Oral herpes and genital herpes can be spread sexually.Approximately one in five adults has genital herpes.Up to 90 percent of persons infected are UNAWARE that they have herpes!Many who have herpes have no symptoms.Symptoms can vary from a mildly irritating and/or itchy area to painful blisters.Always insist that you and any new partner screen for STDs prior to having sex.Cultures of material taken from herpes sores have a small window of time in which they will be accurate for herpes.Blood tests should be done three to four months after a suspected exposure to herpes.The number of outbreaks a person may have is variable.You can shed the herpes virus even when you don’t have symptoms.If you are sexually active, you should use a suppressive therapy prescribed by your provider.Over the counter medications do not protect your partner.Special precautions need to be taken during pregnancy.Always inform any new dating partner before you have sex that you have herpes.Hopefully, in one year, there will be a generic once a day dose for suppression.A vaccine is being tested. It will not protect persons already infected.

The points listed above are discussed in detail in prior blog entries I have made. Please read those entries for more detailed information or go to the resources I listed in the entry entitled “Talking to Your Partner.”

Terri Warren, a nurse practitioner from Portland, Oregon, and Zane Brown, a physician from Seattle, Washington, are both doing excellent research on the topic of herpes. These are authors that you can trust.

Take good care of yourself and the people you care about! Once again, strive to be your best self: A fair, honest, and loving person, who happens to have herpes. Free Medical Advice published By Dr Vivienne Balonwu.

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There are 3 prescriptive medications approved for the treatment of herpes. They work by interfering with DNA synthesis to prevent the virus from reproducing. The directions for each medication vary, so pay close attention to the frequency of taking the medication. Herpes treatment options include:

Acyclovir (Zovirax): This is the oldest and there is a generic of this medication so it is cheaper. Famcyclovir (Famvir)Valacyclovir (Valtrex): There should be a generic of this medication in approximately one year.

All of these medications are effective in suppressing HSV 1 and HSV 2 and can be taken episodically or continuously.

Episodic therapy
This means taking the medication when you have an outbreak or feel a sore coming on. As soon as you feel a sore coming on, begin taking the antiviral medication. If you begin treatment soon enough, the drugs can lessen the severity and shorten the healing time.

You should take the antiviral medication episodically:

If you are not sexually active and have infrequent outbreaksIf both partners are infected with genital herpes.

If you are both infected with the same virus, HSV 1 or HSV 2, in the genital area, you don’t need to worry about giving it to each other. One or both of you may want to suppress if you are having frequent sores, but you don’t have the responsibility to protect each other from getting the virus since you both already have the virus.

Suppressive therapy
You can take the medication continuously to prevent an outbreak or a sore. This is called suppressive therapy. We know that up to 70 percent of new cases of herpes are transmitted from someone showing no apparent symptoms at the time they infect their partner. This is called asymptomatic shedding of the virus. When taken suppressively, the drugs don’t always prevent outbreaks, but help them to occur less frequently. In patients who have at least 6 outbreaks per year, suppressive therapy reduces the frequency by 70 percent to 80 percent. Many patients report no symptomatic outbreaks when using suppressive therapy.

You should take the antiviral medication:

If you have frequent soresIf you have HSV 1 or 2 that and are sexually active with a non-infected partnerIf you have HSV 1 of the mouth and your partner has HSV 2 of the genital area, both of you would suppress to prevent exposing your partner to the another type of herpes

Once again, for optimal protection, it is important to use a condom or dental dam along with antiviral suppressive therapy.

Over-the-counter medications
Currently, there is no over-the-counter medication shown to be effective. The most frequently discussed OTC is L-lysine. Some people report favorable results but studies don’t support L-lysine to be effective in preventing or shortening herpes outbreaks. If you do feel it helps, remember, you still have an obligation to protect your partner. L-lysine has not been shown to be protective for your partner. For now, you will need prescription medication to protect your partner.

Symptom relief
If your genital symptoms are bothersome to severe, here are a few tips to help relieve these discomforts:

Wear loose clothing.Wear cotton underwear.Urinate in the tub or pour water over the genitals while urinating.Use a drying agent in your tub water. You can sprinkle cornstarch lightly on your genitals while in the tub. Soak twice a day for 15 minutes.Tannic acid found in black tea has been found to reduce itching and pain. Place a moist tea bag over the sore.Ice packs to the lesion may be soothing.

A vaccine is being tested. This vaccine will not help the person who already has herpes but will protect a person from getting the virus.

Next, I will address the emotional aspects of herpes and reliable resources. Free Medical Advice published By Dr Vivienne Balonwu.

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Ideally, a blood test would be done at 20-24 weeks of gestation to see if either the mother or her partner has herpes. Screening for herpes is not part of the routine blood work in most obstetrical practices. You may need to request a blood test to protect your baby. Remember, approximately 1 in 5 women have herpes, but many are not aware that they have the virus.

I am going to address different scenarios so you know how to manage your situation if you or your partner has herpes simplex virus (HSV).

Scenario 1. The mother is positive for HSV-2, even if she has never had symptoms.

Babies who get HSV usually acquire it during the labor and delivery process. Contracting the disease while in the uterus is rare but can occur. Precautions would be taken at the end of pregnancy and at the time of delivery to protect the baby. These precautions include:

Mother would be on suppressive therapy from 36 weeks until delivery.Scalp electrodes would be avoided to monitor the baby’s heart rate.Premature rupture of membranes would be avoided.Caesarean section would be performed if the mother had an outbreak in the boxer shorts area of her body at the time of delivery.

Scenario 2. Mother is HSV negative and partner is HSV-2 positive.

Precautions should be taken so the mother isn’t infected with HSV-2. A primary or first outbreak for the mother during the third trimester of pregnancy puts mother and baby at a greater risk for premature delivery. It also puts the baby at a much greater risk for becoming infected. Women that contract herpes during late pregnancy have not had an opportunity to make antibodies prior to delivery. These women have a 30 percent to 50 percent chance of infecting their baby. This is serious. Precautions should include:

Avoid intercourse in the third trimester or the last 3 months.If this is not workable, then the partner should use daily suppression and a condom.

Scenario 3. Mother tests negative for HSV-1 and HSV-2, while partner tests positive for HSV-1 and only recalls a cold sore.

The partner should not give oral sex to the mother during the third trimester. A new HSV-1 genital infection at that time can result in transmission to the baby and be serious.The partner should use suppressive therapy.

Scenario 4. Mother is HSV negative, while the partner is HSV-1 positive but has no history of an outbreak.

The site of the partner’s HSV-1 infection is unknown. Abstaining from both oral sex and intercourse during the third trimester is the safest course of action.Partner should be on suppressive therapy now and in the future to protect the mother and baby.

Scenario 5. Mother and/or partner are HSV-1 positive and have cold sores. Precautions include:

Avoid kissing your baby until the sore has healed.Use suppressive therapy.Avoid touching your cold sore.Use good hand hygiene.Do not share towels with baby.Use liquid soap.

