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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

Parkinson’s disease affects one in every 500 people, with symptoms beginning to show over the age of 50 in most cases, but for 5% of people with the condition, symptoms will first appear before the age of 40. It can have a devastating impact on a person’s quality of life, with movement, balance, memory, mental health and sleep all having the potential to be affected. Current treatment aims solely to ease symptoms and does not cure the condition. But a recent trial of an innovative therapy has hinted at new hope for those with Parkinson’s disease. (1, 2)

What is Parkinson’s disease?

Parkinson’s disease is a neurodegenerative disease involving damage and death of dopamine-releasing nerve cells in a region of the brain known as the substantia nigra, which regulates body movements. Dopamine is a neurotransmitter, which is a chemical which acts as a communicator between nerve cells. Therefore, the diminution in dopamine levels in the brain caused by the death of these cells reduces intercellular communication relating to movement and leads to tremor, sluggishness and stiffness. Symptoms do not usually show until only around a fifth of these nerve cells remain. (2, 3)

In addition to the primary movement symptoms, people with Parkinson’s disease can also experience a deterioration in mental health, difficulty keeping balance (and therefore greater risk of falling), insomnia, reduced sense of smell and poor memory. (2)

What is the outcome of the recent trial?

The results of a recent trial of a radical treatment for Parkinson’s disease have been released. The treatment, known as glial cell line-derived neurotrophic factor (GDNF), is an entirely new approach, administered via a ‘port’ that is embedded in the side of the patient’s head. This allows the drug to be delivered directly into the brain, where it then acts on dopamine nerve endings. (1)

Before the trial, the 35 participants had surgery which involved embedding four tubes into their brains. These tubes would be the route of administration of the drug into the brain, with the outer end being attached to the port where the drug would enter the tube. (1)

The trial lasted nine months, during which half of the participants were administered with a dose of GDNF every month, with the other half being administered a placebo infusion (containing no drug). For those given the drug, brain scans after the trial suggested that the progression of the disease had been significantly reversed. The average length of time since diagnosis for the trial’s participants was eight years, but the post-trial scans appeared to show features typical of brains just two years after diagnosis. This implies that GDNF can revitalise dying nerve cells and restore their function. (1)

However, it is too early to know whether GDNF will become a routine treatment at this stage – more trials involving larger numbers of participants, longer treatment courses and different doses will need to be performed before its licensing is considered. The placebo effect will need to be ruled out (this is when a participant being given a placebo experiences an improvement in their condition or symptoms). (1)

Regardless, it is very exciting that new modes of drug delivery such as this are being developed and tested. If successful, the approach may even be used to develop treatments for other conditions affecting the brain, including Alzheimer’s disease and brain tumours. (1)

References

1. Therrien A (2019). ‘Radical Parkinson’s treatment tested in patients’, BBC News. Available at: https://www.bbc.co.uk/news/health-47370498

2. NHS. Parkinson’s disease – Overview [cited 1 March 2019]. Available at: https://www.nhs.uk/conditions/parkinsons-disease/

3. NHS. Parkinson’s disease – Causes [cited 1 March 2019]. Available at: https://www.nhs.uk/conditions/parkinsons-disease/causes/

   Author
   Gabby Gallagher MPharm

   Medically reviewed by
   Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 
   14/03/19

At this time of year, sore throats are just one of many ailments that become rife in the community. Most are caused by simple viral infections and will resolve on their own within a week or two. But it’s also useful to know in which instances you’d need to seek medical advice or treatment.

What can I do to help ease a sore throat?

When you first develop a sore throat, there are several self-care approaches that you can take to ease the symptoms while your body fights off the infection:

• gargling with warm salt water (not recommended for young children due to the risk of swallowing)

• resting (including resting your voice!)

• getting plenty of fluids, but steering clear of hot drinks

• avoiding rough, sharp, hot or acidic foods

• sucking ice cubes, sweets or lollies (ice cubes and boiled sweets not recommended for young children as they pose a choking hazard)

• avoiding smoking, including second-hand smoke (1)

What medication is available to buy to help a sore throat?

