lzheimer's disease

1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Prevention
Introduction
Alzheimer's disease is the most common type of dementia, affecting an
estimated 850,000 people in the UK.

Dementia is a progressive neurological disease which affects multiple brain

functions, including memory.

The exact cause of Alzheimer's disease is unknown, although a number of

things are thought to increase your risk of developing the condition. These
include:

 increasing age
 a family history of the condition
 previous severe head injuries
 lifestyle factors and conditions associated with cardiovascular disease
It's becoming increasingly understood that it's very common to have both
changes of Alzheimer's and vascular dementia together (mixed dementia).

Read more about the causes of Alzheimer's disease

Signs and symptoms of Alzheimer's disease

Alzheimer's disease is a progressive condition, which means the symptoms
develop gradually and become more severe over the course of several years.
It affects multiple brain functions.

The first sign of Alzheimer's disease is usually minor memory problems. For
example, this could be forgetting about recent conversations or events, and
forgetting the names of places and objects.
As the condition develops, memory problems become more severe
and further symptoms can develop, such as:

 confusion, disorientation and getting lost in familiar places

 difficulty planning or making decisions
 problems with speech and language
 problems moving around without assistance or performing self-care
tasks
 personality changes, such as becoming aggressive, demanding and
suspicious of others
 hallucinations (seeing or hearing things that aren't there) and delusions
(believing things that are untrue)
 low mood or anxiety
Read more about the symptoms of Alzheimer's disease

Who is affected?
Alzheimer's disease is most common in people over the age of 65, and affects
slightly more women than men.

The risk of Alzheimer's disease and other types of dementia increases with
age, affecting an estimated 1 in 14 people over the age of 65 and 1 in every 6
people over the age of 80.

However, around 1 in every 20 cases of Alzheimer's disease affects people

aged 40 to 65.

Receiving a diagnosis
As the symptoms of Alzheimer's disease progress slowly, it can be difficult to
recognise that there's a problem. Many people feel that memory problems are
simply a part of getting older.

However, a timely diagnosis of Alzheimer's disease can give you the best
chance to prepare and plan for the future, as well as receive any treatment or
support that may help.

If you're worried about your memory or think you may have dementia, it's a
good idea to see your GP. If you're worried about someone else, you should
encourage them to make an appointment and perhaps suggest that you go
along with them.

There's no single test that can be used to diagnose Alzheimer's disease. Your
GP will ask questions about any problems you are experiencing and may do
some tests to rule out other conditions.

If Alzheimer's disease is suspected, you may be referred to a specialist

memory service to:

 discuss the process of making the diagnosis

 organise testing
 create a treatment plan
Read more about diagnosing Alzheimer's disease

How Alzheimer's disease is treated

There's no cure for Alzheimer's disease, but medication is available that can
help relieve some of the symptoms and slow down the progression of the
condition in some people.

Various other types of support are also available to help people with
Alzheimer's live as independently as possible, such as making changes to
your home environment so it's easier to move around and remember daily
tasks.

Psychological treatments such as cognitive stimulation therapy may also be

offered to help support your memory, problem solving skills and language
ability.

Read more about treating Alzheimer's disease

Outlook
On average, people with Alzheimer's disease live for around 8 to 10 years
after they start to develop symptoms. However, this can vary considerably
from person to person. Some people with the condition will live longer than
this, but others will not.

Alzheimer's disease is a life-limiting illness, although many people diagnosed

with the condition will die from another cause.
 As Alzheimer’s disease is a progressive neurological condition, it can cause
problems with swallowing. This can lead to aspiration (food being inhaled into
the lungs) which can cause frequent chest infections. It's also common for
people with Alzheimer’s disease to eventually have difficulty eating and to
have a reduced appetite.

There's increasing awareness that people with Alzheimer’s disease

need palliative care. This includes support for families, as well as the person
with Alzheimer's.

Can Alzheimer's disease be prevented?

As the exact cause of Alzheimer's disease isn't clear, there's no known way to
prevent the condition. However, there are things you can do that may reduce
your risk or delay the onset of dementia, such as:

 stopping smoking and cutting down on alcohol

 eating a healthy, balanced diet and maintaining a healthy weight
 staying physically fit and mentally active
These measures have other health benefits, such as lowering your risk of
cardiovascular disease and improving your overall mental health.

Anxiety
1. Introduction
2. Symptoms
3. Diagnosis
4. Treatment
5. Self help
Introduction
Anxiety is a feeling of unease, such as worry or fear, that can be mild or
severe.

Everyone has feelings of anxiety at some point in their life. For example, you
may feel worried and anxious about sitting an exam or having a medical test
or job interview. During times like these, feeling anxious can be perfectly
normal.
However, some people find it hard to control their worries. Their feelings of
anxiety are more constant and can often affect their daily life.

Anxiety is the main symptom of several conditions, including panic disorder,

phobias, post-traumatic stress disorder and social anxiety disorder (social
phobia).

However, the information in this section is about a specific condition called

generalised anxiety disorder (GAD).

Generalised anxiety disorder (GAD)

GAD is a long-term condition that causes you to feel anxious about a wide
range of situations and issues, rather than one specific event.

People with GAD feel anxious most days and often struggle to remember the
last time they felt relaxed. GAD can cause both psychological (mental) and
physical symptoms. These vary from person to person, but can include feeling
restless or worried and having trouble concentrating or sleeping.

Read about the symptoms of GAD

When to see your GP

Although feelings of anxiety at certain times are completely normal, you
should see your GP if anxiety is affecting your daily life or is causing you
distress.

Your GP will ask you about your symptoms and your worries, fears and
emotions to try to find out if you could have GAD.

Read more about diagnosing GAD

What causes GAD?

The exact cause of GAD is not fully understood, although it's likely that a
combination of several factors plays a role. Research has suggested these
may include:

 overactivity in areas of the brain involved in emotions and behaviour

 an imbalance of the brain chemicals serotonin and noradrenaline, which
are involved in the control and regulation of mood
  the genes you inherit from your parents – you're estimated to be five
times more likely to develop GAD if you have a close relative with the
condition
 having a history of stressful or traumatic experiences, such as domestic
violence, child abuse or bullying
 having a painful long-term health condition, such as arthritis
 having a history of drug or alcohol misuse
However, many people develop GAD for no apparent reason.

Who is affected?
GAD is a common condition estimated to affect about 1 in every 25 people in
the UK.

Slightly more women are affected than men, and the condition is more
common in people between the ages of 35 and 55.

How GAD is treated

GAD can have a significant effect on your daily life, but several different
treatments are available that can help ease your symptoms. These include:

 psychological therapy– such as cognitive behavioural therapy (CBT)

 medication – such as a type of antidepressant called selective serotonin
reuptake inhibitors (SSRIs)
There are also many things you can do yourself to help reduce your anxiety,
such as going on a self-help course, exercising regularly, stopping smoking
and cutting down on the amount of alcohol and caffeine you drink.

With treatment, many people are able to control their levels of anxiety.
However, some treatments may need to be continued for a long time and
there may be periods where your symptoms worsen.

Appendicitis
1. Introduction
2. Symptoms
3. Diagnosis
4. Treatment
5. Complications
Introduction
Appendicitis is a painful swelling of the appendix. The appendix is a small, thin
pouch about 5-10cm (2-4 inches) long. It's connected to the large intestine,
where stools (faeces) are formed.

Nobody knows exactly why we have an appendix, but removing it isn't

harmful.

Appendicitis typically starts with a pain in the middle of your tummy

(abdomen) that may come and go.

Within hours, the pain travels to the lower right-hand side, where the appendix
usually lies, and becomes constant and severe.

Pressing on this area, coughing, or walking may all make the pain worse. You
may lose your appetite, feel sick, and occasionally experience diarrhoea.

Read more about the symptoms of appendicitis.

When to get medical help

If you're experiencing abdominal pain that's gradually getting worse, contact
your GP or local out-of-hours service immediately. If these options aren't
available, call NHS 24 111 Service for advice.

You should call 999 for an ambulance if you have sudden pain that continues
to get worse and spreads across your abdomen.

These are signs your appendix may have burst, which can lead to potentially
life-threatening complications.

Read more about:

diagnosing appendicitis

complications of appendicitis

How appendicitis is treated

In most cases of appendicitis, the appendix needs to be surgically removed as
soon as possible.
Removal of the appendix, known as an appendectomy or appendicectomy, is
one of the most common operations in the UK and its success rate is
excellent.

The operation is most commonly performed as keyhole surgery (laparoscopy),

which involves making several small cuts in your abdomen, through which
special surgical instruments are inserted.

Open surgery, where a larger, single cut is made in the abdomen, is usually
carried out if the appendix has burst or access is more difficult.

Most people make a full recovery from an appendectomy in a couple of

weeks, although strenuous activities may need to be avoided for up to
6 weeks after open surgery.

Read more about treating appendicitis.

What causes appendicitis?

It's not exactly clear what the causes of appendicitis are. Most cases are
thought to occur when something blocks the entrance of the appendix.

For example, a blockage may be formed by a small piece of faeces or an

upper respiratory tract infection could lead to a swollen lymph node within the
wall of the bowel.

This obstruction leads to the development of inflammation and swelling. The

pressure caused by the swelling can then lead to the appendix bursting.

As the causes aren't fully understood, there's no guaranteed way of

preventing appendicitis.

Who's affected?
Appendicitis is a common condition. Around 40,000 people are admitted to
hospital with appendicitis each year in England.

It's estimated around 1 in every 13 people develop it at some point in their life.

Appendicitis can develop at any age, but it's most common in young people
aged from 10 to 20 years old.

Arthritis
1. Introduction
2. Living with arthritis
Introduction
Arthritis is a common condition that causes pain and inflammation in a joint.

In the UK, around 10 million people have arthritis. It affects people of all ages,
including children (see below).

Types of arthritis
The two most common types of arthritis are:

 osteoarthritis
 rheumatoid arthritis

Osteoarthritis
Osteoarthritis is the most common type of arthritis in the UK, affecting around
8 million people.

It most often develops in adults who are in their late 40s or older. It's also
more common in women and people with a family history of the
condition. However, it can occur at any age as a result of an injury or be
associated with other joint-related conditions, such as gout or rheumatoid
arthritis.

Osteoarthritis initially affects the smooth cartilage lining of the joint. This
makes movement more difficult than usual, leading to pain and stiffness.

Once the cartilage lining starts to roughen and thin out, the tendons and
ligaments have to work harder. This can cause swelling and the formation of
bony spurs, called osteophytes.

Severe loss of cartilage can lead to bone rubbing on bone, altering the shape
of the joint and forcing the bones out of their normal position.

The most commonly affected joints are those in the:

 hands
 spine
 knees
  hips

Rheumatoid arthritis
In the UK, rheumatoid arthritis affects more than 400,000 people. It often
starts when a person is between 40 and 50 years old. Women are three times
more likely to be affected than men.

Rheumatoid and osteoarthritis are two different conditions. Rheumatoid

arthritis occurs when the body's immune system targets affected joints, which
leads to pain and swelling.

The outer covering (synovium) of the joint is the first place affected. This can
then spread across the joint, leading to further swelling and a change in the
joint's shape. This may cause the bone and cartilage to break down.

People with rheumatoid arthritis can also develop problems with other tissues
and organs in their body.

Other types of arthritis and related conditions

 Ankylosing spondylitis – a long-term inflammatory condition that mainly
affects the bones, muscles and ligaments of the spine, leading to
stiffness and joints fusing together. Other problems can include the
swelling of tendons, eyes and large joints.
 Cervical spondylosis – also known as degenerative osteoarthritis,
cervical spondylitis affects the joints and bones in the neck, which can
lead to pain and stiffness.
 Fibromyalgia – causes pain in the body's muscles, ligaments and
tendons.
 Lupus – an autoimmune condition that can affect many different organs
and the body's tissues.
 Gout – a type of arthritis caused by too much uric acid in the body. This
can be left in joints (usually affecting the big toe) but can develop in any
joint. It causes intense pain, redness and swelling.
 Psoriatic arthritis – an inflammatory joint condition that can affect people
with psoriasis.
 Enteropathic arthritis – a form of chronic, inflammatory arthritis
associated with inflammatory bowel disease (IBD), the two best-known
types being ulcerative colitis and Crohn's disease. About one in five
people with Crohn's or ulcerative colitis will develop enteropathic
 arthritis. The most common areas affected by inflammation are the
peripheral (limb) joints and the spine.
 Reactive arthritis – this can cause inflammation of the joints, eyes and
urethra (the tube that urine passes through). It develops shortly after an
infection of the bowel, genital tract or, less frequently, after a throat
infection.
 Secondary arthritis – a type of arthritis that can develop after a joint
injury and sometimes occurs many years afterwards.
 Polymyalgia rheumatica – a condition that almost always affects people
over 50 years of age, where the immune system causes muscle pain
and stiffness, usually across the shoulders and tops of the legs. It can
also cause joint inflammation.

Symptoms of arthritis
The symptoms of arthritis you experience will vary depending on the type you
have.

This is why it's important to have an accurate diagnosis if you have:

 joint pain, tenderness and stiffness

 inflammation in and around the joints
 restricted movement of the joints
 warm, red skin over the affected joint
 weakness and muscle wasting

Arthritis and children

Arthritis is often associated with older people, but it can also affect children. In
the UK, about 15,000 children and young people are affected by arthritis.

Most types of childhood arthritis are known as juvenile idiopathic arthritis

(JIA). JIA causes pain and inflammation in one or more joints for at least six
weeks.

Although the exact cause of JIA is unknown, the symptoms often improve as a
child gets older, meaning they can lead a normal life.

The main types of JIA are discussed below. Arthritis Research UK has more
information about the different types of juvenile idiopathic arthritis.
Oligo-articular JIA
Oligo-articular JIA is the most common type of JIA. It affects fewer than five
joints in the body – most commonly in the knees, ankles and wrists.

Oligo-articular JIA has good recovery rates and long-term effects are rare.
However, there's a risk that children with the condition may develop eye
problems, so regular eye tests with an ophthalmologist (eye care specialist)
are recommended.

Polyarticular JIA (polyarthritis)

Polyarticular JIA, or polyarthritis, affects five or more joints. It can develop at
any age during childhood.

The symptoms of polyarticular JIA are similar to the symptoms of adult

rheumatoid arthritis. The condition is often accompanied by a rash and a high
temperature of 38C (100.4F) or above.

Systemic onset JIA

Systemic onset JIA begins with symptoms such as a fever, rash, lethargy (a
lack of energy) and enlarged glands. Later on, joints can become swollen and
inflamed.

Like polyarticular JIA, systemic onset JIA can affect children of any age.

Enthesitis-related arthritis
Enthesitis-related arthritis is a type of juvenile arthritis that affects older boys
or teenagers. It can cause pain in the soles of the feet and around the knee
and hip joints, where the ligaments attach to the bone.

Treating arthritis
There's no cure for arthritis, but there are many treatments that can help slow
down the condition.

For osteoarthritis, medications are often prescribed, including:

 painkillers
 non-steroidal anti-inflammatory drugs (NSAIDs)
 corticosteroids
In severe cases, the following surgical procedures may be recommended:
  arthroplasty (joint replacement)
 arthodesis (joint fusion)
 osteotomy (where a bone is cut and re-aligned)
Read more about how osteoarthritis is treated.

Treatment for rheumatoid arthritis aims to slow down the condition's progress
and minimise joint inflammation or swelling. This is to try and prevent damage
to the joints. Recommended treatments include:

 analgesics (painkillers)
 disease modifying anti-rheumatic drugs (DMARDs) – a combination of
treatments is often recommended
 physiotherapy
 regular exercise

Asthma
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Living with asthma
Introduction
Asthma is a common long-term condition that can cause coughing, wheezing,
chest tightness and breathlessness.

The severity of these symptoms varies from person to person. Asthma can be
controlled well in most people most of the time, although some people may
have more persistent problems.

Occasionally, asthma symptoms can get gradually or suddenly worse. This is

known as an "asthma attack", although doctors sometimes use the term
"exacerbation".

Severe attacks may require hospital treatment and can be life threatening,
although this is unusual.

Read more about the symptoms of asthma and diagnosing asthma

What causes asthma?
Asthma is caused by inflammation of the small tubes, called bronchi, which
carry air in and out of the lungs. If you have asthma, the bronchi will be
inflamed and more sensitive than normal.

When you come into contact with something that irritates your lungs – known
as a trigger – your airways become narrow, the muscles around them tighten,
and there is an increase in the production of sticky mucus (phlegm).

Common asthma triggers include:

 house dust mites

 animal fur
 pollen
 cigarette smoke
 exercise
 viral infections
Asthma may also be triggered by substances (allergens or chemicals) inhaled
while at work. Speak to your GP if you think your symptoms are worse at work
and get better on holiday.

The reason why some people develop asthma is not fully understood,
although it is known that you are more likely to develop it if you have a family
history of the condition.

Asthma can develop at any age, including in young children and elderly
people.

Read more about the causes of asthma

Who is affected?
In the UK, around 5.4 million people are currently receiving treatment for
asthma.

That's the equivalent of 1 in every 12 adults and 1 in every 11 children.

Asthma in adults is more common in women than men.

How asthma is treated

 While there is no cure for asthma, there are a number of treatments that can
help control the condition.

Treatment is based on two important goals, which are:

 relieving symptoms
 preventing future symptoms and attacks
For most people, this will involve the occasional – or, more commonly, daily –
use of medications, usually taken using an inhaler. However, identifying and
avoiding possible triggers is also important.

You should have a personal asthma action plan agreed with your doctor or
nurse that includes information about the medicines you need to take, how to
recognise when your symptoms are getting worse, and what steps to take
when they do so.

Read more about treating asthma and living with asthma

Outlook
For many people, asthma is a long-term condition – particularly if it first
develops in adulthood.

Asthma symptoms are usually controllable and reversible with treatment,

although some people with long-lasting asthma may develop permanent
narrowing of their airways and more persistent problems.

For children diagnosed with asthma, the condition may disappear or improve
during the teenage years, although it can return later in life. Moderate or
severe childhood asthma is more likely to persist or return later on.

Attention deficit hyperactivity disorder

(ADHD)
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Living with ADHD
Introduction
Attention deficit hyperactivity disorder (ADHD) is a group of behavioural
symptoms that include inattentiveness, hyperactivity and impulsiveness.

Symptoms of ADHD tend to be noticed at an early age and may become more
noticeable when a child's circumstances change, such as when they start
school. Most cases are diagnosed when children are 6 to 12 years old.

The symptoms of ADHD usually improve with age, but many adults who are
diagnosed with the condition at a young age continue to experience problems.

People with ADHD may also have additional problems, such as sleep and
anxiety disorders.

Read more about the symptoms of ADHD

Getting help
Many children go through phases where they're restless or inattentive. This is
often completely normal and doesn't necessarily mean they have ADHD.

However, you should consider raising your concerns with your child's teacher,
their school's special educational needs co-ordinator (SENCO) or GP if you
think their behaviour may be different to most children their age.

It's also a good idea to speak to your GP if you're an adult and you think you
may have ADHD, but you weren't diagnosed with the condition as a child.

Read more about diagnosing ADHD

What causes ADHD?

The exact cause of ADHD is unknown, but the condition has been shown to
run in families. Research has also identified a number of possible differences
in the brains of people with ADHD compared to those who don't have the
condition.

Other factors that have been suggested as potentially having a role in ADHD
include:

 being born prematurely (before the 37th week of pregnancy)

 having a low birthweight
  smoking, alcohol or drug abuse during pregnancy
ADHD is more common in boys than girls. It's thought that around 2% to 5%
of school-aged children may have the condition.

ADHD can occur in people of any intellectual ability, although it's more
common in people with learning difficulties.

Read more about the causes of ADHD

How ADHD is treated

Although there's no cure for ADHD, it can be managed with appropriate
educational support, advice and support for parents and affected children,
alongside medication, if necessary.

Medication is often the first treatment offered to adults with ADHD, although
psychological therapies such as cognitive behavioural therapy (CBT) may also
help.

Read more about treating ADHD

Living with ADHD

Looking after a child with ADHD can be challenging, but it's important to
remember that they can't help their behaviour.

Some issues that may arise in day-to-day life include:

 getting your child to sleep at night

 getting ready for school on time
 listening to and carrying out instructions
 being organised
 social occasions
 shopping
Adults with ADHD may also find they have similar problems, and some
may have issues with drugs, crime and employment.

Bipolar disorder
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Living with bipolar disorder
Introduction
Bipolar disorder, formerly known as manic depression, is a condition that
affects your moods, which can swing from one extreme to another.

People with bipolar disorder have periods or episodes of:

 depression – feeling very low and lethargic

 mania – feeling very high and overactive (less severe mania is known
as hypomania)
Symptoms of bipolar disorder depend on which mood you're experiencing.
Unlike simple mood swings, each extreme episode of bipolar disorder can last
for several weeks (or even longer), and some people may not experience a
"normal" mood very often.

Depression
You may initially be diagnosed with clinical depression before having a future
manic episode (sometimes years later), after which you may be diagnosed
with bipolar disorder.

During an episode of depression, you may have overwhelming feelings of

worthlessness, which can potentially lead to thoughts of suicide.

If you're feeling suicidal or having severe depressive symptoms, contact your

GP, care co-ordinator or local mental health emergency services as soon as
possible.

If you want to talk to someone confidentially, call the Samaritans, free of

charge, on 116 123. You can talk to them 24 hours a day, 7 days a week.
Alternatively, visit the Samaritans website.

Mania
During a manic phase of bipolar disorder, you may feel very happy and have
lots of energy, ambitious plans and ideas. You may spend large amounts of
money on things you can't afford and wouldn't normally want.
Not feeling like eating or sleeping, talking quickly and becoming annoyed
easily are also common characteristics of this phase.

You may feel very creative and view the manic phase of bipolar as a positive
experience. However, you may also experience symptoms of psychosis,
where you see or hear things that aren't there or become convinced of things
that aren't true.

Living with bipolar disorder

The high and low phases of bipolar disorder are often so extreme that they
interfere with everyday life.

However, there are several options for treating bipolar disorder that can make
a difference. They aim to control the effects of an episode and help someone
with bipolar disorder live life as normally as possible.

The following treatment options are available:

 medication to prevent episodes of mania, hypomania (less severe

mania) and depression – these are known as mood stabilisers and are
taken every day on a long-term basis
 medication to treat the main symptoms of depression and mania when
they occur
 learning to recognise the triggers and signs of an episode of depression
or mania
 psychological treatment – such as talking therapy, which can help you
deal with depression, and provides advice about how to improve your
relationships
 lifestyle advice – such as doing regular exercise, planning activities you
enjoy that give you a sense of achievement, as well as advice
on improving your diet and getting more sleep
It's thought using a combination of different treatment methods is the best way
to control bipolar disorder.

Help and advice for people with a long-term condition or their carers is also
available from charities, support groups and associations.

This includes self-help and self-management advice, and learning to deal with
the practical aspects of a long-term condition.
 Find out more about living with bipolar disorder

Bipolar disorder and pregnancy

Bipolar disorder, like all other mental health problems, can get worse during
pregnancy. However, specialist help is available if you need it.

What causes bipolar disorder?

The exact cause of bipolar disorder is unknown, although it's believed a
number of things can trigger an episode. Extreme stress, overwhelming
problems and life-changing events are thought to contribute, as well as
genetic and chemical factors.

Who's affected?
Bipolar disorder is fairly common and one in every 100 adults will be
diagnosed with the condition at some point in their life.

Bipolar disorder can occur at any age, although it often develops between the
ages of 15 and 19 and rarely develops after 40. Men and women from all
backgrounds are equally likely to develop bipolar disorder.

The pattern of mood swings in bipolar disorder varies widely between people.
For example, some people only have a couple of bipolar episodes in their
lifetime and are stable in between, while others have many episodes.

Breast cancer (female)

1. Introduction
2. Symptoms
3. Causes and risk factors
4. Diagnosis
5. Treatment
6. Living with breast cancer
7. Prevention
Introduction
Breast cancer is the most common type of cancer in the UK.
In 2011, just under 50,000 women were diagnosed with invasive breast
cancer. Most women who get it (8 out of 10) are over 50, but younger women,
and in rare cases, men, can also get breast cancer.

If it's treated early enough, breast cancer can be prevented from spreading to
other parts of the body.

The breasts
The breasts are made up of fat, connective tissue and thousands of tiny
glands called lobules, which produce milk. When a woman has a baby, the
milk is delivered to the nipple through tiny tubes called ducts, which allow her
to breastfeed.

The body is made up of billions of tiny cells, which usually grow and multiply in
an orderly way. New cells are only produced when and where they're needed.
In cancer, this orderly process goes wrong and cells begin to grow and
multiply uncontrollably.

Read more about the causes of breast cancer

Symptoms of breast cancer

Breast cancer can have a number of symptoms, but the first noticeable
symptom is usually a lump or area of thickened breast tissue.

Most breast lumps aren't cancerous, but it's always best to have them
checked by your doctor. You should also see your GP if you notice any of the
following:

 a change in the size or shape of one or both breasts

 discharge from either of your nipples (which may be streaked with
blood)
 a lump or swelling in either of your armpits
 dimpling on the skin of your breasts
 a rash on or around your nipple
 a change in the appearance of your nipple, such as becoming sunken
into your breast
Breast pain isn't usually a symptom of breast cancer.

Learn more about the symptoms of breast cancer

After examining your breasts, your GP may refer you to a specialist breast
cancer clinic for further tests. This might include a mammography (breast
screening) or a biopsy.

Read more about breast screening and how breast cancer is diagnosed

Types of breast cancer

There are several different types of breast cancer, which can develop in
different parts of the breast. Breast cancer is often divided into non-invasive
and invasive types.

Non-invasive breast cancer

Non-invasive breast cancer is also known as cancer or carcinoma in situ. This
cancer is found in the ducts of the breast and hasn't developed the ability to
spread outside the breast.

This form of cancer rarely shows as a lump in the breast that can be felt, and
is usually found on a mammogram. The most common type of non-invasive
cancer is ductal carcinoma in situ (DCIS).

Invasive breast cancer

Invasive cancer has the ability to spread outside the breast, although this
doesn't necessarily mean it has spread.

The most common form of breast cancer is invasive ductal breast cancer,
which develops in the cells that line the breast ducts. Invasive ductal breast
cancer accounts for about 80% of all breast cancer cases and is sometimes
called "no special type".

Other types of breast cancer

Other less common types of breast cancer include invasive lobular breast
cancer, which develops in the cells that line the milk-producing lobules,
inflammatory breast cancer and Paget's disease of the breast.

It's possible for breast cancer to spread to other parts of the body, usually
through the lymph nodes (small glands that filter bacteria from the body) or
the bloodstream. If this happens, it's known as "secondary" or "metastatic"
breast cancer.

Breast cancer screening

About one in eight women are diagnosed with breast cancer during their
lifetime. There's a good chance of recovery if it's detected in its early stages.
For this reason, it's vital that women check their breasts regularly for any
changes and always get any changes examined by their GP.

Mammographic screening (where X-ray images of the breast are taken) is the
best available method of detecting an early breast lesion. However, you
should be aware that a mammogram might fail to detect some breast cancers.
It might also increase your chances of having extra tests and interventions,
including surgery.

Women with a higher-than-average risk of developing breast cancer may be

offered screening and genetic testing for the condition.

As the risk of breast cancer increases with age, all women who are 50-70
years old are invited for breast cancer screening every three years.

Women over 70 are also entitled to screening and can arrange an

appointment through their GP or local screening unit.

The NHS is in the process of extending the programme as a trial, offering

screening to some women aged 47-73.

Read more about breast screening and find breast cancer screening services
near you

Treating breast cancer

If cancer is detected at an early stage, it can be treated before it spreads to
nearby parts of the body.

Breast cancer is treated using a combination of

surgery, chemotherapy and radiotherapy. Surgery is usually the first type of
treatment you'll have, followed by chemotherapy or radiotherapy or, in some
cases, hormone or biological treatments.

The type of surgery and the treatment you have afterwards will depend on the
type of breast cancer you have. Your doctor will discuss the best treatment
plan with you.

Read a document listing the one-year net survival estimates by CCG for
breast cancer
In a small proportion of women, breast cancer is discovered after it's spread to
other parts of the body (metastasis). Secondary cancer, also called advanced
or metastatic cancer, isn't curable, so the aim of treatment is to achieve
remission (symptom relief).

Read more about treating breast cancer

Preventing breast cancer

As the causes of breast cancer aren't fully understood, it's not possible to
know if it can be prevented altogether.

If you're at increased risk of developing the condition, some treatments are

available to reduce the risk.

Studies have looked at the link between breast cancer and diet and, although
there are no definite conclusions, there are benefits for women who maintain
a healthy weight, exercise regularly and who have a low intake of
saturated fat and alcohol.

It's been suggested that regular exercise can reduce your risk of breast
cancer by as much as a third. If you've been through the menopause, it's
particularly important that you're not overweight or obese. This is because
being overweight or obese causes more oestrogen to be produced, which can
increase the risk of breast cancer.

Read more about preventing breast cancer

Living with breast cancer

Being diagnosed with breast cancer can affect daily life in many
ways, depending on what stage it's at and what treatment you're having.

How women cope with their diagnosis and treatment varies from person to
person. You can be reassured that there are several forms of support
available, if you need it. For example:

 your family and friends can be a powerful support system

 you can communicate with other people in the same situation
 find out as much as possible about your condition
 don't try to do too much or overexert yourself
 make time for yourself
 Bronchitis
1. Introduction
2. Symptoms
3. Causes
4. Treatment
Introduction
Bronchitis is an infection of the main airways of the lungs (bronchi), causing
them to become irritated and inflamed.

The main symptom is a cough, which may bring up yellow-grey mucus

(phlegm). Bronchitis may also cause a sore throat and wheezing.

Read more about the symptoms of bronchitis.

When to see your GP

Most cases of bronchitis can be treated easily at home with rest, non-steroidal
anti-inflammatory drugs (NSAIDs) and plenty of fluids.

You only need to see your GP if your symptoms are severe or unusual – for
example, if:

 your cough is severe or lasts longer than three weeks

 you have a constant fever (a temperature of 38°C – 100.4°F – or above)
for more than three days
 you cough up mucus streaked with blood
 you have an underlying heart or lung condition, such as asthma or heart
failure
Your GP may need to rule out other lung infections, such as pneumonia,
which has symptoms similar to those of bronchitis. If your GP thinks you may
have pneumonia, you will probably need a chest X-ray, and a sample of
mucus may be taken for testing.

If your GP thinks you might have an undiagnosed underlying condition, they

may also suggest a pulmonary function test. You will be asked to take a deep
breath and blow into a device called a spirometer, which measures the
volume of air in your lungs. Decreased lung capacity can indicate an
underlying health problem.
Treating bronchitis
In most cases, bronchitis will clear up by itself within a few weeks without the
need for treatment. This type of bronchitis is known as "acute bronchitis".
While you are waiting for it to pass, you should drink lots of fluid and get
plenty of rest.

In some cases, the symptoms of bronchitis can last much longer. If symptoms
last for at least three months, it is known as "chronic bronchitis". There is no
cure for chronic bronchitis, but there are several medications to help relieve
symptoms. It is also important to avoid smoking and smoky environments, as
this can make your symptoms worse.

Read more about treating bronchitis.

Why do I have bronchitis?

The bronchi are the main airways in your lungs, which branch off on either
side of your windpipe (trachea). They lead to smaller and smaller airways
inside your lungs, known as bronchioles.

The walls of the bronchi produce mucus to trap dust and other particles that
could otherwise cause irritation.

Most cases of acute bronchitis develop when an infection causes the bronchi
to become irritated and inflamed, which causes them to produce more mucus
than usual. Your body tries to shift this extra mucus through coughing.

Smoking is the most common cause of chronic bronchitis. Over time, tobacco
smoke can cause permanent damage to the bronchi, causing them to become
inflamed.

Read more about the causes of bronchitis.

Complications
Pneumonia is the most common complication of bronchitis. It happens when
the infection spreads further into the lungs, causing air sacs inside the lungs
to fill up with fluid. 1 in 20 cases of bronchitis leads to pneumonia.

People at an increased risk of developing pneumonia include:

 elderly people
  people who smoke
 people with other health conditions, such as heart, liver or kidney
disease
 people with a weakened immune system
Mild pneumonia can usually be treated with antibiotics at home. More severe
cases may require admission to hospital.

Read more about the treatment of pneumonia.

Who is affected
Acute bronchitis is one of the most common types of lung infection, and is one
of the top five reasons for GP visits.

Acute bronchitis can affect people of all ages, but is most common in younger
children under the age of five. It is more common in winter, and often
develops following a cold, sore throat or flu.

It is estimated that there are around 2 million people in the UK affected by

chronic bronchitis. Most of these are adults over the age of 50.

Diabetes
1. Diabetes
2. Diabetic eye screening
3. FAQs on diabetic eye screening
Diabetes
Diabetes is a lifelong condition that causes a person's blood sugar level to
become too high.

