to their partner about it and it’s thought that ED causes the breakdown of about 20% of all relationships. ³ It seriously impacts on all aspects of a man’s quality of life and his self esteem. It can also affect how a man interacts with his friends and co-workers as it may cause him to lose confidence, reduce his morale and enjoyment of life generally. Furthermore, since ED is not openly discussed, a man may feel isolated and alone as he struggles with these symptoms.

Some men find counselling helpful as a means of exploring psychological causes for ED. Some sexual health clinics (also known as GUM clinics) offer this service or your GP may be able to direct you to someone who can help. ⁴

If someone was too embarrassed to go to their GP about ED, there are other options. The first line treatment for ED is a group of drugs called phosphodiesterase -5 inhibitors (PDE-5 inhibitors) that dilate the blood vessels leading to the penis and, with sexual stimulation, give a much firmer and longer lasting erection.

In the UK there are four PDE-5 inhibitors available for treating erectile dysfunction.

They are:

• Sildenafil – sold under the brand name Viagra or generic name sildenafil
• Tadalafil – sold under the brand name Cialis
• Vardenafil – sold under the brand name Levitra
• Avanafil – sold under the brand name Spedra

There are differences between the various products available. They differ in the time it takes for them to act and how long they act for. This is due to the different pharmacokinetics* of the active ingredient. The pharmacokinetics, which include the half-life** of a medication, dictates how long it stays in the blood.

* Pharmacokinetics – How the drug moves through the body

**Half-life – The time taken for the levels of medicine in your blood to fall by half. This directly relates to how long the medicine acts for.

Sildenafil (Viagra) has a half-life of 4 hours and vardenafil (Levitra) has a half-life of 4-6 hours while tadalafil (Cialis) has a half-life of 17.5 hours and is active for up to 36 hours.

This means that vardenafil (Levitra) should act longer than sildenafil (Viagra) but the clinical significance is not known although some studies have shown that vardenafil (Levitra) is more suitable for diabetics. Tadalafil (Cialis) has the longest half-life and duration of action and so allows you to take the medication and not relate the sexual activity to its immediate use. It’s been called the “week-end pill” because of its long duration of action and in lower doses can be taken continuously each day, for those who are more sexually active and struggle to plan ahead.

The most recently introduced Avanafil (Spedra) has the quickest onset of action and only takes about 15 minutes but its effects last about the same time as vardenafil and sildenafil.  

ED drugs: How soon they start working and how long they last

It’s very important that men realise that they don’t have to suffer in silence as ED is a very common condition that’s easily treated, in most cases, with oral medication that can dramatically improve their performance and general well-being. 

References

1 NHS. Choices. Department of Health. Erectile dysfunction (impotence); 2016 Jun 21 [cited 2016 Sep 21]. Available from: http://www.nhs.uk/Conditions/Erectile-dysfunction/Pages/Introduction.aspx

2 Miller S. Medline Plus. Drugs that may cause impotence: MedlinePlus medical encyclopedia; 2015 Jan 21 [cited 2016 Sep 21].
Available from: https://medlineplus.gov/ency/article/004024.htm

3 Health Centre. Access to health & medical information on Internet; 2016 [cited 2016 Sep 21]. Available from: http://www.healthcentre.org.uk

4 Charitable Company. Sexual Advice Association. Sexual Advice Association. Factsheets [cited 2016 Sep 21].
Available from: http://sexualadviceassociation.co.uk/factsheets/

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 23/09/16

Gonorrhoea is the second-most common bacterial Sexually Transmitted Infection, STI, in the UK after chlamydia - and overall, there were almost 35,000 cases of gonorrhoea reported in England alone last year.[1]

In 2011 the British Association for Sexual Health and HIV, BASHH, gonorrhoea treatment guidelines were changed to an intra-muscular injection of 500mg of ceftriaxone in combination with a 1g oral dose of azithromycin as first-line therapy.[2] For those who find it difficult to access a sexual health clinic, choose not to visit their GP or do not want an injection we supply the alternative dual treatment of an oral dose of 400g cefixime and 1g of azithromycin taken together as a single dose. We also supply a free test of cure to make sure that the treatment has been effective.

An outbreak of a resistant strain of gonorrhoea began in Leeds six months ago and then spread to Scunthorpe, Macclesfield and Oldham and has now more recently been found in the West Midlands and the South-East of England.