There are a number of medicines available on the shop floor and over the counter in pharmacies to help ease a sore throat, including:

• ibuprofen (which is also an anti-inflammatory)

• paracetamol (which can also help with any associated fever)

• medicated or anaesthetic lozenges and anaesthetic sprays and mouthwashes, containing active ingredients such as flurbiprofen and benzydamine (anti-inflammatories), benzocaine (an anaesthetic), and amylmetacresol (a mild antiseptic) (1)

When should I see the GP for a sore throat?

Most sore throats will get better by themselves after a few days. However, if you find you experience any of the following, you’ll need to see your GP:

• your throat is just as painful after a week of symptoms developing

• recurrent sore throats

• fever (feeling hot and shivery with a raised temperature)

• you have a condition that weakens your immune system, such as diabetes

• you are receiving treatment that weakens your immune system, such as chemotherapy (1)

A long-lasting and very painful sore throat can be a sign of infection with a type of bacteria called Group A Streptococcus (this condition is commonly known as strep throat). This will need treatment with a course of antibiotics. (1)

A recurrent or long-lasting sore throat can signify other underlying health issues, such as deficiencies and low levels of certain types of blood cells. Your GP can investigate this and ensure you get the appropriate treatment.

A long-lasting sore throat accompanied by hoarseness and coughing with no other symptoms can be indicative of throat cancer. That’s why it’s so important to see your GP if you experience this with no signs of improvement.

In the news: new pharmacy-based sore throat scheme

Over 30 pharmacies in North Wales are offering a new scheme involving the use of a questionnaire and potentially a swab test to determine whether a patient’s sore throat is bacterial or viral in origin. If a bacterial infection is present, then pharmacists who provide the Common Ailments Scheme (which encourages patients to visit a pharmacy before seeing their GP) will be authorised to supply the relevant antibiotics to treat the infection. If this is a successful service, it may eventually be rolled out across the country, giving the public greater and faster access to the sore throat treatment they need. (2)

References

1. NHS. Sore throat [cited 28 January 2019]. Available at: https://www.nhs.uk/conditions/sore-throat/

2. North Wales Pioneer. New sore throat test and treat service to be piloted in pharmacies across North Wales [cited 28 January 2019]. Available at: https://www.northwalespioneer.co.uk/news/17386085.new-sore-throat-test-and-treat-service-to-be-piloted-in-pharmacies-across-north-wales/

Author
Gabby Gallagher MPharm

Medically reviewed by
Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 
05/01/19

The festive season is well underway, but it can often be overlooked that the financial, social and emotional pressures associated with this time of year can be a major source of stress. So now is the perfect time to consider the ways in which we can aim to reduce the impact of stress on our day to day lives.

What is stress? 

Stress is a physical response to a challenging or threatening situation, initiated by an increase in ‘fight or flight’ hormone adrenaline. It is characterised by an increase in heart rate and breathing rate, sweating and tensing of the muscles. Once the situation is overcome, the body can quickly return to the usual relaxed state. However, if the difficult situation is long-term, such as financial worries, workplace pressures, family or relationship problems, illness, or bereavement, it can cause chronic stress, which can lead to the development of stress-related symptoms. (1)

What are stress-related symptoms?

Chronic stress can manifest itself in various forms. Emotionally, it can make you feel overwhelmed and helpless. You may find you have a short fuse and snap at people easily. Your confidence in yourself and your abilities may drop, and you may feel anxious and uncertain about the future. (1)

Stress can make it difficult to concentrate on tasks, with fleeting thoughts constantly popping up in your mind. You may worry excessively, and sometimes irrationally. Decision making can become very daunting as you over-analyse each option and its outcome. (1)

Physically, you may experience frequent headaches, feel tired and/or dizzy, have trouble sleeping and develop muscle pain as a result of constant tensing. Stress can also affect our diet – some people find they feel less hungry or forget to eat, meaning they don’t eat enough; others find they turn to food for comfort and eat too much. Other unhealthy behaviours that may be adopted during times of stress include heavy drinking, smoking and recreational drug use. (1)

How can I beat stress?