There are two main types of diabetes – type 1 diabetes and type 2 diabetes.

Type 2 diabetes is far more common than type 1. In the UK, around 90% of all
adults with diabetes have type 2.

There are 3.9 million people living with diabetes in the UK. That's more than
one in 16 people in the UK who has diabetes (diagnosed or undiagnosed).

This figure has nearly trebled since 1996, when there were 1.4 million. By
2025, it is estimated that 5 million people will have diabetes in the UK.
Pre-diabetes
Many more people have blood sugar levels above the normal range, but not
high enough to be diagnosed as having diabetes.

This is sometimes known as prediabetes. If your blood sugar level is above

the normal range, your risk of developing full-blown diabetes is increased.

It's very important for diabetes to be diagnosed as early as possible because it

will get progressively worse if left untreated.

When to see a doctor

You should therefore visit your GP as soon as possible if you have symptoms,
such as feeling thirsty, passing urine more often than usual, and feeling tired
all the time.

Symptoms of diabetes
The main symptoms of diabetes are:

 feeling very thirsty

 urinating more frequently than usual, particularly at night
 feeling very tired
 weight loss and loss of muscle bulk
 itching around the penis or vagina, or frequent episodes of thrush
 cuts or wounds that heal slowly
 blurred vision
Type 1 diabetes can develop quickly over weeks or even days.

Many people have type 2 diabetes for years without realising because the
early symptoms tend to be general.

What causes diabetes?

The amount of sugar in the blood is controlled by a hormone called insulin,
which is produced by the pancreas (a gland behind the stomach).

When food is digested and enters your bloodstream, insulin moves glucose
out of the blood and into cells, where it's broken down to produce energy.
However, if you have diabetes, your body is unable to break down glucose
into energy. This is because there's either not enough insulin to move the
glucose, or the insulin produced doesn't work properly.

Type 1 diabetes
In type 1 diabetes, the body's immune system attacks and destroys the cells
that produce insulin. As no insulin is produced, your glucose levels increase,
which can seriously damage the body's organs.

Type 1 diabetes is often known as insulin-dependent diabetes. It's also

sometimes known as juvenile diabetes or early-onset diabetes because it
usually develops before the age of 40, often during the teenage years.

Type 1 diabetes is less common than type 2 diabetes. In the UK, it affects
about 10% of all adults with diabetes.

If you're diagnosed with type 1 diabetes, you'll need insulin injections for the
rest of your life.

You'll also need to pay close attention to certain aspects of your lifestyle and
health to ensure your blood glucose levels stay balanced.

For example, you'll need to eat healthily, take regular exercise and carry out
regular blood tests.

Read more about living with diabetes

Type 2 diabetes
Type 2 diabetes is where the body doesn't produce enough insulin, or the
body's cells don't react to insulin. This is known as insulin resistance.

If you're diagnosed with type 2 diabetes, you may be able to control your
symptoms simply by eating a healthy diet, exercising regularly, and monitoring
your blood glucose levels.

However, as type 2 diabetes is a progressive condition, you may eventually

need medication, usually in the form of tablets.

Type 2 diabetes is often associated with obesity. Obesity-related diabetes is

sometimes referred to as maturity-onset diabetes because it's more common
in older people.

Read more about type 2 diabetes

 Diabetic eye screening
Everyone with diabetes aged 12 or over should be invited to have their eyes
screened once a year.

If you have diabetes, your eyes are at risk from diabetic retinopathy, a
condition that can lead to sight loss if it's not treated.

Screening, which involves a half-hour check to examine the back of the

eyes, is a way of detecting the condition early so it can be treated more
effectively.

Read more about diabetic eye screening

Gestational diabetes (in pregnancy)

During pregnancy, some women have such high levels of blood glucose that
their body is unable to produce enough insulin to absorb it all. This is known
as gestational diabetes and affects up to 18 in 100 women during pregnancy.

Pregnancy can also make existing type 1 diabetes worse. Gestational

diabetes can increase the risk of health problems developing in an unborn
baby, so it's important to keep your blood glucose levels under control.

In most cases, gestational diabetes develops during the second trimester of

pregnancy (weeks 14 to 26) and disappears after the baby is born.

However, women who have gestational diabetes are at an increased risk

(30%) of developing type 2 diabetes later in life (compared with a 10% risk for
the general population).

Diarrhoea
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Prevention
Introduction
Diarrhoea is passing looser or more frequent stools than is normal for you.
It affects most people from time to time and is usually nothing to worry about.
However, it can be distressing and unpleasant until it passes, which normally
takes a few days to a week.

What causes diarrhoea?

There are many different causes of diarrhoea, but a bowel
infection (gastroenteritis) is a common cause in both adults and children.

Gastroenteritis can be caused by:

 a virus – such as norovirus or rotavirus

 bacteria – such as campylobacter and Escherichia coli (E. coli),
which are often picked up from contaminated food
 a parasite – such as the parasite that causes giardiasis, which is spread
in contaminated water
These infections can sometimes be caught during travel abroad, particularly to
areas with poor standards of public hygiene. This is known as travellers'
diarrhoea.

Diarrhoea can also be the result of anxiety, a food allergy, medication, or a

long-term condition, such as irritable bowel syndrome (IBS).

Read more about the causes of diarrhoea.

What to do if you have diarrhoea

Most cases of diarrhoea clear up after a few days without treatment, and you
may not need to see your GP.

However, diarrhoea can lead to dehydration, so you should drink plenty of

fluids – small, frequent sips of water – until it passes. It's very important that
babies and small children do not become dehydrated.

Your pharmacist may suggest you use an oral rehydration solution (ORS) if
you or your child are particularly at risk of dehydration.

You should eat solid food as soon as you feel able to. If you're breastfeeding
or bottle feeding your baby and they have diarrhoea, you should try to feed
them as normal.
Stay at home until at least 48 hours after the last episode of diarrhoea to
prevent spreading any infection to others.

Medications to reduce diarrhoea, such as loperamide, are available. However,

these are not usually necessary, and most types should not be given to
children.

Read more about treating diarrhoea.

When to see your GP

Contact your GP or call NHS 24's 111 service for advice if you're concerned
about yourself or your child.

It's important to see your GP if the diarrhoea is particularly frequent or severe,

or associated with other symptoms, such as:

 blood in your or your child's stool

 persistent vomiting
 a severe or continuous stomach ache
 weight loss
 signs of dehydration – including drowsiness, passing urine infrequently,
and feeling lightheaded or dizzy
 your stool is dark or black – this may be a sign of bleeding inside your
stomach
You should also contact your GP if your or your child's diarrhoea is particularly
persistent, as this may be a sign of a more serious problem. In most
cases, diarrhoea should pass within about a week.

Read more about diagnosing diarrhoea.

Preventing diarrhoea
Diarrhoea is often caused by an infection. You can reduce your risk by making
sure you maintain high standards of hygiene.

For example, you should:

 wash your hands thoroughly with soap and warm water after going to
the toilet and before eating or preparing food
  clean the toilet, including the handle and the seat, with disinfectant after
each bout of diarrhoea
 avoid sharing towels, flannels, cutlery, or utensils with other household
members
It's also important to practise good food and water hygiene while
travelling abroad, such as avoiding potentially unsafe tap water and
undercooked food.

Epilepsy
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Living with
Introduction
Epilepsy is a condition that affects the brain and causes repeated seizures.

Epilepsy is estimated to affect more than 500,000 people in the UK. This
means that almost one in every 100 people has the condition.

Seizures
The cells in the brain, known as neurons, conduct electrical signals and
communicate with each other in the brain using chemical messengers. During
a seizure, there are abnormal bursts of neurons firing off electrical impulses,
which can cause the brain and body to behave strangely.

The severity of seizures can differ from person to person. Some people simply
experience an odd feeling with no loss of awareness, or may have a "trance-
like" state for a few seconds or minutes, while others lose consciousness and
have convulsions (uncontrollable shaking of the body).

Some people may only have a single seizure at some point during their life. If
they do not have a high risk of having further seizures, they would not be
regarded as having epilepsy.

Read more about the symptoms of epilepsy

What causes epilepsy?
Epilepsy can start at any age, but it most often begins during childhood.

It's often not possible to identify a specific reason why someone develops
the condition, although some cases – particularly those that occur later in life
– are associated with damage to the brain.

For example, epilepsy can be caused by strokes, brain tumours and severe
head injuries.

Some cases of epilepsy may be caused by changes in the brain that occur as
a result of the genes you inherit from your parents.

Read more about the causes of epilepsy

How epilepsy is diagnosed

Epilepsy is most often diagnosed after you have had more than one seizure.
This is because many people have a one-off epileptic seizure during their
lifetime.

The most important information needed to make a diagnosis is a description

of your seizures from yourself and someone who witnessed the event, but
tests may also be carried out to help determine which areas of your brain are
affected and look for a potential cause.

Read more about diagnosing epilepsy

How epilepsy is treated

For most people with epilepsy, treatment with medications called anti-epileptic
drugs (AEDs) is recommended. These medications cannot cure epilepsy, but
they are often very effective in controlling seizures.

It can take some time to find the right type and correct dose of AED before
your seizures can be controlled.

In a few cases, surgery may be used to remove a specific area of the

brain that is affected or to install an electrical device that can help control
seizures.

Read more about treating epilepsy

 Living with epilepsy
While epilepsy is different for everyone, there are some general rules that can
make living with the condition easier.

It's important to stay healthy through regular exercise, getting enough sleep,
eating a balanced diet and avoiding excessive drinking.

You may have to think about your epilepsy before you undertake things such
as driving, using contraception and planning a pregnancy.

Advice is available from your GP or support groups to help you adjust to life
with epilepsy.

Gallstones
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Complications
7. Prevention
Introduction
Gallstones are small stones, usually made of cholesterol, that form in the
gallbladder. In most cases they don't cause any symptoms and don't need to
be treated.

However, if a gallstone becomes trapped in a duct (opening) inside the

gallbladder it can trigger a sudden intense abdominal pain that usually lasts
between 1 and 5 hours. This type of abdominal pain is known as biliary colic.

Some people with gallstones can also develop complications, such as

inflammation of the gallbladder (cholecystitis), which can cause:

 persistent pain
 jaundice
 a fever
When gallstones cause symptoms or complications, it's known as gallstone
disease or cholelithiasis. Read more about:
  symptoms of gallstones
 complications of gallstones

The gallbladder
The gallbladder is a small, pouch-like organ found underneath the liver. Its
main purpose is to store and concentrate bile.

Bile is a liquid produced by the liver to help digest fats. It's passed from the
liver through a series of channels, known as bile ducts, into the gallbladder.

The bile is stored in the gallbladder and over time it becomes more
concentrated, which makes it better at digesting fats. The gallbladder releases
bile into the digestive system when it's needed.

What causes gallstones?

Gallstones are thought to develop because of an imbalance in the chemical
make-up of bile inside the gallbladder. In most cases the levels of cholesterol
in bile become too high and the excess cholesterol forms into stones.

Gallstones are very common. It's estimated that more than 1 in every 10
adults in the UK has gallstones, although only a minority of people develop
symptoms.

You're more at risk of developing gallstones if you're:

 overweight or obese
 female, particularly if you've had children
 40 or over (the risk increases as you get older)
Read more about:

 causes of gallstones
 preventing gallstones

Treating gallstones
Treatment is usually only necessary if gallstones are causing:

 symptoms – such as abdominal pain

 complications – such as jaundice or acute pancreatitis
 In these cases, keyhole surgery to remove the gallbladder may be
recommended. This procedure, known as a laparoscopic cholecystectomy, is
relatively simple to perform and has a low risk of complications.

You can lead a perfectly normal life without a gallbladder. Your liver will still
produce bile to digest food, but the bile will just drip continuously into the small
intestine, rather than build up in the gallbladder.

Read more about:

 treating gallstones
 diagnosing gallstones

Outlook
Most cases of gallstone disease are easily treated with surgery. Very severe
cases can be life-threatening, especially in people who are already in poor
health. However, deaths from gallstone disease are rare in the UK

Flu
1. Introduction
2. Symptoms
3. Treatment
4. Complications
5. Prevention
Introduction
Flu (influenza) is a common infectious viral illness spread by coughs and
sneezes. It can be very unpleasant, but you'll usually begin to feel better
within about a week.

You can catch flu all year round, but it's especially common in winter, which is
why it's also known as seasonal flu.

Flu isn't the same as the common cold. Flu is caused by a different group of
viruses and the symptoms tend to start more suddenly, be more severe
and last longer.

Flu symptoms
Some of the main symptoms of flu include:
  a high temperature (fever) of 38C (100.4F) or above
 tiredness and weakness
 a headache
 general aches and pains
 a dry, chesty cough
Cold-like symptoms, such as a blocked or runny nose, sneezing, and a sore
throat, can also be caused by flu, but they tend to be less severe than the
other symptoms you have.

Flu can make you feel so exhausted and unwell that you have to stay in bed
and rest until you feel better.

Read more about the symptoms of flu

What to do
If you're otherwise fit and healthy, there's usually no need to see your GP if
you have flu-like symptoms.

The best remedy is to rest at home, keep warm and drink plenty of water to
avoid dehydration. You can take paracetamol or ibuprofen to lower a high
temperature and relieve aches if necessary.

Stay off work or school until you're feeling better. For most people, this will
take about a week.

Read more about treating flu at home

When to see your GP

Consider visiting your GP if:

 you're 65 years of age or over

 you're pregnant
 you have a long-term medical condition – such as diabetes, heart
disease, lung disease, kidney disease or a neurological disease
 you have a weakened immune system – for example because you're
having chemotherapy or have HIV
 you develop chest pain, shortness of breath, difficulty breathing or start
coughing up blood
  your symptoms are getting worse over time or haven't improved after a
week
In these situations, you may need medication to treat or prevent complications
of flu. Your GP may recommend taking antiviral medicine to reduce your
symptoms and help you recover more quickly.

Read more about antiviral medication for flu

How long does flu last and is it serious?

If you have flu, you generally start to feel ill within a few days of being
infected.

You should begin to feel much better within a week or so, although you may
feel tired for much longer.

You'll usually be most infectious from the day your symptoms start and for a
further 3 to 7 days. Children and people with weaker immune systems may
remain infectious for longer.

Most people will make a full recovery and won't experience any further
problems, but elderly people and people with certain long-term medical
conditions are more likely to have a bad case of flu or develop a serious
complication, such as a chest infection.

Read more about the complications of flu

How you catch flu

The flu virus is contained in the millions of tiny droplets that come out of the
nose and mouth when someone who is infected coughs or sneezes.

These droplets typically spread about one metre. They hang suspended in the
air for a while before landing on surfaces, where the virus can survive for up to
24 hours.

Anyone who breathes in the droplets can catch flu. You can also catch the
virus by touching the surfaces that the droplets have landed on if you pick up
the virus on your hands and then touch your nose or mouth.

Everyday items at home and in public places can easily become contaminated
with the flu virus, including food, door handles, remote controls, handrails,
telephone handsets and computer keyboards. Therefore, it's important to
wash your hands frequently.

You can catch flu many times because flu viruses change regularly and your
body won't have a natural resistance to the new versions.

Preventing the spread of flu

You can help stop yourself catching flu or spreading it to others with good
hygiene measures.

Always wash your hands regularly with soap and warm water, as well as:

 regularly cleaning surfaces such as your computer keyboard, telephone

and door handles to get rid of germs
 using tissues to cover your mouth and nose when you cough or sneeze
 putting used tissues in a bin as soon as possible
You can also help stop the spread of flu by avoiding unnecessary contact with
other people while you're infectious. You should stay off work or school until
you're feeling better.

In some people at risk of more serious flu, an annual flu vaccine or antiviral
medication may be recommended to help reduce the risk of becoming
infected.

Gastroenteritis
Introduction
Gastroenteritis is a very common condition that causes diarrhoea and
vomiting. It's usually caused by a bacterial or viral tummy bug.

It affects people of all ages, but is particularly common in young children.

Most cases in children are caused by a virus called rotavirus. Cases in adults
are usually caused by norovirus (the "winter vomiting bug") or bacterial food
poisoning.

Gastroenteritis can be very unpleasant, but it usually clears up by itself within

a week. You can normally look after yourself or your child at home until you're
feeling better.
Try to avoid going to your GP, as gastroenteritis can spread to others very
easily. Phone the 111 service or your GP if you're concerned or need any
advice.

This page covers:

Symptoms of gastroenteritis

What to do if you have gastroenteritis

When to get medical advice

Looking after a child with gastroenteritis

Getting medical advice for your child

How gastroenteritis is spread

Preventing gastroenteritis

Symptoms of gastroenteritis
The main symptoms of gastroenteritis are:

 sudden, watery diarrhoea

 feeling sick
 vomiting, which can be projectile
 a mild fever
Some people also have other symptoms, such as a loss of appetite, an upset
stomach, aching limbs and headaches.

The symptoms usually appear up to a day after becoming infected. They

typically last less than a week, but can sometimes last longer.

What to do if you have gastroenteritis

If you experience sudden diarrhoea and vomiting, the best thing to do is stay
at home until you're feeling better. There's not always a specific treatment, so
you have to let the illness run its course.

You don't usually need to get medical advice, unless your symptoms don't
improve or there's a risk of a more serious problem.
To help ease your symptoms:

 Drink plenty of fluids to avoid dehydration – You need to drink more

than usual to replace the fluids lost from vomiting and diarrhoea. Water
is best, but you could also try fruit juice and soup.
 Take paracetamol for any fever or aches and pains.
 Get plenty of rest.
 If you feel like eating, try small amounts of plain foods, such as soup,
rice, pasta and bread.
 Use special rehydration drinks made from sachets bought from
pharmacies if you have signs of dehydration, such as a dry mouth or
dark urine – read about treating dehydration.
 Take anti-vomiting medication (such as metoclopramide) and/or
antidiarrhoeal medication (such as loperamide) if you need to – some
types are available from pharmacies, but check the leaflet that comes
with the medicine. You can also ask your pharmacist or GP for advice
about whether they're suitable.
Gastroenteritis can spread very easily, so you should wash your hands
regularly while you're ill and stay off work or school until at least 48 hours after
your symptoms have cleared, to reduce the risk of passing it on
(see Preventing gastroenteritis).

When to get medical advice

You don't normally need to see your GP if you think you have gastroenteritis,
as it should get better on its own.

Visiting your GP surgery can put others at risk, so it's best to phone 111 or
your GP if you're concerned or feel you need advice.

Get medical advice if:

 you have symptoms of severe dehydration, such as

persistent dizziness, only passing small amounts of urine or no urine at
all, or if you're losing consciousness
 you have bloody diarrhoea
 you're vomiting constantly and are unable to keep down any fluids
 you have a fever over 38C (100.4F)
 your symptoms haven't started to improve after a few days
  in the last few weeks you've returned from a part of the world with poor
sanitation
 you have a serious underlying condition, such as kidney disease,
inflammatory bowel disease or a weak immune system, and have
diarrhoea and vomiting
Your GP may suggest sending off a sample of your poo to a laboratory to
check what's causing your symptoms. Antibiotics may be prescribed if this
shows you have a bacterial infection.

Looking after a child with gastroenteritis

You can look after your child at home if they have diarrhoea and vomiting.
There's not usually any specific treatment and your child should start feeling
better in a few days.

You don't normally need to get medical advice unless their symptoms don't
improve or there's a risk of a more serious problem.

To help ease your child's symptoms:

 Encourage them to drink plenty of fluids. They need to replace the fluids
lost from vomiting and diarrhoea. Water is generally best. Avoid giving
them fizzy drinks or fruit juice, as they can make their diarrhoea worse.
Babies should continue to feed as usual, either with breast milk or other
milk feeds.
 Make sure they get plenty of rest.
 Let your child eat if they're eating solids and feel hungry. Try small
amounts of plain foods, such as soup, rice, pasta and bread.
 Give them paracetamol if they have an uncomfortable fever or aches
and pains. Young children may find liquid paracetamol easier to swallow
than tablets.
 Use special rehydration drinks made from sachets bought from
pharmacies if they're dehydrated. Your GP or pharmacist can advise on
how much to give your child. Don't give them antidiarrhoeal and anti-
vomiting medication, unless advised to by your GP or pharmacist.
Make sure you and your child wash your hands regularly while your child is ill
and keep them away from school or nursery until at least 48 hours after their
symptoms have cleared (see Preventing gastroenteritis).
Getting medical advice for your child
You don't usually need to see your GP if you think your child has
gastroenteritis, as it should get better on its own, and taking them to a GP
surgery can put others at risk.

Phone the 111 service or your GP if you're concerned about your child, or
they:

 have symptoms of dehydration, such as passing less urine than normal,

being unusually irritable or unresponsive, pale or mottled skin, or cold
hands and feet
 have blood in their poo or green vomit
 are vomiting constantly and are unable to keep down any fluids or feeds
 have had diarrhoea for more than a week
 have been vomiting for three days or more
 have signs of a more serious illness, such as a high fever (over 38C or
100.4F), shortness of breath, rapid breathing, a stiff neck, a rash that
doesn't fade when you roll a glass over it or a bulging fontanelle (the
soft spot on a baby's head)
 have a serious underlying condition, such as inflammatory bowel
disease or a weak immune system, and have diarrhoea and vomiting
Your GP may suggest sending off a sample of your child's poo to a laboratory
to confirm what's causing their symptoms. Antibiotics may be prescribed if this
shows they have a bacterial infection.

How gastroenteritis is spread

The bugs that cause gastroenteritis can spread very easily from person to
person.

You can catch the infection if small particles of vomit or poo from an infected
person get into your mouth, such as through:

 close contact with someone with gastroenteritis – they may breathe out
small particles of vomit
 touching contaminated surfaces or objects
 eating contaminated food – this can happen if an infected person
doesn't wash their hands before handling food, or you eat food that has
been in contact with contaminated surfaces or objects, or hasn't been
 stored and cooked at the correct temperatures (read more about
the causes of food poisoning)
A person with gastroenteritis is most infectious from when their symptoms
start until 48 hours after all their symptoms have passed, although they may
also be infectious for a short time before and after this.

Preventing gastroenteritis
It's not always possible to avoid getting gastroenteritis, but following the
advice below can help stop it spreading:

 Stay off work, school or nursery until at least 48 hours after the
symptoms have passed. You or your child should also avoid visiting
anyone in hospital during this time.
 Ensure you and your child wash your hands frequently and thoroughly
with soap and water, particularly after using the toilet and before
preparing food. Don't rely on alcohol hand gels, as they're not always
effective.
 Disinfect any surfaces or objects that could be contaminated. It's best to
use a bleach-based household cleaner.
 Wash contaminated items of clothing or bedding separately on a hot
wash.
 Don't share towels, flannels, cutlery or utensils while you or your child is
ill.
 Flush away any poo or vomit in the toilet or potty and clean the
surrounding area.
 Practice good food hygiene. Make sure food is properly refrigerated,
always cook your food thoroughly, and never eat food that is past its
use-by date – read more about preventing food poisoning.
Take extra care when travelling to parts of the world with poor sanitation, as
you could pick up a stomach bug. For example, you may need to boil tap
water before drinking it.

Young children can have the rotavirus vaccination when they’re 2 to 3 months
old, which can reduce their risk of developing gastroenteritis.

Genital herpes
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Complications
7. Prevention
Introduction
Genital herpes is a common infection caused by the herpes simplex virus
(HSV). It causes painful blisters on the genitals and the surrounding areas.

As genital herpes can be passed to others through intimate sexual contact, it's
often referred to as a sexually transmitted infection (STI).

HSV can affect any mucous membrane (moist lining), such as those found in
the mouth (cold sores).

Genital herpes is a chronic (long-term) condition. The virus remains in your

body and can become active again. The average rate of recurrence is four to
five times in the first two years after being infected. However, over time, it
tends to become active less frequently and each outbreak becomes less
severe.

Read more about the symptoms of genital herpes

The herpes simplex virus (HSV)

There are two types of herpes simplex virus (HSV), type 1 and type 2. Both
types are highly contagious and can be passed easily from one person to
another by direct contact.

Genital herpes is usually transmitted by having sex (vaginal, anal or oral) with
an infected person. Even if someone with genital herpes doesn't have any
symptoms, it's possible for them to pass the condition on to a sexual partner.

At least eight out of 10 people who carry the virus are unaware they have
been infected because there are often few or no initial symptoms. However,
certain triggers can activate the virus, causing an outbreak of genital herpes.

Read more about the causes of genital herpes

Treating genital herpes

 Although there's no cure for genital herpes, the symptoms can usually be
controlled using antiviral medicines.

However, it's important to prevent the spread of genital herpes by avoiding

sex until symptoms have cleared up and continuing to use
a condom afterwards.

Read more about how genital herpes is treated

Pregnancy
Genital herpes can cause problems during pregnancy. These complications
can be more serious depending on whether you already have genital herpes,
or develop it for the first time while pregnant.

Gout
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Complications
Introduction
Gout is a type of arthritis in which small crystals form inside and around the
joints. It causes sudden attacks of severe pain and swelling.

It's estimated that between one and two in every 100 people in the UK are
affected by gout.

The condition mainly affects men over 30 and women after the menopause.
Overall, gout is more common in men than women.

Gout can be extremely painful and debilitating, but treatments are available to
help relieve the symptoms and prevent further attacks.

Signs and symptoms of gout

Any joint can be affected by gout, but it usually affects joints towards the ends
of the limbs, such as the toes, ankles, knees and fingers.

Signs and symptoms of gout include:

  severe pain in one or more joints
 the joint feeling hot and very tender
 swelling in and around the affected joint
 red, shiny skin over the affected joint
Symptoms develop rapidly over a few hours and typically last three to 10
days. After this time the pain should pass and the joint should return to
normal.

Almost everyone with gout will experience further attacks at some point,
usually within a year.

Read more about the symptoms of gout.

When to see your GP

See your GP if you suspect you have gout and it hasn't been previously
diagnosed, particularly if the pain keeps getting worse and you also have a
high temperature (fever).

It's important that a diagnosis is confirmed because other conditions that

require urgent treatment, such as an infected joint, can sometimes cause
similar symptoms.

If you've already been diagnosed with gout and you have an attack, see your
GP if any medication you've been prescribed (see below) doesn't start
working within a couple of days.

Read more about diagnosing gout.

What causes gout?

Gout is caused by a build-up of a substance called uric acid in the blood.

If you produce too much uric acid or your kidneys don't filter enough out, it can
build up and cause tiny sharp crystals to form in and around joints. These
crystals can cause the joint to become inflamed (red and swollen) and painful.

Things that may increase your chances of getting gout include:

 obesity, high blood pressure and/or diabetes

 having a close relative with gout
  kidney problems
 eating foods that cause a build-up of uric acid, such as red meat, offal
and seafood
 drinking too much beer or spirits
Read more about the causes of gout.

Treatments for gout

If you have gout, treatment is available from your GP to:

 relieve symptoms during an attack – this can be done using ice packs
and by taking medications such as non-steroidal anti-inflammatory
drugs (NSAIDs), colchicine or corticosteroids
 prevent further attacks – through a combination of lifestyle changes,
such as losing weight or changing your diet, and taking medication that
lowers uric acid levels, such as allopurinol
With treatment, many people are able to reduce their uric acid levels
sufficiently to dissolve the crystals that cause gout – and as a result have no
further attacks. However, lifelong treatment is usually required.

Read more about treating gout.

Can gout cause further problems?

Sometimes gout can lead to further problems, particularly if it's left untreated.

These can include:

 kidney stones
 small firm lumps of uric acid crystals under the skin called tophi
 permanent joint damage
Read more about the complications of gout.

What's pseudogout?
Pseudogout is a similar condition to gout, but usually affects the knee joint
first. It's a form of arthritis that causes pain, stiffness, tenderness, redness,
warmth and swelling in one or more of your joints - commonly the knee or
wrist.
 Gum disease
1. Introduction
2. Symptoms
3. Causes
4. Treatment
5. Complications
Introduction
Gum disease is a very common condition where the gums become swollen,
sore or infected.

Most adults in the UK have gum disease to some degree and most people
experience it at least once. It's much less common in children.

If you have gum disease, your gums may bleed when you brush your teeth
and you may have bad breath. This early stage of gum disease is known as
gingivitis.

If gingivitis isn't treated, a condition called periodontitis can develop. This

affects more tissues that support teeth and hold them in place.

If periodontitis isn't treated, the bone in your jaw may be damaged and small
spaces can open up between the gum and teeth. Your teeth can become
loose and may eventually fall out.

Read more about the symptoms of gum disease.

What causes gum disease?

Gum disease is caused by a build-up of plaque on the teeth. Plaque is a sticky
substance that contains bacteria.

Some bacteria in plaque are harmless, but some are harmful for the health of
your gums. If you don't remove plaque from your teeth by brushing them,
it builds up and irritates your gums. This can lead to redness with bleeding,
swelling and soreness.

Read more about the causes of gum disease.

Seeing your dentist

You should make an appointment to see your dentist if your gums are
painful, swollen or if they bleed when you brush your teeth. Find a dentist near
you.

Your dentist can carry out a thorough dental examination to check the health
of your gums, which may involve inserting a thin metal stick with a bend in one
end (periodontal probe) beside your teeth.

In some cases, a number of X-rays may be needed to check the condition of

your teeth and jaw bone.

Preventing and treating gum disease

Mild cases of gum disease can usually be treated by maintaining a good level
of oral hygiene. This includes brushing your teeth at least twice a day and
flossing regularly. You should also make sure you attend regular dental
check-ups.

In most cases, your dentist or dental hygienist will be able to give your teeth a
thorough clean and remove any hardened plaque (tartar). They'll also be able
to show you how to clean your teeth effectively to help prevent plaque building
up in the future.

If you have severe gum disease, you'll usually need to have further medical
and dental treatment and, in some cases, surgery may need to be carried
out. This will usually be performed by a specialist in gum problems
(periodontics).

Read more about treating gum disease and keeping your teeth clean.

Dental check-ups
It's important to have regular dental check-ups so any problems with your
teeth and gums can be detected and treated early.

If you've never had gum disease and have good oral health, you may only
need to visit your dentist every one to two years for a check-up.

You may need to visit your dentist more frequently if you've had problems with
gum disease in the past. At each appointment your dentist will advise when
you need your next appointment.
 If you have an increased risk of developing gum problems – for example, if
you smoke or have diabetes – you may be advised to visit your dentist more
often so your teeth and gums can be closely monitored.

Complications of gum disease

If you have untreated gum disease that develops into periodontitis, it can lead
to further complications, such as:

 gum abscesses (painful collections of pus)

 receding gums
 loose teeth
 loss of teeth

Haemorrhoids (piles)
1. Introduction
2. Diagnosis
3. Treatment
4. Surgery
Introduction
Haemorrhoids, also known as piles, are swellings containing enlarged blood
vessels that are found inside or around the bottom (the rectum and anus).

In many cases, haemorrhoids don't cause symptoms, and some people don't
even realise they have them. However, when symptoms do occur, they may
include:

 bleeding after passing a stool (the blood is usually bright red)

 itchy bottom
 a lump hanging down outside of the anus, which may need to be
pushed back in after passing a stool
 a mucus discharge after passing a stool
 soreness, redness and swelling around your anus
Haemorrhoids aren't usually painful, unless their blood supply slows down or
is interrupted.

When to seek medical advice

See your GP if you have persistent or severe symptoms of haemorrhoids. You
should always get any rectal bleeding checked out, so your doctor can rule
out more potentially serious causes.

The symptoms of haemorrhoids often clear up on their own or with simple

treatments that can be bought from a pharmacy without a prescription (see
below). However, speak to your GP if your symptoms don't get better or if you
experience pain or bleeding.

Your GP can often diagnose haemorrhoids using a simple internal

examination of your back passage, although they may need to refer you to a
colorectal specialist for diagnosis and treatment.

Some people with haemorrhoids are reluctant to see their GP. However,
there’s no need to be embarrassed, because GPs are very used to diagnosing
and treating haemorrhoids.

Read more about diagnosing haemorrhoids.

What causes haemorrhoids?

The exact cause of haemorrhoids is unclear, but they're associated with
increased pressure in the blood vessels in and around your anus. This
pressure can cause the blood vessels in your back passage to become
swollen and inflamed.

Many cases are thought to be caused by too much straining on the toilet, due
to prolonged constipation – this is often due to a lack of fibre in a person's
diet. Chronic (long-term) diarrhoea can also make you more vulnerable to
getting haemorrhoids.

Other factors that might increase your risk of developing haemorrhoids

include:

 being overweight or obese

 age – as you get older, your body's supporting tissues get weaker,
increasing your risk of haemorrhoids
 being pregnant – which can place increased pressure on your pelvic
blood vessels, causing them to enlarge (read more about piles in
pregnancy)
 having a family history of haemorrhoids
 regularly lifting heavy objects
  a persistent cough or repeated vomiting
 sitting down for long periods of time

Preventing and treating haemorrhoids

Haemorrhoid symptoms often settle down after a few days, without needing
treatment. Haemorrhoids that occur during pregnancy often get better after
giving birth.

