Genital and Anal Warts

Genital warts are caused by HPV or human papilloma virus. This virus is present in most people and does not usually cause symptoms. 

Genital warts are considered a sexually transmitted infection (STI), and they can develop after unprotected vaginal and anal sexual intercourse, close skin-to-skin contact with an infected person, by sharing sex toys, and rarely through oral sex. 

HPV can be passed on to others even when there are no visible warts. Sexual partners of a person with genital warts should consider getting assessed as they may have warts without being aware of this. 

The warts occur in the genital region such as the vagina, penis, anus and perineum which is the area between the genitals and anus. 

Genital warts are usually small rough lumps and can resemble a cauliflower. They can develop over a period of weeks or months after the initial exposure. The warts may appear as a single wart or in a group. These can be same colour as the skin, darker than the usual skin, red or white. 

They are usually asymptomatic but there can be associated itching, pain or bleeding, particularly if caught on something. Sometimes the warts can cause pain or discomfort during intercourse and problems with urination. 

The exact source of genital warts and how long they may have been present in a person may not be determined. 

Genital warts can sometimes disappear on their own within 6 months, and they do not always require treatment if they do not cause any symptoms. 

The treatments for genital warts come in the form of a cream, liquid or ointment. The treatment is not always effective, and the warts could come back. And it can take weeks or months for the treatment to work after it has been started. 

Some genital wart creams can interfere or weaken condoms so extra precautions should be taken. 

Over the counter wart treatments are not suitable for genital warts and should not be used to treat those. It is advised to avoid unprotected vaginal, anal and oral sex until the warts have cleared. 

HPV can rarely be passed to a baby from the mother, however, genital warts themselves are not usually harmful during pregnancy. Having said that, they can get bigger or become more irritated during pregnancy. Most available treatments are not suitable in pregnancy. The warts usually disappear on their own within 6 weeks of giving birth. 

Genital warts can be spread if an infected area is touched and then touching another part of the body. 

It should be noted that genital warts cannot be passed to others through kissing or from sharing towels, cups, cutlery, or toilet seats. 

To prevent genital warts from spreading, it is recommended to use condoms when having vaginal, anal or oral sex, and to avoid skin-to-skin contact. It is also advised to avoid sex if the treatment has been started, and to avoid sharing sex toys.

Imiquimod or Aldara is a common treatment option for genital and anal warts. This works on the immune system to fight HPV that causes the warts. 

Podophyllotoxin can be used for the treatment of genital warts but not for anal warts. 

Other agents including trichloroacetic acid (TCA) and Catephen ointment may also be used to treat genital warts. 

For anal warts, podophyllin, trichloroacetic acid or bichloroacetic acid can be used.

Physical ablation by cryotherapy, surgical excision, electrosurgery or laser treatment may be considered if topical treatments do not work. 

If there is suspicion of genital warts, it is advised to see a doctor in person or go to Sexual Health Clinic for further assessment. 

Genital herpes is a sexually transmitted infection or STI, and it is caused by Herpes Simplex Virus Type 2 or HSV Type 2. The infection can be transmitted through vaginal, anal, or oral sex. 

Herpes Simplex Virus stays in the body for life once the infection has occurred. 

Genital herpes is very contagious and can easily be passed on to others. The infection can happen from when the symptoms first occur to when the sores have completely gone away. It is possible to pass on the virus even if there are no active symptoms. 

Genital herpes can be caught through skin-to-skin contact with an infected area such as the vagina, the penis and anal region, and with oral sex. This can occur in the absence of any visible sores or blisters. 

Genital herpes can also be caught if a cold sore or oral herpes touches genital area, with infection on fingers that touch genital area, and by sharing sex toys with someone who has herpes. 

The infection does not survive outside the body, so it is not possible to get genital herpes from sharing cutlery, cups, or other similar objects. Genital herpes cannot spread from toilet seats, bedding, sharing towels or soaps, or from swimming pools. 

Genital herpes sores usually look like a cluster of blisters filled with fluid. These can be painful or itchy. 