Scenario 6. Mother has HSV-1 or HSV-2 and wants to breast-feed. Precautions include:

If mother has no herpetic lesion on her breast, she may certainly feed her baby confidently.If mother does have a herpetic lesion on her breast (this would be very unusual), then she should avoid breast-feeding.Valcyclovir appears to be a safe suppressant therapy in breastfeeding mothers.

Newborns do not have an immune system that is capable of dealing with herpes. Babies can become very sick or die from herpes. If you or your partner have herpes, it is critical that you share this information with your provider! He or she can then take precautions to protect you and your baby. Free Medical Advice published By Dr Vivienne Balonwu.

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Always discuss the fact that you have herpes before you have sex with a new partner!Don’t begin to discuss herpes in the heat of foreplay! Bring it up when you are alone with your partner.State it as a matter of fact: “I have herpes.”Don’t use adjectives like awful, incurable, painful, dirty.Offer your partner some books, DVDs, Web sites, or pamphlets about herpes.

Here are some trusted books and authors:

“Tender Talk,” by Terri J. Warren, R.N., A.N.P., and Ricks Warren, Ph.D.”The Truth About Herpes,” by Stephen L. Sacks, M.D.”Managing Herpes: How to Live and Love With a Chronic STD,” by Charles Ebel and Anna Wald, M.D., M.P.H.”Understanding Herpes,” by Lawrence R. Stanberry, M.D., Ph.D.

Possible responses
Let’s think of some scenarios of how your partner may respond:

“It doesn’t matter. Let’s have sex now!”
STOP! Someone who reacts like this needs to be reeled in a little. Tell them you would like to help them learn about herpes and think about this so they feel confident that you will protect them as best as you can. Impulsive decisions are usually not good decisions. Also, if this is their true attitude, what else might they be exposing you to?

“This relationship is officially over.”
OUCH! That is the response you were worried about. Remember, they are rejecting the herpes and not you. They may think about it for a few days and then contact you, or they may not want to consider a sexual relationship with you. Trust me, there is someone who will.

“————.” The person is totally silent.
This is an awkward response but a normal one. Once again, tell them you would like to help them learn about and understand herpes so they feel confident that you will protect them as best as you can. Let them know that they don’t even need to respond until they have more information. Give them time to make an educated and heartfelt choice.

“I have herpes too!”
Make sure you have the same viral type. If you both have HSV-1 or you both have HSV-2, then you don’t need to worry about giving it to each other or passing it back and forth. If you don’t have the same viral type, you will want to protect each other from getting a different type of herpes as well.

Not telling your partner you have herpes will certainly set the relationship up for failure. It is easy to hear the anger from people who got infected when they were not informed of the risk of herpes ahead of time; just read some of the blog responses from readers in that situation. Trust is a very difficult thing to earn back after it is lost!

Strive to be your best: A fair, honest and loving person who happens to have herpes. Free Medical Advice published By Dr Vivienne Balonwu.

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But it’s not yet safe to assume you’ve seen the last of chlamydia. Get retested in three to four months to be sure the infection has really cleared.

Retesting after chlamydia treatment isn’t a new recommendation, but the three to four month interval is. Until recently, we retested much earlier – just a few weeks after chlamydia treatment. Now, evidence suggests that you still risk reinfection later. That’s important because women whose sex partners have not been appropriately treated are at high risk of getting multiple chlamydia infections. Multiple infections increase your risk of serious reproductive health complications. In other words, your ability to have a baby may be threatened. 

To avoid chlamydia infection and reinfection:

Abstain from sex or be in a long-term mutually monogamous relationship with a partner who has a negative test.Use latex condoms consistently and correctly. Make sure your partner gets chlamydia treatment if you have chlamydia.Abstain from intercourse until you and your partner have finished treatment.Get retested three to four months after chlamydia treatment.

Remember!
All sexually active women, ages 15 to 24, should be tested annually for chlamydia. Free Medical Advice published By Dr Vivienne Balonwu.

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This increase could be partially due to more testing, especially in women, and to the use of more sensitive tests. However, health officials believe that the reported number of diagnoses might not reflect the actual number of infections, which could be closer to 3 million.

Underreporting is common because many people are unaware of their infection and do not seek testing. That’s unfortunate, because while chlamydia infection may be silent, it’s also serious. Chlamydia can cause irreversible damage to a woman’s reproductive tract, affecting her ability to have babies.

So what is chlamydia?
Chlamydia is a sexually transmitted infection caused by the bacteria Chlamydia trachomatis. Chlamydia primarily targets the cells of mucous membranes including the urethra (both male and female), vagina, cervix and endometrium (lining of the uterus). It can also target the mouth and throat. Infections in the mouth and throat happen infrequently. Ejaculation is not necessary to spread chlamydia.

More facts and statistics

Chlamydia is a very common STD. Women between the ages of 15 and 24 years have the highest chlamydia rate of all age groups and both sexes. Teenage girls and young women are most at risk because the cervix (opening to the uterus) is not fully mature at that age, so it’s more susceptible to infections.Men have a much lower rate of chlamydia than do women. In 2007, men between the ages of 20 and 24 years had the highest rate of chlamydia infection among males in all age groups.Black women between the ages of 15 and 19 have the highest rate of chlamydia. Blacks make up 12 percent of the U.S. population but account for 48 percent of the chlamydia cases. Several factors account for this disparity, including lack of access to health care and distrust of the health-care system.Other racial disparities are also apparent. Chlamydia is 4.5 times higher in Hispanics than in whites and 2.9 times higher in American Indian/Alaska Natives than in whites.

Symptoms of chlamydia
Symptoms can be mild to severe. Men and women experience different symptoms. If a person does develop symptoms, they usually occur within one to three weeks after contact with someone who has chlamydia.

Women may not experience any chlamydia symptoms. In fact, about 50 to 75 percent of women have no symptoms. The most common symptoms are vaginal discharge or itching, bleeding between periods, or pain with urination. A woman may also experience pain during sexual intercourse, low abdominal pain, low back pain, nausea, and fever.

Up to 30 to 50 percent of men have no symptoms. Men typically develop urethritis, which causes pain during urination and a discharge from the penis. In a small number of men, infection with chlamydia can cause epididymitis, with testicular pain, heaviness and tenderness, and swelling of the scrotum.

Proctitis usually occurs in men having sex with men. This is an infection of the anus or rectum. Symptoms may include anal or rectal pain, discharge, a persistent desire to move the bowels and constipation.

Stay tuned for my next blog entry, where I will talk about chlamydia testing, treatment, complications and screening. Free Medical Advice published By Dr Vivienne Balonwu.

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Some common questions

Why does this recommendation focus on young women?

The highest rate of chlamydia is in women age 15 to 19. Most chlamydia infections don’t cause symptoms in women or men.Up to 40 percent of untreated chlamydia infections in women lead to pelvic inflammatory disease, which can cause infertility, a sad legacy that may not be apparent for years. Women infected with chlamydia are five times more likely to become infected with HIV.

Why do you need a test every year?