However, making lifestyle changes to reduce the strain on the blood vessels
in and around your anus is often recommended. These can include:

 gradually increasing the amount of fibre in your diet – good sources of

fibre include fruit, vegetables, wholegrain rice, wholewheat pasta and
bread, pulses and beans, seeds, nuts and oats
 drinking plenty of fluid – particularly water, but avoiding or cutting down
on caffeine and alcohol
 not delaying going to the toilet – ignoring the urge to empty your bowels
can make your stools harder and drier, which can lead to straining when
you do go to the toilet
 avoiding medication that causes constipation – such as painkillers that
contain codeine
 losing weight (if you're overweight)
 exercising regularly – can help prevent constipation, reduce your blood
pressure and help you lose weight
These measures can also reduce the risk of haemorrhoids returning, or even
developing in the first place.

Medication that you apply directly to your back passage (known as topical
treatments) or tablets bought from a pharmacy or prescribed by your GP may
ease your symptoms and make it easier for you to pass stools.

There are various treatment options for more severe haemorrhoids. One of
these options is banding, which is a non-surgical procedure where a very tight
elastic band is put around the base of the haemorrhoid to cut off its blood
supply. The haemorrhoid should fall off after about a week.

Surgery carried out under general anaesthetic (where you're unconscious) is

sometimes used to remove or shrink large or external haemorrhoids.
Hand, foot and mouth disease
Introduction
Hand, foot and mouth disease is a common infection that causes mouth
ulcers and spots on the hands and feet.

It's most common in young children – particularly those under 10 – but can
affect older children and adults as well.

Hand, foot and mouth disease can be unpleasant, but it will usually clear up
by itself within 7 to 10 days. You can normally look after yourself or your child
at home.

The infection is not related to foot and mouth disease, which affects cattle,
sheep and pigs.

This page covers:

Symptoms

What to do if you or your child has it

When to get medical advice

How it spreads

Prevention

Symptoms of hand, foot and mouth disease

The symptoms of hand, foot and mouth disease usually develop between
three and five days after being exposed to the infection.

The first symptoms may include:

 a high temperature (fever), usually around 38-39C (100.4-102.2F)

 a general sense of feeling unwell
 loss of appetite
 coughing
 abdominal (tummy) pain
  a sore throat and mouth

Mouth ulcers
After one or two days, red spots appear on the tongue and inside the mouth.

These quickly develop into larger yellow-grey mouth ulcers with red edges.

The ulcers can be painful and make eating, drinking and swallowing difficult.
They should pass within a week.

Spotty rash and blisters

Soon after the mouth ulcers appear, you'll probably notice a rash made up of
small, raised red spots on the skin.

These typically develop on the fingers, the backs or palms of the hand, the
soles of the feet, and occasionally on the buttocks and groin.

The spots may then turn into small blisters with a grey centre.

The spots and blisters can sometimes be itchy or uncomfortable and

typically last up to 10 days.

What to do if you or your child has hand, foot and

mouth disease
If you have hand, foot and mouth disease, the best thing to do is to stay at
home until you're feeling better. There's no cure for it, so you have to let it run
its course.

To help ease your or your child's symptoms:

 drink plenty of fluidsto avoid dehydration – water or milk are ideal; it may
help to give a baby smaller but more frequent bottle or breast milk feeds
 eat soft foods such as mashed potatoes, yoghurt and soups if eating
and swallowing is uncomfortable – avoid hot, acidic or spicy foods and
drinks
 take over-the-counter painkillers, such as paracetamol or ibuprofen,
to ease a sore throat and fever – aspirin shouldn't be given to children
under the age of 16; paracetamol is best if you're pregnant
  try gargling with warm, salty water to relieve discomfort from mouth
ulcers – it's important not to swallow the mixture, so this isn't
recommended for young children
 alternatively, use mouth gels, rinses or sprays for mouth ulcers – these
are available from pharmacies, but aren't routinely recommended, and
some aren't suitable for young children; ask your pharmacist for advice
and make sure you read the instructions first
You should keep your child away from nursery or school until they're feeling
better. Adults with the condition should stay away from work until they're
feeling better.

See preventing hand, foot and mouth disease below for more information
about stopping the infection spreading.

When to get medical advice

You don't usually need medical attention if you think you or your child has
hand, foot and mouth disease. The infection will usually pass in 7 to 10 days,
and there isn't much your doctor can do.

Antibiotics won't help as hand, foot and mouth disease is caused by a virus.

If you're unsure whether you or your child has hand, foot and mouth disease,
you can call the NHS 24 '111' service or your GP for advice.

You should also get medical advice if:

 your child is unable or unwilling to drink any fluids

 your child has signs of dehydration, such as unresponsiveness, passing
small amounts of urine or no urine at all, or cold hands and feet
 your child develops fits (seizures), confusion, weakness or a loss of
consciousness
 your child is under three months old and has a temperature of 38C
(101F) or above, or is between three and six months old and has a
temperature of 39C (102F) or above
 the skin becomes very painful, red, swollen and hot, or there's a
discharge of pus
 the symptoms are getting worse or haven't improved after 7 to 10 days
Get advice from your GP if you're pregnant and you become infected within a
few weeks of your due date. Infection in pregnancy is usually nothing to worry
about, but there's a small chance it could make your baby ill if you're
infected shortly before you give birth.

Read more about the risks of hand, foot and mouth disease in pregnancy

How hand, foot and mouth disease spreads

Someone with hand, foot and mouth disease is most infectious from just
before their symptoms start until they're feeling better.

The infection can be spread by close person to person contact and contact
with contaminated surfaces. The virus is found in:

 the droplets in the coughs and sneezes of an infected person – you can
become infected if you get these on your hands and then touch your
mouth, or if you breathe in the droplets
 an infected person's poo – if an infected person doesn't wash their
hands properly after going to the toilet, they can contaminate food or
surfaces
 an infected person's saliva or fluid from their blisters – you can become
infected if this gets in your mouth
The infection is caused by a number of different viruses, so it's possible to get
it more than once. Most people develop immunity to these viruses as they get
older.

Preventing hand, foot and mouth disease

It's not always possible to avoid getting hand, foot and mouth disease, but
following the advice below can help stop the infection spreading.

 Stay off work, school or nursery until you or your child are feeling better
– there's usually no need to wait until the last blister has healed,
provided you're otherwise well.
 Use tissues to cover your mouth and nose when you cough or sneeze
and put used tissues in a bin as soon as possible.
 Wash your hands with soap and water often – particularly after going to
the toilet, coughing, sneezing or handling nappies, and before preparing
food.
 Avoid sharing cups, utensils, towels and clothes with people who are
infected.
  Disinfect any surfaces or objects that could be contaminated – it's best
to use a bleach-based household cleaner.
 Wash any bedding or clothing that could have become contaminated
separately on a hot wash.

Hepatitis A
1. Introduction
2. Symptoms
3. Causes
4. Treatment
5. Vaccination
Introduction
Hepatitis A is a liver infection caused by a virus that's spread in the poo of an
infected person.

It's uncommon in the UK, but certain groups are at increased risk. This
includes travellers to parts of the world with poor levels of sanitation, men who
have sex with men, and people who inject drugs.

Hepatitis A can be unpleasant, but it's not usually serious and most people
make a full recovery within a couple of months.

Some people, particularly young children, may not have any symptoms.
But hepatitis A can occasionally last for many months and, in rare cases, it
can be life-threatening if it causes the liver to stop working properly (liver
failure).

A hepatitis A vaccine is available for people at a high risk of infection.

This page covers:

Symptoms of hepatitis A

When to get medical advice

How you can get hepatitis A

Vaccination against hepatitis A

Treatments for hepatitis A

Outlook for hepatitis A

Symptoms of hepatitis A
The symptoms of hepatitis A develop, on average, around 4 weeks after
becoming infected, although not everyone will experience them.

Symptoms can include:

 feeling tired and generally unwell

 joint and muscle pain
 a high temperature (fever)
 loss of appetite
 feeling or being sick
 pain in the upper-right part of your tummy
 yellowing of the skin and eyes (jaundice)
 dark urine and pale stools
 itchy skin
The symptoms will usually pass within a couple of months.

Read more about symptoms of hepatitis A.

When to get medical advice

See your GP for advice if:

 you have symptoms of hepatitis A – a blood test can usually confirm

whether you have the infection
 you might have been exposed to the hepatitis A virus recently but you
don't have any symptoms – treatment given early on may be able to
stop the infection developing
 you think you might need the hepatitis A vaccine – your GP can advise
you about whether you should have the vaccine (see below)
Although hepatitis A isn't usually serious, it's important to get a proper
diagnosis to rule out more serious conditions with similar symptoms, such
as hepatitis Cor cirrhosis (scarring of the liver).

It may also be necessary to test your friends, family and any sexual partners,
in case you've spread the infection to them.
How you can get hepatitis A
Hepatitis A is most widespread in parts of the world where standards of
sanitation and food hygiene are generally poor, such as parts of Africa, the
Indian subcontinent, the Far East, the Middle East, and Central and South
America.

You can get the infection from:

 eating food prepared by someone with the infection who hasn't washed
their hands properly or washed them in water contaminated with
sewage
 drinking contaminated water (including ice cubes)
 eating raw or undercooked shellfish from contaminated water
 close contact with someone who has hepatitis A
 less commonly, having sex with someone who has the infection (this is
particularly a risk for men who have sex with men) or injecting drugs
using contaminated equipment
Someone with hepatitis A is most infectious from around two weeks before
their symptoms appear until about a week after the symptoms first develop.

Read more about the causes of hepatitis A.

Vaccination against hepatitis A

Vaccination against hepatitis A isn't routinely offered in the UK because the
risk of infection is low for most people.

It's only recommended for people at an increased risk, including:

 close contacts of someone with hepatitis A

 people planning to travel to or live in parts of the world where hepatitis A
is widespread, particularly if levels of sanitation and food hygiene are
expected to be poor
 people with any type of long-term (chronic) liver disease
 men who have sex with other men
 people who inject illegal drugs
 people who may be exposed to hepatitis A through their job – this
includes sewage workers, staff of institutions where levels of personal
 hygiene may be poor (such as a homeless shelter) and people working
with monkeys, apes and gorillas
The hepatitis A vaccine is usually available for free on the NHS for anyone
who needs it.

Read more about the hepatitis A vaccine.

Treatments for hepatitis A

There's currently no cure for hepatitis A, but it will normally pass on its own
within a couple of months. You can usually look after yourself at home.

While you're ill, it's a good idea to:

 get plenty of rest

 take painkillers such as paracetamol or ibuprofen for any aches and
pains – ask your GP for advice about this, as you may need to take
lower doses than normal or avoid certain medications until you've
recovered
 maintain a cool, well-ventilated environment, wear loose clothing, and
avoid hot baths or showers to reduce any itching
 eat smaller, lighter meals to help reduce nausea and vomiting
 avoid alcohol to reduce the strain on your liver
 stay off work or school and avoid having sex until at least a week after
your jaundice or other symptoms started
 practise good hygiene measures, such as washing your hands with
soap and water regularly
Speak to your GP if your symptoms are particularly troublesome or haven't
started to improve within a couple of months. They can prescribe medications
to help with itchiness, nausea or vomiting, if necessary.

Read more about treating hepatitis A.

Outlook for hepatitis A

For most people, hepatitis A will pass within 2 months and there will be no
long-term effects. Once it passes, you normally develop life-long immunity
against the virus.
 For around 1 in every 7 people with the infection, the symptoms may come
and go for up to 6 months before eventually passing.

Life-threatening complications such as liver failure are rare, affecting less than
1 in every 250 people with hepatitis A. People most at risk include those with
pre-existing liver problems and elderly people.

If liver failure does occur, a liver transplant is usually needed to treat it

Hepatitis B
1. Introduction
2. Symptoms
3. Causes
4. Treatment
5. Complications
Introduction
Hepatitis B is an infection of the liver caused by a virus that's spread through
blood and body fluids.

It often doesn't cause any obvious symptoms in adults and typically passes in
a few months without treatment, but in children it often persists for years and
may eventually cause serious liver damage.

Hepatitis B is less common in the UK than other parts of the world, but certain
groups are at an increased risk. This includes people originally from high-risk
countries, people who inject drugs, and people who have unprotected sex with
multiple sexual partners.

A hepatitis B vaccine is available for people at high risk of the condition.

Symptoms of hepatitis B
Many people with hepatitis B won't experience any symptoms and may fight
off the virus without realising they had it.

If symptoms do develop, they tend to occur 2 or 3 months after exposure to

the hepatitis B virus.

Symptoms of hepatitis B include:

  flu-like symptoms, including tiredness, a fever, and general aches and
pains
 loss of appetite
 feeling and being sick
 diarrhoea
 tummy (abdominal) pain
 yellowing of the skin and eyes (jaundice)
These symptoms will usually pass within one to three months (acute hepatitis
B), although occasionally the infection can last for six months or more (chronic
hepatitis B).

Read more about the symptoms of hepatitis B.

When to get medical advice

Hepatitis B can be serious, so you should get medical advice if:

 you think you may have been exposed to the hepatitis B virus –
emergency treatment can help prevent infection if given within a few
days of exposure
 you have symptoms associated with hepatitis B
 you're at a high risk of hepatitis B – high-risk groups include people born
in a country where the infection is common, babies born to mothers
infected with hepatitis B, and people who have ever injected drugs
You can go to your local GP surgery, drug service, genitourinary medicine
(GUM) clinic or sexual health clinic for help and advice.

A blood test can be carried out to check if you have hepatitis B or have had it
in the past. The hepatitis B vaccine may also be recommended to reduce your
risk of infection.

Treatments for hepatitis B

Treatment for hepatitis B depends on how long you've been infected for:

 if you've been exposed to the virus in the last few days, emergency
treatment can help stop you becoming infected
  if you've only had the infection for a few weeks or months (acute
hepatitis B), you may only need treatment to relieve your symptoms
while your body fights off the infection
 if you've had the infection for more than 6 months (chronic hepatitis B),
you may be offered treatment with medicines that can keep the virus
under control and reduce the risk of liver damage
Chronic hepatitis B often requires long-term or lifelong treatment and regular
monitoring to check for any further liver problems.

Read more about treating hepatitis B.

How hepatitis B is spread

The hepatitis B virus is found in the blood and bodily fluids, such as semen
and vaginal fluids, of an infected person.

It can be spread by:

 a mother to her newborn baby, particularly in countries where the

infection is common
 within families (child to child) in countries where the infection is common
 injecting drugs and sharing needles and other drug equipment, such as
spoons and filters
 having sex with an infected person without using a condom
 having a tattoo, body piercing, or medical or dental treatment in an
unhygienic environment with unsterilised equipment
 sharing toothbrushes or razors contaminated with infected blood
Hepatitis B isn't spread by kissing, holding hands, hugging, coughing,
sneezing, or sharing crockery and utensils.

Read more about the causes of hepatitis B.

Preventing hepatitis B
A vaccine that offers protection against hepatitis B is available for all babies
born in the UK on or after 1 August 2017. It is also available for people at high
risk of the infection or complications from it.

This includes:
  babies born to hepatitis B-infected mothers
 close family and sexual partners of someone with hepatitis B
 people travelling to a part of the world where hepatitis B is widespread,
such as sub-Saharan Africa, east and southeast Asia, and the Pacific
Islands
 families adopting or fostering children from high-risk countries
 people who inject drugs or have a sexual partner who injects drugs
 people who change their sexual partner frequently
 men who have sex with men
 male and female sex workers
 people who work somewhere that places them at risk of contact with
blood or body fluids, such as nurses, prison staff, doctors, dentists and
laboratory staff
 people with chronic liver disease
 people with chronic kidney disease
 prisoners
 people receiving regular blood or blood products, and their carers
The hepatitis B vaccine is given to infants as part of the routine child
vaccination schedule and to those who are at high risk of developing the
infection.

You do not need to pay for the vaccine if your child is eligible to receive it as
part of the routine child vaccination schedule or if born to a hepatitis B-
infected mother. Others may have to pay for it.

Read more about hepatitis B vaccination

Outlook for hepatitis B

The vast majority of people infected with hepatitis B in adulthood are able to
fight off the virus and fully recover within 1 to 3 months. Most will then be
immune to the infection for life.

Babies and children with hepatitis B are more likely to develop a chronic
infection. Chronic hepatitis B affects around:

 90% of babies with hepatitis B

 20% of older children with hepatitis B
  5% of adults with hepatitis B
Although treatment can help, there's a risk that people with chronic hepatitis B
could eventually develop life-threatening problems such as scarring of the
liver (cirrhosis) or liver cancer.

Hepatitis C
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Complications
7. Living with hepatitis C
Introduction
Hepatitis C is a virus that can infect the liver. If left untreated, it can
sometimes cause serious and potentially life-threatening damage to the liver
over many years.

However, with modern treatments it's often possible to cure the infection and
most people with it will have a normal life expectancy.

It's estimated that around 215,000 people in the UK have hepatitis C.

You can become infected with it if you come into contact with the blood of an
infected person.

Symptoms of hepatitis C
Hepatitis C often doesn't have any noticeable symptoms until the liver has
been significantly damaged. This means many people have the infection
without realising it.

When symptoms do occur, they can be mistaken for another condition.

Symptoms can include:

 flu-like symptoms, such as muscle aches and a high temperature (fever)

 feeling tired all the time
 loss of appetite
 abdominal (tummy) pain
  feeling and being sick
The only way to know for certain if these symptoms are caused by hepatitis C
is to get tested (see below).

Read more about the symptoms of hepatitis C.

How do you get hepatitis C?

The hepatitis C virus is usually spread through blood-to-blood contact.

Some ways the infection can be spread include:

 sharing unsterilised needles – particularly needles used to inject

recreational drugs
 sharing razors or toothbrushes
 from a pregnant woman to her unborn baby
 through unprotected sex – although this is very rare
In the UK, most hepatitis C infections occur in people who inject drugs or have
injected them in the past. It's estimated that around half of those who inject
drugs have the infection.

Read more about the causes of hepatitis C.

Getting tested for hepatitis C

Seek medical advice if you have persistent symptoms of hepatitis C, or there's
a risk you're infected, even if you don't have any symptoms. A blood test can
be carried out to see if you have the infection.

Your GP, sexual health clinic, GUM (genitourinary medicine) clinic or drug
treatment service all offer testing for hepatitis C.

Early diagnosis and treatment can help prevent or limit any damage to your
liver and help ensure the infection isn't passed on to other people.

Read more about testing for hepatitis C.

Treatments for hepatitis C

Hepatitis C can be treated with a combination of medicines that stop the virus
multiplying inside the body. These usually need to be taken for several
months.
Most people will take 2 main medications called pegylated interferon (a
weekly injection) and ribavirin (a capsule or tablet), although newer tablet-only
treatments are likely to replace the interferon injections for most people in the
near future.

These newer hepatitis C medications have been found to make treatment

more effective. They include simeprevir, sofosbuvir and daclatasvir.

Using the latest medications, up to 90% or more of people with hepatitis C

may be cured. However, it's important to be aware that you won't be immune
to the infection and should take steps to reduce your risk of becoming infected
again (see below).

Read more about treating hepatitis C and living with hepatitis C.

Complications of hepatitis C
If the infection is left untreated for many years, some people with hepatitis C
will develop scarring of the liver (cirrhosis). Over time, this can cause the liver
to stop working properly.

In severe cases, life-threatening problems such as liver failure (where the liver
loses most or all of its functions) or liver cancer can eventually develop.

Treating hepatitis C as early as possible can help reduce the risk of these
problems occurring.

Read more about the complications of hepatitis C.

Preventing hepatitis C
There's no vaccine for hepatitis C, but there are ways to reduce your risk of
becoming infected, such as:

 not sharing any drug-injecting equipment with other people –

including needles and other equipment such as syringes, spoons and
filters
 not sharing razors or toothbrushes that might be contaminated with
blood
The risk of getting hepatitis C through sex is very low. However, it may be
higher if blood is present, such as menstrual blood or from minor bleeding
during anal sex.
 Condoms aren't usually necessary to prevent hepatitis C for long-term
heterosexual couples, but it's a good idea to use them when having anal sex
or sex with a new partner.

Hepatitis C
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Complications
7. Living with hepatitis C
Introduction
Hepatitis C is a virus that can infect the liver. If left untreated, it can
sometimes cause serious and potentially life-threatening damage to the liver
over many years.

However, with modern treatments it's often possible to cure the infection and
most people with it will have a normal life expectancy.

It's estimated that around 215,000 people in the UK have hepatitis C.

You can become infected with it if you come into contact with the blood of an
infected person.

Symptoms of hepatitis C
Hepatitis C often doesn't have any noticeable symptoms until the liver has
been significantly damaged. This means many people have the infection
without realising it.

When symptoms do occur, they can be mistaken for another condition.

Symptoms can include:

 flu-like symptoms, such as muscle aches and a high temperature (fever)

 feeling tired all the time
 loss of appetite
 abdominal (tummy) pain
 feeling and being sick
The only way to know for certain if these symptoms are caused by hepatitis C
is to get tested (see below).

Read more about the symptoms of hepatitis C.

How do you get hepatitis C?

The hepatitis C virus is usually spread through blood-to-blood contact.

Some ways the infection can be spread include:

 sharing unsterilised needles – particularly needles used to inject

recreational drugs
 sharing razors or toothbrushes
 from a pregnant woman to her unborn baby
 through unprotected sex – although this is very rare
In the UK, most hepatitis C infections occur in people who inject drugs or have
injected them in the past. It's estimated that around half of those who inject
drugs have the infection.

Read more about the causes of hepatitis C.

Getting tested for hepatitis C

Seek medical advice if you have persistent symptoms of hepatitis C, or there's
a risk you're infected, even if you don't have any symptoms. A blood test can
be carried out to see if you have the infection.

Your GP, sexual health clinic, GUM (genitourinary medicine) clinic or drug
treatment service all offer testing for hepatitis C.

Early diagnosis and treatment can help prevent or limit any damage to your
liver and help ensure the infection isn't passed on to other people.

Read more about testing for hepatitis C.

Treatments for hepatitis C

Hepatitis C can be treated with a combination of medicines that stop the virus
multiplying inside the body. These usually need to be taken for several
months.
Most people will take 2 main medications called pegylated interferon (a
weekly injection) and ribavirin (a capsule or tablet), although newer tablet-only
treatments are likely to replace the interferon injections for most people in the
near future.

These newer hepatitis C medications have been found to make treatment

more effective. They include simeprevir, sofosbuvir and daclatasvir.

Using the latest medications, up to 90% or more of people with hepatitis C

may be cured. However, it's important to be aware that you won't be immune
to the infection and should take steps to reduce your risk of becoming infected
again (see below).

Read more about treating hepatitis C and living with hepatitis C.

Complications of hepatitis C
If the infection is left untreated for many years, some people with hepatitis C
will develop scarring of the liver (cirrhosis). Over time, this can cause the liver
to stop working properly.

In severe cases, life-threatening problems such as liver failure (where the liver
loses most or all of its functions) or liver cancer can eventually develop.

Treating hepatitis C as early as possible can help reduce the risk of these
problems occurring.

Read more about the complications of hepatitis C.

Preventing hepatitis C
There's no vaccine for hepatitis C, but there are ways to reduce your risk of
becoming infected, such as:

 not sharing any drug-injecting equipment with other people –

including needles and other equipment such as syringes, spoons and
filters
 not sharing razors or toothbrushes that might be contaminated with
blood
The risk of getting hepatitis C through sex is very low. However, it may be
higher if blood is present, such as menstrual blood or from minor bleeding
during anal sex.
 Condoms aren't usually necessary to prevent hepatitis C for long-term
heterosexual couples, but it's a good idea to use them when having anal sex
or sex with a new partner.

High cholesterol
1. Introduction
2. Causes of high cholesterol
3. Diagnosis
4. Treatment
5. Prevention
Introduction
Cholesterol is a fatty substance known as a lipid and is vital for the normal
functioning of the body. It's mainly made by the liver, but can also be found in
some foods.

Having an excessively high level of lipids in your blood (hyperlipidemia) can

have an effect on your health.

High cholesterol itself doesn't usually cause any symptoms, but it increases
your risk of serious health conditions.

About cholesterol
Cholesterol is carried in your blood by proteins. When the two combine,
they're called lipoproteins.

The two main types of lipoprotein are:

 high-density lipoprotein (HDL) – carries cholesterol away from the cells

and back to the liver, where it's either broken down or passed out of the
body as a waste product; for this reason, HDL is referred to as "good
cholesterol", and higher levels are better
 low-density lipoprotein (LDL) – carries cholesterol to the cells that need
it, but if there's too much cholesterol for the cells to use, it can build up
in the artery walls, leading to disease of the arteries; for this reason,
LDL is known as "bad cholesterol"
The amount of cholesterol in the blood – both HDL and LDL – can be
measured with a blood test.
The recommended cholesterol levels in the blood vary between those with a
higher or lower risk of developing arterial disease.

Why should I lower my cholesterol?

Evidence strongly indicates that high cholesterol can increase the risk of:

 narrowing of the arteries (atherosclerosis)

 heart attack
 stroke
 transient ischaemic attack (TIA) – often known as a "mini stroke"
 peripheral arterial disease (PAD)
This is because cholesterol can build up in the artery wall, restricting the blood
flow to your heart, brain and the rest of your body. It also increases the risk of
a blood clot developing somewhere in your body.

Your risk of developing coronary heart disease also rises as your blood's
cholesterol level increases. This can cause pain in your chest or arm during
stress or physical activity (angina).

What causes high cholesterol?

Many factors can increase your chances of having heart problems or a stroke
if you have high cholesterol.

These include:

 an unhealthy diet – in particular, eating high levels of saturated fat

 smoking – a chemical found in cigarettes called acrolein stops HDL
transporting cholesterol from fatty deposits to the liver, leading to
narrowing of the arteries (atherosclerosis)
 having diabetes or high blood pressure (hypertension)
 having a family history of stroke or heart disease
There's also an inherited condition called familial hypercholesterolaemia,
which can cause high cholesterol even in someone who eats healthily.

Read more about the causes of high cholesterol

When should my cholesterol levels be tested?

Your GP may recommend that you have your blood cholesterol levels tested if
you:

 have been diagnosed with coronary heart disease, stroke or mini stroke
(TIA), or peripheral arterial disease (PAD)
 have a family history of early cardiovascular disease
 have a close family member who has a cholesterol-related condition
 are overweight
 have high blood pressure, diabetes, or a health condition that can
increase cholesterol levels
Read more about how cholesterol is tested

What should my cholesterol levels be?

Blood cholesterol is measured in units called millimoles per litre of blood, often
shortened to mmol/L.

As a general guide, total cholesterol levels should be:

 5mmol/L or less for healthy adults

 4mmol/L or less for those at high risk
As a general guide, LDL levels should be:

 3mmol/L or less for healthy adults

 2mmol/L or less for those at high risk
An ideal level of HDL is above 1mmol/L. A lower level of HDL can increase
your risk of heart disease.

Your ratio of total cholesterol to HDL may also be calculated. This is your total
cholesterol level divided by your HDL level. Generally, this ratio should be
below four, as a higher ratio increases your risk of heart disease.

However, cholesterol is only one risk factor and the level at which specific
treatment is required will depend on whether other risk factors, such as
smoking and high blood pressure, are also present.

How can I lower my cholesterol level?

The first step in reducing your cholesterol is to maintain a healthy, balanced
diet. It's important to keep your diet low in fatty food.
 You can swap food containing saturated fat for fruit, vegetables and
wholegrain cereals. This will also help prevent high cholesterol returning.

Other lifestyle changes, such as taking regular exercise and giving up

smoking (if you smoke), can also make a big difference in helping to lower
your cholesterol.

If these measures don't reduce your cholesterol and you continue to have a
high risk of developing heart disease, your GP may prescribe a cholesterol-
lowering medication, such as statins.

Your GP will take into account the risk of any side effects from statins, and the
benefit of lowering your cholesterol must outweigh any risks.

HIV
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Prevention
7. Living with HIV
Introduction
HIV is a long term health condition which is now very easy to manage. HIV
stands for human immunodeficiency virus. The virus targets the immune
system and if untreated, weakens your ability to fight infections and disease.

Nowadays, HIV treatment can stop the virus spreading and if used early
enough, can reverse damage to the immune system.

HIV is most commonly transmitted through having unprotected sex with

someone with HIV who isn't taking HIV treatment. Unprotected sex means
having sex without taking HIV PrEP or using condoms.

HIV can also be transmitted by:

 sharing infected needles and other injecting equipment

 an HIV-positive mother to her child during pregnancy, birth and
breastfeeding
All pregnant women are offered an HIV test and if the virus is found, they can
be offered treatment which virtually eliminates risk to their child during
pregnancy and birth.

People who take HIV treatment and whose virus level is undetectable can't
pass HIV on to others. Although there is no cure for HIV yet, people living with
HIV who take their treatment should have normal lifespans and live in good
health.

Without treatment, people with HIV will eventually become unwell. HIV can be
fatal if it's not detected and treated in time to allow the immune system to
repair. It's extremely important to test for HIV if you think you've been
exposed.

How do you get HIV?

HIV is found in body fluids of a person with the virus, whose levels of virus are
detectable.

The body fluids most likely to contain enough virus to pass on HIV to another
person are:

 semen (including pre-cum)

 vaginal fluid
 anal mucus
 blood
 breast milk
HIV is a fragile virus and does not survive outside the body for long.

HIV is most commonly passed on through unprotected anal or vaginal sex.

There is a very low risk of getting HIV through oral sex and there can be a
small risk through sharing sex toys, which can be eliminated by using fresh
condoms for each person using the toy.

Read more about what causes HIV

How do I know if I have HIV?

Seek healthcare advice as soon as possible if you think you might have been
exposed to HIV.
The only way to find out if you have HIV is to have an HIV test. This involves
testing a sample of your blood or occasionally saliva for signs of the infection.
In NHS services this usually involves a blood test with results available within
a few days.

Some services, including HIV or sexual health charities, may provide saliva
tests. Saliva tests that indicate a person may have HIV will need to be
confirmed through a blood test.

It's important to be aware that:

 HIV tests may need to be repeated four weeks after potential exposure
to HIV, this is known as the "window period", but you shouldn't wait this
long to seek help
 you can get tested in a number of places, including your GP surgery,
sexual health clinics and clinics run by charities
 clinic tests can sometimes give you a result in minutes, although it may
take a few days to get the result of a more detailed blood test
 home-testing or home-sampling kits are available to buy or order online
or from pharmacies – depending on the type of test you use, your result
will be available in a few minutes or a few days
If the test shows you have HIV, you'll be referred to a specialist HIV clinic for
some more tests and a discussion about your treatment options.

Read more about diagnosing HIV

Treating and living with HIV

Treatments for HIV are now very effective, enabling people with HIV to live
long and healthy lives.

Medication, known as antiretrovirals, work by stopping the virus replicating in

the body, allowing the immune system to repair itself and preventing further
damage. These medicines usually come in the form of tablets, which need to
be taken every day.

HIV is able to develop resistance to a single HIV drug very easily, but taking a
combination of different drugs makes this much less likely. Most people with
HIV take a combination of 3 antiretrovirals (although some people take 1 or 2)
and it's vital that the medications are taken every day as recommended by
your doctor.
Taking a number of different drugs doesn’t always mean taking many tablets
though as some drugs are combined together into one tablet.

For people living with HIV, taking effective antiretroviral therapy (where the
HIV virus is "undetectable" in blood tests) will prevent you passing on HIV to
sexual partners.

It's extremely rare for a pregnant woman living with HIV to transmit it to their
babies, provided they receive timely and effective antiretroviral therapy (ART)
and medical care. An HIV test is routinely offered to all women in Scotland as
part of antenatal screening.

Read more about living with HIV

Preventing HIV
It has never been easier to prevent the transmission of HIV.

Someone living with HIV who takes their HIV treatment and who has had an
undetectable level of virus for six months, cannot transmit HIV to anyone else.
Over 90% of all people diagnosed with HIV in Scotland have undetectable
virus. It's therefore extremely rare for someone to get HIV from a person that
knows they have the virus.

HIV Pre Exposure Prophylaxis (PrEP)

PrEP is a form of HIV medication taken by someone who does not have HIV
which will help to prevent them from getting HIV. In Scotland PrEP is available
on the NHS through sexual health clinics for people who are at risk of getting
HIV. PrEP only provides protection from HIV and not from any other sexually
transmitted infections.

Condoms (and lubricant)

Properly used condoms (and lubricant for anal sex) are effective at preventing
transmission of HIV as well as other sexually transmitted infections and
pregnancy.

HIV Post Exposure Prophylaxis (PEP)

PEP is a form of HIV medication taken by someone who does not have HIV
who has or may have been very recently been exposed or had a risk. Ideally
PEP should be taken within 24 hours, but it can be taken up to 72 hours after
exposure. The earlier it is taken the more effective it is.
 You can get PEP from sexual health clinics and A+E departments when the
sexual health clinic is not open.