Genital herpes sores can be different sizes and can occur in various places in the genital and anal region, and on buttocks and thighs. Sometimes, these sores can break leading to bleeding and discharge. 

The sores can resolve on their own without treatment, and they could come back again as an outbreak. Recurrent outbreaks usually produce milder symptoms than the first episode. The frequency of outbreaks may become less and less over time and less severe. It is possible that some people may never get any outbreaks. 

The common symptoms of genital herpes are blisters that can be open sores, tingling, burning or itching in the affected areas, pain on urination, and unusual discharge. 

If there are sores or symptoms suggestive of genital herpes, it is advisable to see a doctor or go to a sexual health clinic for further assessment and testing. 

Genital herpes can be treated with an antiviral medication called Valtrex or Valacyclovir. 

The treatment with antiviral medication could help shorten an outbreak by a few days if is taken as soon as the symptoms start. 

If there have been more than six outbreaks in a year, taking antiviral medication for 6 to 12 months can be beneficial. 

There are several measures that can help to reduce the pain or discomfort associated with genital herpes. 

It is recommended to keep the affected area clean using plain or salt water to prevent further infection. 

An ice pack can help with the pain or irritation. Ice should not directly be put on the skin. 

Vaseline or 5 % lidocaine numbing cream applied to the affected area could help with pain as well. 

Pouring water over the genitals while urinating can help ease the pain. 

It is best to avoid tight clothing and underwear that might irritate the sores. 

It is advised to avoid vaginal, anal or oral sex until all the sores have gone away. 

It is also advised to avoid any possible triggers such as sunbathing or sunbeds, irritants or friction in genital area, smoking, and alcohol. 

The other possible triggers of genital herpes are monthly cycle, surgery in genital region, stress, low immunity, and other infections. 

Genital herpes infection before a pregnancy should not cause any major problems during the progression of the pregnancy and the labour. 

If there are symptoms of genital herpes during a pregnancy, it is strongly advised to see a doctor in person as treatment with antiviral medication may be needed. 

Hay fever is a very common medical condition, and it is also called allergic rhinitis. Hay fever causes cold-like symptoms such as runny nose, sneezing, coughing, congestion, itchy eyes and sinus pressure. 

Although it causes cold-like symptoms it is not caused by a virus and it is an allergic reaction. 

Hay fever occurs in some people when immune system overreacts to allergens in the air, leading to inflammation in the nose. The common allergens are pollen, dust, animal dander, and mould. The body produces an allergic reaction when these come into contact with the mouth, nose, throat and eyes. 

Apart from the common symptoms mentioned earlier, hay fever can also cause blocked nose, red or watery eyes, itchy throat, mouth, nose and ears, loss of smell, headache, and feeling tired. 

The symptoms of hay fever usually become worse between late March and September due to warm, humid and windy weather and an increase in pollen count.  

Hay fever symptoms can last for weeks or months, depending on the presence of allergens. 

There is currently no cure for hay fever or a way to prevent it, but the symptoms can be managed well with various measures and medicines. 

The symptoms of hay fever can be prevented by avoiding the common allergens and triggers. 

Petroleum jelly like Vaseline can be put around the nose to trap pollen during high pollen counts and when outside. Wearing a wide-brimmed hat and sunglasses can stop pollen getting into the nose and eyes. 

It is advisable to change clothes and shower after being outside to wash off pollen. Keeping windows and doors closed and regular vacuuming during times of high pollen presence may also be beneficial. 

It is not recommended to cut grass or walk on grass as this would increase the exposure to pollens. Avoiding active and passive smoking, drying clothes outside, fresh flowers and pets in the house can also help. 

If these measures do not help or if the symptoms of hay fever are severe, medical treatment options can be considered. 

The main treatments for hay fever are antihistamine tablets, drops or nasal sprays, and steroid nasal sprays. The most widely available antihistamines that can be obtained without a prescription are loratadine, cetirizine and fexofenadine. 

It should be noted that some antihistamines can cause drowsiness, so extra precautions should be taken if operating heavy machinery or driving, and to consider non-drowsy antihistamines.