Your partner can reinfect you after you’ve both been treated at once. People without symptoms of an infection often forget to take prescribed antibiotics on schedule or stop treatment before they should. The infection persists, and it can ping-pong back to you.You can catch chlamydia over and over again. Treatment doesn’t protect you from another chlamydia infection, even if you only have sex once or twice after you’re treated.

Chlamydia testing is also a must for pregnant women. You should be tested as early in your pregnancy as possible. If your test is positive, you and your partner should both be treated. Also, if you start a new relationship during your pregnancy, tell your provider so you can get tested again.

The good news

Uncomplicated chlamydia is easy to treat and cure with antibiotics. The treatment is the same for men and women. There are two main treatment options.

Azithromycin. This antibiotic can be given as a single dose. Because azithromycin is a one-time treatment, you won’t need to worry whether your partner remembered to take all of it. Azithromycin is safe during pregnancy. Doxycycline. You take this antibiotic in two doses – one in the morning and one at night – for seven days. Doxycycline is not safe during pregnancy. Tips for couples

Before you start treatment:

Ask your health care provider to write a prescription for both of you. Some providers do that routinely.Make sure your partner is not allergic to the medication.

During and after treatment:

Abstain from intercourse for the entire time you’re on medication and for one week afterwards to prevent reinfection.If you and your partner finish the medication as directed, it is not necessary to go back to your provider for a recheck. If your symptoms persist, make an appointment to see your provider for further evaluation. Free Medical Advice published By Dr Vivienne Balonwu.

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I’m surprised and disappointed.

The HPV vaccine, which protects against the strains of human papillomavirus involved in most cases of genital warts and cervical cancer, was the topic of my blog post on October 7, 2008. At that time, I explained the value of the HPV vaccine and examined a few of the controversies surrounding it.

Now it’s time to consider some possible reasons why more girls and women aren’t getting the HPV vaccine.

Cost

A three-shot series costs several hundred dollars, which puts it out of the affordable range for many young women and parents of pre-teen girls. If cost is one of your obstacles, find out whether the shots really will set you back as much as you think. Start by checking directly with your insurance company, if you’re insured through an employer. Many health plans are covering HPV immunization. After all, the vaccination is far less expensive than the alternative – abnormal Pap smears and the followup examinations and treatment they require.

Medicaid, the government-financed health insurance program for the poor, also covers HPV immunization for eligible girls and young women.

Availability

Because the HPV vaccine is expensive, many clinics can’t afford to keep it in stock. If your clinic does not carry HPV immunizations, check with your county public health department to find out where the shots are offered and how you can receive all three.

Safety

Parents in particular are concerned about the safety of HPV immunization. The risks, however, are exceedingly small. The vaccination is made from viruslike particles, not from fully formed, infection-causing HPV. It can’t give you the disease.

Also, no serious side effects have been reported. Pain and redness are common at the site of the immunization, and flu or cold symptoms sometimes occur. You may want to schedule the immunization for a time when you can take it easy for a few days if these symptoms develop.

Implications

Unlike the first three factors, which are matters of verifiable fact, this factor is rooted in a conflict of belief. Some people oppose HPV immunization for the same reason they oppose sex education: They view both as implied endorsements of promiscuity. But if fear of HPV and other STDs is such a deterrent to promiscuity, why are STD rates rising every year, especially among adolescent girls and young women?

It’s impossible for everyone to agree on a single standard of sexual morality, let alone on the right way for school and health officials to uphold that standard. On the other hand, everyone recognizes the essential good of saving many thousands of women – mothers, wives, sisters and daughters – from needless premature death.

If you have questions and thoughts about the HPV vaccine, post them here or discuss them with your health care provider. Free Medical Advice published By Dr Vivienne Balonwu.

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An IUD provides continuous contraception as long as it’s in place. You don’t have to reinsert it when you want to have sex or remove it afterwards; it stays in your uterus for as long as you want to avoid pregnancy. Because inconsistent contraceptive use leads to many pregnancies, particularly in teens, this is a major benefit.

If an IUD sounds like a good contraceptive choice for you, here are a few things to keep in mind:

IUDs do not protect against sexually transmitted infections. Unless you’re absolutely sure your partner has no STDs and is completely faithful, use condoms to prevent sexually transmitted infections.Mild to severe discomfort is common with IUD insertion. Cramping may last a few days.With an IUD, your periods may be heavier than usual.IUDs can get displaced or expelled from the uterus, and you may not know it’s happened. Explusion occurs most often during your first period after the device is inserted. Soon after you’ve had that period, see your provider to make sure the IUD is still in place. Your provider will show you how to check your IUD so you can recheck it yourself after every period. If you’re ever unsure, make an appointment with your provider, and use another form of contraception until you know your IUD is where it’s supposed to be.The risk of IUD expulsion is higher in younger women and women who have expelled IUDs in the past.IUDs do not cause pelvic infections or infertility — STDs do. If you are interested in using an IUD, you’ll be tested for chlamydia and gonorrhea before the device is inserted.

Women should not consider an IUD if they are:

Currently pregnant Currently infected Bleeding for unknown reasons

They should also avoid IUD use if they have:

Cancer of the uterusBirth defects of the uterus Allergies to any component of the IUD

The IUD is a highly effective contraceptive, but American women have shied away from it because the Dalkon Shield, one of the first IUDs introduced in the United States, was linked to high rates of infection and subsequent complications. Today, several professional women’s health groups wholeheartedly endorse the IUD for sexually active women of any age. The IUDs in use now are more sophisticated and better adapted to the reproductive tract than were the Dalkon Shield and its counterparts.

Many of the 750,000 teen pregnancies each year in the United States are due to inconsistent contraceptive use. Wider acceptance of the IUD – with its almost-unmatched simplicity – would greatly reduce that number. Free Medical Advice published By Dr Vivienne Balonwu.

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Over-the-counter (OTC) emergency contraception – Plan B – is nothing new. The FDA approved the drug, for prescription only, in 1999. Then, in 2006, Plan B got OTC approval, but only for sale to women age 18 or older.

Reproductive rights organizations challenged the age restriction in court, finally receiving a favorable ruling earlier this year. Now, a new product called One-Step – a single-dose OTC version of the same hormone in Plan B – has been approved for anyone over the age of 16.

Plan B and One-Step contain a synthetic form of a hormone called progesterone. Birth control pills also contain progesterone, but at a lower dose.

Here are some common questions about emergency contraception.

Where do drugstores keep their stock of Plan B?

You still won’t find Plan B on the open pharmacy shelf. In its unique regulations for selling Plan B without a prescription, the FDA set these rules:

The product has to be kept behind the pharmacy counter. If you want it, you have to ask the pharmacist or pharmacy clerk for the product.A licensed pharmacist has to be on the pharmacy premises when you buy Plan B, although an assistant or clerk can handle the transaction.You need to present some form of government-issued identification to prove your age before buying Plan B. How do I know if a pharmacist sells Plan B?