Clean Injecting Equipment

Using fresh injecting equipment, including any needles, syringes, swabs and
spoons and avoiding sharing will eliminate any risk of HIV.

How common is HIV?

At the end of 2017, there were an estimated 5099 people in Scotland living
with HIV. The majority got the virus through sex.

Around 1 in every 1087 people in the Scotland has HIV, but the three groups
with highest rates of HIV are:

 gay and bisexual men or other men who have sex with men
 people from countries with high HIV prevalence, especially sub Saharan
African countries
 people who share injecting equipment (including needles, syringes,
spoons and swabs) or who have sex with people who inject drugs

Insomnia
1. Introduction
2. Causes
3. Self-help tips
4. Treatments
Introduction
Insomnia is difficulty getting to sleep or staying asleep for long enough to feel
refreshed the next morning.

It's a common problem thought to regularly affect around one in every three
people in the UK, and is particularly common in elderly people.

If you have insomnia, you may:

 find it difficult to fall asleep

 lie awake for long periods at night
 wake up several times during the night
  wake up early in the morning and not be able to get back to sleep
 not feel refreshed when you get up
 find it hard to nap during the day, despite feeling tired
 feel tired and irritable during the day and have difficulty concentrating
Occasional episodes of insomnia may come and go without causing any
serious problems, but for some people it can last for months or even years at
a time.

Persistent insomnia can have a significant impact on your quality of life. It can
limit what you're able to do during the day, affect your mood, and lead to
relationship problems with friends, family and colleagues.

How much sleep do I need?

There are no official guidelines about how much sleep you should get each
night because everyone is different.

On average, a "normal" amount of sleep for an adult is considered to be

around seven to nine hours a night. Children and babies may sleep for much
longer than this, whereas older adults may sleep less.

What's important is whether you feel you get enough sleep, and whether your
sleep is good quality.

You're probably not getting enough good-quality sleep if you constantly feel
tired throughout the day and it's affecting your everyday life.

What causes insomnia?

It's not always clear what triggers insomnia, but it's often associated with:

 stress and anxiety

 a poor sleeping environment – such as an uncomfortable bed, or a
bedroom that's too light, noisy, hot or cold
 lifestyle factors – such as jet lag, shift work, or drinking alcohol or
caffeine before going to bed
 mental health conditions – such as depression and schizophrenia
 physical health conditions – such as heart problems, other sleep
disorders and long-term pain
  certain medicines – such as some antidepressants, epilepsy medicines
and steroid medication
Read more about the causes of insomnia

What you can do about it

There are a number of things you can try to help yourself get a good night's
sleep if you have insomnia.

These include:

 setting regular times for going to bed and waking up

 relaxing before bed time – try taking a warm bath or listening to calming
music
 using thick curtains or blinds, an eye mask and earplugs to stop you
being woken up by light and noise
 avoiding caffeine, nicotine, alcohol, heavy meals and exercise for a few
hours before going to bed
 not watching TV or using phones, tablets or computers shortly
before going to bed
 not napping during the day
 writing a list of your worries, and any ideas about how to solve them,
before going to bed to help you forget about them until the morning
Some people find over-the-counter sleeping tablets helpful, but they don't
address the underlying problem and can have troublesome side effects.

Read more self-help tips for insomnia

When to see your GP

Make an appointment to see your GP if you're finding it difficult to get to sleep
or stay asleep and it's affecting your daily life – particularly if it has been a
problem for a month or more and the above measures have not helped.

Your GP may ask you about your sleeping routines, your daily alcohol and
caffeine consumption, and your general lifestyle habits, such as diet and
exercise.

They will also check your medical history for any illness or medication that
may be contributing to your insomnia.
 Your GP may suggest keeping a sleep diary for a couple of weeks to help
them gain a better understanding of your sleep patterns.

Each day, make a note of things such as the time you went to bed and woke
up, how long it took you to fall asleep, and the number of times you woke up
during the night.

Treatments for insomnia

Your GP will first try to identify and treat any underlying health condition, such
as anxiety, that may be causing your sleep problems.

They'll probably also discuss things you can do at home that may help to
improve your sleep.

In some cases, a special type of cognitive behavioural therapy

(CBT) designed for people with insomnia (CBT-I) may be recommended.

This is a type of talking therapy that aims to help you avoid the thoughts and
behaviours affecting your sleep. It's usually the first treatment recommended
and can help lead to long-term improvement of your sleep.

Prescription sleeping tablets are usually only considered as a last resort and
should be used for only a few days or weeks at a time.

This is because they don't treat the cause of your insomnia and are
associated with a number of side effects. They can also become less effective
over time.

Irritable bowel syndrome (IBS)

1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
Introduction
Irritable bowel syndrome (IBS) is a common, long-term condition of the
digestive system. It can cause bouts of stomach cramps, bloating, diarrhoea
and/or constipation.
IBS is thought to affect up to 1 in 5 people at some point in their life, and it
usually first develops when a person is between 20 and 30 years of age.
Around twice as many women are affected as men.

The condition is often lifelong, although it may improve over several years.

IBS symptoms
The symptoms of IBS vary between individuals and affect some people more
severely than others. They tend to come and go in periods lasting a few days
to a few months at a time, often during times of stress or after eating certain
foods.

You may find some of the symptoms of IBS ease after going to the toilet and
opening your bowels.

Read more about the symptoms of IBS

When to see your GP

See your GP if you think you have IBS symptoms, so they can try
to determine the cause.

Your GP may be able to identify IBS based on your symptoms, although blood
tests may be needed to rule out other conditions.

Read more about diagnosing IBS

What causes IBS?

The exact cause of IBS is unknown, but most experts think that it's related to
increased sensitivity of the gut and problems digesting food.

These problems may mean that you're more sensitive to pain coming from
your gut, and you may become constipated or have diarrhoea because your
food passes through your gut either too slowly or too quickly.

Psychological factors such as stress may also play a part in IBS.

Read more about the causes of IBS

How is IBS treated?

 There is no cure for IBS, but the symptoms can often be managed by making
changes to your diet and lifestyle.

For example, it may help to:

 identify and avoid foods or drinks that trigger your symptoms

 alter the amount of fibre in your diet
 exercise regularly
 reduce your stress levels
Medication is sometimes prescribed for people with IBS to treat the individual
symptoms they experience.

Read more about treating IBS

Living with IBS

IBS is unpredictable. You may go for many months without any symptoms,
then have a sudden flare-up.

The condition can also be painful and debilitating, which can have a negative
impact on your quality of life and emotional state. Many people with IBS will
experience feelings of depression and anxiety, at some point.

Speak to your GP if you have feelings of depression or anxiety that

are affecting your daily life. These problems rarely improve without treatment
and your GP can recommend treatments such as antidepressants or cognitive
behavioural therapy (CBT), which can help you cope with IBS, as well as
directly treating the condition.

With appropriate medical and psychological treatment, you should be able to

live a normal, full and active life with IBS.

IBS does not pose a serious threat to your physical health and doesn't
increase your chances of developing cancer or other bowel-related conditions.

Kidney stones
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Prevention
Introduction
Kidney stones can develop in one or both kidneys and most often affect
people aged 30 to 60.

They're quite common, with around three in 20 men and up to two in 20

women developing them at some stage of their lives.

The medical term for kidney stones is nephrolithiasis, and if they cause severe
pain it's known as renal colic.

Symptoms of kidney stones

Small kidney stones may go undetected and be passed out painlessly in the
urine. But it's fairly common for a stone to block part of the urinary system,
such as the:

 ureter – the tube connecting the kidney to the bladder

 urethra – the tube urine passes through on its way out of the body
A blockage can cause severe pain in the abdomen or groin and sometimes
causes a urinary tract infection (UTI).

Read more about the symptoms of kidney stones.

What causes kidney stones?

The waste products in the blood can occasionally form crystals that collect
inside the kidneys. Over time, the crystals may build up to form a hard stone-
like lump.

This is more likely to happen if you don't drink enough fluids, if you're
taking some types of medication, or if you have a medical condition that raises
the levels of certain substances in your urine.

Read more about the causes of kidney stones.

After a kidney stone has formed, your body will try to pass it out when you go
to the toilet (in the urine). This means it will often travel through the urinary
system (the kidneys, kidney tubes and bladder).
 Treating and preventing kidney stones
Most kidney stones are small enough to be passed in your urine, and it may
be possible to treat the symptoms at home with medication.

Larger stones may need to be broken up using ultrasound or laser energy.

Occasionally, keyhole surgery may be needed to remove very large kidney
stones directly.

Read more about treating kidney stones.

It's estimated that up to half of all people who have had kidney stones will
experience them again within the following five years.

To avoid getting kidney stones, make sure you drink plenty of water every
day so you don't become dehydrated. It's very important to keep your urine
diluted (clear) to prevent waste products forming into kidney stones.

Yellow fever
1. Introduction
2. Yellow fever vaccination
Introduction
Yellow fever is a serious viral infection that is spread by certain types of
mosquito. It’s mainly found in sub-Saharan Africa, South America and parts of
the Caribbean.

The condition can be prevented with a vaccination and is a very rare cause of
illness in travellers.

Six travellers from Europe and North America have died from yellow fever
since 1996. None of them were vaccinated.

If you're planning to visit places where yellow fever infection is found, you
should seek travel health advice about the vaccination available. A map and
list of countries where yellow fever is found is available on the NHS Fit for
Travel website.

How yellow fever is spread

The virus that causes yellow fever is passed to humans through the bites of
infected mosquitoes. The mosquitoes that spread the infection are usually
active and bite during daylight hours, from dusk until dawn, and are found in
both urban and rural areas.

Yellow fever can’t be passed directly from person to person through close
contact.

Yellow fever symptoms

The symptoms of yellow fever occur in two stages. The initial symptoms
develop three to six days after infection, and can include:

 a high temperature (fever)

 a headache
 nausea or vomiting
 muscle pain, including backache
 loss of appetite
This stage will usually pass after three to four days and most people will make
a full recovery.

However, around 15% of people go on to develop more serious problems,

including jaundice (yellowing of the skin and whites of the eyes), kidney failure
and bleeding from the mouth, nose, eyes or stomach (causing blood in your
vomit and stools).

Up to half of those who experience these symptoms will die.

When to seek medical advice

You should see a doctor as soon as possible if you develop symptoms of
yellow fever and are currently travelling in an area where the virus is found, or
have recently returned from one of these areas.

To help determine whether you have yellow fever, the doctor will want to know
exactly where you have been travelling and what symptoms you have.
A blood test will be needed to confirm the diagnosis.

Treating yellow fever

There is no specific treatment for yellow fever, but the symptoms can be
treated while your body fights off the virus.

Headache, high temperature and muscle pain can be treated using painkillers
such as paracetamol or ibuprofen. You should also drink plenty of fluids to
avoid dehydration.

If your symptoms are particularly severe, you may be admitted to hospital so

that your condition can be monitored and you can receive supportive care.

Yellow fever vaccination

The vaccination against yellow fever should be given at least 10 days before
travelling to an area where the infection is found, to allow your body to
develop protection against the virus that causes the infection.

Some countries require a proof of vaccination certificate before they will let
you enter the country. This will only become valid 10 days after you are
vaccinated.

The yellow fever vaccination is given as a single injection and it offers

protection to over 95% of those who have it.

The protection offered by the vaccine may be life-long, but vaccination

certificates are currently only valid for 10 years, and a booster dose may
sometimes be needed after this time if you are planning another visit to an
area where yellow fever is found.

Even if you have been vaccinated, it’s still a good idea to take steps to prevent
mosquito bites while you’re travelling – for example, by using mosquito nets,
wearing loose, long-sleeved clothing, and applying insect repellent containing
50% DEET to exposed skin.

Read more about the yellow fever vaccination.

Information about you

If you have yellow fever, your clinical team will pass information about you on
to the National Congenital Anomaly and Rare Diseases Registration Service
(NCARDRS).

This helps scientists look for better ways to prevent and treat this condition.
You can opt out of the register at any time.
Whooping cough
Introduction
Whooping cough, also called pertussis, is a highly contagious bacterial
infection of the lungs and airways.

It causes repeated coughing bouts that can last for two to three months or
more, and can make babies and young children in particular very ill.

Whooping cough is spread in the droplets of the coughs or sneezes of

someone with the infection.

This page covers:

Symptoms

Who's at risk

When to get medical advice

Treatment

Stopping the infection spreading

Vaccinations

Complications

Symptoms of whooping cough

The first symptoms of whooping cough are similar to those of a cold, such
as a runny nose, red and watery eyes, a sore throat, and a slightly raised
temperature.

Intense coughing bouts start about a week later.

 The bouts usually last a few minutes at a time and tend to be more
common at night.
 Coughing usually brings up thick mucus and may be followed by
vomiting.
  Between coughs, you or your child may gasp for breath – this may
cause a "whoop" sound, although not everyone has this.
 The strain of coughing can cause the face to become very red, and
there may be some slight bleeding under the skin or in the eyes.
 Young children can sometimes briefly turn blue (cyanosis) if they have
trouble breathing – this often looks worse than it is and their breathing
should start again quickly.
 In very young babies, the cough may not be particularly noticeable, but
there may be brief periods where they stop breathing.
The bouts will eventually start to become less severe and less frequent over
time, but it may be a few months before they stop completely.

Who's at risk of whooping cough

Whooping cough can affect people of any age, including:

 babies and young children – young babies under six months of age are
at a particularly increased risk of complications of whooping cough
 older children and adults – it tends to be less serious in these cases, but
can still be unpleasant and frustrating
 people who've had whooping cough before – you're not immune to
whooping cough if you've had it before, although it tends to be less
severe the second time around
 people vaccinated against whooping cough as a child – protection from
the whooping cough vaccine tends to wear off after a few years
You can get whooping cough if you come into close contact with someone
with the infection.

A person with whooping cough is infectious from about six days after they
were infected – when they just have cold-like symptoms – until three weeks
after the coughing bouts start.

Antibiotic treatment can reduce the length of time someone is infectious.

When to get medical advice

See your GP or call the NHS 24 '111' if you or your child:

 have symptoms of whooping cough

  have had a cough for more than three weeks
 have a cough that is particularly severe or is getting worse
Call 999 or go to your nearest accident and emergency (A&E)
department if you or your child:

 have significant breathing difficulties, such as long periods of

breathlessness or choking, shallow breathing, periods where breathing
stops, or dusky, blue skin
 develop signs of serious complications of whooping cough, such as fits
(seizures) or pneumonia

Treatment for whooping cough

Treatment for whooping cough depends on your age and how long you've had
the infection.

 Children under six months who are very ill and people with severe
symptoms will usually be admitted to hospital for treatment.
 People diagnosed during the first three weeks of infection may be
prescribed antibiotics to take at home – these will help stop the infection
spreading to others, but may not reduce the symptoms.
 People who've had whooping cough for more than three weeks won't
normally need any specific treatment, as they're no longer contagious
and antibiotics are unlikely to help.
While you're recovering at home, it can help to get plenty of rest, drink lots of
fluids, clean away mucus and sick from your or your child's mouth, and take
painkillers such as paracetamol or ibuprofen for a fever.

Avoid using cough medicines, as they're not suitable for young children and
are unlikely to be of much help.

Stopping the infection spreading

If you or your child are taking antibiotics for whooping cough, you need to be
careful not to spread the infection to others.

 Stay away from nursery, school or work until five days from the start of
antibiotic treatment or three weeks after the coughing bouts started
(whichever is sooner).
  Cover your or your child's mouth and nose with a tissue when coughing
and sneezing.
 Dispose of used tissues immediately.
 Wash your and your child's hands regularly with soap and water.
Other members of your household may also be given antibiotics and a dose of
the whooping cough vaccine to stop them becoming infected.

Vaccinations for whooping cough

There are three routine vaccinations that can protect babies and children from
whooping cough:

 the whooping cough vaccine in pregnancy – this can protect your baby
during the first few weeks of life; the best time to have it is soon after the
16th week of your pregnancy
 the 5-in-1 vaccine – offered to babies at 8, 12 and 16 weeks of age
 the 4-in-1 pre-school booster – offered to children by 3 years and 4
months
These vaccines don't offer lifelong protection from whooping cough, but they
can help stop children getting it when they're young and more vulnerable to
the effects of the infection.

Older children and adults aren't routinely vaccinated, except during pregnancy
or a whooping cough outbreak.

Complications of whooping cough

Babies and young children under six months are usually most severely
affected by whooping cough.

They're at an increased risk of:

 dehydration
 breathing difficulties
 weight loss
 pneumonia – an infection of the lungs
 fits (seizures)
 kidney problems
  brain damage caused by a lack of oxygen reaching the brain
 death – although this is very rare
Older children and adults tend to be less severely affected, although they may
experience problems caused by repeated coughing, such as nosebleeds,
bruised ribs or a hernia.

Warts and verrucas

1. Introduction
2. Symptoms
3. Causes
4. Treatment
5. Prevention
Introduction
Warts are small lumps that often develop on the skin of the hands and feet.

Warts vary in appearance and may develop singly or in clusters. Some are
more likely to affect particular areas of the body. For example, verrucas are
warts that usually develop on the soles of the feet.

Warts are non-cancerous, but can resemble certain cancers.

Most people will have warts at some point in their life. They tend to affect
children and teenagers more than adults.

Read more about the symptoms of warts.

What causes warts?

Warts are caused by an infection with the human papilloma virus (HPV).

The virus causes an excess amount of keratin, a hard protein, to develop in

the top skin layer (epidermis). The extra keratin produces the rough, hard
texture of a wart.

Read more about the causes of warts.

Are warts contagious?

Warts aren't considered very contagious, but they can be caught by close
skin-to-skin contact. The infection can also be transmitted indirectly from
contaminated objects or surfaces, such as the area surrounding a swimming
pool.

You are more likely to get infected if your skin is wet or damaged. After you
become infected, it can take weeks or even months for a wart or verruca to
appear.

When to see your GP

Most types of warts are easy to identify because they have a distinctive
appearance. You should always see your GP if you have a growth on your
skin you are unable to identify or are worried about.

Your GP will be able to tell if it's a wart simply by looking at it. Where it is on
your body and how it affects surrounding skin will also be taken into
consideration.

You should visit your GP if you have a wart that:

 bleeds
 changes in appearance
 spreads
 causes you significant pain, distress or embarrassment

Treating warts
Most warts are harmless and clear up without treatment.

The length of time it takes a wart to disappear will vary from person to person.
It may take up to 2 years for the viral infection to leave your system and
for the wart to disappear.

You might decide to treat your wart if it is painful, or in an area that is causing
discomfort or embarrassment.

Common methods of treatment include:

 salicylic acid
 cryotherapy (freezing the skin cells)
 duct tape
  chemical treatments
Treatment for warts is not always completely effective, and a wart
will sometimes return following treatment.

Surgery is not usually recommended for warts.

Vitamin B12 or folate deficiency anaemia

1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Complications
Introduction
Vitamin B12 or B9 (commonly called folate) deficiency anaemia occurs when
a lack of vitamin B12 or folate causes the body to produce abnormally large
red blood cells that can't function properly.

Red blood cells carry oxygen around the body using a substance called
haemoglobin.

Anaemia is the general term for having either fewer red blood cells than
normal or having an abnormally low amount of haemoglobin in each red blood
cell.

There are several different types of anaemia, and each one has a different
cause. For example, iron deficiency anaemia, which occurs when the body
doesn't contain enough iron.

Symptoms of vitamin B12 or folate deficiency

Vitamin B12 and folate perform several important functions in the body,
including keeping the nervous system healthy.

A deficiency in either of these vitamins can cause a wide range of problems,

including:

 extreme tiredness
 a lack of energy
  pins and needles (paraesthesia)
 a sore and red tongue
 mouth ulcers
 muscle weakness
 disturbed vision
 psychological problems, which may include depression and confusion
 problems with memory, understanding and judgement
Some of these problems can also occur if you have a deficiency in vitamin
B12 or folate, but don't have anaemia.

Read about the symptoms of vitamin B12 or folate deficiency anaemia

When to see your GP

See your GP if you think you may have a vitamin B12 or folate deficiency.
These conditions can often be diagnosed based on your symptoms and the
results of a blood test.

It's important for vitamin B12 or folate deficiency anaemia to be diagnosed

and treated as soon as possible because, although many of the symptoms
improve with treatment, some problems caused by the condition can be
irreversible.

Read about diagnosing vitamin B12 or folate deficiency anaemia

Causes of a vitamin B12 or folate deficiency

There are a number of problems that can lead to a vitamin B12 or folate
deficiency, including:

 pernicious anaemia – where your immune system attacks healthy cells

in your stomach, preventing your body from absorbing vitamin B12 from
the food you eat; this is the most common cause of vitamin B12
deficiency in the UK
 a lack of these vitamins in your diet – this is uncommon, but can occur if
you have a vegan diet, follow a fad diet or have a generally poor diet for
a long time
  medication – certain medications, including anticonvulsants and proton
pump inhibitors (PPIs), can affect how much of these vitamins your
body absorbs
Both vitamin B12 deficiency and folate deficiency are more common in older
people, affecting around 1 in 10 people aged 75 or over, and 1 in 20 people
aged 65 to 74.

Read about the causes of vitamin B12 or folate deficiency anaemia

Treating vitamin B12 or folate deficiency anaemia

Most cases of vitamin B12 and folate deficiency can be easily treated with
injections or tablets to replace the missing vitamins.

Vitamin B12 supplements are usually given by injection at first. Then,

depending on whether your B12 deficiency is related to your diet, you'll either
require B12 tablets between meals or regular injections. These treatments
may be needed for the rest of your life.

Folic acid tablets are used to restore folate levels. These usually need to be
taken for four months.

In some cases, improving your diet can help treat the condition and prevent it
recurring. Vitamin B12 is found in meat, fish, eggs, dairy products, yeast
extract (such as Marmite) and specially fortified foods. The best sources of
folate include green vegetables such as broccoli, Brussels sprouts and peas.

Read about treating vitamin B12 or folate deficiency

Complications of vitamin B12 or folate deficiency

anaemia
Although it's uncommon, vitamin B12 or folate deficiency (with or without
anaemia) can lead to complications, particularly if you've been deficient in
vitamin B12 or folate for some time.

Potential complications can include:

 problems with the nervous system

 temporary infertility
 heart conditions
  pregnancy complications and birth defects
Adults with severe anaemia are also at risk of developing heart failure.

Some complications improve with appropriate treatment, but others – such as

problems with the nervous system – can be permanent.

Urinary tract infection (UTI)

Introduction
Urinary tract infections (UTIs) are common infections that can affect the
bladder, the kidneys and the tubes connected to them.

Anyone can get them, but they're particularly common in women. Some
women experience them regularly (called recurrent UTIs).

UTIs can be painful and uncomfortable, but usually pass within a few
days and can be easily treated with antibiotics.

This page is about UTIs in adults. There is a separate article about UTIs in
children.

This page covers:

Symptoms

When to get medical advice

Treatment

Causes

Prevention

Symptoms of UTIs
Infections of the bladder (cystitis) or urethra (tube that carries urine out of the
body) are known as lower UTIs. These can cause:

 a need to pee more often than usual

 pain or discomfort when peeing
 sudden urges to pee
  feeling as though you're unable to empty your bladder fully
 pain low down in your tummy
 urine that's cloudy, foul-smelling or contains blood
 feeling generally unwell, achy and tired
Infections of the kidneys or ureters (tubes connecting the kidneys to the
bladder) are known as upper UTIs. These can cause the above symptoms
and also:

 a high temperature (fever) of 38C (100.4ºF) or above

 pain in your sides or back
 shivering and chills
 feeling and being sick
 confusion
 agitation or restlessness
Lower UTIs are common and aren't usually a cause for major concern. Upper
UTIs can be serious if left untreated, as they could damage the kidneys
or spread to the bloodstream.

When to get medical advice

It's a good idea to see your GP if you think you might have a UTI, particularly
if:

 you have symptoms of an upper UTI (see above)

 the symptoms are severe or getting worse
 the symptoms haven't started to improve after a few days
 you get UTIs frequently
Your GP can rule out other possible causes of your symptoms by testing a
sample of your urine and can prescribe antibiotics if you do have an infection.

Antibiotics are usually recommended because untreated UTIs can potentially

cause serious problems if they're allowed to spread.

Treatment for UTIs

UTIs are normally treated with a short course of antibiotics.
Most women are given a three-day course of antibiotic capsules or tablets.
Men, pregnant women and people with more serious symptoms may need a
slightly longer course.

Your symptoms will normally pass within three to five days of starting
treatment. But make sure you complete the whole course of antibiotics that
you've been prescribed, even if you're feeling better.

Over-the-counter painkillers such as paracetamol can help with any pain.

Drinking plenty of fluids may also help you feel better.

Return to your GP if your symptoms don't improve, get worse or come back
after treatment.
Pharmacy First: UTI treatment from your local pharmacy
Women with certain types of UTI can seek advice and treatment directly from
their pharmacist through the Pharmacy First scheme. To find out if you would
be eligible, visit our Urinary Infection self-help guide.

Self-help guide: Urinary infection

Causes of UTIs
UTIs occur when the urinary tract becomes infected, usually by bacteria. In
most cases, bacteria from the gut enter the urinary tract through the urethra.

This may occur when wiping your bottom or having sex, for example, but often
it's not clear why it happens.

The following may increase your risk of getting a UTI:

 conditions that obstruct your urinary tract, such as kidney stones

 difficulty emptying your bladder fully
 using a contraceptive diaphragm or condoms coated in spermicide
 diabetes
 a weak immune system – from chemotherapy or HIV, for example
 a urinary catheter (a tube in your bladder used to drain urine)
 an enlarged prostate gland in men
Women may be more likely to get UTIs because their urethra is shorter than a
man's and is closer to their anus (back passage).
 Preventing UTIs
If you get UTIs frequently, there are some things you can try that may stop it
coming back. However, it's not clear how effective most of these measures
are.

These measures include:

 avoiding perfumed bubble bath, soap or talcum powder around your

genitals – use plain, unperfumed varieties, and have a shower rather
than a bath
 going to the toilet as soon as you need to pee and always emptying
your bladder fully
 staying well hydrated
 wiping your bottom from front to back when you go to the toilet
 emptying your bladder as soon as possible after having sex
 not using a contraceptive diaphragm or condoms with spermicidal
lubricant on them – you may wish to use another method of
contraception instead
 wearing underwear made from cotton, rather than synthetic material
such as nylon, and avoiding tight jeans and trousers
Speak to your GP if these measures don't work. They may suggest taking a
long-term course of antibiotics or they may give you a prescription for
antibiotics you can use as soon as you experience symptoms of a UTI.

There's currently little evidence to suggest that drinking cranberry juice or

using probiotics significantly reduces your chances of getting UTIs.

Type 2 diabetes
1. Introduction
2. Symptoms
3. Causes
4. Treatment
5. Complications
6. Living with type 2 diabetes
Introduction
Diabetes is a lifelong condition that causes a person's blood sugar level to
become too high.

The hormone insulin – produced by the pancreas – is responsible for

controlling the amount of glucose in the blood

There are two main types of diabetes:

 type 1 – where the pancreas doesn't produce any insulin

 type 2 – where the pancreas doesn't produce enough insulin or the
body's cells don't react to insulin
This topic is about type 2 diabetes.

Read more about type 1 diabetes

Another type of diabetes, known as gestational diabetes, occurs in some

pregnant women and tends to disappear after birth.

Symptoms of diabetes
The symptoms of diabetes occur because the lack of insulin means glucose
stays in the blood and isn't used as fuel for energy.

Your body tries to reduce blood glucose levels by getting rid of the excess
glucose in your urine.

Typical symptoms include:

 feeling very thirsty

 passing urine more often than usual, particularly at night
 feeling very tired
 weight loss and loss of muscle bulk
Read more about the symptoms of type 2 diabetes

It's very important for diabetes to be diagnosed as soon as possible as it will

get progressively worse if left untreated.

Causes of type 2 diabetes

Type 2 diabetes occurs when the body doesn't produce enough insulin to
function properly, or the body's cells don't react to insulin. This means glucose
stays in the blood and isn't used as fuel for energy.
Type 2 diabetes is often associated with obesity and tends to be diagnosed in
older people. It's far more common than type 1 diabetes.

Read about the causes and risk factors for type 2 diabetes

Treating type 2 diabetes

As type 2 diabetes usually gets worse, you may eventually need
medication – usually tablets – to keep your blood glucose at normal levels.

Read more about the treatment of type 2 diabetes

Complications of type 2 diabetes

Diabetes can cause serious long-term health problems. It's the most common
cause of vision loss and blindness in people of working age.

Everyone with diabetes aged 12 or over should be invited to have their

eyes screened once a year for diabetic retinopathy.

Diabetes is also responsible for most cases of kidney failure and lower limb
amputation, other than accidents.

People with diabetes are up to five times more likely to have cardiovascular
disease, such as a stroke, than those without diabetes.

Read more about the complications of type 2 diabetes

Preventing type 2 diabetes

If you're at risk of type 2 diabetes, you may be able to prevent it developing by
making lifestyle changes.

These include:

 eating a healthy, balanced diet

 losing weight if you're overweight, and maintaining a healthy weight
 stopping smoking if you smoke
 drinking alcohol in moderation
 taking plenty of regular exercise

Living with type 2 diabetes

 If you already have type 2 diabetes, it may be possible to control your
symptoms by making the above changes. This also minimises your risk of
developing complications.

Type 1 diabetes
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Complications
7. Living with type 1 diabetes
Introduction
Diabetes is a lifelong condition that causes a person's blood sugar (glucose)
level to become too high.

The hormone insulin – produced by the pancreas – is responsible for

controlling the amount of glucose in the blood.

There are two main types of diabetes:

 Type 1 – where the pancreas doesn't produce any insulin

 Type 2 – where the pancreas doesn't produce enough insulin or the
body’s cells don't react to insulin
This topic is about type 1 diabetes.

Read more about type 2 diabetes

Another type of diabetes, known as gestational diabetes, occurs in some

pregnant women and tends to disappear following birth.

It's very important for diabetes to be diagnosed as soon as possible, because

it will get progressively worse if left untreated.

You should therefore visit your GP if you have symptoms, which include
feeling thirsty, passing urine more often than usual and feeling tired all the
time (see the list below for more diabetes symptoms).

Type 1 and type 2 diabetes

Type 1 diabetes can develop at any age, but usually appears before the age
of 40, particularly in childhood. Around 10% of all diabetes is type 1, but it's
the most common type of childhood diabetes. This is why it's sometimes
called juvenile diabetes or early-onset diabetes.

In type 1 diabetes, the pancreas (a small gland behind the stomach) doesn't
produce any insulin – the hormone that regulates blood glucose levels. This is
why it's also sometimes called insulin-dependent diabetes.

If the amount of glucose in the blood is too high, it can, over time, seriously
damage the body's organs.

In type 2 diabetes, the body either doesn't produce enough insulin to function
properly, or the body's cells don't react to insulin. Around 90% of adults with
diabetes have type 2, and it tends to develop later in life than type 1.

Diabetes symptoms
The symptoms of diabetes occur because the lack of insulin means that
glucose stays in the blood and isn’t used as fuel for energy.

Your body tries to reduce blood glucose levels by getting rid of the excess
glucose in your urine.

Typical symptoms include:

 feeling very thirsty

 passing urine more often than usual, particularly at night
 feeling very tired
 weight loss and loss of muscle bulk
The symptoms of type 1 diabetes usually develop very quickly in young
people (over a few days or weeks). In adults, the symptoms often take longer
to develop (a few months).

Read more about the symptoms of type 1 diabetes

Causes of type 1 diabetes

Type 1 diabetes occurs as a result of the body being unable to produce
insulin, which moves glucose out of the blood and into your cells to be used
for energy.
Without insulin, your body will break down its own fat and muscle, resulting
in weight loss. This can lead to a serious short-term condition called diabetic
ketoacidosis, where the bloodstream becomes acidic and you develop
dangerous levels of dehydration.

Type 1 diabetes is an autoimmune condition, where the immune system (the

body's natural defence against infection and illness) mistakes the cells in your
pancreas as harmful and attacks them.

Read more about the causes of type 1 diabetes

Treating type 1 diabetes

It's important that diabetes is diagnosed as early as possible, so that
treatment can be started.

Diabetes can't be cured, but treatment aims to keep your blood glucose levels
as normal as possible and control your symptoms, to prevent health problems
developing later in life.

If you're diagnosed with diabetes, you'll be referred to a diabetes care team

for specialist treatment and monitoring.

As your body can't produce insulin, you'll need regular insulin injections to
keep your glucose levels normal. You'll be taught how to do this and how to
match the insulin you inject to the food you eat, taking into account your blood
glucose level and how much exercise you do.

Insulin injections come in several different forms, with each working slightly
differently. Some last up to a whole day (long-acting), some last up to eight
hours (short-acting) and some work quickly but don't last very long (rapid-
acting). You'll most likely need a combination of different insulin preparations.