It’s often not possible to completely remove the factor that is causing stress from your life – at least not immediately. Therefore it’s important to try to find coping mechanisms to reduce the impact stress has on your health and wellbeing. If chronic stress is not tackled, it could lead to mental illnesses including anxiety and depression, and changes in diet could lead to poor physical health – undereating potentially leading to being underweight, deficiencies and muscle wastage, and overeating to being overweight or obese, with associated problems such as raised blood pressure and cholesterol and increased risk of diabetes. (1, 2)

Talk to someone about your stress

Talking to people close to you about the causes of your stress can not only help you to feel less alone in your struggles, but to gain a different insight and receive advice which could help to solve problem(s). Spending quality time with friends and family can help you to wind down and focus on enjoying the moment. (1, 2)

Alternatively, you can speak to your GP, or there are a number of organisations which have helplines available to offer advice and support, often 24 hours a day, including SupportLine and AnxietyUK. (1, 2)

Look after number one

Many people find work begins to become the centre of their life, or they strive to look after others whilst neglecting their own needs. Try not to let this happen - make sure you take time to do the things you enjoy. Whether it’s something as simple as setting an hour aside in the evening to do some reading, to going for a family meal, to booking a short break to escape from the stresses of day to day life for a few days. Finding a new hobby can help to refocus your thoughts and renew your sense of purpose. (2)

Get moving

Physical exercise can also help to clear your mind and boost levels of mood-enhancing chemicals (called endorphins) in the brain. Not to mention the clear benefits to your physical health! Find a form of exercise that works for you – whether it be going to the gym, a walk or run, swimming, cycling, attending a dance class, or even gardening! (2)

Offer a helping hand

Doing your good deed for the day can be surprisingly uplifting and increase your resilience. It can be something as small as pointing someone who’s lost in the right direction to donating to a charity of your choice or volunteering for a good cause. (2)

Count your blessings

Remember the positives in your life. It’s easy to take them for granted when something else is really getting you down. At the end of each day, try writing down three things that you enjoyed or that you’re grateful for. This should help you to put things into perspective and think more rationally. (2)

There is a new article on Stress Relief by Katie Holmes, where she has compiled some fantastic comments from 34 different therapists, psychologists, social workers and others on how to overcome stress. (3) With suggestions including:

• Practice deep breathing exercises
• Develop strong relationships and let yourself be surrounded by your loved ones
• Practice mindfulness
• Take a trip in your mind with guided imagery
• Disconnect from technology

And much more.

References

1. NHS Moodzone. How to deal with stress [cited 10 December 2018]. Available at: https://www.nhs.uk/conditions/stress-anxiety-depression/understanding-stress/
2. NHS Moodzone. 10 stress busters [cited 10 December 2018]. Available at: https://www.nhs.uk/conditions/stress-anxiety-depression/reduce-stress/




3.  How To Relieve Stress: 34 Comments From Therapists, Psychologists and people Who’ve Overcome Stress at: https://outwittrade.com/how-to-relieve-stress




Author
Gabby Gallagher MPharm 

Medically reviewed  and updated by
Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 
17/12/18, updated 24/09/20

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

Male pattern baldness, sometimes called genetic hair loss or alopecia and rogenetica, affects or will affect as many as two thirds of all men at some point in their lifetime. For many, it is a source of embarrassment and upset and may even contribute to depression in some cases, as hair is often considered to be an important part of our identity, one of many ways in which we can express ourselves. (1)

What is male pattern baldness?

Explore Hair Loss treatments available from Webmed FInd out more Male pattern baldness is the most commonly occurring type of hair loss in men. The first sign is often a bald spot forming on top of the scalp, with thinning of the hair at the temples (sides of the head). Usually a receding hairline will develop. It can sometimes result in complete baldness of the scalp, though this happens rarely, and if it does happen, it’s very gradually. The condition may occur in men of any age, but symptoms most commonly begin to appear in men in their thirties. (1)

Why does male pattern baldness happen?