The simplest thing is to call ahead and ask. Alternatively, your health provider may be able to direct you to local pharmacies where you can get Plan B.

Some pharmacies have chosen not to stock Plan B because of perceived lack of consumer demand. But media attention has focused mainly on individual pharmacists and drugstore owners who have publicly stated their religious objections to emergency contraception and made a point of refusing to stock or dispense Plan B. It’s unclear whether this stance has made Plan B harder to purchase in general, but courts are already grappling with related issues. The controversy has been particularly heated in the state of Washington. Since 2007, pharmacies there have been required either to sell Plan B themselves or to give any customer who requests Plan B the name and address of a pharmacy where it’s sold.

What if I am not 17 yet?
If you are under 17, you can get a prescription for emergency contraception (Plan B, One-Step or Next Choice, which is a generic, prescription-only version of Plan B) from your medical provider. Title Ten clinics and Planned Parenthood clinics also prescribe emergency contraception.

Can I just have a prescription available in case I need it?
Yes – in fact, that’s a great idea! Ask your provider for a prescription when you go for your well-woman exam.

Far too many pregnancies are unplanned. If efforts to reduce the number of unintended pregnancies are to be successful, women must be given access to a full range of contraception options. Free Medical Advice published By Dr Vivienne Balonwu.

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To bring perspective to the discussion of vaccine risks in general and HPV vaccine risks in particular, I’d like to make a few more points.

Is the HPV vaccine safe?
The vaccine has been licensed as safe. Before it was approved by the Food and Drug Administration (FDA), the vaccine was studied in thousands of girls and women age 9 through 26 in the United States and around the world. The most common side effect is soreness where the shot is given, in the arm.

What about the frightening reports from VAERS?
VAERS stands for Vaccine Adverse Event Reporting System. It is a national vaccine safety surveillance program co-sponsored by the Centers for Disease Control and Prevention (CDC) and the FDA.

VAERS collects and analyzes information from reports of side effects after immunizations, so it serves as an early warning system for problems that may be related to a vaccine. The system helps to identify any important new safety concerns and thereby assists in making sure the benefits of the vaccines continue to be far greater than the risks.

Reports to VAERS do nothing to prove that particular vaccines cause specific adverse events. The only thing inclusion in VAERS means is that the reported event occurred after vaccination. Anyone can submit a report to VAERS, although health care providers are required to report certain adverse events.

How many reports of HPV vaccination-related adverse events has VAERS received?
At last count (June 2008), VAERS had received a total of 9,749 reports of potential adverse events following HPV vaccination. Ninety-four percent of these reports were about non-serious adverse events such as pain with the injection, or redness and swelling afterwards.

Six percent of adverse events reported for the HPV vaccine were considered serious. That’s about half of the average number of serious events reported for other vaccines.  Keep in mind that the rate is 6 percent of all reported HPV vaccine side effects, not 6 percent of all girls who had the vaccine.

Many of the problems reported to VAERS are chance occurrences. They are as likely to have showed up shortly before the vaccination as after it. Sometimes, problems reported to VAERS actually stem from medications unrelated to the vaccine, or from undiagnosed illness. Sometimes there’s no identifiable cause.

VAERS data are routinely updated, and the number of reports and the type of adverse events will vary depending on the date of analysis. Free Medical Advice published By Dr Vivienne Balonwu.

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Pills marketed for continuous use

Three brands of birth control pills – Seasonique, Seasonale and Lybrel – have FDA approval for continuous use. This means they suppress your period completely because every pill in a pack contains hormones. If you take Seasonique or Seasonale, you’ll have no period for three months. If you take Lybrel, you can go without a period for as long as you want.

What about your regular pill?

If you’d like to try the no-period route and you’re taking a combination pill other than one of the brands mentioned above, you may not have to switch brands. The pill you’re already taking may cost less as well.

Standard birth control pills come in 28-day packs containing 21 active pills and seven inactive (“sugar” or placebo) pills. On day 22 of each month, you switch from active to inactive pills. Shortly after that, you experience vaginal bleeding much like a period. You take your last inactive pill on day 28, then start a new pack.

Stopping your period works best with monophasic pills, which have the same dose of hormones in every active pill. Try this technique:

Take the first three weeks of a new pack of pills as usual.On the first day of the fourth week, start a new pack of pills, skipping all the inactive pills in the first pack. When you reach the inactive pills in your second pack, skip them, too, and start a third pack.Again, take the first 21 pills and skip to your fourth pack.Do not skip the inactive pills in your fourth pack. Take every pill in that pack, including the sugar pills, so you’ll have a period.What can go wrong?

Many women complain of breakthrough bleeding or spotting when they are continuously taking active pills.

To solve that problem, try taking your traditional pills until you have spotting. Once you start to spot, switch to inactive pills for four days or seven days, whichever is your normal routine. With time, you may find that you can go longer and longer before you spot.

Will it affect your fertility?

No. Whether you take inactive pills for four or seven days out of 28 days, four or seven days out of 84 days, or continuously with no inactive pills, birth control pills simply put your fertility on hold. They do not reduce your ability to have a baby.

The important issue is to take your pills correctly to avoid pregnancy.

Birth control pills do not protect you from STDs. Unless you’re in a stable, long-term relationship with someone you trust absolutely, you still need to use condoms. Before having sex with a new partner, you should both get tested to make sure you’re free of STDs. Free Medical Advice published By Dr Vivienne Balonwu.

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Using male condoms seems pretty easy, too. But condoms don’t work unless you use them – correctly – every time you have sex. All it takes is one unprotected act of intercourse to infect your partner with an STD, which you may not even know you have.

So, again: Use a new latex condom every time you have sex.

Studies show that this isn’t happening. According to the Minnesota Student Survey, a health and safety questionnaire administered every three years to teenage students, only 66 percent of male 12th graders and 59 percent of female 12th graders used a condom the last time they had intercourse.

Similarly, if condoms are not used correctly every time, the protective effect may be reduced. Using the condom incorrectly can lead to breakage, slippage, or leakage. The most common mistakes are:

Putting the condom on after sexual activity has startedPutting the condom on incorrectlyFailing to withdraw the penis while it is still erect

If you’re using a latex condom every time, great. But to be sure you’re getting the most possible protection from condoms, carefully read these instructions the Centers for Disease Control and Prevention.

Use a new condom for every act of vaginal, anal and oral sex-throughout the entire sex act (from start to finish). Before any genital contact, put the condom on the tip of the erect penis with the rolled side out. If the condom does not have a reservoir tip, pinch the tip enough to leave a half-inch space for semen to collect. Holding the tip, unroll the condom all the way to the base of the erect penis. After ejaculation and before the penis gets soft, grip the rim of the condom and carefully withdraw. Then gently pull the condom off the penis, making sure that semen doesn’t spill out. Wrap the condom in a tissue and throw it in the trash where others won’t handle it. If you feel the condom break at any point during sexual activity, stop immediately, withdraw, remove the broken condom, and put on a new condom. Ensure that adequate lubrication is used during vaginal and anal sex, which might require water-based lubricants such as K-Y JellyTM, AstroglideTM, AquaLubeTM, and glycerin. Oil-based lubricants (e.g., petroleum jelly, shortening, mineral oil, massage oils, body lotions, and cooking oil) should not be used because they can weaken latex, causing breakage.