There are alternatives to insulin injections, but they're only suitable for a small
number of patients. They are:

 insulin pump therapy – where a small device constantly

pumps insulin (at a rate you control) into your bloodstream through a
needle that's inserted under the skin
 islet cell transplantation – where healthy insulin-producing cells from the
pancreas of a deceased donor are implanted into the pancreas of
someone with type 1 diabetes (read about the criteria for having an islet
transplant)
  a complete pancreas transplant
Read more about diagnosing diabetes and treating type 1 diabetes

Complications
If diabetes is left untreated, it can cause a number of different health
problems. Large amounts of glucose can damage blood vessels, nerves and
organs.

Even a mildly raised glucose level that doesn't cause any symptoms can have
damaging effects in the long term.

Read more about the complications of type 1 diabetes

Living with diabetes

If you have type 1 diabetes, you'll need to look after your health very carefully.
Caring for your health will also make treating your diabetes easier and
minimise your risk of developing complications.

For example, eating a healthy, balanced diet and exercising

regularly will lower your blood glucose level. Stopping smoking (if you smoke)
will also reduce your risk of developing cardiovascular disease.

If you have diabetes, your eyes are at risk from diabetic retinopathy, a
condition that can lead to sight loss if it's not treated. Everyone with diabetes
aged 12 or over should be invited to have their eyes screened once a year.

Tuberculosis (TB)
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
Introduction
Tuberculosis (TB) is a bacterial infection spread through inhaling tiny droplets
from the coughs or sneezes of an infected person.

It is a serious condition, but can be cured with proper treatment.

TB mainly affects the lungs. However, it can affect any part of the body,
including the glands, bones and nervous system.

Symptoms of TB
Typical symptoms of TB include:

 a persistent cough that lasts more than three weeks and usually brings
up phlegm, which may be bloody
 weight loss
 night sweats
 high temperature (fever)
 tiredness and fatigue
 loss of appetite
 new swellings that haven't gone away after a few weeks
You should see a GP if you have a cough that lasts more than three weeks or
if you cough up blood.

Read more about the symptoms of TB and diagnosing TB

What causes TB?

TB is caused by a bacterium called Mycobacterium tuberculosis.

TB that affects the lungs is the most contagious type, but it usually only
spreads after prolonged exposure to someone with the illness. For example, it
often spreads within a family who live in the same house.

In most healthy people, the immune system (the body's natural defence
against infection and illness) kills the bacteria, and you have no symptoms.

Sometimes the immune system cannot kill the bacteria, but manages to
prevent it spreading in the body. This means you will not have any symptoms,
but the bacteria will remain in your body. This is known as "latent TB".

If the immune system fails to kill or contain the infection, it can spread within
the lungs or other parts of the body and symptoms will develop within a few
weeks or months. This is known as "active TB".

Latent TB could develop into an active TB infection at a later date, particularly

if your immune system becomes weakened.
Read more about the causes of TB

Who is affected?
Before antibiotics were introduced, TB was a major health problem in the UK.
Nowadays, the condition is much less common.

However, in the last 20 years, TB cases have gradually increased, particularly

among ethnic minority communities who are originally from countries where
TB is more common.

In 2014, more than 6,500 cases of TB were reported in England. Of these,

around 4,700 affected people who were born outside the UK.

It's estimated that around one-third of the world's population is infected with
latent TB. Of these, up to 10% will become active at some point.

How TB is treated
With treatment, TB can usually be cured. Most people will need a course of
antibiotics, usually for six months.

Several different antibiotics are used. This is because some forms of TB are
resistant to certain antibiotics. If you are infected with a drug-resistant form of
TB, treatment with six or more different medications may be needed.

If you are in close contact with someone who has TB, tests may be carried out
to see if you are also infected. These can include a chest X-ray, blood tests,
and a skin test called the Mantoux test.

Read more about treating TB

Tuberculosis vaccination
The BCG vaccine can provide effective protection against TB in up to 8 out of
10 people who are given it.

Currently, BCG vaccinations are only recommended for groups of people who
are at a higher risk of developing TB.

This includes children living in areas with high rates of TB, or those who have
close family members from countries with high TB rates, and people under the
age of 16 who are going to live and work with local people in an area with high
rates of TB for more than three months.

It's also recommended that some people, such as healthcare workers, are
vaccinated because of the increased risk of contracting TB while working.

Symptoms
The symptoms of tuberculosis (TB) depend on where the infection occurs.

TB usually develops slowly. Your symptoms might not begin until months or
even years after you were initially infected.

In some cases the infection doesn't cause any symptoms, which is known as
latent TB. It's called active TB if you have symptoms. You should contact your
GP if you or your child have symptoms of TB.

Read about the causes of tuberculosis for more information about latent and
active TB.

Main symptoms
General symptoms of TB include:

 lack of appetite and weight loss

 a high temperature (fever)
 night sweats
 extreme tiredness or fatigue
These symptoms can have many different causes, however, and are not
always a sign of TB.

Additional symptoms
TB can also cause additional symptoms depending on which part of the body
is infected.

Pulmonary TB
Most infections affect the lungs, which can cause:

 a persistent cough that lasts more than three weeks and usually brings
up phlegm, which may be bloody
  breathlessness that gradually gets worse
This is known as pulmonary TB.

Extrapulmonary TB
Less commonly, TB infections develop in areas outside the lungs, such as the
lymph nodes (small glands that form part of the immune system), the bones
and joints, the digestive system, the bladder and reproductive system, and
the nervous system (brain and nerves).

This is known as extrapulmonary TB.

Symptoms of extrapulmonary TB vary, but can include:

 persistently swollen glands

 abdominal (tummy) pain
 pain and loss of movement in an affected bone or joint
 confusion
 a persistent headache
 seizures (fits)
Extrapulmonary TB is more common in people with a weakened immune
system, such as those with HIV.

Tooth decay
Introduction
Tooth decay can occur when acid is produced from plaque, which builds up
on your teeth.

If plaque is allowed to build up, it can lead to further problems, such as dental
caries (holes in the teeth), gum disease or dental abscesses, which are
collections of pus at the end of the teeth or in the gums.

This topic covers:

Symptoms

Seeing a dentist

Treatment
Cost of NHS treatment

Prevention

Protecting your child's teeth

How plaque causes tooth decay

Symptoms of tooth decay

Tooth decay may not cause any pain. However, if you have dental caries you
might have:

 toothache – either continuous pain keeping you awake or occasional

sharp pain without an obvious cause
 tooth sensitivity – you may feel tenderness or pain when eating or
drinking something hot, cold or sweet
 grey, brown or black spots appearing on your teeth
 bad breath
 an unpleasant taste in your mouth

Seeing a dentist
Visit your dentist regularly, so early tooth decay can be treated as soon as
possible and the prevention of decay can begin. Tooth decay is much easier
and cheaper to treat in its early stages. Dentists can usually identify tooth
decay and further problems with a simple examination or X-ray.

Find your nearest dentist.

It's also important to have regular dental check-ups. Adults should have a
check-up at least once every two years and children under the age of 18
should have a check-up at least once a year.

Read more on getting over a fear of the dentist

Treatments for tooth decay

Treatment of tooth decay depends on how advanced it is.

 For early stage tooth decay – your dentist will talk to you about the
amount of sugar in your diet and the times you eat. They may apply
 a fluoride gel, varnish or paste to the area. Fluoride helps to protect
teeth by strengthening the enamel, making teeth more resistant to the
acids from plaque that can cause tooth decay.
 Your dentist may discuss a filling or crown with you – this involves
removing the dental decay, offering local anaesthetic to numb the tooth
and filling the hole
 If tooth decay has spread to the pulp (in the centre of the tooth,
containing blood and nerves) – this may be removed in a process
known as root canal treatment.
 If the tooth is so badly damaged that it can't be restored – it may need to
be removed. Your dentist may be able to replace the tooth with a
partial denture, bridge or implant.

Cost of NHS treatment

NHS charges are set by the government and are standard for all NHS
patients. Charges are assessed each year and usually change every April.

Some people don't have to pay for dental treatment, including children,
pregnant women and new mothers. Financial help may also be available to
those on a low income.

The cost of private dental treatment varies between practices, as there is no

set charge. If you choose to see a private dentist, make sure to agree the cost
before having treatment.

Preventing tooth decay

Although tooth decay is a common problem, it's often entirely preventable.
The best way to avoid tooth decay is to keep your teeth and gums as healthy
as possible. For example, you should:

 visit your dentist regularly – your dentist will decide how often they need
to see you based on the condition of your mouth, teeth and gums
 cut down on sugary and starchy food and drinks, particularly between
meals or within an hour of going to bed – some medications can also
contain sugar, so it's best to look for sugar-free alternatives where
possible
 look after your teeth and gums – brushing your teeth properly with a
fluoride toothpaste twice a day, using floss and an interdental brush at
least once a day
  avoid smoking or drinking alcohol excessively – tobacco can interfere
with saliva production, which helps to keep your teeth clean, and alcohol
can contribute to the erosion of tooth enamel
 see your dentist or GP if you have a persistently dry mouth – this may
be caused by certain medicines, treatment or medical conditions
Read:

how to keep your teeth clean

reading food labels

Protecting your child's teeth

Establishing good eating habits by limiting sugary snacks and drinks can help
your child avoid tooth decay. Regular visits to the dentist at an early age
should also be encouraged.

It's important to teach your child how to clean their teeth properly and
regularly. Your dentist can show you how to do this. Younger children should
use a children's toothpaste, but make sure to read the label about how to use
it.

Children should still brush their teeth twice a day, especially before bedtime.

How plaque causes tooth decay

Your mouth is full of bacteria that form a film over the teeth called dental
plaque.

When you consume food and drink high in carbohydrates – particularly sugary
foods and drinks – the bacteria in plaque turn the carbohydrates into energy
they need, producing acid at the same time.

If the plaque is allowed to build up, the acid can begin to break down
(dissolve) the surface of your tooth, causing holes known as cavities.

Once cavities have formed in the enamel, the plaque and bacteria can reach
the dentine (the softer, bone-like material underneath the enamel). As the
dentine is softer than the enamel, the process of tooth decay speeds up.
Without treatment, bacteria will enter the pulp (the soft centre of the tooth that
contains nerves and blood vessels). At this stage, your nerves will be exposed
to bacteria, usually making your tooth painful.

The bacteria can cause a dental abscess in the pulp and the infection could
spread into the bone, causing another type of abscess.

Introduction
Tonsillitis is inflammation of the tonsils. It's usually caused by a viral infection
or, less commonly, a bacterial infection.

Tonsillitis is a common condition in children, teenagers and young adults.

The symptoms of tonsillitis include:

 a sore throat and pain when swallowing

 earache
 high temperature (fever) over 38C (100.4F)
 coughing
 headache
Symptoms usually pass within three to four days.

When to see your GP

Tonsillitis isn't usually a serious condition. You only need to see your GP if
symptoms:

 last longer than four days and don't show any signs of improvement
 are severe – for example, if you're unable to eat or drink due to the pain,
or you have difficulty breathing
Your GP will examine your throat and ask you some questions about your
symptoms. If necessary, a throat swab can be taken to confirm the diagnosis.
The results usually take a few days to return.

If your tonsillitis is caused by a bacterial infection, they may

prescribe antibiotics. Typical signs of a bacterial infection include white pus-
filled spots on the tonsils, no cough and swollen or tender lymph glands.

If you develop severe tonsillitis as a teenager or adult, your GP may

recommend a blood test for glandular fever.
The tonsils
The tonsils are two small glands that sit on either side of the throat. In young
children, they help to fight germs and act as a barrier against infection.

When the tonsils become infected, they isolate the infection and stop it
spreading further into the body.

As a child's immune system develops and gets stronger, the tonsils become
less important and usually shrink. In most people, the body is able to fight
infection without the tonsils.

Removal of the tonsils is usually only recommended if they're causing

problems, such as severe or repeated episodes of tonsillitis (see below).

What causes tonsillitis?

Most cases of tonsillitis are caused by a viral infection, such as the viruses
that cause the common cold or flu virus (influenza).

Some cases can also be caused by a bacterial infection, typically a strain of

bacteria called group A streptococcus bacteria.

These types of infections spread easily, so it's important to try to avoid

passing the infection on to others by:

 staying away from public places, such as work, school or nursery, until
your GP says it's safe to return (usually after the symptoms have
passed)
 coughing and sneezing into a tissue and disposing of the tissue
 washing hands before eating, after going to the toilet and, if possible,
after coughing and sneezing
Read more about the causes of tonsillitis.

Treating tonsillitis
There's no specific treatment for tonsillitis, but you may be able to reduce the
symptoms by:

 taking paracetamol or ibuprofen to help relieve pain

 drinking plenty of fluids
 getting plenty of rest
If test results show that your tonsillitis is caused by a bacterial infection, a
short course of oral antibiotics may be prescribed.

If oral antibiotics aren't effective at treating bacterial tonsillitis, intravenous

antibiotics (given directly into a vein) may be needed in hospital.

Chronic tonsillitis
In most cases, tonsillitis gets better within a week. However, a small number
of children and adults have tonsillitis for longer, or it keeps returning. This is
known as chronic tonsillitis and surgical treatment may be needed.

Surgery to remove the tonsils (a tonsillectomy) is usually only

recommended if:

 you've had several severe episodes of tonsillitis over a long period of

time
 repeated episodes are disrupting normal activities
Read more about treating tonsillitis.

Complications of tonsillitis
Complications of tonsillitis are rare and usually only occur if it's caused by a
bacterial infection. They're usually the result of the infection spreading to
another part of the body.

Possible complications of tonsillitis include:

 a middle ear infection (otitis media) – where fluid between the eardrum
and inner ear becomes infected by bacteria
 quinsy (peritonsillar abscess) – an abscess (collection of pus) that
develops between one of the tonsils and the wall of the throat
 obstructive sleep apnoea (OSA) – where the walls of the throat relax
during sleep, which causes breathing difficulties and poor sleep
Other complications of tonsillitis are very rare and usually only occur if an
underlying bacterial infection is left untreated. They include:

 scarlet fever – a condition that causes a distinctive pink-red skin rash

 rheumatic fever – this causes widespread inflammation throughout the
body, leading to symptoms such as joint pain, rashes and jerky body
movements
  glomerulonephritis – an infection (swelling) of the filters in the kidneys
that can cause vomiting and a loss of appetite
Symptoms
The main symptom of tonsillitis is a sore throat.

Your tonsils will be red and swollen, and your throat may be very painful,
making swallowing difficult.

In some cases, the tonsils are coated or have white, pus-filled spots on them.

Other common symptoms of tonsillitis include:

 high temperature (fever) over 38C (100.4F)

 coughing
 headache
 earache
 feeling sick
 feeling tired
 swollen, painful lymph glands in your neck
 loss of voice or changes to your voice
The symptoms of tonsillitis usually get better after three to four days.

If you have tonsillitis that's caused by a viral infection, such as the common
coldor flu, your symptoms may be milder.

If your tonsillitis is caused by a bacterial infection, such as a streptococcal

infection, your symptoms will usually be more severe and you may also have
bad breath.

It's difficult to tell just by looking at a person's throat whether they have
tonsillitis as a result of a virus or a bacterial infection. Tests are needed to
confirm this.

Antibiotics may be recommended if test results show that your tonsillitis is

caused by a bacterial infection.

Sunburn
Introduction
Sunburn is skin damage caused by ultraviolet (UV) rays. It usually causes the
skin to become red, sore, warm, tender and occasionally itchy for about a
week.

The skin will normally start to flake and peel after a few days and will usually
fully heal within seven days.

While sunburn is often short-lived and mild, it's important to try to avoid it,
because it can increase your chances of developing serious health problems,
such as skin cancer, in later life.

It’s easy to underestimate your exposure to the sun when outside, as the
redness doesn’t usually develop for several hours. Breezes and getting wet
(such as going in and out of the sea) may cool your skin, so you don’t realise
you’re getting burnt.

You should always be aware of the risk of sunburn if you’re outside in strong
sun, and look out for your skin getting hot.

What to do if you're sunburnt

If you or your child has sunburn, you should get out of the sun as soon as
possible – head indoors or into a shady area.

You can usually treat mild sunburn at home, although there are some
circumstances where you should seek medical advice (see below).

The following advice may help to relieve your symptoms until your skin heals:

 Cool the skin by sponging it with cold water or by having a cold bath or
shower – applying a cold compress such as a cold flannel to the
affected area may also help.
 Drink plenty of fluids to cool you down and prevent dehydration.
 Apply a water-based emollient or petroleum jelly (such as Vaseline) to
keep your skin cool and moist.
 Take painkillers such as ibuprofen or paracetamol to relieve any pain –
aspirin should not be given to children under 16.
Try to avoid all sunlight, including through windows, by covering up the
affected areas of skin until your skin has fully healed.
When to seek medical advice
You should contact your GP or the NHS 24 111 service for advice if you feel
unwell or have any concerns about your sunburn, particularly if you are burnt
over a large area or have any of the more severe symptoms listed below.

You should also see your GP if a young child or baby has sunburn, as their
skin is particularly fragile.

Signs of severe sunburn can include:

 blistering or swelling of the skin (oedema)

 chills
 a high temperature (fever) of 38C (100.4F) or above, or 37.5C (99.5F)
or above in children under five
 dizziness, headaches and feeling sick (symptoms of heat exhaustion)
Your GP may recommend using hydrocortisone cream for a few days (this is
also available over the counter at pharmacies) to reduce the inflammation of
your skin.

Severe sunburn may require special burn cream and burn dressings from your
GP or a nurse at your GP surgery. Very occasionally, hospital treatment may
be needed.

Who's at risk of sunburn?

Everyone who is exposed to UV light is at risk of getting sunburn, although
some people are more vulnerable than others.

You should take extra care when out in the sun if you:

 have pale, white or light brown skin

 have freckles or red or fair hair
 tend to burn rather than tan
 have many moles
 have skin problems relating to a medical condition
 are only exposed to intense sun occasionally – for example, while on
holiday
 are in a hot country where the sun is particularly intense
 have a family history of skin cancer
People who spend a lot of time in the sun, whether it’s for work or play, are at
increased risk of skin cancer if they don’t take the right precautions.

Snow, sand, concrete and water can reflect the sun’s rays onto your skin, and
the sun is more intense at high altitudes.

Dangers of UV rays
The short-term risks of sun exposure are sunburn and sun allergy.

The longer-term risks (over decades) include:

 actinic (solar) keratoses – rough and scaly pre-cancerous spots on the

skin
 skin cancer – including both melanoma and non-melanoma skin cancer
 eye problems – such as photokeratitis (snow blindness) and cataracts
 premature ageing of the skin and wrinkling

Preventing sunburn
Skin should be protected from strong sunlight by covering up with suitable
clothing, seeking shade and applying sunscreen.

In the UK, the risk of getting sunburnt is highest from March to October,
particularly from 11am to 3pm, when the sun's rays are strongest.

There is also a risk of getting sunburn in other weather conditions – for

example, light reflecting off snow can also cause sunburn. You can also burn
in cloudy and cool conditions.

Suitable clothing:

 a wide-brimmed hat that shades the face, neck and ears

 a long-sleeved top
 trousers or long skirts in close-weave fabrics that do not allow sunlight
through
 sunglasses with wraparound lenses or wide arms with the CE Mark and
European Standard EN 1836:2005.
Sunscreen:
When buying sunscreen, make sure it's suitable for your skin and blocks both
ultraviolet A (UVA) and ultraviolet B (UVB) radiation.

The sunscreen label should have:

 the letters "UVA" in a circle logo and at least 4-star UVA protection
 at least SPF15 sunscreen to protect against UVB
Most people do not apply enough sunscreen. The amount of sunscreen
needed for the body of an average adult to achieve the stated sun protection
factor (SPF) is around 35ml or 6 to 8 teaspoons of lotion.

If sunscreen is applied too thinly, it provides less protection. If you’re worried

you might not be applying enough SPF15, you could use a stronger SPF30
sunscreen.

If you plan to be out in the sun long enough to risk burning, sunscreen needs
to be applied twice:

 30 minutes before going out

 just before you go out
Sunscreen should be applied to all exposed skin, including the face, neck and
ears (and head if you have thinning or no hair), but a wide-brimmed hat is
better.

How long it takes for your skin to go red or burn varies from person to person.
The Cancer Research UK website has a handy tool where you can find out
your skin type, to see when you might be at risk of burning.

Water-resistant sunscreen is needed if sweating or contact with water is likely.

Sunscreen needs to be reapplied liberally, frequently and according to the

manufacturer’s instructions. This includes straight after you've been in water
(even if it is "water-resistant") and after towel drying, sweating or when it may
have rubbed off.

Advice for babies and children

Children aged under six months should be kept out of direct strong sunlight.

From March to October in the UK, children should:

 cover up with suitable clothing

  spend time in the shade (particularly from 11am to 3pm)
 wear at least SPF15 sunscreen
To ensure they get enough vitamin D, children aged under five are advised to
take vitamin D supplements even if they do get out in the sun.

Stroke
1. Introduction
2. Symptoms and signs
3. Causes
4. Diagnosis
5. Treatment
6. Recovering after a stroke
7. Prevention
Introduction
A stroke is a serious, life-threatening medical condition that occurs when the
blood supply to part of the brain is cut off.

Strokes are a medical emergency and urgent treatment is essential because

the sooner a person receives treatment for a stroke, the less damage is likely
to happen.

If you suspect that you or someone else is having a stroke, phone 999
immediately and ask for an ambulance.

Signs and symptoms

The main symptoms of stroke can be remembered with the word FAST: Face-
Arms-Speech-Time.

 Face – the face may have dropped on one side, the person may not be
able to smile or their mouth or eye may have dropped.
 Arms – the person with suspected stroke may not be able to lift both
arms and keep them there because of arm weakness or numbness in
one arm.
 Speech – their speech may be slurred or garbled, or the person may not
be able to talk at all despite appearing to be awake.
 Time – it is time to dial 999 immediately if you see any of these signs or
symptoms.
Read more about the symptoms of a stroke

Why do strokes happen?

Like all organs, the brain needs the oxygen and nutrients provided by blood to
function properly. If the supply of blood is restricted or stopped, brain cells
begin to die. This can lead to brain injury, disability and possibly death.

There are two main causes of strokes:

 ischaemic– where the blood supply is stopped due to a blood clot (this
accounts for 85% of all cases)
 haemorrhagic – where a weakened blood vessel supplying the brain
bursts
There is also a related condition known as a transient ischaemic attack (TIA),
where the supply of blood to the brain is temporarily interrupted, causing a
"mini-stroke" often lasting between 30 minutes and several hours. TIAs should
be treated seriously as they are often a warning sign that you are at risk of
having a full stroke in the near future.

Read more about the causes of strokes

Who is at risk?
In the UK, strokes are a major health problem. Every year, around 110,000
people have a stroke in England and it is the third largest cause of death,
after heart disease and cancer. The brain injuries caused by strokes are a
major cause of adult disability in the UK.

Older people are most at risk of having strokes, although they can happen at
any age – including in children.

If you are south Asian, African or Caribbean, your risk of stroke is higher. This
is partly because of a predisposition (a natural tendency) to developing high
blood pressure (hypertension), which can lead to strokes.

Smoking, being overweight, lack of exercise and a poor diet are also risk
factors for stroke, as are high cholesterol, atrial fibrillation and diabetes.

How strokes are treated

Treatment depends on the type of stroke you have, including which part of the
brain was affected and what caused it.

Most often, strokes are treated with medication. This generally includes
medicines to prevent and remove blood clots, reduce blood pressure and
reduce cholesterol levels.

In some cases, surgery may be required to treat brain swelling and reduce the
risk of further bleeding in cases of haemorrhagic strokes.

Read more about diagnosing strokes and treating strokes

Life after a stroke

Around one in every four people who has a stroke will die, and those who do
survive are often left with long-term problems resulting from the injury to their
brain.

Some people need to have a long period of rehabilitation before they can
recover their former independence, while many will never fully recover and will
need support adjusting to living with the effects of their stroke.

Local authorities should provide free "reablement services" for anyone

assessed as needing them. These services help the person recovering from a
stroke to learn or relearn the skills necessary for independent daily living at
home.

Around half the people who have a stroke will be dependent on some form of
care for help with their daily activities.

For example, a care worker could come to the person's home to help with
washing and dressing, or even just to provide companionship. Read more
about care services in your home on Care Information Scotland.

A team of specialists are also available to help, including physiotherapists,

psychologists, occupational therapists, speech therapists and specialist
nurses and doctors.

Read more about recovering from a stroke

Can strokes be prevented?

You can significantly reduce your risk of having a stroke through a healthy
lifestyle, such as eating a healthy diet, taking regular exercise, drinking
alcohol in moderation and not smoking.

Lowering high blood pressure and cholesterol levels with medication also
lowers the risk of stroke substantially, as does taking anticoagulant medication
if you have an irregular heartbeat due to a condition called atrial fibrillation.

If you have had a stroke or TIA in the past, these measures are particularly
important because your risk of having another stroke in the future is greatly
increased.

Symptoms and signs

If you suspect that you or someone else is having a stroke, phone 999
immediately and ask for an ambulance.

Even if the symptoms of a stroke disappear while you are waiting for the
ambulance to arrive, you or the person having the stroke should still go to
hospital for an assessment.

Symptoms that disappear quickly (and in less than 24 hours) may mean you
have had a transient ischaemic attack (TIA) and you could be at risk of having
a full stroke in the near future.

After an initial assessment, you may need to be admitted to hospital to receive

a more in-depth assessment and, if necessary, for specialist treatment to
begin.

Recognising the signs of a stroke

The signs and symptoms of a stroke vary from person to person but usually
begin suddenly. As different parts of your brain control different parts of your
body, your symptoms will depend on the part of your brain affected and the
extent of the damage.

The main stroke symptoms can be remembered with the word FAST: Face-
Arms-Speech-Time.

 Face – the face may have dropped on one side, the person may not be
able to smile or their mouth or eye may have drooped.
  Arms – the person with suspected stroke may not be able to lift both
arms and keep them there because of arm weakness or numbness in
one arm.
 Speech – their speech may be slurred or garbled, or the person may not
be able to talk at all despite appearing to be awake.
 Time – it is time to dial 999 immediately if you notice any of these signs
or symptoms.
It is important for everyone to be aware of these signs and symptoms. If you
live with or care for somebody in a high-risk group, such as someone who is
elderly or has diabetes or high blood pressure, being aware of the symptoms
is even more important.

Other possible symptoms

Symptoms in the FAST test identify most strokes, but occasionally a stroke
can cause different symptoms.

Other symptoms and signs may include:

 complete paralysis of one side of the body

 sudden loss or blurring of vision
 dizziness
 confusion
 difficulty understanding what others are saying
 problems with balance and co-ordination
 difficulty swallowing (dysphagia)
 a sudden and very severe headache resulting in a blinding pain unlike
anything experienced before
 loss of consciousness
However, there are usually other causes for these symptoms.

'Mini-stroke' or transient ischaemic attack (TIA)

The symptoms of a TIA are the same as a stroke, but they tend to only last
between a few minutes and a few hours before disappearing completely.

Although the symptoms do improve, a TIA should never be ignored as it is a

serious warning sign there is a problem with the blood supply to your brain
and means you are at an increased risk of having a stroke in the near future.
 If you have had a TIA, you should contact your GP, local hospital or out-of-
hours service, as soon as possible.

Stillbirth
1. Introduction
2. Causes
3. How it's confirmed
4. What happens afterwards
5. Prevention
6. Support
Introduction
A stillbirth is a baby born dead after 24 completed weeks of pregnancy.

If the baby dies before 24 completed weeks, it's known as a miscarriage or

late foetal loss.

Stillbirth is more common than many people think. There are more than 3,600
stillbirths every year in the UK, and one in every 200 births ends in a stillbirth.
Eleven babies are stillborn every day in the UK, making it 15 times more
common than cot death.

What causes stillbirth?

Around a half of all stillbirths are linked to placental complications. This means
that for some reason the placenta (the organ that links the baby's blood supply
to the mother's and nourishes the baby in the womb) isn't functioning properly.

About 10% of stillborn babies have some kind of birth defect that contributed
to their death. A small percentage of stillbirths are caused by problems with
the mother's health, for example pre-eclampsia, or other problems, including
cord accidents and infections.

Read more about causes of stillbirth

What happens when a baby dies in the womb?

If it's suspected that your baby may have died during your pregnancy, a
handheld Doppler device or an ultrasound scan can be used to check your
baby's heartbeat.
If your baby has died and there's no immediate risk to your health, you'll
usually be given time to think about what you want to do next.

You may be able to choose whether you would like to wait for labour to begin
naturally, or if you want it to be started with medication (induced).

If your health is at risk, the baby may need to be delivered as soon as

possible. It's rare for a stillborn baby to be delivered by caesarean section.

At this stage, it's common for parents to ask why their baby died. Those caring
for you may give you some basic information about tests to try to find out why
your baby died.

Read more about how stillbirths happen

After a stillbirth
After a stillbirth, many parents want to see and hold their baby. You may also
wish to give your baby a name and create memories by taking photographs or
a lock of hair. It's completely up to you what you want to do. Decisions about
what to do are very personal and there’s no right or wrong way to respond.

Finding out why a stillbirth has happened can be helpful with the grieving
process and provide information if you want to get pregnant in the future, so
you'll be offered tests to try to find out why your baby died.

By law, all stillborn babies have to be formally registered. In Scotland, this

must be done within 21 days of your baby's birth.

A senior doctor will discuss the test results and post-mortem (if you decided to
have one) during a follow-up appointment several weeks after the birth. You
may also want to discuss any possible effects on future pregnancies.

Read more about what happens after a stillbirth

Help and support

Stillbirth and late miscarriage can be devastating for the baby's parents, and
they can also affect wider family members, including children and friends.

You may find it helpful to discuss your feelings with your GP, community
midwife or health visitor, or with other parents who've lost a baby.
There are many support groups in the UK for bereaved parents and their
families.

Find further information and support around bereavement

Some of these groups are run by parents who've experienced stillbirth, or by

healthcare professionals, such as baby loss support workers or specialist
midwives.

Read more about stillbirth support

Can stillbirths be prevented?

Not all stillbirths can be prevented. However, there are some things you can
do to reduce your risk of having a stillbirth, such as:

 stopping smoking
 avoiding alcohol and drugs during pregnancy – these can seriously
affect your baby's development and increase the risk of miscarriage and
stillbirth
 attending all your antenatal appointments so that midwives can monitor
the growth and wellbeing of your baby
Read more about preventing stillbirth

Information about you

If you have experienced a stillbirth, your clinical team may pass information
about you on to the National Congenital Anomaly and Rare Diseases
Registration Service (NCARDRS).

This helps scientists to understand more about this complication. You can opt
out of the register at any time.

Causes
A large proportion of stillbirths seem to happen in otherwise healthy babies
and the cause often can't be explained.

However, many stillbirths are linked to placental complications. This means

that for some reason the placenta (the organ that links the baby's blood supply
to the mother's and nourishes the baby in the womb) isn't functioning properly.
A poorly functioning placenta may be the direct cause of stillbirth, or it may
contribute to it because the baby's growth has been held back.

If there have been problems with the placenta, stillborn babies are usually
born perfectly formed, though often small. With more research, it's hoped that
placental causes may become better understood, leading to better detection
of placental problems and better care for these babies.

Other conditions that can cause stillbirth or may be associated with stillbirth
include:

 bleeding (haemorrhage) before or during labour

 placental abruption – where the placenta separates from the womb
before the baby is born (this may be associated with bleeding or
abdominal pain)
 pre-eclampsia – a condition that causes high blood pressure in the
mother
 a problem with the umbilical cord, which attaches the placenta to the
baby's tummy button – the cord can slip down through the entrance of
the womb before the baby is born (cord prolapse), or it can be wrapped
around the baby and become knotted
 intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis – a
liver disorder during pregnancy characterised by severe itching
 a genetic physical defect in the baby
 pre-existing diabetes
 infection in the mother that also affects the baby

Infections
Around one in 10 stillbirths are caused by an infection. The most common
type of infection is a bacterial infection that travels from the vagina into the
womb (uterus). These bacteria include group B streptococcus, escherichia coli
(E.coli), klebsiella, enterococcus, haemophilus influenza, chlamydia, and
mycoplasma or ureaplasma.

Some bacterial infections, such as chlamydia and mycoplasma or

ureaplasma, which are sexually transmitted infections (STIs), can be
prevented using barrier contraception, such as condoms.