Male pattern baldness is a genetic condition, meaning it runs in families. It’s commonly believed that the gene responsible is passed from mother to son, but it has been found that genes from either or both parents can contribute to male pattern baldness. (2)

It is believed that the genes involved code for hair follicles (the ‘roots’ from which individual hairs grow on the scalp) that are more sensitive to a hormone called dihydrotestosterone, which causes follicles to shrink and eventually stop working altogether. This translates to hairs becoming thinner and shorter until they are no longer produced. (2)

Can male pattern baldness be cured?

Unfortunately, there’s no cure for male pattern baldness. Thankfully, the progression of the condition can be slowed or stopped with the right treatment. A surgery known as a hair transplant can also be performed for more instant results, but this will still need aftercare with the right treatment. (1)

What treatment is available from Webmed Pharmacy for male pattern baldness?

Buy Finasteride from Webmed from only £20 FInd out more Finasteride is an oral drug used to treat male pattern baldness. It works by lowering dihydrotestosterone levels, helping to slow the shrinkage of hair follicles, therefore promoting hair growth. It may take as long as six months for effects to show. If used after a hair transplant, it can help to maintain the hair. Finasteride needs to be taken daily long-term, otherwise the effects will be lost. It is available to purchase from Webmed Pharmacy as the branded product, Propecia, or the generic, Finasteride. Both the branded and generic products work in exactly the same way as they both have finasteride as the active ingredient at the same strength. The only difference is that the generic is considerably cheaper.

There is now a range of topical products available to purchase from Webmed Pharmacy which can be used alongside finasteride to optimise the effects. These products are recommended by Dr Mabroor Bhatty, one of the top surgeons in the field of hair transplant and cosmetics in the UK.

Visit our Hair Loss Clinic For Total Scalp Care The first of these products is Tony Maleedy Juniper Scalp Therapy Shampoo. Composed of essential oils and moisture-binding compounds of natural origin, it works by deeply cleansing the scalp to remove scale (dead skin and oils); reducing the levels of a fungus which can live on the scalp and cause a number of irritating and uncomfortable conditions such as dandruff, spots and flaking of the scalp; and slowing down the life cycle of skin cells on the scalp, which reduces further build-up of scale. All of this promotes optimum health of the scalp and can strengthen hair follicles, reducing hair loss.

This shampoo should be used at least twice weekly to tackle hair loss, but ideally daily for six months, after which frequency can be reduced.

The next product is Tony Maleedy Juniper Scalp Therapy Conditioner, which can be used alone or alongside the shampoo. Containing four plant-derived organic oils and amino acids, it works by sealing moisture into the hair, preventing breakage and strengthening the hair. This in turn helps to protect against hair loss.

According to Dr Bhatty, Tony Maleedy products can be used both before a hair transplant to prepare the scalp, and afterwards to calm the scalp and promote the health of the scalp and hair.

The final products are Regaine for Men Extra Strength Foam and Solution. The active ingredient in Regaine is minoxidil 5%, and it works by improving blood flow to the scalp, which reinvigorates hair follicles, even reversing the shrinkage in some cases. This will result in thicker, longer, stronger hair growing from the follicles.

Regaine should be massaged into the scalp twice daily, preferably every twelve hours. The hair and scalp must be completely dry before application. It usually takes two to four months to take effect.

All of these products can be used alongside one another to combat hair loss and are available to buy from Webmed Pharmacy as part of an online Hair Loss Clinic, with discounts applied when multiple products are purchased at the same time, or when longer ‘courses’ of treatment are purchased.

Why not visit Webmed’s Hair Loss Clinic  - click here.

If you would like to see what other treatments Webmed can provide, please click here.

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 03/10/18. Updated 20/12/19.