If these treatments do not work, it is recommended to see a doctor in person for further assessment. Oral steroids can be prescribed for more severe or resistant cases of hay fever. 

If oral steroids and other treatments do not work, immunotherapy can be considered, which is a specialised therapy for hay fever. This involves taking small amounts of pollen as an injection or tablet to slowly build up the immunity to pollen. Immunotherapy usually starts a few months before hay fever season begins so that it can be effective. 

It should be noted that this therapy is offered when all the other treatments have failed. This is a specialist treatment and may not be available everywhere. 

Headaches are very common in people and in most cases, they are not due to anything serious. Headaches can last from a few hours to a few days and usually resolve on their own. 

The common causes of headaches are acute illness such as a cold or flu, tension headache, dehydration, excess alcohol, not eating well, bad posture, stress, eye or tooth problems. 

The other possible causes are migraine, sinus infection, being on a period or going through menopause, and neck problems. 

Taking too many painkillers can also cause headaches and this is known as medication overuse headache. 

Tension headache is like a tight band around the head. The causes of tension headache are stress, anxiety, poor posture, lack of sleep, and muscle tension in the neck and shoulders. 

Tension headache usually gets worse towards the end of the day. 

This can be treated with painkillers such as paracetamol and ibuprofen. Ibuprofen should not be used if there is history of asthma or stomach disease or if on blood thinners. 

Stress management techniques, relaxation exercises, regular sleep, good hydration and physiotherapy can also be beneficial. 

Migraine can be related to genetic predisposition, hormonal changes, environmental factors, and rarely certain foods or drinks in some people. 

The treatment options available for migraine include paracetamol and ibuprofen, migraine tablets such as sumatriptan, and anti-sickness medication. 

Preventive measures for migraine include beta-blockers, calcium channel blockers, and topiramate. 

Avoiding triggers, having regular sleep, and keeping well hydrated can also help. 

Sinus headaches occur due to inflammation or infection of the sinuses and allergies.

Treatment with decongestants, nasal corticosteroids, and painkillers can help. If the underlying cause is infection, a course of antibiotics will be required. 

Medication overuse headache can be treated with gradual reduction or discontinuation of pain medications. This should ideally be done under the supervision of a doctor to ensure it goes smoothly without causing any further problems. 

If this does not work, non-pharmacological treatments like cognitive behavioural therapy or CBT and relaxation techniques can be considered.

Headaches associated with eyesight can be improved by avoiding prolonged screen time and improper lighting, and by correcting any vision problems through an optician. Corrective eyewear may be needed and this should be used where necessary.

Cervicogenic headache originates from the neck and is often due to muscle tension or structural issues like poor posture or spinal problems. 

Treatment of this involves painkillers and physiotherapy.

If headaches are frequent or persistent, or if they are accompanied by symptoms such as visual disturbances, nausea, vomiting, or neurological symptoms such as weakness, numbness or dizziness, it is advisable to see a doctor or go to a hospital for further assessment. 

Heart palpitations are when the heart is beating faster than usual and when the heartbeat is more noticeable in the chest, neck or throat. 

Heart palpitations are not usually due to any serious underlying cause if there are no other symptoms. 

The common feelings that a person can experience with palpitations include racing heart, pounding or thumping feeling in the chest, fluttering, irregular heartbeat with skipped or extra beats. 

Heart palpitations are common and can last seconds, minutes or longer. 

The common causes are stress and anxiety, lack of sleep, alcohol, caffeine, nicotine, recreational drugs, strenuous exercise, low blood pressure, current infection, and certain medications. 

Palpitations can also occur during pregnancy and when going through menopause. 

The rarer causes are heart disease or arrythmia, hyperthyroidism or overactive thyroid, and iron deficiency anaemia. 

If the palpitations occur for a short period of time, it is recommended to see a doctor in person for full assessment and various tests. 

However, if heart palpitations are associated with chest pain, breathlessness, dizziness or feeling faint, it is advisable to call an ambulance for more urgent assessment. 