If you have frequent yeast infections, use a water-based lubricant, such as System JO, that does not contain glycogen. Glycogen promotes yeast infections.

Using a condom correctly and consistently shows that you respect yourself and your partner. Free Medical Advice published By Dr Vivienne Balonwu.

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I’m adding a quick note to my June 9 blog, which says when and how often women should have Pap smears to screen for cervical cancer.

As you probably heard, the American College of Obstetricians and Gynecologists (ACOG) just came out with new Pap smear guidelines. The latest ACOG recommendations, which appeared several months after my blog on the topic, mark a further departure from the conventional wisdom that every woman should have a Pap smear every year. If you were still getting used to the idea of a Pap smear every two years – the recommendation when I wrote the blog – news that you can wait three years between Pap smears could make you wonder what’s going on.

Happily, what’s going on is progress. In the 1970s, cervical cancer rates went down by 70 percent because of Pap smear screening. Because of this simple screening test, we were able to prevent almost all abnormal Pap smears from becoming cervical cancer. Since then, we have learned a great deal more about Pap smears and cervical cancer. After analyzing the most recent findings in this area, the American College of Obstetricians and Gynecologists (ACOG) published new recommendations. Here’s a quick summary:

Women should have their first screening Pap smear at age 21.Women in their 20′s should have a Pap smear every two years.Women age 30 and older who have had three normal Pap smears in a row should have a Pap smear every three years.Women who have had a hysterectomy should no longer have Pap smears if the hysterectomy was for non-cancerous reasons and they don’t have a history of severely abnormal Pap smears. If you have had a hysterectomy but still have your cervix, you will need to continue routine Pap smears.Pap smear screening can be stopped in women 65-70 years old and above who have had three or more normal Pap smears in a row.These guidelines should be followed whether you have or have not had the vaccine.

My next blog will tell you more about why ACOG made these changes and what they mean to you.

(Following is my original post, which reflects Pap smear guidelines before ACOG published revised recommendations.)

June 9, 2009

Pap smears: How often?

The Pap smear screening test is one of modern medicine’s greatest successes. In areas of the world where it’s available, the Pap smear has reduced cervical cancer rates dramatically by detecting infection with human papilloma virus (HPV) and associated changes in cervical cells.

The tradition has been to do a Pap smear annually on all women. Now we are learning that we can decrease the frequency of Pap smears and still protect women.

For example, if you have never had an abnormal Pap smear and you have been with the same partner for a long time, your partner probably doesn’t have HPV, so an annual Pap smear is not necessary.

The following questions and answers cover additional recent refinements in Pap smear recommendations.

When should a young woman start having Pap smears?
The recommendation is to have your first Pap smear test three years after you become sexually active or at age 21, whichever comes first. The prevalence of HPV is particularly high in young women soon after they start sexual activity. The good news, though, is that younger women have extremely low rates of invasive cervical cancer, so they usually don’t need aggressive treatment for HPV infection.

After I start to have Pap smears, how often do I need them?
From the time you start to have Pap smears until age 30, we recommend a Pap smear every year. If at age 30 you are still in the dating world or have just recently become monogamous (committed to one partner), continue to have a Pap smear every year. Once you have started a long term commitment, you may begin to have a Pap smear every 3 years.

Women age 40 and above still need an annual mammogram, clinical breast examination and pelvic examination. We reduce the frequency of Pap smears, but not visits to a provider.

What if I find myself back in the dating world and I am over 30 years old?
Now you are at risk for HPV again and you should resume annual Pap smears until you are in a committed relationship.

When can I stop Pap smears?
Opinions vary, but most women can stop Pap smears at age 65 or 70 if they’ve had three consecutive normal Pap smears over the last ten years. But the new-partner rule still applies: Regardless of your age or gynecologic history, a new sex partner puts you at risk again, so you’ll need to restart annual Pap smears.

We are all used to getting a Pap smear every year. It can feel uncomfortable to let go of this familiar schedule, but technological progress and accumulated knowledge have made it unnecessary in many circumstances. Talk to your provider each year to assess what your needs are for Pap smear screening. Free Medical Advice published By Dr Vivienne Balonwu.

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A generic form of Valtrex is now available to treat herpes outbreaks when they’re underway and to suppress future herpes outbreaks in people with the infection. With suppressive treatment, you take the drug continuously to make it harder for the herpes viruses (HSV-1 and HSV-2) to get reactivated and cause new sores.

Generic Valtrex (valacyclovir) joins another herpes treatment, acyclovir (originally branded Zovirax), on the generic market. A third drug for herpes treatment, Famvir (famciclovir), is also available.

All three medications are effective against HSV-1 and HSV-2, either of which can cause genital sores. You can take any of the three episodically (when symptoms are present) or continuously. These medications work by interfering with DNA synthesis to prevent the virus from reproducing. The directions for each medication vary depending on your situation, so pay close attention to the frequency and strength of the medication. Always consult with your provider about which dosing would be most effective for you.

Considerations of cost and convenience may be important factors when you and your provider consider herpes treatment. Points to consider:

Acyclovir (Zovirax) is effective, and its patent expired years ago, so its cost is usually low. The down side of this medication is that you must take it twice a day.Valacyclovir (Valtrex) is also effective and relatively inexpensive. Its plus: You only have to take it once a day. Famciclovir (Famvir) can still be quite expensive because it’s not available as a generic drug. Free Medical Advice published By Dr Vivienne Balonwu.

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Routine Pap smears didn’t just lower the rate of invasive cervical cancer by 74 percent in the past several decades. The Pap test also helped improve medical understanding of cervical cancer, particularly its cause – human papillomavirus (HPV) infection – and the way it develops. As we find out more about the disease, we also find better ways to prevent it. The new Pap schedule reflects that improvement.

The first big step: Proving that cervical cancer is almost exclusively caused by HPV, and that HPV is usually sexually transmitted.

Next came many insights into how cervical cells react to HPV infection over time. Among the things scientists observed was that most young women infected with the specific type of HPV that causes abnormal Pap smears clear the virus on their own in one to two years.

That’s why a woman’s first Pap smear can be delayed to age 21. The extra time doesn’t put younger women at additional risk, and it spares them the emotional and physical distress of learning they had an abnormal Pap and going through unnecessary followup procedures. In young women, the procedures to treat abnormal Pap tests can interfere with having a baby.

Similar insights led to the other changes in the recommended Pap schedule. The new schedule is appended to my blog post of June 9, 2009, but I’ll repeat it here:

Women should have their first screening Pap smear at age 21.Women in their 20′s should have a Pap smear every two years.Women age 30 and older who have had 3 normal Pap smears in a row should have a Pap smear every three years.Women who have had a hysterectomy should no longer have Pap smears if the hysterectomy was for non-cancerous reasons and they don’t have a history of severely abnormal Pap smears. If you have had a hysterectomy but still have your cervix, you will need to continue routine Pap smears.Pap smear screening can be stopped in women 65-70 years old and above who have had three or more normal Pap smears in a row.These guidelines should be followed whether you have or have not had the HPV vaccine.

