Attitudes towards sexual well-being are perforated by ignorance even in the 21st century. Neil Trainis talks to celebrity doctor and regular health expert on GMTVs This Morning, Rob Hicks, to shed some light on the problems....
An all-too-familiar subject continues to cause unsettling befuddlement. Sexual health remains strangely, and worringly, enigmatic to many people in the UK. The late 1980s and early 1990s saw an intense advertising campaign designed at raising awareness of HIV and Aids. To hammer home the message the public were subjected to TV commercials showing tombstones engraved with the words “Don't die of ignorance”. Hard-hitting images tend to shock audiences into unremitting caution, yet such perils still elude the British psyche, or more to the point, the youthful British psyche.
The emergence of HIV in the 1980s, and with it the availability of testing in 1985, brought such dangers to the surface but, somewhat astoundingly, awareness has dwindled with the sands of time. A practising GP who juggles his time on the GMTV sofa discussing health issues with working in a hospital sexual health clinic, Dr Rob Hicks is not easily shocked but even he struggles to contain an underlying sense of exasperation towards an alarming misconception among Britain's youth.
“HIV is treatable but not curable. People, particularly young people, think it can actually be cured so there is a casual attitude towards sex,” he says with a hint of frustration. “People don't realise it cannot be cured and have unprotected sex.” In the six months leading up to September 30 2008, Durex reported a 10% rise in sales of condoms to £126.4million. Ocado, the online retailer, also reported a 60% increase in sales across its range of contraceptives during the same period. Nonetheless, unfamiliarity with the virus persists and extends right across the board.
Epidemics of infectious syphilis and Lymphogranuloma venereum (LGV) are continuing especially among men who have sex with men (MSM) who are known to be HIV-infected. In fact, 3,762 diagnoses of infectious syphilis were made in 2007, more than in any other year since 1950, and 849 cases of LGV were diagnosed between 2003 and 2008, the majority of whom had symptoms of proctitis (rectal pain, discharge, bloody stools and constipation).
Neisseria gonorrhoea is the second most common bacterial STI in the UK and young people are most commonly infected, with current rates highest in males aged between 20 and 24 and females aged 16 to19. Hicks is similarly frustrated at a lack of awareness, again largely among the younger generation, of STIs on the whole, suggesting that “syphilis and gonorrhoea are thought to be infections of the past” when they are on the up.
“It is a dangerous assumption. In fact there's been an increase in them but because they are old infections people think they have disappeared when they have not,” he insists. Publicity of STIs, aimed at generating awareness, has been heavily focused, in recent years, on chlamydia and gonorrhoea. Hicks is disappointed that syphilis has, to all intents and purposes, been neglected by publicity-mongers in recent times.
“There's been a focus on chlamydia and gonorrhoea and little on syphilis,” he suggests. “But we need awareness of all the infections, genital warts to HIV.” Syphilis concerns Hicks because of the assumptions which have forced it into the background, yet primary and secondary syphilis can be successfully treated with a single dose of penicillin, normally given as an injection into the buttock. Those allergic to penicillin will be prescribed another antibiotic in tablet form. The latter stages of the disease is treated with three penicillin injections at weekly intervals.
Some of the antibiotics used to treat syphilis can adversely affect methods of contraception containing the hormones oestrogen and progestogen, such as the combined pill or contraceptive patch, so additional contraceptive methods may be required to protect the patient from pregnancy.
Antibiotics are commonly used to treat chlamydia and studies have shown that they are more than 95% effective if taken correctly. The course of antibiotics can be either a single dose or a longer course of up to two weeks. The two most commonly prescribed antibiotics to treat chlamydia are Azithromycin (single dose) and Doxycycline (usually two capsules a day for a week) while less commonly prescribed antibiotics include Ofloxacin, Amoxicillin and Erythromycin.
“Many STIs are treated with antibiotics which are decided nationally. The commonest bacterial infections include chlamydia, which can be treated with the antibiotic azithromycin,” Hicks suggests. The current treatment of choice for gonorrhoea is a ceftriaxone 250mg injection. Genital warts, according to the NHS, are “the leading type of (STI) in England, accounting for one in five cases. Each year in England, on average, 80,000 new cases of genital warts are diagnosed by GUM (genito-urinary medicine) clinics.”