Mild intermittent palpitations may not require any treatment and avoiding any triggers can be sufficient. When there is a history of palpitations it is best to avoid alcohol, caffeine, smoking, and stress. 

An ECG or electrocardiogram may be required to check the heart if the palpitations become persistent or lead to other symptoms. Treatment with medications or other interventions may be necessary if the underlying cause is found to be an arrythmia. 

A high temperature or fever is very common in babies and children. This is usually due to common childhood illnesses such as coughs and colds, throat infection, chickenpox, and vaccinations. High temperature is a natural and healthy response for the body to fight an infection. 

High temperature can last between 1 to 5 days. If high temperature lasts more than 5 days, this will warrant a medical assessment by a doctor.  

The normal body temperature can vary slightly from person to person, and it is between 36 - 37C. A high temperature is defined as being 38C or higher.

The temperature of a baby or child can be measured with a digital thermometer. 

If there are no other associated symptoms, a child with high temperature can be managed at home. It is recommended to provide adequate fluids or milk to prevent dehydration. 

Paracetamol can be given if babies and children show signs of discomfort or distress due to high temperature. 

It is best to keep them at home and monitor them regularly, including during the night. 

It is not advisable to undress or sponge babies and children to try to reduce the temperature. These are outdated practices and do not usually work. Babies and children should not be covered up in too many clothes or bedclothes, even if they give the impression that they are cold. 

Aspirin is not recommended for children under 16 years of age, and it is best not to alternate between paracetamol and ibuprofen unless necessary or advised by a doctor. 

Paracetamol is not suitable for children under 2 months. Ibuprofen is not suitable for those under 3 months and if there is history of asthma or chickenpox infection.

It should be noted that urgent medical assessment is advised if a child under 3 months has a temperature of 38C or higher, and a child 3 to 6 months old with a temperature of 39C or higher. 

If there are other symptoms such as a rash, vomiting, breathing difficulties, drowsiness, or dehydration, this will also require urgent assessment. 

Temperature alone may not be a reliable way of knowing how unwell a child is. If a child or baby has a mild fever and looks unwell, they must be assessed by a doctor as soon as possible. 

It is possible to delay a period for various reasons such as holiday, wedding or exam. 

There are two common ways to delay a period. 

If on a fixed dose combined oral contraceptive pill, this can be taken back-to-back without having a pill free period and this would delay the period. 

Taking two packs of combined pill back-to-back is usually safe if this is done occasionally. There should be a 7-day pill free period after taking two packs back-to-back. 

If not on a combined oral contraceptive pill, a medication called norethisterone can be taken to delay the period. This is a hormone-based medication and contains progestogen. 

This is usually taken 3 to 4 days before the period is due to begin. It can be continued until it is ready to have the next period, usually up to 3 to 4 weeks.

The usual dose is one 5 mg tablet three times a day. The period normally begins 2 to 3 days after stopping norethisterone. 

Norethisterone should only be taken occasionally to delay the period and not on a regular basis or as a form of contraception.  And it should not be taken if there is a possibility of pregnancy as it can cause problems in the developing baby. 

If there is spotting before the actual period, norethisterone can still be taken. 

Norethisterone should not be taken if there is a high risk of DVT or deep vein thrombosis. Instead, medroxyprogesterone can be considered as this has a lower risk of causing DVT. 

Norethisterone can cause side effects in some women and these include stomach upset, bloating, reduced libido and breast discomfort.

It is advisable to see a doctor if it is required to delay the period to ensure that there are no contraindications. 

Thyroid gland is a gland in the neck that produces thyroid hormones which are essential for normal functioning of the body.  

Hyperthyroidism or overactive thyroid is when the thyroid gland is producing too much of the hormones. Hyperthyroidism is also known as thyrotoxicosis. 

Hyperthyroidism usually occurs between 20 and 40 years of age. Although it can affect anyone it is ten times more common in women. 

The causes of hyperthyroidism include Graves’ disease which is an autoimmune disease, infection, goitre, nodules in the thyroid gland, other hormonal imbalances, and certain medications such as amiodarone. 