Speak to your women’s health provider about how often you should be seen in the office. There are many considerations such as age, sexual risks and your history that will help you to make a plan that takes care of your health needs. Free Medical Advice published By Dr Vivienne Balonwu.

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How is the disease spread from one person to another person?What part of the body does the condom protect?

There are two primary ways that STDs are spread:

One way is through contact between the infected partner’s genital secretions or discharge and the mucous membranes of the uninfected partner. Diseases transmitted this way are HIV, chlamydia, gonorrhea and trichomoiasis. Condoms do a good job of protecting you from diseases transmitted by genital secretions. The other way is through skin or mucous membrane contact with sores shedding sexually transmissible viruses or bacteria – herpes, syphilis, chancroid and human papillomavirus. These sores aren’t limited to the genital or oral areas, so condoms are less effective in stopping transmission.HIV

Latex condoms used consistently and correctly are highly effective in preventing the sexual transmission of HIV, the virus that causes AIDS. This is good news as HIV is the most deadly of all STDs. Latex condoms provide an essentially impermeable barrier to particles the size of HIV. In couples where one partner is infected with HIV and the other is not infected, consistent use of condoms has been highly effective in protecting the uninfected partner.

Chlamydia, gonorrhea, and trichomoniasis

All of these diseases are transmitted by genital secretions. Latex condoms when used consistently and correctly reduce the spread of these infections. Latex condoms provide an impermeable barrier to particles the size of these bacteria. Studies also provide evidence that latex condoms protect against the spread of these infections.

Genital ulcer diseases and HPV infections

Condoms may reduce the spread of genital ulcer diseases and HPV. These lesions or sores may occur in areas covered by a condom, but frequently, they are located on other parts of the body. If the sore is located on an area covered or protected by the condom, using a condom will reduce transmission rates. Consistent and correct condom use has been associated with a lower risk of cervical cancer. If the sore is located on a different area of the body – for instance, the buttocks – then the condom will not protect an uninfected partner. Protection against genital ulcer diseases and HPV depends on the site of the sore or ulcer.

Consistent and correct use of condoms is the key for reducing the spread of infections. Free Medical Advice published By Dr Vivienne Balonwu.

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Health care providers often order a different test, the IgM test. A positive IgM test, however, doesn’t necessarily mean you have HSV-2, the genital herpes virus.

Why not IgM?

Herpes testing based on IgM seems like a good idea because your immune system starts producing IgM in early infection with most viruses. Theoretically, an IgM test can tell you whether sores you just developed are or aren’t herpes, and it might help you figure out when you were infected.

For diagnosing HSV-2, though, the IgM test has serious shortcomings.

The IgM test doesn’t distinguish one herpes virus from another. A new infection with HSV-1, which causes oral cold sores, could give you a positive herpes IgM result. If that’s not taken into account, you could be told you have HSV-2 (genital herpes) when you really don’t.A positive herpes IgM test could also mean you’re having a recurrence of HSV-2. Many people with HSV-2 produce new IgM every time they have a herpes outbreak. With IgM testing, there’s no way to know whether you have a new infection or when you initially acquired the virus.

In contrast, IgG testing can distinguish between HSV-1 and HSV-2. It’s an important distinction, because HSV-1 is less severe and quite common. Most people have antibodies to HSV-1 by the time they’re grown.

The IgG tests approved by the FDA are very accurate. That means there is only a small chance that you would get a false positive or false negative result.

But there is a drawback: You have to wait four months between your first outbreak and your IgG test. Your immune system takes that long to produce IgG against herpes, so a negative result from an earlier IgG test isn’t reliable.

If you’re not sure whether you have HSV-2, or if you doubt the accuracy of a genital herpes diagnosis you received some time ago, it makes sense to get tested (or retested). Be sure to ask for IgG testing. Free Medical Advice published By Dr Vivienne Balonwu.

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But bacterial vaginosis (BV for short) is not a sexually transmitted disease. Instead, it’s the overgrowth of normal vaginal bacteria. All women have bacteria in the vagina. These bacteria are part of the normal vaginal ecosystem. When some types of these normal bacteria overgrow, the result is BV.

Bacterial vaginosis symptoms include:

Increased vaginal discharge, usually watery and gray or greenStrong alkaline or “fishy” odor, which can come and goBurning of the vulvar tissueItching (this is not very common)

The vagina is normally acidic, helping to keep the bacteria in normal volumes. If the pH of the vagina becomes alkaline, the bacteria overgrow. Bacteria love an alkaline environment. Things that can increase vaginal alkalinity are:

Menstruation. Blood is alkaline. If your periods are heavy and long, exposure to blood may raise the vaginal pH to a higher alkaline level, so the bacteria can overgrow. The alkaline odor may be particularly strong during your period.Frequent sexual intercourse between a male and female. Sperm is also alkaline. The sperm can alter the pH of the vagina to be more alkaline. With frequent exposure to an alkaline substance, the bacteria can over grow. After sex, you or your partner may notice a stronger alkaline odor.During menopause, women are more prone to BV because the vagina becomes alkaline due to hormone changes.

How is BV treated?

First, it is important that you see your provider to make sure you have BV.There are several antibiotics used to treat BV. Treating the partner is not usually necessary. Remember, he didn’t give you an infection but the sperm promotes BV by altering the pH of the vagina.

If exposure to alkaline substances continues, BV can recur after treatment.

What are some basic things you can do to prevent BV?

If you have heavy periods, talk to your provider about reducing the blood flow of your period. Your provider has many options to offer.If you are having frequent sex, use a condom to reduce the exposure of the alkaline sperm in the vagina. For example, if you have sex 3 times a week, consider using a condom 2 of those times. (If you are using a condom to prevent STDs, then you need to use it all the time!)If you are menopausal, consider local estrogen to help keep the vagina acidic. Local estrogen comes in the form of a cream, pill or acrylic ring that you insert in the vagina.

Bacterial vaginosis can be very frustrating for some women because it can be recurring. We are not sure why some women get it so frequently. Remember, promoting an acid environment in the vagina helps to prevent BV. Free Medical Advice published By Dr Vivienne Balonwu.

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Twenty to 70 percent of people infected with syphilis also have human immunodeficiency virus (HIV), the virus that causes AIDS. It’s no accident that these two STDs frequently coexist. Early syphilis causes sores on the mucosal surfaces of the genitals and mouth, creating an easy route for catching as well as transmitting HIV. If either you or your partner has a genital rash or sore, you’ll both be safer if you let the skin heal before having sex.