In an attempt to resuscitate awareness of chlamydia, and in the process destigmatise the condition, a national screening programme last year “took a major step forward” as GPs ramped up the number of screens done in general practice, according to a report by the Health Protection Agency.
The report praised GPs for the “enormous progress” the profession has made in screening sexually active men and women aged 16-24 for chlamydia and over 1.5 million tests were conducted as part of the programme in 2009/10. That was an increase of 442,000 tests and a 58% rise on the previous year.
Another sexual complaint, genital warts, are most common in sexually active teenagers and young adults. Men aged between 20 and 24 and women between 16 and 19 represent the highest rates of the condition. “Genital warts is a very common viral infection which can be treated with cryotherapy, which entails freezing the wart using liquid nitrogen to kill the cells of the wart by splitting their outer membranes,” Hicks says. Topical treatments include Podophyllotoxin, normally recommended to treat clusters of small warts. It comes in liquid form and works by having a toxic effect on the cells of the warts. Then there is Imiquimod, a type of cream usually recommended to treat larger warts by helping to stimulate the immune system into attacking them, although there are side-effects.
Trichloroacetic acid (TCA) is used to treat small warts that are very hard and is recommended for pregnant women because it is considered the safest of all the topical treatments to use during pregnancy. Warticon cream, a prescription-only topical treatment of condylomata acuminata affecting the penis and the external female genitalia, is another treatment volunteered by Hicks.
The contraceptive pill, he suggested, is “the most popular” preventative product among women but the choices have opened up. “We're seeing more and more women using long-acting and reversible contraceptives like the intrauterine device, more commonly known as the coil,” he says. “We're increasingly finding women choosing this because it's difficult to take the pill. They forget to take it. You'd be surprised how many of us forget to take our pills during the daily grind.”
Erectile dysfunction is another condition which heaps misery many, particularly older men. It is estimated that half of all men between 40 and 70 years of age will experience this at least once. “Viagra, cialis and levitra are the three tablet medications for this,” Hicks says. Other treatments include Viridal, Muse and Caverject.
“Guys seem to like (Viagra, cialis and levitra). They seem to believe in those. Vacuum pumps and injections into the penis are alternatives, though not particularly nice alternatives. They are still used but I haven't seen a guy treated that way in the last 10 years,” Hicks adds. Viagra, he suggests, “is still being prescribed and is still very popular among men.”
The prostate has also been a source of consternation. Prostate cancer is Britain's most common cancer among men and the second highest killer, after lung cancer, with around 35,000 people a year diagnosed with it. The mortality rate stands at around 12,000. “A lot of men with prostate enlargemnent are treated with saw palmetto which is very popular here. There is also tamsulosin which is a daily tablet and effective,” Hicks remarks. Prostacet, a powerful natural supplement designed to keep the prostate healthy,
contains saw palmetto extract and is another effective treatment of choice. Tamsulosin is, according to Hicks, “the most popular treatment” partly because it is now available over the counter. Flomax, used to improve urination in men with benign prostatic hyperplasia, is the brand name pharmacists should look out for.
Similarly, pregnancy is not a peripheral issue. Figures released in February confirmed that the UK still had the highest teenage pregnancy rate in Europe, with some 40,000 underage girls falling pregnant in 2008. Hicks touches on the treatments available. “Folic acid supplements are popular. Women take these for the first three months of pregnancy and vitamin D is used by pregnant women and breast-feeding women in tablets and capsules,” he says. “Pregnacare is a very popular product and Boots do a good range of treatments.”
As for pain during intercourse, Hicks observes the importance of identifying “what is causing the pain. Sometimes it turns out that there's an infection affecting her tubes or a woman is not libricating there.” He proposes KY Jelly and Yes, a range of organic lubricants “which are pretty good treatments for lubrication.” Sexual health continues to immerse pharmacy with problems and treatments in equal measure.