There are rarer causes of hyperthyroidism, and these include raised human chorionic gonadotrophin or HCG , pituitary adenoma, thyroid cancer, and thyroiditis. 

HCG is usually related to various forms of pregnancy, but it can stimulate thyroid stimulating hormone or TSH. 

The main symptoms of hyperthyroidism are weight loss, irregular or fast heartbeat, fatigue, tremor or twitching, feeling hot, frequent bowel motions or diarrhoea, feeling nervous or anxious, mood swings, difficulty sleeping, swelling in the neck, itchiness, persistent thirst, and reduced sexual drive. 

Untreated hyperthyroidism can lead to eye problems such as bulging eyes, double vision and irritation. Additionally, it may cause pregnancy problems, and thyroid storm which is a sudden and severe flare up. 

The diagnosis is clinical and this can be confirmed with a blood test to check thyroid function. 

The treatments for hyperthyroidism include medications such as carbimazole and propylthiouracil, radioiodine therapy which is a type of radiotherapy, and surgery to remove part or all of the thyroid gland. 

Thyroid medication is usually taken for 12 to 18 months, and it could take a few months before seeing any improvements. Once the hormone levels are under control, the dose can be gradually reduced and then stopped. Some people may need to take the medication for life. 

Carbimazole must not be taken during pregnancy and adequate contraception should be used while taking this medication as it can cause serious problems in the developing baby. 

A beta blocker such as propranolol can also be used to treat some of the symptoms of hyperthyroidism, particularly fast heartbeat and palpitations. 

If there are any symptoms that may be related to hyperthyroidism, it is advisable to see a doctor in person for full assessment. 

Hypothyroidism or underactive thyroid is a condition where thyroid gland does not produce sufficient amounts of thyroid hormone. 

Hypothyroidism is a common condition and it is not possible to prevent it. Most cases are caused by autoimmune disease in which the body’s own immune system attacks the thyroid gland, or by external factors. 

So, the common causes of hypothyroidism include autoimmune disease, excess or lack of iodine, infection or inflammation of thyroid gland called thyroiditis, and certain medications such lithium, amiodarone and interferons. 

The other causes are previous surgery or radiotherapy, thyroid cancer, and problems with the pituitary gland located in the brain. 

The most common autoimmune disease affecting the thyroid gland is called Hashimoto’s disease, and the exact cause of this is not clear. 

The symptoms of hypothyroidism can develop slowly and may not be noticeable for years. 

The common symptoms are lack of energy, tiredness, slow bowels or constipation, weight gain, feeling cold, muscle aches, dry skin and hair, and psychological issues such as depression. 

The other symptoms that can occur are loss of libido, pain, numbness or tingling in hands and fingers, and irregular or heavy periods. 

If hypothyroidism is more advanced, there could be other symptoms such as puffy face, hoarse voice, thinned eyebrows, hearing loss, anaemia, and slow heart rate.

Hypothyroidism is normally diagnosed with a blood test to check the level of thyroid hormones. 

Hypothyroidism can occur at any age although it is more common in adults. 

Children can develop it as well, and some babies are born with it, a condition known as congenital hypothyroidism. All newborn babies are therefore checked for hypothyroidism by a screening blood test 5 days after they are born. 

The treatment of hypothyroidism is with daily hormone replacement called levothyroxine which raises thyroid hormone level in the body. This treatment is usually taken indefinitely, and most people have a normal life once stable on the optimal dose. 

Untreated hypothyroidism can lead to complications such as heart disease, goitre, pregnancy problems, and more rarely myxoedema coma. 

Myxoedema presents with swelling and thickening of the skin, confusion, drowsiness and hypothermia or very low body temperature. Myxoedema is an emergency and requires admission to the hospital. It is treated with intravenous thyroxine, plus steroids and antibiotics as appropriate. 

Alternative or natural remedies are not usually recommended for hypothyroidism as their effectiveness and safety is not clear. It is thought that glandular extract and selenium supplements may help with hypothyroidism but these may not work at all. 

It is advisable to see a doctor if there are symptoms that might suggest possible hypothyroidism.