In the primary stage of syphilis, about 10 days to three months after exposure, a small, firm, painless sore (chancre, pronounced SHANG-ker) appears on the part of your body where the bacteria entered, usually your genitals, rectum, tongue or lips. A single chancre is typical, but you may have multiple sores. Chancres go away without treatment, but you still have the infection.

The secondary stage of syphilis occurs two to 10 weeks after the chancre appears. In this stage, you develop multiple flulike symptoms, along with a rash and wartlike sores in the genital area or mouth. You may have secondary syphilis in a single episode lasting a few weeks, or the signs and symptoms may come and go for as long as a year.

Next, the infection may enter a latent or hidden stage in which all symptoms often go away. This stage can last for years.

Without treatment, syphilis progresses to the tertiary stage in 15 to 30 percent of those infected. Tertiary syphilis may permanently damage your brain, nerves, eyes, heart, liver, bones and joints.

Fortunately, penicillin cures syphilis at any stage. The sooner you get treated, the simpler it will be to get rid of the infection.

Want to know more about syphilis? Enter “syphilis” in the search box under the blue bar across the top of this page to find detailed information. Free Medical Advice published By Dr Vivienne Balonwu.

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Uterine Fibroids

Uterine fibroids are ‘knots’ or hard ‘balls’ of muscle fibres that grow in the muscular part of the wall of a woman’s uterus, or womb.

They are very common, occurring in about 10% of women in the UK, and can be single or multiple.

Their size varies from miniscule to large, and they can occur in any part of the womb including the cervix.

They always develop during a woman’s fertile years, and tend to shrink in size after the menopause, suggesting they grow as a result of exposure to the hormone oestrogen.

What causes Uterine Fibroids?

This is unknown. They are more common in black women, and less common in thin women who have never been pregnant, or who have been on the Pill for at least 10 years continuously.

What Are The Signs And Symptoms Of Fibroid Tumors?

Most women are unaware they have fibroids. They are often discovered by doctors at well-women clinics or during examinations for other conditions. Any symptoms reported are usually of very heavy, painful periods with ‘flooding’ and the passage of blood clots. There may be abdominal pain or pain on intercourse, and very occasionally there may be fertility problems such as recurrent miscarriages.

Will I Have Any Tests Or Investigations?

Most fibroids can be felt by a vaginal examination, and present as firm lumps inside the womb. This is usually followed up by an ultrasound scan – such as pregnant women have – which clearly show them up.

What Fibroid Treatment Might I Need?

This depends entirely on the symptoms they cause since many women with fibroids have no problems whatsoever and so need no treatment. Some specialists may recommend tablet treatment called ‘GnRH analogues’ which can cause fibroids to shrink, but the most effective treatment remains surgery. This always used to involve a hysterectomy – where the whole womb was removed, but many women are now favouring two newer techniques;

1. Myomectomy – the fibroids alone are removed, leaving the rest of the womb intact. This is a much more difficult operation to perform, and is not undertaken by all consultant gynaecologists as it can sometimes cause heavy bleeding and may not cure the problem of flooding / heavy periods.

2. Endometrial resection – here a special wire fshaves away’ the lining of the womb under general anaesthetic. This is often better at stopping the problem of heavy periods but does not remove all of the fibroid.

What course will the illness follow?

If there are no symptoms, many ladies never need treatment. Fibroids often gradually enlarge until the menopause, when they begin to shrink back down again. Symptoms may therefore increase and decrease with age.

Can I Do Anything To Help Myself?

Although fibroids cannot be prevented, some women with small fibroids find that alternative treatments such as acupuncture, homeopathy or reflexology help their symptoms. If your periods are heavy, ask your doctor if you need to be tested for anaemia.

Tell Your Doctor

1. Have your periods become heavier or more painful?
2. Do you pass clots during a period?
3. Do you have any unusual abdominal pain or pain on intercourse?
4. Do you want any more children in the future?
5. Have you had recurrent miscarriages in the past?

Ask Your Doctor

1. If I get pregnant, can fibroids be a problem?
2. Can fibroids become cancerous?
3. What side effects do any drug treatments have?
4. Am I still able to have hormone replacement therapy?
5. What do I do if my local specialists are not keen on doing endometrial resections but I would like this as a form of treatment?

By Roger Henderson

Free medical advice online published by Vivienne Balonwu.

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Prostate Cancer

The prostate gland is not essential for life. It surrounds the outlet from the bladder and secretes a fluid into the semen that nourishes the sperms. It gradually enlarges with age and can block the passage of urine from the bladder.

Who Is At Risk Of Prostate Cancer?

The risk of prostate cancer increases with age and is doubled if a relative has the disease and is quadrupled if a father or brother has it. Latent or inactive cancer may be found in 50 per cent or more of 80-year-olds, but in them it is generally of no concern and is unlikely to require treatment.

What Are Prostate Cancer Symptoms?

It is uncommon for early cancer to produce urinary symptoms. However, symptoms may include urgent and frequent urination, getting up at night to urinate, or slowing of the urinary stream with difficulty starting or emptying. A urine infection or blood in the urine may occur. See your doctor if you experience any of these symptoms because they are more likely to be due to other problems.

How Is Prostate Cancer Diagnosed?

Sometimes prostate cancer is found incidentally after an operation for a benign (non-cancerous) enlargement of the prostate. It may be found during a routine check by your doctor, who examines the prostate gland with his/her finger in the rectum. This is called a digital rectal examination.

No blood test clearly shows whether you do or don’t have cancer. There is now a blood test which can help your doctor to manage prostate cancer. This is called PSA, as it tests for prostate specific antigens. The level of PSA in the blood can be raised by many infections and conditions, including a benign enlargement of the prostate, as well as prostate cancer. However, if a digital rectal examination is suspicious and/or the blood PSA is raised, your doctor may suggest a biopsy.

A biopsy involves taking a small piece of tissue from the prostate with a special needle so that it can be examined under a microscope by a pathologist. The needle is positioned in the prostate with the help of an ultrasound probe in the rectum.

If the biopsy is positive, the doctor may order a bone scan to ensure the disease hasn’t spread into the bones. If it has spread, different treatment may be needed to control the progress. If it hasn’t spread, you probably have an early cancer.

What Are Prostate Cancer Treatments?

For early prostate cancer, there are several options that you should discuss with your doctor.

* Watchful waiting

No immediate treatment may be needed in some men, especially those who have small, slowly growing tumours, or those with limited life expectancy. Your doctor will see you periodically to monitor your condition.

* Radiotherapy (treatment with X-rays)

This has been standard therapy for small, localised prostate cancer for many years. Radiotherapy involves daily outpatient treatment that lasts about 15-30 minutes each time, for up to seven weeks. Some patients can suffer irritation of the bowel or bladder, but this can usually be controlled by medication. Loss of erections (impotence) may be a problem.

* Radical prostatectomy

A biopsy of the lymph nodes takes place initially to see if the cancer has spread into them. If it hasn’t spread, the surgeon then removes the entire prostate gland (radical prostatectomy), preserving adjacent nerves where possible. If the cancer is confined to the prostate, the results of radical prostatectomy and radiotherapy are similar. The possible complications of this surgery include incontinence (usually mild), impotence and blockage of the urine flow.