References

1. Men’s Health Forum. Hair loss FAQs [cited 20 September 2018]. Available at: https://www.menshealthforum.org.uk/hair-loss-faqs

2. Alopecia UK. Types of Alopecia [cited 20 September 2018]. Available at: https://www.alopecia.org.uk/Pages/FAQs/Category/types-of-alopecia

Cycling is great for both mind and body – depending on whether you’re going uphill, downhill or on a flat surface, or on smooth or rough terrain, you can exercise different muscle groups at different intensities – all while soaking up the sights and sounds of the world around you. But could your daily commute, or your weekend unwind, be damaging your sexual health? A number of studies and news articles over the years have suggested that there may be a link between cycling and erectile dysfunction (ED).

Does research show a correlation between Cycling and ED?

A study conducted in Norway in 1997 collected data from 160 men who had taken part in a long distance bicycle race. It found that 13% of this sample had developed temporary ED after the race, in some cases lasting longer than a month. (1) In 2001, another study on 40 men found that ED occurred in nearly a fifth of long distance cyclists. (2) In 2004, a review of 62 medical articles summarised that up to a quarter of male cyclists had reported ED. (3) And in 2010, a further review found a ‘significant relationship’ between cycling and ED. (4)

The sample sizes (number of people studied) for many of these studies are small – generally the larger the sample size, the more reliable the results of a study are. But clearly the general message from these studies is worth noting, as the NHS Choices page on ED advises men against cycling for three hours or longer per week. (5)

How can I  avoid ED?

The Men’s Health and Cycling UK websites suggest investing in modified bicycle seats. A split bicycle seat has part of the saddle ‘cut out’ to ease pressure on the groin area, especially the pudendal nerve, which runs through the perineum (the area separating the genitals from the anus), which if damaged can lead to ED. Noseless saddles reduce contact between the saddle and the perineum. And saddles incorporating holes and grooves are also available, which are designed to be a better fit to the genital area, reducing pressure. (6, 7)

An article from the prestigious US-based Harvard Medical School also highlights the importance of saddle shape for those concerned about cycling and ED. Wider, softer saddles are preferable to hard, narrow saddles as the weight of the cyclist is spread out over a larger area and the softer seat will put less pressure on the genitals. (8)

Would it be safer if I just stopped cycling altogether?

Absolutely not! Don’t forget, cycling is a superb form of exercise. The better your health and fitness, generally the better your sexual health will be. Just take heed of the above advice and consider supplementing cycling with other forms of exercise if you feel 3 hours a week isn’t enough Even if you do find yourself with ED issues further down the road, there are many treatments available online that can help.

References

1. Andersen KV, Bovim G. Impotence and nerve entrapment in long distance amateur cyclists. Acta neurologica Scandinavica. 1997 Apr;95(4):233-40. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9150814 [accessed 30 August 2018].
2. Sommer F et al. Impotence and genital numbness in cyclists. International journal of sports medicine. 2001 Aug;22(6):410-3. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11531032 [accessed 30 August 2018].
3. Leibovitch I, Mor Y. The vicious cycling: bicycling related urogenital disorders. European urology. 2005 Mar;47(3):277-86; discussion 286-7. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15716187 [accessed 30 August 2018].
4. Sommer F, Goldstein I, Korda JB. Bicycle riding and erectile dysfunction: a review. The journal of sexual medicine. 2010 Jul;7(7):2346-58. doi: 10.1111/j.1743-6109.2009.01664.x. Available at: https://www.ncbi.nlm.nih.gov/pubmed/20102446 [accessed 30 August 2018].
5. NHS Choices. Erectile dysfunction [cited 30 August 2018]. Available at: https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/
6. Men’s Health. Is Your Bike Killing Your Boner? [cited 30 August 2018]. Available at: https://www.menshealth.com/health/a19539158/can-bicycles-cause-erectile-dysfunction/
7. Cycling UK. Boy stuff: cycling, the prostate and erectile dysfunction [cited 30 August 2018]. Available at: https://www.cyclinguk.org/blog/olivercw/boy-stuff-cycling-prostate-and-erectile-dysfunction
8. Harvard Medical School. Can cycling cause erectile dysfunction? [cited 30 August 2018]. Available at: https://www.health.harvard.edu/staying-healthy/can-cycling-cause-erectile-dysfunction

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 11/09/18

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

Despite there being a dramatic increase in bowel cancer cases above the age of 50, the screening programme in England is currently only offered to those aged 60 and over. However, Public Health England have recently announced that it plans to bring the starting age for screening down to 50, a move which will mean countless more cases are spotted in the earlier, more easily treatable stages. (1)

What is bowel cancer?