Public Health England, PHE, said on Sunday there had been 34 confirmed cases since November 2014.[3] Since September 2015, 11 cases have been confirmed in the West Midlands and in the South East of England, five of which were in London.

This particular strain of gonorrhoea, known as HO41, is highly resistant to azithromycin, the drug most commonly used in dual therapy to treat the infection.[4] HO41 has so far proved resistant to current antibiotic treatment and so it has been placed in the superbug category. Instances of this particular strain were previously rare, according to the BASHH guidelines and they added: "PHE is concerned that the effectiveness of current frontline dual therapy for gonorrhoea will be threatened if this resistant strain continues to spread unchecked."

There are no other effective drugs to tackle the resistant strain, raising the prospect of it becoming untreatable if it builds further resistance.

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.

PHE have urged people to use condoms with new or casual partners to cut the risk of catching the disease and anyone beginning a new relationship should get tested along with their partner.

There is more information on our website about the symptoms in both men and women and on testing and treatment.

Medically reviewed by: Super intendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 18/04/16

References

[1] Public Health England. Sexual and Reproductive Health Profiles [cited 2016 Apr 17]. Available from: http://fingertips.phe.org.uk/profile/sexualhealth/data#page/0

[2] BASHH. UK national guideline for the management of gonorrhoea in adults [cited 2016 Apr 17]. Available from: http://www.bashh.org/documents/3920.pdf

[3] Public Health England. GOV.UK. Safe sex reminder as antibiotic resistant gonorrhoea investigations continue; 2016 Apr 17 [cited 2016 Apr 17]. Available from: https://www.gov.uk/government/news/safe-sex-reminder-as-antibiotic-resistant-gonorrhoea-investigations-continue

[4] Science World Report. Science World Report. Gonorrhea HO41 Superbug may be ‘worse than AIDS’; 2013 May 6 [cited 2016 Apr 17]. Available from: http://www.scienceworldreport.com/articles/6672/20130506/gonorrhea-ho41-superbug-worse-aids.htm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 18/04/16

"Sexpression:UK is a network of student-led projects at over thirty universities across the UK. They deliver fun, informal workshops on sex and relationships to schools, youth clubs and sports clubs in their local areas.

They believe in empowering young people to make their own informed decisions about their sexual health and relationships. Sexpression:UK, their branches, and their volunteers, have won, and been shortlisted for, several awards for their outstanding commitment to volunteering and promoting sexual health."They are an entirely volunteer run and led organisation where schools and clubs are not charged any fee for their services.

Sexpression:UK  is involved in educating young people about Sexually Transmitted Infections, STIs, and safer sex.

It’s advisable that sexually active, under 25 year olds should be screened every year and on change of sexual partner.

Chlamydia is the most common STI in the UK and easily transferred during sex. There were approximately 440,000 STI diagnoses made in England alone in 2014. Genital chlamydial infection was the most common, accounting for 47% of diagnoses resulting in 206,774 cases. There were 138,000 chlamydia diagnoses among young people aged between 15 and 24 years old.

However, the actual number of infections is likely to be far higher as STIs, because they are symptomless in many cases, are often passed on unknowingly before someone realises they are infected. Also, younger adults are at greater risk as they are more likely to have unsafe sex with multiple sexual partners.

WebMed pharmacy can supply STI kits for both males and females, at a competitive price, to check if you are clear of the 7 most common STIs.

If treatment is required for either chlamydia or gonorrhea then WebMed pharmacy can deliver it, after a short medical questionnaire is completed and approved by our online doctor. There is a charge for this service. If ordered by 4p.m. it will be discreetly delivered the next day in a very convenient one hour time slot. This service is provided to all mainland UK except the Scottish Highlands where we use Royal Mail Special Delivery.

We use dpd as our preferred carrier with their industry-leading predict and follow my parcel service. You will receive a one hour delivery window via your chosen method, SMS or email from webmed-supplies.co.uk. This allows you to track the progress of your treatment on a map, counting down to a 15 minute window.

If for any reason this is not convenient, you will be offered other options; to leave with a neighbour, change the day or to be delivered to the nearest dpd pickup point.

STIs can be prevented through sexual health promotion and education and encouraging safer sexual behaviour. WebMed pharmacy simply provides you with more choice in accessing sexual health services.  

Our service is fast, discreet and confidential where you can be tested and receive treatment in the comfort of your own home.

https://webmedpharmacy.co.uk/gonorrhoea-symptoms-and-treatment