* Hormone therapy

Hormone therapy involves eliminating the effects of the male hormone, testosterone – it is known that testosterone helps spread prostate cancer. Hormone therapy can be accomplished by removing the hormone-producing part of the testicles through a small incision in the scrotum. Alternatively, medications can be taken to stop the testicles from producing testosterone or to block the effects of the male hormone. This medication must be taken for life.
 
You should carefully discuss with your doctor the full implications of all these treatments, their side-effects and their impact on your working and family life.

Your doctor will arrange follow up blood tests, especially to determine the PSA level. A rise in PSA may mean the disease has returned. Careful monitoring means that any progress of the cancer can be treated early by hormone therapy.

What About Survival From Prostate Cancer?

If prostate cancer is diagnosed before it has spread, it may be treated with radiotherapy, hormones, radical prostatectomy or watchful waiting. Your survival depends upon the biological activity of the tumour and your general level of fitness. Men over 70 seldom benefit from radical surgery.

* If you have just been found to have prostate cancer, don’t panic.

* If you’re anxious that you may have a problem, ask your doctor to check you out.

* During treatment, try to eat well, stay active and keep track of your weight. And remember to follow your treatment program exactly as your doctor advises.

By Dr Mike Kirkby

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Cystitis, or urinary tract infections (UTIs) affect a great many people, with women being affected far more frequently than men. Normal urine is sterile, and free of any infection. Cystitis is the name commonly given to the symptoms caused by a UTI affecting the bladder.

What causes Cystitis?

Most infections are due to one type of bacteria – E.Coli – which lives normally in the bowel but which can also cling to the opening of the urinary system called the urethra. An infection limited to here is called urethritis, and one which affects the bladder is called cystitis. Any infection which then spreads to the kidneys is called a pyelonephritis, but this is much rarer than cystitis.

Certain People Are More At Risk Of Cystitis;

¤ people with diabetes
¤ men with enlarged prostate glands
¤ people with catheters
¤ people with disorders of their immune (defence) system
¤ women using the diaphragm as contraception

Some women are also prone to cystitis after intercourse, although the reasons for this remain poorly understood.

What Are The Signs And Symptoms Of Cystitis?

Most people with cystitis experience some symptoms (although not invariably). The commonest of these are;

¤  A frequent urge to pass water. Despite this, it is usual for little urine to actually be passed.
¤  A painful ‘stinging’ or ‘burning’ discomfort when urinating.
¤  A general feeling of tiredness, malaise and of being generally unwell.
¤  Going hot and cold.
¤  The urine may look cloudy or discoloured.
¤  Feeling sick.
¤  With a pyelonephritis, there may be fever, pain in the back or sides, and vomiting.

Will I Have Any Tests Or Investigations?

The standard investigation is to test a sample of urine for infection. Some doctors will use a dipstick test at their surgery for this, as well as sending a sample to the local hospital laboratory for analysis. The urine is examined for blood cells and bacteria, and any bacteria found are grown in a special culture, and tested against different antibiotics to see which one best destroys the bacteria (a sensitivity test). Most results are available within 48 hours, but many doctors will begin treatment once the sample has been obtained and before obtaining the results.

To obtain a clean sample of urine, your GP will ask you to give a ‘clean catch’ specimen. This is done by washing the genital area thoroughly, and collecting some urine after 2 or 3 seconds of urination in a sterile container, obtained from your doctor. This method helps to prevent other bacteria from contaminating the sample.

If the same infection appears to repeatedly recur, or there is a severe attack of pyelonephritis, an ultrasound scan of the kidneys may be performed, which is a simple and painless procedure. Another possible test is an IVP – an intravenous pyelogram – where a dye is injected into a vein, and this dye then shows up on simple X-rays taken shortly afterwards. The kidneys and urinary system are outlined by the dye, allowing any blockages or changes to show up. A cystoscopy is a test where a fibreoptic tube is inserted through the urethra and into the bladder, either under local or general anaesthetic, allowing for a direct view of the inside of the bladder. This is sometimes performed if the urine test shows a lot of red blood cells, or if there is a concern there may be any bleeding in the bladder.

What Treatment Might I Need?

The treatment is with antibiotics, the choice of which depends on the test results and any patient allergies they may have to medication. The usual ones used in the UK are trimethoprim, amoxycillin and nitrofurantoin although there are a number of other possible types available. It is usual for only a very few days treatment to be needed, and your doctor may ask you to provide another sample at the end of the course to make sure the infection has cleared. It is always important to finish any course of antibiotics prescribed as symptoms often disappear before the infection fully clears.

What Course Will The Illness Follow?

Most cases of uncomplicated cystitis either resolve without treatment, or respond very quickly to antibiotic therapy. If there are repeated attacks of cystitis – at least 4 each year – your GP may consider the following treatment options;

¤ a single night-time low dose antibiotic for many weeks or months. This appears to be effective and without any serious side effects.
¤ taking a single dose of antibiotic after sexual intercourse.
¤ a 1 or 2 day course of antibiotics when symptoms first appear.

Can I Do Anything To Help Myself?

For the symptoms, a warm pad or hot water bottle can help to relieve the abdominal or loin pain, as well as drinking plenty of water at this time. Avoid coffee, tea and alcohol, and it is also sensible not to eat spicy foods during an attack. Other helpful measures include;

¤  Drink cranberry juice daily. This appears to reduce the ability of E. Coli to ‘stick’ to the bladder as well as acidifying the urine, and so reduces the risk of infection occurring.
¤  Urinate when you need to – do not be tempted to ‘hold on’.
¤  Wipe from the front to the back to prevent bacteria around the anus from entering the vagina or urethra.
¤  Shower instead of bathe.
¤  Try to urinate after intercourse or before sleeping.
¤  Avoid douches and feminine hygiene products – these can irritate the urethra.

Tell Your Doctor

1. When did your symptoms start?
2. Has your urine been cloudy or discoloured?
3. Do you feel the need to urinate more frequently?
4. Do you feel unwell in yourself?
5. Do you have any burning or stinging when you urinate?

Ask Your Doctor

1. Can my partner catch cystitis from me?
2. If I am pregnant, do I need to be treated differently for cystitis?
3. Are infections in men more serious?
4. What are the side effects of any treatment?
5. I have been told that smoking is bad for the bladder. Is this true?

By Dr Roger Henderson, MB BS Lond., LMSSA Lond.

Useful contacts

Interstitial Cystitis Support Group
Address: 76 High Street, Stony Stratford, MK11 1AH
Telephone: 01908 569 169
Fax: 01908 569 169
Email: info [at] intersitialcystitis.co.uk
Website: www.interstitialcystitis.co.uk
Women’s Nutritional Advisory Service
Address: PO Box 268, Lewes, East Sussex, BN7 2QN
Telephone: 01273 487 366
Fax: 01273 487 576
Email: wnas [at] wnas.org.uk
Website: www.wnas.org.uk

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