Other infections that can cause stillbirths include:

  rubella – commonly known as German measles
 flu – it's recommended that all pregnant women have the seasonal flu
vaccine irrespective of their stage of pregnancy
 parvovirus B19 – this causes slapped cheek syndrome, a common
childhood infection that's dangerous for pregnant women
 coxsackie virus – this can cause hand, foot and mouth disease in
humans
 cytomegalovirus – a common virus spread through bodily fluids, such as
saliva or urine, which often causes few symptoms in the mother
 herpes simplex – the virus that causes cold sores
 listeriosis – an infection that usually develops after eating food
contaminated by bacteria called Listeria monocytogenes (listeria);
see preventing stillbirth for more information about the foods to avoid
during pregnancy
 leptospirosis – a bacterial infection spread by animals such as mice and
rats
 Lyme disease – a bacterial infection spread by infected ticks
 Q fever – a bacterial infection caught from animals such as sheep,
goats and cows
 toxoplasmosis – an infection caused by a parasite found in soil and cat
faeces
 malaria – a serious tropical disease spread by mosquitoes

Increased risk
There are also a number of things that may increase your risk of having a
stillborn baby, including:

 having twins or a multiple pregnancy

 having a baby who doesn't reach his or her growth potential in the
womb
 being over 35 years of age
 smoking, drinking alcohol or misusing drugs while pregnant
 being obese (having a body mass index (BMI) over 30)
 having a pre-existing physical health condition such as epilepsy
 Baby's growth
Your midwife will check the growth and wellbeing of your baby at
each antenatal appointment, and they'll plot your baby's growth on a chart to
ensure he or she is continuing to grow.

Every baby is different and should grow to the size that's normal for him or her
(some babies are naturally small). However, all babies should continue to
grow steadily throughout the pregnancy.

If a baby is smaller than expected, or his or her growth pattern tails off as the
pregnancy continues, it may be because the placenta isn't working properly.
This increases the risk of stillbirth.

Problems with a baby's growth should be picked up during antenatal

appointments. However, it's important to be aware of your baby's movements
and let your midwife know immediately if you notice a reduction in the baby’s
movements.

Sinusitis
1. Introduction
2. Treatment
3. Complications
4. Diagnosis
Introduction
Sinusitis is a common condition in which the lining of the sinuses becomes
inflamed. It's usually caused by a viral infection and often improves within two
or three weeks.

The sinuses are small, air-filled cavities behind your cheekbones and
forehead.

The mucus produced by your sinuses usually drains into your nose through
small channels. In sinusitis, these channels become blocked because the
sinus linings are inflamed (swollen).

Signs and symptoms

Sinusitis usually occurs after an upper respiratory tract infection, such as
a cold. If you have a persistent cold and develop the symptoms below, you
may have sinusitis.
Symptoms of sinusitis include:

 a green or yellow discharge from your nose

 a blocked nose
 pain and tenderness around your cheeks, eyes or forehead
 a sinus headache
 a high temperature (fever) of 38C (100.4F) or more
 toothache
 a reduced sense of smell
 bad breath (halitosis)
Children with sinusitis may be irritable, breathe through their mouth, and have
difficulty feeding. Their speech may also sound nasal (as though they have a
stuffy cold).

The symptoms of sinusitis often clear up within a few weeks (acute sinusitis),
although occasionally they can last three months or more (chronic sinusitis).

When to see your GP

If your symptoms are mild and getting better, you don't usually need to see
your GP and can look after yourself at home.

See your GP if:

 your symptoms are severe or getting worse

 your symptoms haven't started to improve after around 7-10 days
 you experience episodes of sinusitis frequently
Your GP will usually be able to diagnose sinusitis from your symptoms and by
examining the inside of your nose.

If you have severe or recurrent sinusitis, they may refer you to an ear, nose
and throat (ENT) specialist for further assessment.

How sinusitis is treated

Most people with sinusitis will feel better within two or three weeks and can
look after themselves at home.

You can help relieve your symptoms by:

  taking over-the-counter painkillers such as paracetamol or ibuprofen
 using nasal decongestants – these shouldn't be used for more than a
week, as this might make things worse
 holding warm packs to your face
 regularly cleaning the inside of your nose with a saline solution – you
can make this at home yourself or use sachets of ingredients bought
from a pharmacy
If your symptoms aren't improving or are getting worse, your GP may
prescribe antibiotics or corticosteroid spray or drops to see if they help.

If your symptoms don't get better after trying these treatments, you may be
referred to an ENT specialist for surgery to improve the drainage of your
sinuses.

Read more about treating sinusitis

What causes sinusitis?

Sinusitis is usually the result of a cold or flu virus spreading to the sinuses
from the upper airways. Only a few cases are caused by bacteria infecting the
sinuses.

An infected tooth or fungal infection can also occasionally cause the sinuses
to become inflamed.

It's not clear exactly what causes sinusitis to become chronic (long-lasting),
but it has been associated with:

 allergies and related conditions, including allergic

rhinitis, asthma and hay fever
 nasal polyps (growths inside the nose)
 smoking
 a weakened immune system
Making sure underlying conditions such as allergies and asthma are well
controlled may improve the symptoms of chronic sinusitis.

Sexually transmitted infections (STIs)

Introduction
Sexually transmitted infections (STIs) are passed from one person to another
through unprotected sex or genital contact.

You can be tested for STIs at a sexual health clinic, genitourinary medicine
(GUM) clinic or GP surgery. Search for a sexual health clinic near you and
find out what services they offer.

This page provides an overview of the different STIs and links to more
information about these conditions.

Chlamydia
Chlamydia is the most common STI in the UK and is easily passed on during
sex. Most people don't experience any symptoms, so they are unaware
they're infected.

In women, chlamydia can cause pain or a burning sensation when urinating, a

vaginal discharge, pain in the lower abdomen during or after sex, and
bleeding during or after sex or between periods. It can also cause heavy
periods.

In men, chlamydia can cause pain or a burning sensation when urinating, a

white, cloudy or watery discharge from the tip of the penis, and pain or
tenderness in the testicles.

It's also possible to have a chlamydia infection in your rectum (bottom), throat
or eyes.

Diagnosing chlamydia is done with a urine test or by taking a swab of the

affected area. The infection is easily treated with antibiotics, but can lead to
serious long-term health problems if left untreated, including infertility.

Genital warts
Genital warts are small fleshy growths, bumps or skin changes that appear on
or around your genital or anal area. They're caused by the human papilloma
virus (HPV) and are the second most common STI in England after
chlamydia.

The warts are usually painless, but you may notice some itching or redness.
Occasionally, they can cause bleeding.
You don't need to have penetrative sex to pass the infection on because HPV
is spread by skin-to-skin contact.

Several treatments are available for genital warts, including creams and
freezing the warts (cryotherapy).

Read more about genital warts

Genital herpes
Genital herpes is a common infection caused by the herpes simplex virus
(HSV), which is the same virus that causes cold sores.

Some people develop symptoms of HSV a few days after coming into contact
with the virus. Small, painful blisters or sores usually develop, which may
cause itching or tingling, or make it painful to urinate.

After you've been infected, the virus remains dormant (inactive) most of the
time. However, certain triggers can reactivate the virus, causing the blisters to
develop again, although they're usually smaller and less painful.

It's easier to test for HSV if you have symptoms. Although there's no cure for
genital herpes, the symptoms can usually be controlled using antiviral
medicines.

Read more about genital herpes

Gonorrhoea
Gonorrhoea is a bacterial STI easily passed on during sex. About 50% of
women and 10% of men don't experience any symptoms and are unaware
they're infected.

In women, gonorrhoea can cause pain or a burning sensation when urinating,

a vaginal discharge (often watery, yellow or green), pain in the lower abdomen
during or after sex, and bleeding during or after sex or between periods,
sometimes causing heavy periods.

In men, gonorrhoea can cause pain or a burning sensation when urinating, a

white, yellow or green discharge from the tip of the penis, and pain or
tenderness in the testicles.

It's also possible to have a gonorrhoea infection in your rectum, throat or eyes.
Gonorrhoea is diagnosed using a urine test or by taking a swab of the affected
area. The infection is easily treated with antibiotics, but can lead to serious
long-term health problems if left untreated, including infertility.

Syphilis
Syphilis is a bacterial infection that in the early stages causes a painless, but
highly infectious, sore on your genitals or around the mouth. The sore can last
up to six weeks before disappearing.

Secondary symptoms such as a rash, flu-like illness or patchy hair loss

may then develop. These may disappear within a few weeks, after which you'll
have a symptom-free phase.

The late or tertiary stage of syphilis usually occurs after many years, and can
cause serious conditions such as heart problems, paralysis and blindness.

The symptoms of syphilis can be difficult to recognise. A simple blood test can
usually be used to diagnose syphilis at any stage. The condition can be
treated with antibiotics, usually penicillin injections. When syphilis is treated
properly, the later stages can be prevented.

HIV
HIV is most commonly passed on through unprotected sex. It can also be
transmitted by coming into contact with infected blood – for example, sharing
needles to inject steroids or drugs.

The HIV virus attacks and weakens the immune system, making it less able to
fight infections and disease. There's no cure for HIV, but there are treatments
that allow most people to live a long and otherwise healthy life.

AIDS is the final stage of an HIV infection, when your body can no longer fight
life-threatening infections.

Most people with HIV look and feel healthy and have no symptoms. When you
first develop HIV, you may experience a flu-like illness with a fever, sore throat
or rash. This is called a seroconversion illness.

A simple blood test is usually used to test for an HIV infection. Some clinics
may also offer a rapid test using a finger-prick blood test or saliva sample.

Read more about HIV and AIDS

Trichomoniasis
Trichomoniasis is an STI caused by a tiny parasite called Trichomonas
vaginalis (TV). It can be easily passed on through sex and most people don't
know they're infected.

In women, trichomoniasis can cause a frothy yellow or watery vaginal

discharge that has an unpleasant smell, soreness or itching around the
vagina, and pain when passing urine.

In men, trichomoniasis rarely causes symptoms. You may experience pain or

burning after passing urine, a whitish discharge, or an inflamed foreskin.

Trichomoniasis can sometimes be difficult to diagnose and your GP may

suggest you go to a specialist clinic for a urine or swab test. Once diagnosed,
it can usually be treated with antibiotics.

Pubic lice
Pubic lice ("crabs") are easily passed to others through close genital contact.
They're usually found in pubic hair, but can live in underarm hair, body hair,
beards and occasionally eyebrows or eyelashes.

The lice crawl from hair to hair but don't jump or fly from person to person. It
may take several weeks for you to notice any symptoms. Most people
experience itching, and you may notice the lice or eggs on the hairs.

Pubic lice can usually be successfully treated with special creams or

shampoos available over the counter in most pharmacies or from a GP or
GUM clinic. You don't need to shave off your pubic hair or body hair.

Scabies
Scabies is caused by tiny mites that burrow into the skin. It can be passed on
through close body or sexual contact, or from infected clothing, bedding or
towels.

If you develop scabies, you may have intense itching that's worse at night.
The itching can be in your genital area, but it also often occurs between your
fingers, on wrists and ankles, under your arms, or on your body and breasts.

You may have a rash or tiny spots. In some people, scabies can be
confused with eczema. It's usually very difficult to see the mites.
 Scabies can usually be successfully treated using special creams or
shampoos available over the counter in most pharmacies, or from a GP or
GUM clinic. The itching can sometimes continue for a short period, even after
effective treatment.

Scabies
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Complications of scabies
Introduction
Scabies is a contagious skin condition caused by tiny mites that burrow into
the skin.

The main symptom of scabies is intense itching that's worse at night. It also
causes a skin rash on areas where the mites have burrowed.

Read more about the symptoms of scabies.

Scabies mites
Scabies mites are called Sarcoptes scabiei. They feed using their mouths and
front legs to burrow into the outer layer of skin (epidermis), where they lay
eggs.

After 3 to 4 days, the baby mites (larvae) hatch and move to the surface of the
skin, where they mature into adults.

Scabies like warm places, such as skin folds, between the fingers, under
fingernails, or around the buttock or breast creases. They can also hide under
watch straps, bracelets or rings.

Read more about the life cycle of the scabies mite.

How scabies is spread

Scabies is usually spread through prolonged periods of skin-to-skin contact
with an infected person, or through sexual contact.
It's also possible – but rare – for scabies to be passed on by sharing clothing,
towels and bedding with someone who's infected.

It can take up to 8 weeks for the symptoms of scabies to appear after the
initial infection. This is known as the incubation period.

Read more about the causes of scabies.

Scabies outbreaks
Scabies is widespread in densely populated areas with limited access to
medical care, and is most common in the following tropical and subtropical
areas:

 Africa
 Central and South America
 northern and central Australia
 Caribbean Islands
 India
 southeast Asia
In developed countries, scabies outbreaks can sometimes occur in places
where there are lots of people, such as schools, nurseries and care homes.

In the UK, most outbreaks of scabies occur in the winter. This may be
because people tend to spend more time indoors and closer to each other at
this time of year.

It's difficult to know exactly how many cases of scabies there are in the UK.
This is because many people don't visit their GP and treat the condition with
non-prescription medicines.

Treating scabies
Visit your GP if you think you have scabies. It's not usually a serious condition,
but it does need to be treated.

The 2 most widely used treatments for scabies are permethrin cream
and malathion lotion (brand name Derbac M). Both medications contain
insecticides that kill the scabies mite.
 Permethrin 5% cream is usually recommended as the first treatment.
Malathion 0.5% lotion is used if permethrin is ineffective.

If your partner has been diagnosed with genital scabies, to avoid reinfection
you should visit your nearest sexual health clinic so you can be checked and,
if necessary, treated.

Avoid having sex and other forms of close bodily contact until both you and
your partner have completed the full course of treatment.

Read more about diagnosing scabies and treating scabies.

Complications of scabies
Scabies can sometimes lead to a secondary skin infection if your skin
becomes irritated and inflamed through excessive itching.

Crusted scabies is a rare but more severe form of scabies, where a large
number of mites are in the skin. This can develop in older people and those
with a lowered immunity.

Rheumatoid arthritis
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Living with
7. Complications
Introduction
Rheumatoid arthritis is a long-term condition that causes pain, swelling and
stiffness in the joints.

The hands, feet and wrists are commonly affected, but it can also cause
problems in other parts of the body.

There may be periods where your symptoms become worse, known as a

flare-up or flare. A flare can be difficult to predict, but with treatment it is
possible to decrease the number of flares and minimise or prevent long-term
damage to the joints.
Read more about the symptoms of rheumatoid arthritis and living with
rheumatoid arthritis.

When to seek medical advice

You should see your GP if you think you have symptoms of rheumatoid
arthritis, so your GP can try to identify the underlying cause.

Diagnosing rheumatoid arthritis quickly is important because early treatment

can help stop the condition getting worse and reduce the risk of further
problems such as joint damage.

Read more about diagnosing rheumatoid arthritis.

What causes rheumatoid arthritis?

Rheumatoid arthritis is an autoimmune disease. This means that your immune
system – which usually fights infection – attacks the cells that line your joints
by mistake, making them swollen, stiff and painful.

Over time, this can damage the joint itself, the cartilage and nearby bone.

It's not clear what triggers this problem with the immune system, although you
are at an increased risk if you are a woman, you have a family history of
rheumatoid arthritis, or you smoke.

Read more about the causes of rheumatoid arthritis.

Who is affected
Rheumatoid arthritis affects around 400,000 people in the UK.

It can affect adults at any age, but most commonly starts between the ages of
40 and 50. About three times as many women as men are affected.

How rheumatoid arthritis is treated

There is no cure for rheumatoid arthritis, but early diagnosis and appropriate
treatment enables many people with rheumatoid arthritis to have periods of
months or even years between flares and to be able to lead full lives and
continue regular employment.

The main treatment options include:

  medication that is taken in the long-term to relieve symptoms and slow
the progress of the condition
 supportive treatments, such as physiotherapy and occupational therapy,
to help keep you mobile and find ways around any problems you have
with daily activities
 surgery to correct any joint problems that develop
Read more about treating rheumatoid arthritis.

Possible complications
Having rheumatoid arthritis can lead to several other conditions that may
cause additional symptoms and can sometimes be life-threatening.

Possible complications include carpal tunnel syndrome, inflammation of other

areas of the body (such as the lungs, heart and eyes), and an increased risk
of heart attacks and strokes.

Ensuring that rheumatoid arthritis is well controlled helps reduce your risk of
complications such as these.

Symptoms
Rheumatoid arthritis mainly affects the joints, although it can cause problems in other
parts of the body too.

The symptoms of rheumatoid arthritis often develop gradually over several weeks, but
some cases can progress quickly over a number of days.

The symptoms vary from person to person. They can come and go, and may change
over time. You may occasionally experience flares when your condition deteriorates and
your symptoms become more severe.

Symptoms affecting the joints

Rheumatoid arthritis is primarily a condition that affects the joints. It can cause problems
in any joint in the body, although the small joints in the hands and feet are often the first
to be affected.

Rheumatoid arthritis typically affects the joints symmetrically (both sides of the body at
the same time and to the same extent), but this is not always the case.

The main symptoms of rheumatoid arthritis affecting the joints are outlined below.
Pain
The joint pain associated with rheumatoid arthritis is usually a throbbing and aching
pain. It is often worse in the mornings and after a period of inactivity.

Stiffness
Joints affected by rheumatoid arthritis can feel stiff. For example, if your hands are
affected, you may not be able to fully bend your fingers or form a fist.

Like joint pain, the stiffness is often more severe in the morning or after a period of
inactivity. Morning stiffness associated with another type of arthritis
called osteoarthritis usually wears off within 30 minutes of getting up, but rheumatoid
arthritis morning stiffness often lasts longer than this.

Swelling, warmth and redness

The lining of joints affected by rheumatoid arthritis become inflamed, which can cause
the joints to swell, and become hot and tender to touch.

In some people, firm swellings called rheumatoid nodules can also develop under the
skin around affected joints.

Additional symptoms
As well as problems affecting the joints, some people with rheumatoid arthritis
experience a range of more general symptoms, such as:

 tiredness and a lack of energy

 a high temperature (fever)
 sweating
 a poor appetite
 weight loss
The inflammation associated with rheumatoid arthritis can also sometimes cause
problems affecting other areas of the body, including dry eyes if the eyes are affected
and chest pain if the heart or lungs are affected. Read more about the complications of
rheumatoid arthritis.

When to seek medical advice

You should see your GP if you think you have symptoms of rheumatoid arthritis.

There are a number of conditions that can cause problems such as joint pain and
stiffness, so it's important to get a proper diagnosis.
 Diagnosing rheumatoid arthritis as soon as possible is particularly important because
early treatment can help stop the condition getting worse and reduce the risk of further
problems such as joint damage.

Ringworm and other fungal infections

1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Prevention
Introduction
Ringworm is a common fungal infection that can cause a red or silvery ring-
like rash on the skin. Ringworm commonly affects arms and legs, but it can
appear almost anywhere on the body. Despite its name, ringworm doesn't
have anything to do with worms.

Other similar fungal infections can affect the scalp, feet, groin and nails.
These fungal infections, medically known as "tinea", are not serious and are
usually easily treated. However, they are contagious and easily spread.

Tinea fungal infections

There are different types of tinea fungal infection, based on the affected area
of the body:

 ringworm (tinea corporis) – affecting the body

 fungal nail infection (onychomycosis) – affecting the nails
 athlete's foot (tinea pedis) – affecting the feet
 jock itch (tinea cruris) – affecting the groin
 tinea capitis – affecting the scalp
Ringworm usually looks like a round, red or silvery patch of skin that may be
scaly, inflamed and itchy, but other fungal infections may present themselves
slightly differently. Read more about the symptoms of ringworm and other
tinea fungal infections.

When to see a doctor

See your GP if you or your child has a fungal scalp infection, as it’s treated
with antifungal tablets, which are only available on prescription. Symptoms of
a fungal scalp infection include small patches of scaly scalp skin (which may
be sore), patchy hair loss and itchiness. Other types of fungal infections
(including ringworm) are generally treated with antifungal cream from the
pharmacy, and you don't need to see a doctor unless it persists. However,
pharmacists often prefer children to see a GP to confirm a diagnosis.

What’s the cause?

Fungal spores are passed between people through direct skin contact and by
sharing objects such as towels, hairbrushes and bedding. Athlete’s foot is
commonly spread in gym and swimming pool changing rooms.

Pets, such as dogs and cats, can have ringworm, and you can catch it by
stroking them.

Read more about the causes of ringworm.

Who is affected?
It's estimated that 10-20% of people will have ringworm in their lifetime.

Although children are more likely to get this, people of all ages can be
affected.

Groin infections are more common in young men.

Fungal scalp infections (tinea capitis) are most common in children who have
not reached puberty, particularly African-Caribbean children and those who
live in urban areas.

Treatment
Most ringworm infections are mild and can be treated using a pharmacy
antifungal cream. Scalp infections can be treated with antifungal tablets,
sometimes combined with antifungal shampoo. If the skin is irritated or
broken, it can lead to other bacterial infections, which may need treatment
with antibiotics. Read more about how to treat fungal infections.

Stopping it spreading
It's important to prevent the infection spreading. You should avoid sharing
towels, bedding or clothes with someone with a fungal infection. If you think
your pet has ringworm, take it to the vet. If your pet is treated quickly, you’ll be
less likely to catch it. If your child has a fungal infection, they can go to school,
but you should inform their teacher. In addition to treatment, your child should
maintain a good level of personal hygiene to prevent the infection spreading.
Read more about how to stop the spread of fungal infections.

Symptoms
The symptoms of a tinea fungal infection depend on where the infection is.

Ringworm (on the skin)

The symptoms of ringworm include:

 a ring-like red or silvery rash on your skin – your skin will look red and
irritated around the ring, but healthy inside
 scaly, itchy and inflamed skin
In more severe cases:

 the rings may multiply, grow in size and merge together

 the rings may feel slightly raised and the skin underneath may be itchy
 blisters and pus-filled sores may form around the rings
The ring spreads outwards as it progresses. You can have one patch or
several patches of ringworm, and in more serious cases, your skin may
become raised and blistered.

Face and neck ringworm

Ringworm on the face and neck may not appear ring-shaped, but may be
itchy and swollen, and it can become dry and crusted. If you have a beard,
you may notice patches of hair breaking away.

Hand ringworm
Ringworm on the hand often causes the skin to become thicker on the palm
and in between the fingers. It may affect one hand or both and normally only
appears on one side.

Fungal scalp infection (tinea capitis)

The symptoms of a fungal scalp infection include:

 small patches of scaly skin on the scalp, which may be sore

 patchy hair loss
 an itchy scalp
In more severe cases:

 small, pus-filled sores on the scalp

 crusting on the scalp
 bald patches (if your hair is affected)
In very severe cases, a large inflamed sore called a kerion may form on your
scalp. This can ooze pus, and you may also have a fever and swollen lymph
glands.

Athlete’s foot (tinea pedis)

The main symptom of athlete’s foot is an itchy, dry, red and flaky rash, usually
in the spaces between your toes. In more severe cases, you may have:

 cracked skin in the affected area

 blisters, which may ooze or crust
 swelling of the skin
 a burning or stinging sensation in your skin
 scaling patterns around your sole, between your toes and on the side of
your foot

Jock itch (tinea cruris)

The symptoms of jock itch include:

 red-brown sores, which may have blisters or pus-filled sores around the
edge
 itchiness and redness around your groin area, such as your inner thighs
and bottom (the genitals are not usually affected)
 scaly, flaky skin on your inner thighs
Exercising, walking and wearing tight clothing or underwear can make the
symptoms of a groin infection worse.
 Fungal nail infection (onychomycosis)
The symptoms of a fungal nail infection include:

 a whitish thickening of the nail

 discolouration (the nail can turn white, black, yellow or green)
 the nail can become brittle and start to fall off
 the skin around the nail may be sore and irritated
Read more about fungal nail infection.

When to seek medical advice

Make an appointment to see your GP if you:

 or your child develop the symptoms of a fungal scalp infection

 have ringworm that has not improved after two weeks of treatment with
antifungal cream
 have another medical condition, or you’re having medical treatment that
is known to weaken your immune system, such as chemotherapy or
steroid tablets

Pneumonia
1. Introduction
2. Treatment
Introduction
Pneumonia is swelling (inflammation) of the tissue in one or both lungs. It's
usually caused by a bacterial infection.

At the end of the breathing tubes in your lungs are clusters of tiny air sacs. If
you have pneumonia, these tiny sacs become inflamed and fill up with fluid.

Symptoms of pneumonia
The symptoms of pneumonia can develop suddenly over 24 to 48 hours, or
they may come on more slowly over several days.

Common symptoms of pneumonia include:

  a cough – which may be dry, or produce thick yellow, green, brown or
blood-stained mucus (phlegm)
 difficulty breathing – your breathing may be rapid and shallow, and you
may feel breathless, even when resting
 rapid heartbeat
 fever
 feeling generally unwell
 sweating and shivering
 loss of appetite
 chest pain – which gets worse when breathing or coughing
Less common symptoms include:

 coughing up blood (haemoptysis)

 headaches
 fatigue
 nausea or vomiting
 wheezing
 joint and muscle pain
 feeling confused and disorientated, particularly in elderly people

When to see your GP

See your GP if you feel unwell and you have typical symptoms of pneumonia.

Seek urgent medical attention if you're experiencing severe symptoms, such

as rapid breathing, chest pain or confusion.

Who's affected?
In the UK, pneumonia affects around 8 in 1,000 adults each year. It's more
widespread in autumn and winter.

Pneumonia can affect people of any age, but it's more common – and can be
more serious – in certain groups of people, such as the very young or the
elderly.

People in these groups are more likely to need hospital treatment if they
develop pneumonia.
What causes pneumonia?
Pneumonia is usually the result of a pneumococcal infection, caused by
bacteria called Streptococcus pneumoniae.

Many different types of bacteria, including Haemophilus influenzae and

Staphylococcus aureus, can also cause pneumonia, as well as viruses and,
more rarely, fungi.

As well as bacterial pneumonia, other types include:

 viral pneumonia – most commonly caused by the respiratory syncytial

virus (RSV) and sometimes influenza type A or B; viruses are a
common cause of pneumonia in young children
 aspiration pneumonia – caused by breathing in vomit, a foreign object,
such as a peanut, or a harmful substance, such as smoke or a chemical
 fungal pneumonia – rare in the UK and more likely to affect people with
a weakened immune system
 hospital-acquired pneumonia – pneumonia that develops in hospital
while being treated for another condition or having an operation; people
in intensive care on breathing machines are particularly at risk of
developing ventilator-associated pneumonia

Risk groups
The following groups have an increased risk of developing pneumonia:

 babies and very young children

 elderly people
 people who smoke
 people with other health conditions, such as asthma, cystic fibrosis, or a
heart, kidney or liver condition
 people with a weakened immune system – for example, as a result of a
recent illness, such as flu, having HIV or AIDS, having chemotherapy, or
taking medication following an organ transplant

Diagnosing pneumonia
Your GP may be able to diagnose pneumonia by asking about your symptoms
and examining your chest. Further tests may be needed in some cases.
Pneumonia can be difficult to diagnose because it shares many symptoms
with other conditions, such as the common cold, bronchitis and asthma.

To help make a diagnosis, your GP may ask you:

 whether you feel breathless or you're breathing faster than usual

 how long you've had your cough, and whether you're coughing up
mucus and what colour it is
 if the pain in your chest is worse when you breathe in or out
Your GP may also take your temperature and listen to your chest and back
with a stethoscope to check for any crackling or rattling sounds.

They may also listen to your chest by tapping it. Lungs filled with fluid produce
a different sound from normal healthy lungs.

If you have mild pneumonia, you probably won't need to have a chest X-ray or
any other tests.

You may need a chest X-ray or other tests, such as a sputum (mucus) test
or blood tests, if your symptoms haven't improved within 48 hours of starting
treatment.

Treating pneumonia
Mild pneumonia can usually be treated at home by:

 getting plenty of rest

 taking antibiotics
 drinking plenty of fluids
If you don't have any other health problems, you should respond well to
treatment and soon recover, although your cough may last for some time.

As pneumonia isn't usually passed from one person to another, it's safe to be
around others, including family members.

However, people with a weakened immune system should avoid close contact
with a person with pneumonia until they start to get better.

For at-risk groups, pneumonia can be severe and may need to be treated in
hospital.
This is because it can lead to serious complications, which in some cases can
be fatal, depending on a person's health and age.

Read more about treating pneumonia.

Complications of pneumonia
Complications of pneumonia are more common in young children, the
elderly and those with pre-existing health conditions, such as diabetes.

Possible complications of pneumonia include:

 pleurisy – where the thin linings between your lungs and ribcage
(pleura) become inflamed, which can lead to respiratory failure
 a lung abscess – a rare complication that's mostly seen in people with a
serious pre-existing illness or a history of severe alcohol misuse
 blood poisoning (septicaemia) – also a rare but serious complication
You'll be admitted to hospital for treatment if you develop one of these
complications.

Preventing pneumonia
Although most cases of pneumonia are bacterial and aren't passed on from
one person to another, ensuring good standards of hygiene will help prevent
germs spreading.

For example, you should:

 cover your mouth and nose with a handkerchief or tissue when you
cough or sneeze
 throw away used tissues immediately – germs can live for several hours
after they leave your nose or mouth
 wash your hands regularly to avoid transferring germs to other people or
objects
A healthy lifestyle can also help prevent pneumonia. For example, you should
avoid smoking as it damages your lungs and increases the chance of
infection.

Find out how to stop smoking.

Excessive and prolonged alcohol misuse also weakens your lungs' natural
defences against infections, making you more vulnerable to pneumonia.

People at high risk of pneumonia should be offered the pneumococcal

vaccine and flu vaccine.

Treatment
Mild pneumonia can usually be treated at home with rest, antibiotics and by
drinking plenty of fluids. More severe cases may need hospital treatment.

Unless a healthcare professional tells you otherwise, you should always finish
taking a prescribed course of antibiotics, even if you feel better.

If you stop taking an antibiotic part way through a course, the bacteria can
become resistant to the antibiotic.

After starting treatment, your symptoms should steadily improve.

However, how quickly they improve will depend on how severe your
pneumonia is.

As a general guide, after:

 one week – fever should have resolved

 four weeks – chest pain and mucus production should have
substantially reduced
 six weeks – cough and breathlessness should have substantially
reduced
 three months – most symptoms should have resolved, but you may still
feel very tired (fatigue)
 six months – most people will feel back to normal

Treatment at home
Visit your GP if your symptoms don't improve within three days of
starting antibiotics.

Symptoms may not improve if:

  the bacteria causing the infection is resistant to antibiotics – your GP
may prescribe a different antibiotic, or they may prescribe a second
antibiotic for you to take with the first one
 a virus is causing the infection, rather than bacteria – antibiotics have no
effect on viruses, and your body's immune system will have to fight the
viral infection by creating antibodies
Painkillers, such as paracetamol or ibuprofen, may help relieve pain and
reduce fever.

However, you shouldn't take ibuprofen if you:

 are allergic to aspirin or other non-steroidal anti-inflammatory drugs

(NSAIDs)
 have asthma, kidney disease, a history of stomach ulcers or indigestion
Cough medicines aren't recommended as there's also little evidence they are
effective. A warm honey and lemon drink can help relieve discomfort caused
by coughing.

Your cough may persist for two to three weeks after you finish your course
of antibiotics, and you may feel tired for even longer as your body continues to
recover.

Drink plenty of fluids to avoid dehydration, and get plenty of rest to help your
body recover.

If you smoke, it's more important than ever to stop, as smoking damages your
lungs.

Read more about stop smoking treatments and how to stop smoking.

See your GP if, after following the above self-help measures, your condition is
deteriorating or isn't improving as expected.

Pneumonia isn't usually passed from one person to another, so it's safe to be
around others, including family members.

However, it's best for people with a weakened immune system to avoid close
contact with a person with pneumonia until they start to get better.

Follow-up
Your GP will probably arrange a follow-up appointment for you about six
weeks after you start your course of antibiotics.
 In some cases, they may arrange follow-up tests, such as a chest X-ray, if:

 your symptoms haven't improved

 your symptoms have come back
 you smoke
 you're over the age of 50
Some people may be advised to have a flu vaccination or pneumococcal
vaccination after recovering from pneumonia.

Read more about preventing pneumonia.

Treatment in hospital
You may need treatment in hospital if your symptoms are severe. You'll be
given antibiotics and fluids intravenously through a drip, and you may need
oxygen to help breathing.

In very serious cases of pneumonia, breathing assistance through a ventilator

in an intensive care unit (ICU) may be required.

Psychosis
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Complications
Introduction
Psychosis is a mental health problem that causes people to perceive or
interpret things differently from those around them. This might involve
hallucinations or delusions.

The two main symptoms of psychosis are:

 hallucinations – where a person hears, sees and, in some cases, feels,

smells or tastes things that aren't there; a common hallucination is
hearing voices
  delusions – where a person believes things that, when examined
rationally, are obviously untrue – for example, thinking your next door
neighbour is planning to kill you
The combination of hallucinations and delusional thinking can often severely
disrupt perception, thinking, emotion, and behaviour.

Experiencing the symptoms of psychosis is often referred to as having a

psychotic episode.

What causes psychosis?

Psychosis isn't a condition in itself – it's triggered by other conditions.

