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. 

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, 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. 

Lyme disease is a bacterial infection that is caused by the bacterium Borrelia Burgdorferi. This can spread to humans from infected ticks. Some people may be unaware of the tick bite. 

90% of patients with Lyme disease present with erythema migrans. This is a circular or oval shaped rash around the tick bite which can expand outwards. The rash can be flat or slightly raised, and it is not usually itchy or hot. 

This rash usually appears within 1-4 weeks after the initial tick bite, but this could be up to 3 months. The rash can last for several weeks. 

There may be associated flu-like symptoms such as fever, shivers, headache, muscle and joint pain, fatigue and loss of energy. 

Not all ticks carry the bacterium that causes Lyme disease, and the risk of infection is low. It is still recommended to remove a tick if possible. 

It is advised to use a fine-tipped tweezers or tick-removal tool to grasp the tick as close to the skin as possible to remove it. The tick should be pulled upwards without squeezing or crushing it. The bite site should be cleaned with an antiseptic or soap and water. 

It is advised to see a doctor if there has been a tick bite with subsequent rash and flu-like symptoms. 

A blood test for serological analysis may be required to confirm the diagnosis of Lyme disease. Serology may take several weeks to become positive following the tick bite. Re-testing may be needed if the initial test is negative and there are still symptoms of Lyme disease. 

Lyme disease is normally treated with a course of antibiotics such as doxycycline. The duration of the antibiotics depends on the symptoms or stage of Lyme disease, and this can be 2 or 4 weeks. 

Most people recover fully with the treatment, although this can take several months for some people. If symptoms continue for a long time, a specialist assessment in the hospital and further blood tests may be needed.