Bowel cancer is cancer of the large intestine, and depending on the area affected, may be referred to as colon cancer or rectal cancer. It is the fourth most commonly diagnosed cancer in the UK, responsible for 42,000 cases and over 16,000 deaths each year. (1, 2)

What are the symptoms?

One of the most common symptoms is blood in your poo. This may be noticed as red streaks on the surface of your poo or the poo being discoloured (red, very dark red/brown or black), toilet water being stained red or pink, or blood visible on toilet paper. Often, blood in poo has other, less serious causes, such as haemorrhoids or anal fissures (cuts). But if you’ve had any of the above symptoms for three weeks or longer, visit your GP. (2, 3)

A change in bowel habit can also be a sign of bowel cancer. One off changes in bowel habit can be caused by eating certain foods or stressful situations, but if this occurs persistently don’t ignore it. If you find you are needing to poo more frequently than what’s usual for you, and the poo is softer and thinner than usual for three weeks or more, see your GP. (2,3)

Another common symptom is lower abdominal pain, discomfort or bloating. This tends to worsen after eating and may therefore put you off eating, leading to weight loss. See your GP if you experience any of the above symptoms. (2, 3)

Other symptoms may include tiredness from anaemia caused by persistent blood loss from the bowel, slime in your poo and feeling like you can’t fully empty your bowel when you poo. (2, 3)

Bowel cancer screening

Currently, the bowel cancer screening programme in England involves inviting everyone aged between 60 and 74 to have a faecal occult blood (FOB) test every two years. This is a simple home testing kit which allows a small stool sample to be collected. When sent to the laboratory, this sample is tested for traces of blood, which could indicate bowel cancer. (1, 2)

A new, more accurate bowel screening kit is due to replace the FOB test this autumn, known as the faecal immunochemical test (FIT). It is the FIT that will be in use when bowel screening is introduced to people aged 50 and over in England. (1)

In some parts of England, a different test is also offered to 55 year olds, called bowel scope screening. During this screening, a healthcare professional will inspect the lower bowel for polyps (small growths that can be an early sign of cancer) using a gentle instrument. (2)

What causes bowel cancer?

Bowel cancer, like all cancers, doesn’t have a definite cause, but there are several risk factors:

• Regularly eating red or processed meat
• Not eating enough fibre
• Being overweight or obese
• Sedentary lifestyle
• Excessive alcohol consumption
• Smoking
• Being 60 years of age or older
• Having a parent or sibling who had bowel cancer under 50 years of age
• Having had ulcerative colitis or Crohn’s disease for over 10 years

As you can see, some factors are unavoidable, but others can be changed. A diet high in fibre, fruit and vegetables and low in red and processed meat will help protect against bowel cancer, as will stopping smoking (if applicable), drinking alcohol in moderation or not at all, getting moderate exercise regularly and maintaining or attaining a healthy weight. (2)

For more information and support, visit Bowel Cancer UK here.

References

1. BBC News (2018). Bowel cancer screening to start earlier at age 50 in England [cited 13 August 2018]. Available at: https://www.bbc.co.uk/news/health-45143895

2. NHS Choices. Overview: Bowel cancer [cited 13 August 2018]. Available at: https://www.nhs.uk/conditions/bowel-cancer/

3. NHS Choices. Bleeding from the bottom (rectal bleeding) [cited 13 August 2018]. Available at: https://www.nhs.uk/conditions/bleeding-from-the-bottom-rectal-bleeding/

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 15/08/18