It's sometimes possible to identify the cause of psychosis as a specific mental

health condition, such as:

 schizophrenia – a condition that causes a range of psychological

symptoms, including hallucinations and delusions
 bipolar disorder – a mental health condition that affects mood; a person
with bipolar disorder can have episodes of depression (lows) and mania
(highs)
 severe depression – some people with depression also have symptoms
of psychosis when they're very depressed
Psychosis can also be triggered by traumatic experiences, stress, or physical
conditions, such as Parkinson's disease, a brain tumour, or as a result
of drug misuse or alcohol misuse.

How often a psychotic episode occurs and how long it lasts can depend on
the underlying cause.

For example, schizophrenia can be long term, but most people can make a
good recovery and about a quarter only have a single psychotic episode.
Episodes related to bipolar disorder usually resolve, but may recur.

Read more about the causes of psychosis.

Diagnosing psychosis
You should see your GP immediately if you're experiencing psychotic
episodes. It's important psychosis is treated as soon as possible as early
treatment usually has better long-term outcomes.
Your GP will look at your symptoms and rule out short-term causes, such as
drug misuse. They may ask you some questions to help determine what's
causing your psychosis. For example, they may ask you:

 whether you're taking any medication

 whether you've been taking illegal substances
 how your mood has been – for example, whether you've been
depressed
 how you've been functioning day-to-day – for example, whether you're
still working
 whether you have a family history of mental health conditions – such as
schizophrenia
 about your hallucinations – such as whether you've heard voices
 about your delusions – such as whether you feel people are controlling
you
 whether you have any other symptoms
Your GP should refer you to a mental health specialist for further assessment
and treatment.

Read more about diagnosing psychosis.

Treating psychosis
Treatment for psychosis involves using a combination of:

 antipsychotic medication – which can help relieve the symptoms of

psychosis
 psychological therapies – the one-to-one talking therapy cognitive
behavioural therapy (CBT) has proved successful in helping people with
schizophrenia; in appropriate cases, family therapy has been shown to
reduce the need for hospital treatment in people with psychosis
 social support – support with social needs, such as education,
employment, or accommodation
Most people with psychosis who get better with medication need to continue
taking it for at least a year. Some people need to take medication long term to
prevent symptoms recurring.

If a person's psychotic episodes are severe, they may need to be admitted to

a psychiatric hospital.
Read more about the treatment of psychosis.

Getting help for others

People with psychosis often have a lack of insight. They're unaware that
they're thinking and acting strangely.

Because of their lack of insight, it's often down to the friends, relatives, or
carers of a person affected by psychosis to seek help for them.

If you're concerned about someone you know and think they may have
psychosis, you could contact their social worker or community mental health
nurse if they've previously been diagnosed with a mental health condition. If
you think the person's symptoms are placing them at possible risk of harm,
you can:

 take them to the nearest accident and emergency (A&E) department, if

they agree
 call their GP or local out-of-hours GP
 call 999 and ask for an ambulance

Complications
People with a history of psychosis are much more likely to have drug or
alcohol misuse problems, or both.

This may be because these substances can provide short-term symptom

relief, although they usually make symptoms worse in the long term.

People with psychosis also have a higher than average risk of suicide. It's
estimated 1 in 5 people with psychosis will attempt to commit suicide at some
point in their life, and 1 in 25 people with psychosis will kill themselves.

Side effects can also occur if someone is taking antipsychotics on a long-term

basis. Weight gain is a common side effect. In rare cases, a person with
psychosis may also develop type 2 diabetes.

Symptoms
Someone who develops psychosis will have their own unique set of symptoms
and experiences, according to their particular circumstances.
However, four main symptoms are associated with a psychotic episode. They
are:

 hallucinations
 delusions
 confused and disturbed thoughts
 lack of insight and self-awareness
These are outlined in more detail below.

Hallucinations
Hallucinations are where a person perceives something that doesn't exist in
reality. They can occur in all five of the senses:

 sight – someone with psychosis may see colours and shapes, or people
or animals that aren't there
 sounds – someone with psychosis may hear voices that are angry,
unpleasant or sarcastic
 touch – a common psychotic hallucination is that you are being touched
when there is nobody there
 smell – usually a strange or unpleasant odour
 taste – some people with psychosis have complained of having a
constant unpleasant taste in their mouth

Delusions
A delusion is where a person has an unshakeable belief in something
implausible, bizarre, or obviously untrue. Paranoid delusion and delusions of
grandeur are two examples of psychotic delusions.

A person with psychosis will often believe an individual or organisation is

making plans to hurt or kill them. This can lead to unusual behaviour. For
example, a person with psychosis may refuse to be in the same room as a
mobile phone because they believe they are mind control devices.

Someone with psychosis may also have delusions of grandeur. This is where
they believe they have some imaginary power or authority. For example, they
may think they're the president of a country or they have the power to bring
people back from the dead.
Confused and disturbed thoughts
People with psychosis often have disturbed, confused, and disrupted patterns
of thought. Signs of this include:

 rapid and constant speech

 random speech – for example, they may switch from one topic to
another mid-sentence
 a sudden loss in their train of thought, resulting in an abrupt pause in
conversation or activity

Lack of insight
People who have psychotic episodes are often totally unaware their behaviour
is in any way strange or that their delusions or hallucinations are not real.

They may recognise delusional or bizarre behaviour in others, but lack the
self-awareness to recognise it in themselves.

For example, a person with psychosis being treated in a psychiatric ward may
complain that their fellow patients are mentally unwell, while they're perfectly
normal.

Postnatal psychosis
Postnatal psychosis, also called puerperal psychosis, is a severe form
of postnatal depression, a type of depression some women experience after
having a baby.

It's estimated postnatal psychosis affects around 1 in every 1,000 women who
give birth. It most commonly occurs during the first few weeks after having a
baby.

Postnatal psychosis is more likely to affect women who already have a mental
health condition, such as bipolar disorder or schizophrenia.

As well as the symptoms of psychosis, symptoms of postnatal psychosis can

also include:

 a high mood (mania) – for example, talking and thinking too much or too
quickly
  a low mood – for example, depression, lack of energy, loss of appetite,
and trouble sleeping
Postnatal psychosis is regarded as a medical emergency. Contact your GP
immediately if you think someone you know may have developed postnatal
psychosis. If this isn't possible, call the NHS 24 '111' service or your local out-
of-hours service.

Prostate cancer
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Testing
6. Treatment
7. Living with prostate cancer
Introduction
Prostate cancer is the most common cancer in men in the UK, with over
40,000 new cases diagnosed every year.

Prostate cancer usually develops slowly, so there may be no signs you have it
for many years.

Symptoms often only become apparent when your prostate is large enough to
affect the urethra (the tube that carries urine from the bladder to the penis).

When this happens, you may notice things like an increased need to urinate,
straining while urinating and a feeling that your bladder has not fully emptied.

These symptoms shouldn’t be ignored, but they do not mean you definitely
have prostate cancer. It is more likely that they are caused by something else,
such as benign prostatic hyperplasia (also known as BPH or prostate
enlargement).

Read more about the symptoms of prostate cancer

What is the prostate?

The prostate is a small gland in the pelvis found only in men. About the size of
a satsuma, it's located between the penis and the bladder and surrounds the
urethra.

The main function of the prostate is to help in the production of semen. It

produces a thick white fluid that is mixed with the sperm produced by the
testicles, to create semen.

Why does prostate cancer happen?

The causes of prostate cancer are largely unknown. However, certain
things can increase your risk of developing the condition.

The chances of developing prostate cancer increase as you get older. Most
cases develop in men aged 50 or older.

For reasons not yet understood, prostate cancer is more common in men of
African-Caribbean or African descent, and less common in men of Asian
descent.

Men who have first degree male relatives (such as a father or brother)
affected by prostate cancer are also at slightly increased risk.

Read more about the causes of prostate cancer

Tests for prostate cancer

There is no single test for prostate cancer. All the tests used to help diagnose
the condition have benefits and risks, which your doctor should discuss with
you.

The most commonly used tests for prostate cancer are blood tests, a physical
examination of your prostate (known as a digital rectal examination or DRE)
and a biopsy.

The blood test, known as a prostate-specific antigen (PSA) test, measures the
level of PSA and may help detect early prostate cancer. Men are not routinely
offered PSA tests to screen for prostate cancer, as results can be unreliable.

This is because the PSA blood test is not specific to prostate cancer. PSA can
be raised due to a large non-cancerous growth of the prostate (BPH), a
urinary tract infection or inflammation of the prostate, as well as prostate
cancer. Raised PSA levels also cannot tell a doctor whether a man has life-
threatening prostate cancer or not. This means a raised PSA can lead to
unnecessary tests and treatment.

However, you can ask to be tested for prostate cancer once the benefits and
risks have been explained to you.

Read more about diagnosing prostate cancer and PSA screening for prostate
cancer

How is prostate cancer treated?

For many men with prostate cancer, treatment is not immediately necessary.

If the cancer is at an early stage and not causing symptoms, a policy of

"watchful waiting" or "active surveillance" may be adopted. This involves
carefully monitoring your condition.

Some cases of prostate cancer can be cured if treated in the early stages.
Treatments include surgically removing the prostate, radiotherapy and
hormone therapy.

Some cases are only diagnosed at a later stage when the cancer has spread.
If the cancer spreads to other parts of the body, typically the bones, it cannot
be cured and treatment is focused on prolonging life and relieving symptoms.

All treatment options carry the risk of significant side effects, including erectile
dysfunction and urinary incontinence. For this reason, many men choose to
delay treatment until there is a risk the cancer might spread.

Newer treatments, such as high-intensity focused ultrasound (HIFU) or

cryotherapy, aim to reduce these side effects. Some hospitals may offer them
as an alternative to surgery, radiotherapy or hormone therapy. However, the
long-term effectiveness of these treatments are not yet known.

Read more about treating prostate cancer

Living with prostate cancer

As prostate cancer usually progresses very slowly, you can live for decades
without symptoms or needing treatment.

Nevertheless, it can have an effect on your life. As well as causing physical

problems such as erectile dysfunction and urinary incontinence, a diagnosis of
prostate cancer can understandably make you feel anxious or depressed.
You may find it beneficial to talk about the condition with your family, friends, a
family doctor and other men with prostate cancer.

Financial support is also available if prostate cancer reduces your ability to

work.

Symptoms
Prostate cancer does not normally cause symptoms until the cancer has
grown large enough to put pressure on the urethra.

This normally results in problems associated with urination. Symptoms can

include:

 needing to urinate more frequently, often during the night

 needing to rush to the toilet
 difficulty in starting to pee (hesitancy)
 straining or taking a long time while urinating
 weak flow
 feeling that your bladder has not emptied fully
Many men's prostates get larger as they get older due to a non-cancerous
condition known as prostate enlargement or benign prostatic hyperplasia.

Symptoms that the cancer may have spread include bone and back pain, a
loss of appetite, pain in the testicles and unexplained weight loss.

Want to know more?

 Prostate Cancer UK: understanding the prostate

 Cancer Research UK: prostate cancer symptoms
Causes
It is not known exactly what causes prostate cancer, although a number of
things can increase your risk of developing the condition.

These include:

 age – risk rises as you get older and most cases are diagnosed in men
over 50 years of age.
  ethnic group – prostate cancer is more common among men of African-
Caribbean and African descent than in men of Asian descent.
 family history – having a brother or father who developed prostate
cancer under the age of 60 seems to increase the risk of you developing
it. Research also shows that having a close female relative who
developed breast cancer may also increase your risk of
developing prostate cancer.
 obesity – recent research suggests that there may be a link between
obesity and prostate cancer.
 exercise – men who regularly exercise have also been found to be at
lower risk of developing prostate cancer.
 diet – research is ongoing into the links between diet and prostate
cancer. There is evidence that a diet high in calcium is linked to an
increased risk of developing prostate cancer.
In addition, some research has shown that prostate cancer rates appear to be
lower in men who eat foods containing certain nutrients including lycopene,
found in cooked tomatoes and other red fruit, and selenium, found in brazil
nuts. However, more research is needed.

Personality disorder
1. Introduction
2. Signs and symptoms of personality disorders
3. Treating a personality disorder
Introduction
Personality disorders are conditions in which an individual differs significantly
from an average person, in terms of how they think, perceive, feel or relate to
others.

Changes in how a person feels and distorted beliefs about other people can
lead to odd behaviour, which can be distressing and may upset others.

Common features include:

 being overwhelmed by negative feelings such as distress, anxiety,

worthlessness or anger
 avoiding other people and feeling empty and emotionally disconnected
  difficulty managing negative feelings without self-harming (for example,
abusing drugs and alcohol, or taking overdoses) or, in rare
cases, threatening other people
 odd behaviour
 difficulty maintaining stable and close relationships, especially with
partners, children and professional carers
 sometimes, periods of losing contact with reality
Symptoms typically get worse with stress.

People with personality disorders often experience other mental health

problems, especially depression and substance misuse.

When and why personality disorders occur

Personality disorders typically emerge in adolescence and continue into
adulthood.

They may be mild, moderate or severe, and people may have periods of
"remission" where they function well.

Personality disorders may be associated with genetic and family factors.

Experiences of distress or fear during childhood, such as neglect or abuse,
are common.

Types of personality disorder

Several different types of personality disorder are recognised. They have
been broadly grouped into one of three clusters – A, B or C – which are
summarised below.

Read about the symptoms of personality disorders for a full list of the main
types and signs of personality disorders.

Cluster A personality disorders

A person with a cluster A personality disorder tends to have difficulty relating
to others and usually shows patterns of behaviour most people would regard
as odd and eccentric. Others may describe them as living in a fantasy world of
their own.

An example is paranoid personality disorder, where the person is extremely

distrustful and suspicious.
Cluster B personality disorders
A person with a cluster B personality disorder struggles to regulate their
feelings and often swings between positive and negative views of others. This
can lead to patterns of behaviour others describe as dramatic, unpredictable
and disturbing.

An example is borderline personality disorder, where the person is emotionally

unstable, has impulses to self-harm, and has intense and unstable
relationships with others.

Cluster C personality disorders

A person with a cluster C personality disorder struggles with persistent and
overwhelming feelings of fear and anxiety. They may show patterns of
behaviour most people would regard as antisocial and withdrawn.

An example is avoidant personality disorder, where the person appears

painfully shy, socially inhibited, feels inadequate and is extremely sensitive to
rejection. The person may want to be close to others, but lacks confidence to
form a close relationship.

How many people are affected?

Personality disorders are common mental health problems.

In England, it is estimated that around 1 in 20 people has a personality

disorder. However, many people have only mild conditions so only need help
at times of stress (such as bereavement). Other people with more severe
problems may need specialist help for longer periods.

Outlook
Many people recover from personality disorders over time. Psychological or
medical treatment is sometimes helpful; sometimes support is all that is
needed. This depends on the severity of the disorder and whether there are
ongoing problems.

Some mild to moderate personality disorders improve with psychotherapy.

Different types of psychological therapies have been shown to help people

with personality disorders. However, there is no single approach that suits
everyone and treatment should be tailored to the individual. Not all talking
therapies are effective and it is essential they are delivered by a trained
therapist.

Signs and symptoms of personality disorders

The different types of personality disorder that might need treatment can be
broadly grouped into one of three clusters, called A, B or C.

Cluster A personality disorders

A person with a cluster A personality disorder tends to have difficulty relating
to others and usually shows patterns of behaviour most people would regard
as odd and eccentric.

The main personality disorders in this category are listed below.

Paranoid personality disorder

A person with a paranoid personality disorder is extremely distrustful and
suspicious. Other features include:

 thinking other people are lying to them or trying to manipulate them

 feeling they cannot really trust their friends and associates
 worrying that any confidential information shared with others will be
used against them
 thinking there are hidden meanings in remarks most would regard as
innocent
 worrying that their spouse or partner is unfaithful, despite a lack of
evidence

Schizoid personality disorder

Someone with a schizoid personality disorder may appear cold and detached,
and avoid making close social contact with others. Other features include:

 preferring to take part in activities that do not require interaction with

others
 having little desire to form close relationships, including sexual
relationships
 being uninterested when receiving criticism or praise
 having a limited ability to experience pleasure or joy
Schizotypal personality disorder
A person with a schizotypal personality disorder is likely to have poor social
skills and delusional thoughts, and behave in unusual ways. Other features
include:

 attaching undue and misguided significance to everyday events – such

as thinking newspaper headlines are secret messages to them
 believing in special powers – such as telepathy or the ability to influence
other people’s emotions and actions
 having unusual ways of speaking – such as long, rambling vague
sentences or going off on a tangent
 experiencing excessive anxiety in social situations – even if they have
known a particular person or group of people a long time

Cluster B personality disorders

Someone with a cluster B personality disorder struggles to relate to others. As
a result, they show patterns of behaviour most would regard as dramatic,
erratic and threatening or disturbing.

The main personality disorders in this category are listed below.

Antisocial personality disorder

A person with an antisocial personality disorder sees other people as
vulnerable and may intimidate or bully others without remorse. They lack
concern about the consequences of their actions.

Symptoms include:

 lack of concern, regret or remorse about other people's distress

 irresponsibility and disregard for normal social behaviour
 difficulty in sustaining long-term relationships
 little ability to tolerate frustration and to control their anger
 lack of guilt, or not learning from their mistakes
 blaming others for problems in their lives
The National Institute for Health and Care Excellence (NICE) has published
guidelines on how people with antisocial personality disorders should be
treated. For more information, see NICE: antisocial personality disorder (PDF,
250kb).
Borderline personality disorder
A person with borderline personality disorder is emotionally unstable, has
impulses to self-harm, and has very intense and unstable relationships with
others.

Histrionic personality disorder

A person with histrionic personality disorder is anxious about being
ignored. As a result, they feel a compulsion (overwhelming urge) to be noticed
and the centre of everyone’s attention. Features include:

 displaying excessive emotion, yet appearing to lack real emotional

sincerity
 dressing provocatively and engaging in inappropriate flirting or sexually
seductive behaviour
 moving quickly from one emotional state to another
 being self-centred and caring little about other people
 constantly seeking reassurance and approval from other people
Symptoms and signs may co-exist with borderline and narcissistic personality
disorders.

Narcissistic personality disorder

A person with narcissistic personality disorder swings between seeing
themselves as special and fearing they are worthless. They may act as if they
have an inflated sense of their own importance and show an intense need for
other people to look up to them.

Other symptoms include:

 exaggerating their own achievements and abilities

 thinking they are entitled to be treated better than other people
 exploiting other people for their own personal gain
 lacking empathy for other people's weaknesses
 looking down on people they feel are "beneath" them, while feeling
deeply envious of people they see as being "above" them

Cluster C personality disorders

Someone with a cluster C personality disorder fears personal relationships
and shows patterns of anxious and fearful behaviour around other people.
Others may be withdrawn and reluctant to socialise.

The main personality disorders in this category are listed below.

Avoidant personality disorder

A person with avoidant personality disorder appears painfully shy, is socially
inhibited, feels inadequate and is extremely sensitive to rejection.

Unlike people with schizoid personality disorders, they desire close

relationships with others, but lack the confidence and ability to form them.

Dependent personality disorder

A person with dependent personality disorder feels they have no ability to be

independent. They may show an excessive need for others to look after them
and are "clingy". Other features include:

 finding it difficult to make decisions without other people’s guidance

 needing others to take responsibility over what should be their own
important life choices
 not being able to express disagreement with other people
 finding it difficult to start new activities due to a lack of confidence
 going to extremes to obtain support and comfort
 feeling helpless and uncomfortable when alone
 urgently needing to start a new relationship once a previous relationship
comes to an end
 having an unrealistic and constant fear they will be left alone to fend for
themselves

Obsessive compulsive personality disorder

A person with obsessive compulsive personality disorder is anxious about
issues that seem out of control or "messy". They are preoccupied with
orderliness and ways to control their environment, and may come across to
others as a "control freak".

Other features include:

 having an excessive interest in lists, timetables and rules

  being so concerned with completing a task perfectly that they have
problems completing it (perfectionism)
 being a workaholic
 having very rigid views about issues such as morality, ethics and how a
person should behave in daily life
 hoarding items that seem to have no monetary or sentimental value
 being unable to delegate tasks to other people
 disliking spending money, as they think it is always better to save for a
"rainy day"
This personality disorder differs from obsessive compulsive disorder (OCD), a
related mental health condition, in several important ways:

 People with OCD are aware that their behaviour is abnormal and are
anxious about it. Most people with obsessive compulsive personality
disorder think their behaviour is perfectly acceptable and have no desire
to change it.
 Some people with OCD are compelled to carry out rituals, such as
having to touch every second lamppost as they walk down the street.
This is not usually the case with people with obsessive compulsive
personality disorder.
 People with OCD may feel compelled to make lists or organise items in
their house, but feel anxious about doing so. People with obsessive
compulsive personality disorder find relief from anxiety when doing such
tasks and may become irritated when prevented from doing so.
Treating a personality disorder
Treatment for most personality disorders usually involves a course of
psychological therapy. This normally lasts at least six months, often longer,
depending on the severity of the condition and other co-existing problems.

Psychological therapies
Psychotherapy is a treatment that involves discussion of thoughts, emotions
and behaviours with a trained professional. The aim of all psychological
therapies is to improve people's ability to regulate their thoughts and
emotions.
Some therapies focus on dysfunctional thoughts, while others focus on self-
reflection and being aware of how your own mind works. Some therapies,
especially group therapies, help people understand social relationships better.

Psychological therapies can be effective for many personality disorders.

However, they should only be delivered by a trained professional who has
experience of working with personality disorders and other clinical conditions.
This is because personality disorders are serious conditions that can be
associated with high-risk behaviours, such as self-harm.

As well as listening and discussing important issues with you, the

psychotherapist can suggest strategies to resolve problems and, if necessary,
can help you change your attitudes and behaviour.

A range of different psychotherapies are used to treat personality disorders.

They can be broadly classified into three types of therapy, outlined below.

Psychodynamic (reflective) psychotherapy

Psychodynamic psychotherapy is based on the idea that many adult patterns
of behaviour are related to negative early childhood experiences. These
experiences cause patterns of distorted thinking and beliefs that may have
been understandable in childhood, but do not work in adult life. The goal of
therapy is to explore these distortions, understand how they arose, and find
effective ways to overcome their influence on your thinking and behaviour.

Both individual and group psychodynamic therapy may be helpful for

personality disorders, especially borderline personality disorder (BPD). A
particular form, called mentalisation-based therapy, is recommended for BPD.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is based on the theory that how we think
about a situation affects how we act. In turn, our actions can affect how we
think and feel. Therefore, it is necessary to change both the act of thinking
(cognition) and behaviour at the same time.

A type of CBT called dialectical behaviour therapy (DBT) has proved

successful in helping people reduce impulsive self-harming behaviours,
especially in BPD. DBT is designed to help you cope better with emotional
instability, while at the same time encouraging you to behave in a more
positive way.
 Interpersonal therapy
Interpersonal therapy (IPT) is based on the theory that our relationships with
other people and the outside world in general have a powerful effect on our
mental health.

Several personality disorders may be associated with feelings of low self-

esteem, anxiety and self-doubt, caused by problems interacting with people.

During IPT, the therapist will explore any negative issues associated with your
interpersonal relationships and how these issues can be resolved.

Therapeutic communities
Therapeutic communities (TCs) are a form of group therapy, in which the
experience of having a personality disorder is explored in depth. TCs are an
intensive form of therapy.

The minimum type of TC is one day a week, but others are 9am-5pm, five
days a week. They have been shown to be effective for mild to moderate
personality disorders, but require a high level of commitment.

Medication
No medication is currently licensed for the treatment of any personality
disorder. However, medications may be prescribed to treat associated
problems, such as depression, anxiety or psychotic symptoms.

For example, if you have moderate to severe symptoms of depression that

make it difficult to approach your therapy with confidence or enthusiasm, you
may be prescribed a type of antidepressant called a selective serotonin
reuptake inhibitor (SSRI).

Parkinson's disease
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Living with
Introduction
Parkinson's disease is a condition in which parts of the brain become
progressively damaged over many years.

The three main symptoms of Parkinson's disease are:

 involuntary shaking of particular parts of the body (tremor)

 slow movement
 stiff and inflexible muscles
A person with Parkinson's disease can also experience a wide range of other
physical and psychological symptoms, including:

 depression and anxiety

 balance problems – this may increase the chance of a fall
 loss of sense of smell anosmis
 problems sleeping (insomnia)
 memory problems
Read more about the symptoms of Parkinson's disease

Seeking medical advice

See your GP if you're concerned that you may have symptoms of Parkinson's
disease.

Your GP will ask about the problems you're experiencing and may refer you to
a specialist for further tests.

Read more about diagnosing Parkinson's disease

Causes of Parkinson's disease

Parkinson's disease is caused by a loss of nerve cells in part of the brain
called the substantia nigra. This leads to a reduction in a chemical called
dopamine in the brain.

Dopamine plays a vital role in regulating the movement of the body. A

reduction in dopamine is responsible for many of the symptoms of Parkinson's
disease.

Exactly what causes the loss of nerve cells is unclear. Most experts think that
a combination of genetic and environmental factors is responsible.
Read more about the causes of Parkinson's disease

Who's affected?
It's thought around 1 in 500 people are affected by Parkinson's disease, which
means there are an estimated 127,000 people in the UK with the condition.

Most people with Parkinson's start to develop symptoms when they're over
50, although around 1 in 20 people with the condition first experience
symptoms when they're under 40.

Men are slightly more likely to get Parkinson's disease than women.

Treating Parkinson's disease

Although there's currently no cure for Parkinson's disease, treatments are
available to help reduce the main symptoms and maintain quality of life for as
long as possible.

These include:

 supportive treatments – such as physiotherapy and occupational

therapy
 medication
 in some cases, brain surgery
You may not need any treatment during the early stages of Parkinson's
disease, as symptoms are usually mild. However, you may need regular
appointments with your specialist so your condition can be monitored.

Read more about treating Parkinson's disease

Outlook
As the condition progresses, the symptoms of Parkinson's disease can get
worse and it can become increasingly difficult to carry out everyday activities
without assistance.

Many people respond well to treatment and only experience mild to moderate
disability, whereas the minority may not respond as well and can, in time,
become more severely disabled.
Parkinson's disease doesn't directly cause people to die, but the condition can
place great strain on the body, and can make some people more vulnerable to
serious and life-threatening infections.

However, with advances in treatment, most people with Parkinson's disease

now have a normal or near-normal life expectancy.

Read more about living with Parkinson's disease

It may also be useful to read your guide to care and support – written for
people with care and support needs, as well as their carers and relatives.

Symptoms
The symptoms of Parkinson's disease usually develop gradually and are mild
at first.

There are many different symptoms associated with Parkinson's disease.

Some of the more common symptoms are described below.

However, the order in which these develop and their severity is different for
each individual. It's unlikely that a person with Parkinson's disease would
experience all or most of these.

Main symptoms
The three main symptoms of Parkinson's disease affect physical movement:

 tremor – shaking, which usually begins in the hand or arm and is more
likely to occur when the limb is relaxed and resting
 slowness of movement (bradykinesia) – where physical movements are
much slower than normal, which can make everyday tasks difficult and
can result in a distinctive slow, shuffling walk with very small steps
 muscle stiffness (rigidity) – stiffness and tension in the muscles, which
can make it difficult to move around and make facial expressions, and
can result in painful muscle cramps (dystonia)
These main symptoms are sometimes referred to by doctors as parkinsonism
as there can be causes other than Parkinson's disease.

Other symptoms
Parkinson's disease can also cause a range of other physical and mental
symptoms.

Physical symptoms
 balance problems – these can make someone with the condition more
likely to have a fall and injure themselves
 loss of sense of smell (anosmia) – sometimes occurs several years
before other symptoms develop
 nerve pain – can cause unpleasant sensations, such as burning,
coldness or numbness
 problems with urination – such as having to get up frequently during the
night to urinate or unintentionally passing urine (urinary incontinence)
 constipation
 an inability to obtain or sustain an erection (erectile dysfunction) in men
 difficulty becoming sexually aroused and achieving an orgasm (sexual
dysfunction) in women
 dizziness, blurred vision or fainting when moving from a sitting or lying
position to a standing one – caused by a sudden drop in blood pressure
 excessive sweating (hyperhidrosis)
 swallowing difficulties (dysphagia) – this can lead
to malnutrition and dehydration
 excessive production of saliva (drooling)
 problems sleeping (insomnia) – this can result in excessive sleepiness
during the day

Cognitive and psychiatric symptoms

 depression and anxiety
 mild cognitive impairment – slight memory problems and problems with
activities that require planning and organisation
 dementia – a group of symptoms, including more severe memory
problems, personality changes, seeing things that aren't there (visual
hallucinations) and believing things that aren't true (delusions)

When to seek medical advice

 See your GP if you're concerned you may have symptoms of Parkinson's
disease.

Your GP will ask about your symptoms and your medical history to help them
decide whether it's necessary to refer you to a specialist for further tests.

Osteoporosis
1. Introduction
2. Causes
3. Treatment
4. Prevention
5. Living with
Introduction
Osteoporosis is a condition that weakens bones, making them fragile and
more likely to break. It develops slowly over several years and is often only
diagnosed when a minor fall or sudden impact causes a bone fracture.

The most common injuries in people with osteoporosis are:

 wrist fractures
 hip fractures
 fractures of the spinal bones (vertebrae)
However, they can also occur in other bones, such as in the arm or
pelvis. Sometimes a cough or sneeze can cause a rib fracture or the partial
collapse of one of the bones of the spine.

Osteoporosis isn't usually painful until a fracture occurs, but spinal

fractures are a common cause of long-term (chronic) pain.

Although a fracture is the first sign of osteoporosis, some older people

develop the characteristic stooped (bent forward) posture. It happens when
the bones in the spine have fractured, making it difficult to support the weight
of the body.

Who's affected?
Osteoporosis affects over three million people in the UK.
More than 500,000 people receive hospital treatment for fragility fractures
(fractures that occur from standing height or less) every year as a result of
osteoporosis.

Causes of osteoporosis
Losing bone is a normal part of the ageing process, but some people lose
bone density much faster than normal. This can lead to osteoporosis and an
increased risk of fractures.

Women also lose bone rapidly in the first few years after
the menopause(when monthly periods stop and the ovaries stop producing an
egg). Women are more at risk of osteoporosis than men, particularly if the
menopause begins early (before the age of 45).

Many other factors can also increase the risk of developing osteoporosis,
including:

 long-term use of high-dose oral corticosteroids

 other medical conditions – such as inflammatory conditions, hormone-
related conditions, or malabsorption problems
 a family history of osteoporosis – particularly history of a hip fracture in
a parent
 long-term use of certain medications which can affect bone strength or
hormone levels
 having a low body mass index (BMI)
 heavy drinking and smoking
Read more about the causes of osteoporosis.

Diagnosing osteoporosis
Risk assessment tools
If your doctor suspects you have osteoporosis, they can make an assessment
using an online programme, such as FRAX or Q-Fracture.

These tools help to predict a person's risk of fracture between the ages of 40
and 90. The algorithms used give a 10-year probability of hip fracture and a
10-year probability of a major fracture in the spine, hip, shoulder or forearm.
DEXA scan
They may also refer you for a DEXA (DXA) scan to measure your bone
mineral density. It's a short, painless procedure that takes about five minutes,
depending on the part of the body being scanned.

Your bone mineral density can be compared to the bone mineral density of a
healthy young adult and someone who's the same age and sex as you. The
difference is calculated as a standard deviation (SD) and is called a T score.

Standard deviation is a measure of variability based on an average or

expected value. A T score of:

 above -1 SD is normal
 between -1 and -2.5 SD is defined as decreased bone mineral density
compared with peak bone mass
 below -2.5 is defined as osteoporosis

Osteopenia
You may be diagnosed with osteopenia if bone density tests show you have
decreased bone density, but not enough to be classed as osteoporosis.

Your doctor may still recommend some of the treatments described

below, depending on your results and your risk of fracture.

Treating osteoporosis
Treatment for osteoporosis is based on treating and preventing fractures, and
using medication to strengthen bones.

The decision about whether you need treatment depends on your risk of
fracture. This will be based on a number of factors such as your age, sex and
the results of your DEXA scan.

If you need treatment, your doctor can suggest the safest and most effective
treatment plan for you.

Read more about how osteoporosis is treated.

Preventing osteoporosis
 If you're at risk of developing osteoporosis, you should take steps to help keep
your bones healthy. This may include:

 taking regular exercise

 healthy eating – including foods rich in calcium and vitamin D
 making lifestyle changes – such as giving up smoking and reducing
your alcohol consumption
Read more about preventing osteoporosis.

Living with osteoporosis

If you're diagnosed with osteoporosis, there are steps you can take to reduce
your chances of a fall, such as removing hazards from your home and having
regular sight tests and hearing tests.

To help you recover from a fracture, you can try using:

 hot and cold treatments such as warm baths and cold packs
 transcutaneous electrical nerve stimulation (TENS) – where a small
battery-operated device is used to stimulate the nerves and reduce pain
 relaxation techniques
Speak to your GP or nurse if you're worried about living with a long-term
condition. They may be able to answer any questions you have.

You may also find it helpful to talk to a trained counsellor or psychologist, or

other people with the condition.

The National Osteoporosis Society can put you in touch with local support
groups, and they also have an online discussion forum.

Obsessive compulsive disorder (OCD)

1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
Introduction
Obsessive compulsive disorder (OCD) is a mental health condition where a
person has obsessive thoughts and compulsive activity.

An obsession is an unwanted and unpleasant thought, image or urge that

repeatedly enters a person's mind, causing feelings of anxiety, disgust or
unease.

A compulsion is a repetitive behaviour or mental act that someone feels they

need to carry out to try to temporarily relieve the unpleasant feelings brought
on by the obsessive thought.

For example, someone with a fear of their house being burgled may feel they
need to check all the windows and doors are locked several times before they
can leave the house.

OCD symptoms can range from mild to severe. Some people with OCD may
spend an hour or so a day engaged in obsessive-compulsive thinking and
behaviour, but for others the condition can completely take over their life.

Read more about the symptoms of OCD.

What causes OCD?

It's not clear exactly what causes OCD, although a number of factors have
been suggested.

In some cases the condition may run in families, and may be linked to certain
inherited genes that affect the brain's development.

Brain imaging studies have shown the brains of some people with OCD can
be different from the brains of people who do not have the condition.

For example, there may be increased activity in certain areas of the brain,
particularly those that deal with strong emotions and the responses to them.

Studies have also shown people with OCD have an imbalance of serotonin in
their brain. Serotonin is a chemical the brain uses to transmit information from
one brain cell to another.

Read more about the causes of OCD.

Who is affected?
It's estimated around 12 in every 1,000 people in the UK are affected by the
condition. This equates to almost 750,000 people.

OCD affects men, women and children. The condition typically first starts to
significantly interfere with a person's life during early adulthood, although
problems can develop at any age.

Getting help
People with OCD are often reluctant to seek help because they feel
ashamed or embarrassed.

However, if you have OCD, there is nothing to feel ashamed or embarrassed

about. It is a long-term health condition like diabetes or asthma, and it is not
your fault you have it.

Seeking help is important because it is unlikely your symptoms will improve if

left untreated, and they may get worse.

You should visit your GP if you think you may have OCD. Initially, they will
probably ask a number of questions about your symptoms and how they affect
you.

If your GP suspects OCD, you may need to be referred to a specialist for an

assessment and appropriate treatment.

Read more about diagnosing OCD.

How OCD is treated

With treatment, the outlook for OCD is good. Many people will eventually be
cured of their OCD, or their symptoms will at least be reduced enough that
they can enjoy a good quality of life.

The main treatments for OCD are:

 cognitive behavioural therapy (CBT) – involving a therapy known as

graded exposure with response prevention (ERP), which encourages
you to face your fear and let the obsessive thoughts occur without
"neutralising" them with compulsions
 selective serotonin reuptake inhibitors (SSRIs) – this medication can
help reduce your symptoms by altering the balance of chemicals in your
brain
If these treatments aren't effective or your condition is particularly severe, you
may need to be referred to a specialist mental health service for treatment.

Symptoms
Obsessive compulsive disorder (OCD) affects people differently, but usually
causes a particular pattern of thought and behaviour.

This pattern has four main steps:

 obsession – where an unwanted, intrusive and often distressing

thought, image or urge repeatedly enters your mind
 anxiety – the obsession provokes a feeling of intense anxiety or distress
 compulsion – repetitive behaviours or mental acts that you feel driven to
perform as a result of the anxiety and distress caused by the obsession
 temporary relief – the compulsive behaviour brings temporary relief from
anxiety, but the obsession and anxiety soon return, causing the cycle to
begin again

Obsessive thoughts
Almost everyone has unpleasant or unwanted thoughts at some point in their
life, such as a concern that they may have forgotten to lock the door of the
house or that they may contract a disease from touching other people, or even
sudden unwelcome violent or offensive mental images.

Most people are able to put these types of thoughts and concerns into
context, and they can carry on with their day-to-day life. They do not
repeatedly think about worries they know have little substance.

However, if you have a persistent, unwanted and unpleasant thought that

dominates your thinking to the extent it interrupts other thoughts, you may
have developed an obsession.

Some common obsessions that affect people with OCD include:

 fear of deliberately harming yourself or others – for example, fear you

may attack someone else, even though this type of behaviour disgusts
you
 fear of harming yourself or others by mistake or accident – for example,
fear you may set the house on fire by accidentally leaving the cooker on
  fear of contamination by disease, infection or an unpleasant substance
 a need for symmetry or orderliness – for example, you may feel the
need to ensure all the labels on the tins in your cupboard face the same
way

Compulsive behaviour
Compulsions arise as a way of trying to reduce or prevent the harm of the
obsessive thought. However, this behaviour is either excessive or not
realistically connected at all.

For example, a person who fears becoming contaminated with dirt and germs
may wash their hands repeatedly throughout the day, or someone with a fear
of causing harm to their family may have the urge to repeat an action multiple
times to try to "neutralise" the thought of harm. This latter type of compulsive
behaviour is particularly common in children with OCD.

Most people with OCD realise that such compulsive behaviour is irrational and
makes no logical sense, but they cannot stop acting on their compulsion.

Some common types of compulsive behaviour that affect people with OCD
include:

 cleaning and hand washing

 checking – such as checking doors are locked, or that the gas or a tap
is off
 counting
 ordering and arranging
 hoarding
 asking for reassurance
 repeating words silently
 extensively "overthinking" to ensure the feared consequence of the
obsession does not occur – for example, if you fear you may act
violently
 thinking "neutralising" thoughts to counter the obsessive thoughts
 avoiding places and situations that could trigger obsessive thoughts
Not all compulsive behaviours will be obvious to other people.
Related problems
Some people with OCD may also have or develop other serious mental health
problems, including:

 depression – a condition that typically causes lasting feelings of

sadness and hopelessness, or a loss of interest in the things you used
to enjoy
 eating disorders – conditions characterised by an abnormal attitude
towards food that cause you to change your eating habits and behaviour
 generalised anxiety disorder – a condition that causes you to feel
anxious about a wide range of situations and issues, rather than one
specific event
 a hoarding disorder – a condition that involves excessively acquiring
items and not being able to throw them away, resulting in
unmanageable amounts of clutter
People with OCD and severe depression also frequently
have suicidal feelings.

Getting help
OCD can stop you carrying out normal day-to-day activities and can have a
significant impact on your career, education and social life.

It is therefore important to seek help from your GP if you think you have the
condition. With the correct diagnosis and treatment, you should be able to
manage your symptoms and have a better quality of life.

You should also visit your GP if you think you may have one of the related
mental health problems mentioned above, as these conditions may become
more severe if they are left untreated and may make it more difficult for you to
cope with your OCD.

Contact your GP or care team immediately if you are depressed and feeling
suicidal. You can also telephone the Samaritans to talk in confidence to a
counsellor on 08457 90 90 90. Alternatively, you can call NHS 111.

If you think a friend or family member may have OCD, it's a good idea to talk
to them about your concerns and suggest they seek medical advice.
 While it might seem natural to try to protect the person with OCD from their
own fears, this is counterproductive because it means the problem is not
resolved and there is no hope of moving on.

Mumps
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Complications
Introduction
Mumps is a contagious viral infection that used to be common in children
before the introduction of the MMR vaccine.

It’s most recognisable by the painful swellings at the side of the face under the
ears (the parotid glands), giving a person with mumps a distinctive "hamster
face" appearance.

Other symptoms of mumps include headaches, joint pain and a high

temperature, which may develop a few days before the swelling of the parotid
glands.

When to see your GP

It's important to contact your GP if you suspect mumps so a diagnosis can be
made. While mumps isn't usually serious, the condition has similar symptoms
to more serious types of infection, such as glandular fever and tonsillitis.

Your GP can usually make a diagnosis after seeing and feeling the swelling,
looking at the position of the tonsils in the mouth and checking the person's
temperature to see if it's higher than normal.

Let your GP know in advance if you're coming to the surgery, so they can take
any necessary precautions to prevent the spread of infection.

If your GP suspects mumps, they should notify your local health protection
unit (HPU). The HPU will arrange for a sample of saliva to be tested to confirm
or rule out the diagnosis.
How mumps is spread
Mumps is spread in the same way as colds and flu – through infected droplets
of saliva that can be inhaled or picked up from surfaces and transferred into
the mouth or nose.

A person is most contagious a few days before the symptoms develop and for
a few days afterwards.

During this time, it's important to prevent the infection spreading to others,
particularly teenagers and young adults who haven't been vaccinated.

If you have mumps, you can help prevent it spreading by:

 regularly washing your hands with soap

 using and disposing of tissues when you sneeze
 avoiding school or work for at least five days after your symptoms first
develop

Preventing mumps
You can protect your child against mumps by making sure they're given the
combined MMR vaccine (for mumps, measles and rubella). The MMR vaccine
is part of the routine NHS childhood immunisation schedule.

Your child should be given one dose when they are around 12-13 months and
a second booster dose before they start school. Your child needs to get 2
doses of the vaccine to provide the best protection against mumps.

Treatment for mumps

There's currently no cure for mumps, but the infection should pass within one
or two weeks.

Treatment is used to relieve symptoms and includes:

 getting plenty of bed rest and fluids

 using painkillers, such as ibuprofen and paracetamol – aspirin shouldn't
be given to children under 16
 applying a warm or cool compress to the swollen glands to help relieve
pain
Read more about treating mumps
Complications
Mumps usually passes without causing serious damage to a person's
health. Serious complications are rare.

However, mumps can lead to viral meningitis if the virus moves into the outer
layer of the brain. Other complications include swelling of the testicles in
males or the ovaries in females (if the affected male or female has gone
through puberty).

Read more about the complications of mumps

Who is affected
Most cases of mumps occur in young adults (usually born between 1980 and
1990) who didn’t receive the MMR vaccine as part of their childhood
vaccination schedule or didn't have mumps as a child. There were 2,224
confirmed cases of mumps in England and Wales during 2014.

Once you've been infected by the mumps virus, you normally develop a life-
long immunity to further infection.

Symptoms
The symptoms of mumps usually develop 14 to 25 days after becoming
infected with the mumps virus (this delay is known as the incubation period).
The average incubation period is around 17 days.

Swelling of the parotid glands is the most common symptom of mumps. The
parotid glands are a pair of glands responsible for producing saliva. They're
located in either side of your face, just below your ears.

Both glands are usually affected by the swelling, although only one gland can
be affected. The swelling can cause pain, tenderness and difficulty with
swallowing.

More general symptoms often develop a few days before the parotid glands
swell. These can include:

 headache
 joint pain
 feeling sick
  dry mouth
 mild abdominal pain
 feeling tired
 loss of appetite
 a high temperature (fever) of 38C (100.4F), or above
In about one in three cases, mumps doesn't cause any noticeable symptoms.

When to seek medical advice

If you suspect mumps, it's important to call your GP.

While the infection isn't usually serious, mumps has similar symptoms to
other, more serious types of infection, such as glandular fever and tonsillitis.
It's always best to visit your GP so they can confirm (or rule out) a diagnosis of
mumps.

It's also important to let your GP know in advance if you're coming to the
surgery so they can take any necessary precautions to avoid the spread of
infection.

Meningitis
1. Introduction
2. Causes
3. Treatment
4. Complications
5. Prevention
Introduction
Meningitis is an infection of the protective membranes that surround the brain
and spinal cord (meninges).

It can affect anyone, but is most common in babies, young children, teenagers
and young adults.

Meningitis can be very serious if not treated quickly. It can cause life-
threatening blood poisoning (septicaemia) and result in permanent damage to
the brain or nerves.
A number of vaccinations are available that offer some protection against
meningitis.

Symptoms of meningitis
Symptoms of meningitis develop suddenly and can include:

 a high temperature (fever) over 37.5C (99.5F)

 being sick
 a headache
 a blotchy rash that doesn't fade when a glass is rolled over it (this won't
always develop)
 a stiff neck
 a dislike of bright lights
 drowsiness or unresponsiveness
 seizures (fits)
These symptoms can appear in any order and some may not appear.

Read more about the symptoms of meningitis

When to get medical help

You should get medical advice as soon as possible if you're concerned that
you or your child could have meningitis.

Trust your instincts and don't wait until a rash develops.

Call 999 for an ambulance or go to your nearest accident and emergency

(A&E) department immediately if you think you or your child might be seriously
ill.

Call the 111 service or your GP surgery for advice if you're not sure if it's
anything serious or you think you may have been exposed to someone with
meningitis.

How meningitis is spread

Meningitis is usually caused by a bacterial or viral infection. Bacterial
meningitis is rarer but more serious than viral meningitis.
Infections that cause meningitis can be spread through:

 sneezing
 coughing
 kissing
 sharing utensils, cutlery and toothbrushes
Meningitis is usually caught from people who carry these viruses or bacteria in
their nose or throat but aren't ill themselves.

It can also be caught from someone with meningitis, but this is less common.

Read more about the causes of meningitis

Vaccinations against meningitis

Vaccinations offer some protection against certain causes of meningitis.

These include the:

 meningitis B vaccine – offered to babies aged 8 weeks, followed by a

second dose at 16 weeks, and a booster at 1 year
 5-in-1 vaccine – offered to babies at 8, 12 and 16 weeks of age
 pneumococcal vaccine – offered to babies at 8 weeks, 16 weeks and 1
year old
 meningitis C vaccine – offered at 12 weeks of age, 1 year
 MMR vaccine – offered to babies at 1 year and a second dose at 3
years and 4 months
 meningitis ACWY vaccine – offered to teenagers who are in S3 (around
14 years of age) at school. Young people who are in S4-S6 and missed
the opportunity to get immunised last year, may also get the vaccine at
school this year
Read more about the meningitis vaccinations

Treatments for meningitis

People with suspected meningitis will usually have tests in hospital to confirm
the diagnosis and check whether the condition is the result of a viral or
bacterial infection.
Bacterial meningitis usually needs to be treated in hospital for at least a week.
Treatments include:

 antibiotics given directly into a vein

 fluids given directly into a vein
 oxygen through a face mask
Viral meningitis tends to get better on its own within 7 to 10 days and can
often be treated at home. Getting plenty of rest and taking painkillers and anti-
sickness medication can help relieve the symptoms in the meantime.

Read more about how meningitis is treated

Outlook for meningitis

Viral meningitis will usually get better on its own and rarely causes any long-
term problems.

Most people with bacterial meningitis who are treated quickly will also make a
full recovery, although some are left with serious, long-term problems. These
can include:

 hearing loss or vision loss, which may be partial or total

 problems with memory and concentration
 recurrent seizures (epilepsy)
 co-ordination, movement and balance problems
 loss of limbs – amputation of affected limbs is sometimes necessary
Overall, it's estimated that up to 1 in every 10 cases of bacterial meningitis is
fatal.

Causes
Meningitis is usually caused by a viral or bacterial infection.

Viral meningitis is the most common and least serious type. Bacterial
meningitis is rare but can be very serious if not treated.

Several different viruses and bacteria can cause meningitis, including:

 meningococcal bacteria – there are several different types, called A, B,

C, W, X, Y and Z
  pneumococcal bacteria
 Haemophilus influenzae type b (Hib) bacteria
 enteroviruses – viruses that usually only cause a mild stomach infection
 the mumps virus
 the herpes simplex virus – a virus that usually causes cold
sores or genital herpes
A number of meningitis vaccinations provide protection against many of the
infections that can cause meningitis.

How meningitis is spread

The viruses and bacteria that cause meningitis can be spread through:

 sneezing
 coughing
 kissing
 sharing utensils, cutlery and toothbrushes
The infection is usually spread by people who carry these viruses or bacteria
in their nose or throat, but aren't ill themselves.

The infection can also be spread by someone with meningitis, although this is
less common.

It is possible to get meningitis more than once.

Who's most at risk?

Anyone can potentially get meningitis, but it's more common in:

 babies and young children

 teenagers and young adults
 elderly people
 people with a weak immune system – for example, those with HIV and
those having chemotherapy
You can reduce the risk of getting meningitis by ensuring all your vaccinations
are up-to-date.

Migraine
1. Introduction
2. Symptoms
3. Causes
4. Diagnosis
5. Treatment
6. Complications
7. Prevention
Introduction
A migraine is usually a moderate or severe headache felt as a throbbing pain
on one side of the head.

Many people also have symptoms such as nausea, vomiting and increased
sensitivity to light or sound.

Migraine is a common health condition, affecting around one in every five

women and around one in every 15 men. They usually begin in early
adulthood.

There are several types of migraine, including:

 migraine with aura – where there are specific warning signs just before
the migraine begins, such as seeing flashing lights
 migraine without aura – the most common type, where the migraine
occurs without the specific warning signs
 migraine aura without headache, also known as silent migraine – where
an aura or other migraine symptoms are experienced, but a headache
doesn't develop
Some people have migraines frequently, up to several times a week. Other
people only have a migraine occasionally. It's possible for years to pass
between migraine attacks.

Read more about the symptoms of migraine

When to seek medical advice

You should see your GP if you have frequent or severe migraine symptoms.

Simple painkillers such as paracetamol or ibuprofen can be effective for

migraine. However, be careful not to take too many painkillers as this could
make it harder to treat headaches over time.
You should also make an appointment to see your GP if you have frequent
migraines (on more than five days a month), even if they can be controlled
with medication, as you may benefit from preventative treatment.

You should call 999 for an ambulance immediately if you or someone you're
with experiences:

 paralysis or weakness in one or both arms and/or one side of the face
 slurred or garbled speech
 a sudden agonising headache resulting in a blinding pain unlike
anything experienced before
 headache along with a high temperature (fever), stiff neck, mental
confusion, seizures, double vision and a rash
These symptoms may be a sign of a more serious condition, such as
a stroke or meningitis, and should be assessed by a doctor as soon as
possible.

Read more about diagnosing migraines

Causes of migraines
The exact cause of migraines is unknown, although they're thought to be the
result of temporary changes in the chemicals, nerves and blood vessels in the
brain.

Around half of all people who experience migraines also have a close relative
with the condition, suggesting that genes may play a role.

Some people find migraine attacks are associated with certain triggers, which
can include:

 starting their period

 stress
 tiredness
 certain foods or drinks
Read more about the causes of migraines

Treating migraines
There's no cure for migraines, but a number of treatments are available to
help reduce the symptoms.

These include:

 painkillers – including over-the-counter medications such

as paracetamoland ibuprofen
 triptans – medications that can help reverse the changes in the brain
that may cause migraines
 anti-emetics – medications often used to reduce nausea and vomiting
During an attack, many people find that sleeping or lying in a darkened room
can also help.

Read more about treating migraines

Preventing migraines
If you suspect a specific trigger is causing your migraines, such as stress or a
certain type of food, avoiding this trigger may help reduce your risk of
experiencing migraines.

It may also help to maintain a generally healthy lifestyle, including regular

exercise, sleep and meals, as well as ensuring you stay well hydrated and
limiting your intake of caffeine and alcohol.

If your migraines are severe or you've tried avoiding possible triggers and are
still experiencing symptoms, your GP may prescribe medication to help
prevent further attacks.

Medications used to prevent migraines include the anti-seizure medication

topiramate and a medication called propranolol that's usually used to
treat high blood pressure. It may take several weeks before your migraine
symptoms begin to improve.

Read more about preventing migraines

Outlook
Migraines can severely affect your quality of life and stop you carrying out
your normal daily activities. Some people find they need to stay in bed for
days at a time.
However, a number of effective treatments are available to reduce the
symptoms and prevent further attacks.

Migraine attacks can sometimes get worse over time, but they tend to
gradually improve over many years for most people.

Symptoms
The main symptom of a migraine is usually an intense headache on one side
of the head.

The pain is usually a moderate or severe throbbing sensation that gets worse
when you move and prevents you from carrying out normal activities.

In some cases, the pain can occur on both sides of your head and may affect
your face or neck.

Additional symptoms
Other symptoms commonly associated with a migraine include:

 nausea
 vomiting
 increased sensitivity to light and sound – which is why many people with
a migraine want to rest in a quiet, dark room
Some people also occasionally experience other symptoms, including:

 sweating
 poor concentration,
 feeling very hot or very cold
 abdominal (tummy) pain
 diarrhoea
Not everyone with a migraine experiences these additional symptoms and
some people may experience them without having a headache.

The symptoms of a migraine usually last between four hours and three days,
although you may feel very tired for up to a week afterwards.

Symptoms of aura
About one in three people with migraines have temporary warning symptoms,
known as aura, before a migraine. These include:

 visual problems – such as seeing flashing lights, zig-zag patterns or

blind spots
 numbness or a tingling sensation like pins and needles – which usually
starts in one hand and moves up your arm before affecting your face,
lips and tongue
 feeling dizzy or off balance
 difficulty speaking
 loss of consciousness – although this is unusual
Aura symptoms typically develop over the course of about five minutes and
last for up to an hour. Some people may experience aura followed by only a
mild headache or no headache at all.

When to seek medical advice

You should see your GP if you have frequent or severe migraine symptoms
that can't be managed with occasional use of over-the-counter painkillers,
such as paracetamol.

However, be careful not to take too many painkillers as this could make it
harder to treat headaches over time.

You should also make an appointment to see your GP if you have frequent
migraines (on more than five days a month), even if they can be controlled
with medication, as you may benefit from preventative treatment.

You should call 999 for an ambulance immediately if you or someone you're
with experiences:

 paralysis or weakness in one or both arms and/or one side of the face
 slurred or garbled speech
 a sudden agonising headache resulting in a blinding pain unlike
anything experienced before
 headache along with a high temperature (fever), stiff neck, mental
confusion, seizures, double vision, and a rash
These symptoms may be a sign of a more serious condition, such as
a stroke or meningitis, and should be assessed by a doctor as soon as
possible.
 Malaria
1. Introduction
2. Symptoms
3. Causes
4. Antimalarial medication
5. Complications
6. Prevention
Introduction
Malaria is a serious tropical disease spread by mosquitoes. If it isn't
diagnosed and treated promptly, it can be fatal.

A single mosquito bite is all it takes for someone to become infected.

Symptoms of malaria
It's important to be aware of the symptoms of malaria if you're travelling to
areas where there's a high risk of the disease. Symptoms include:

 a high temperature (fever)

 sweats and chills
 headaches
 vomiting
 muscle pains
 diarrhoea
Symptoms usually appear between 7 and 18 days after becoming infected,
but in some cases the symptoms may not appear for up to a year, or
occasionally even longer.

Read more about the symptoms of malaria

When to seek medical attention

Seek medical help immediately if you develop symptoms of malaria during or
after a visit to an area where the disease is found.

You should still seek medical help even if it's several weeks, months or a year
after you return from travelling.
If there's a possibility you have malaria, a blood test will be carried out to
confirm whether or not you're infected.

You should receive the results of your blood test on the same day. If you have
malaria, treatment will be started straight away.

What causes malaria?

Malaria is caused by a type of parasite known as Plasmodium. There are
many different types of Plasmodia parasites, but only five cause malaria in
humans.

The Plasmodium parasite is mainly spread by female Anopheles mosquitoes,

which mainly bite at dusk and at night. When an infected mosquito bites a
human, it passes the parasites into the bloodstream.

Malaria can also be spread through blood transfusions and the sharing of
needles, but this is very rare.

Read more about the causes of malaria and how it's spread

Malaria risk areas

Malaria is found in more than 100 countries, mainly in tropical regions of the
world, including:

 large areas of Africa and Asia

 Central and South America
 Haiti and the Dominican Republic
 parts of the Middle East
 some Pacific islands
The 2014 World Malaria Report, published by the World Health Organization
(WHO), estimates there were 198 million cases of malaria worldwide and
584,000 deaths in 2013.

Malaria is not found in the UK, although about 1,586 travellers were
diagnosed with the disease after returning to the UK in 2014, and three people
died.

The Fit for Travel website has more information about the risk of malaria in
specific countries.
Preventing malaria
Many cases of malaria can be avoided. An easy way to remember is the
ABCD approach to prevention:

 Awareness of risk – find out whether you're at risk of getting malaria

before travelling
 Bite prevention – avoid mosquito bites by using insect repellent,
covering your arms and legs, and using an insecticide-treated mosquito
net
 Check whether you need to take malaria prevention tablets – if you do,
make sure you take the right antimalarial tablets at the right dose, and
finish the course
 Diagnosis – seek immediate medical advice if you develop malaria
symptoms, as long as up to a year after you return from travelling
Speak to your GP if you're planning to visit an area where there's a malaria
risk. It may be recommended that you take antimalarial tablets to prevent
infection.

Read more about preventing malaria

Treating malaria
If malaria is diagnosed and treated promptly, virtually everyone will make a full
recovery. Treatment should be started as soon as the diagnosis has been
confirmed.

Antimalarial medication is used to both treat and prevent malaria. Which type
of medication is used and the length of treatment will depend on:

 the type of malaria

 the severity of your symptoms
 where you caught malaria
 whether you took an antimalarial to prevent malaria
 whether you're pregnant
In some cases, you may be prescribed emergency standby treatment for
malaria before you travel. This is usually if there's a risk of you becoming
infected with malaria while travelling in a remote area with little or no access
to medical care.
Read more about treating malaria

Complications of malaria
Malaria is a serious illness that can get worse very quickly. It can be fatal if not
treated promptly.

It can also cause serious complications, including:

 severe anaemia – where red blood cells are unable to carry enough
oxygen around the body, leading to drowsiness and weakness
 cerebral malaria – in rare cases, the small blood vessels leading to the
brain can become blocked, causing seizures, brain damage and coma
The effects of malaria are usually more severe in pregnant women, babies,
young children and the elderly. Pregnant women in particular are usually
advised not to travel to malaria risk areas.

Symptoms
Symptoms of malaria can develop as quickly as seven days after you're bitten
by an infected mosquito.

Typically, the time between being infected and when symptoms start
(incubation period) is 7 to 18 days, depending on the specific parasite you're
infected with. However, in some cases it can take up to a year for symptoms
to develop.

The initial symptoms of malaria are flu-like and include:

 a high temperature (fever)

 headache
 sweats
 chills
 vomiting
These symptoms are often mild and can sometimes be difficult to identify
as malaria.

With some types of malaria, the fever occurs in 48-hour cycles. During these
cycles, you feel cold at first with shivering. You then develop a fever,
accompanied by severe sweating and fatigue. These symptoms usually last
between 6 and 12 hours.

Other symptoms of malaria can include:

 muscle pains
 diarrhoea
 generally feeling unwell
The most serious type of malaria is caused by the Plasmodium falciparum
parasite. Without prompt treatment, this type could lead to you quickly
developing severe and life-threatening complications, such as breathing
problems and organ failure.

Read more about the complications of malaria

Seeking medical advice

Seek medical advice immediately if you develop symptoms of malaria during
or after a visit to an area where the disease is found.

You should still seek medical help even if it's several weeks, months or a year
after you return from travelling.

Causes
Malaria is caused by the Plasmodium parasite. The parasite can be spread to
humans through the bites of infected mosquitoes.

There are many different types of plasmodium parasite, but only five types
cause malaria in humans.

These are:

 Plasmodium falciparum – mainly found in Africa, it's the most common

type of malaria parasite and is responsible for most malaria deaths
worldwide
 Plasmodium vivax – mainly found in Asia and South America, this
parasite causes milder symptoms than Plasmodium falciparum, but it
can stay in the liver for up to three years, which can result in relapses
 Plasmodium ovale – fairly uncommon and usually found in West Africa,
it can remain in your liver for several years without producing symptoms
  Plasmodium malariae – this is quite rare and usually only found in Africa
 Plasmodium knowlesi – this is very rare and found in parts of southeast
Asia

How malaria is spread

The plasmodium parasite is spread by female Anopheles mosquitoes, which
are known as "night-biting" mosquitoes because they most commonly bite
between dusk and dawn.

If a mosquito bites a person already infected with malaria, it can also become
infected and spread the parasite on to other people. However, malaria can't
be spread directly from person to person.

Once you're bitten, the parasite enters the bloodstream and travels to the
liver. The infection develops in the liver before re-entering the bloodstream
and invading the red blood cells.

The parasites grow and multiply in the red blood cells. At regular intervals, the
infected blood cells burst, releasing more parasites into the blood. Infected
blood cells usually burst every 48-72 hours. Each time they burst, you'll have
a bout of fever, chills and sweating.

Malaria can also be spread through blood transfusions and the sharing of
needles, but this is very rare.

Measles
1. Introduction
2. Symptoms of measles
3. Treating measles
4. Complications of measles
5. Preventing measles
Introduction
Measles is a highly infectious viral illness that can be very unpleasant and
sometimes lead to serious complications. It's now uncommon in the UK
because of the effectiveness of vaccination.

Anyone can get measles if they haven't been vaccinated or they haven't had it
before, although it's most common in young children.
The infection usually clears in around 7 to 10 days.

Symptoms of measles
The initial symptoms of measles develop around 10 days after you're infected.
These can include:

 cold-like symptoms, such as a runny nose, sneezing, and a cough

 sore, red eyes that may be sensitive to light
 a high temperature (fever), which may reach around 40C (104F)
 small greyish-white spots on the inside of the cheeks
A few days later, a red-brown blotchy rash will appear. This usually starts on
the head or upper neck, before spreading outwards to the rest of the body.

Read more about the symptoms of measles

When to see your GP

You should contact your GP as soon as possible if you suspect that you or
your child may have measles.

It's best to phone before your visit as your GP surgery may need to make
arrangements to reduce the risk of spreading the infection to others.

You should also see your GP if you've been in close contact with someone
who has measles and you've not been fully vaccinated (had two doses of the
MMR vaccine) or haven't had the infection before – even if you don't have any
symptoms.

Is measles serious?
Measles can be unpleasant, but will usually pass in about 7 to 10 days without
causing any further problems.

Once you've had measles, your body builds up resistance (immunity) to the
virus and it's highly unlikely you'll get it again.

However, measles can lead to serious and potentially life-threatening

complications in some people. These include infections of the
lungs (pneumonia)and brain (encephalitis).

Read more about the complications of measles

How measles is spread
The measles virus is contained in the millions of tiny droplets that come out of
the nose and mouth when an infected person coughs or sneezes.

You can easily catch measles by breathing in these droplets or, if the droplets
have settled on a surface, by touching the surface and then placing your
hands near your nose or mouth. The virus can survive on surfaces for a few
hours.

People with measles are infectious from when the symptoms develop until
about four days after the rash first appears.

How measles can be prevented

Measles can be prevented by having the measles, mumps and rubella (MMR)
vaccine.

This is given in two doses as part of the NHS childhood vaccination

programme. The first dose is given when your child is around 12 months old
and a second dose is given from age 3 years 4 months.

Adults and older children can be vaccinated at any age if they haven't been
fully vaccinated before. Ask your GP about having the vaccination.

If the MMR vaccine isn't suitable for you, a treatment called human normal
immunoglobulin (HNIG) can be used if you're at immediate risk of catching
measles.

Read more about preventing measles

Treating measles
There are several things you can do to help relieve your symptoms and
reduce the risk of spreading the infection, including:

 taking paracetamol or ibuprofen to relieve fever, aches and pains –

aspirin should not be given to children under 16 years old
 drinking plenty of water to avoid dehydration
 closing the curtains to help reduce light sensitivity
 using damp cotton wool to clean the eyes
 staying off school or work for at least four days from when the rash first
appears
In severe cases, especially if there are complications, you or your child may
need to be admitted to hospital for treatment.

Symptoms of measles
Measles starts with cold-like symptoms that develop about 10 days after
becoming infected. This is followed a few days later by the measles rash.

For most people, the illness lasts around 7 to 10 days in total.

Initial symptoms
The initial symptoms of measles can include:

 a runny or blocked nose

 sneezing
 watery eyes
 swollen eyelids
 sore, red eyes that may be sensitive to light
 a high temperature (fever), which may reach around 40C (104F)
 small greyish-white spots in the mouth (see below)
 aches and pains
 a cough
 loss of appetite
 tiredness, irritability and a general lack of energy

Spots in the mouth

A day or two before the rash appears, many people with measles
develop small greyish-white spots in their mouth.

Not everyone with measles has these spots, but if someone has them in
addition to the other symptoms listed above or a rash, it's highly likely they
have the condition.

The spots will usually last for a few days.

The measles rash

The measles rash appears around two to four days after the initial symptoms
and normally fades after about a week.
You'll usually feel most ill on the first or second day after the rash develops.

The rash:

 is made up of small red-brown, flat or slightly raised spots that may join
together into larger blotchy patches
 usually first appears on the head or neck, before spreading outwards to
the rest of the body
 is slightly itchy for some people
 can look similar to other childhood conditions, such as slapped cheek
syndrome, roseola or rubella
 is unlikely to be caused by measles if the person has been fully
vaccinated (had two doses of the MMR vaccine) or had measles before

When to seek medical advice

Contact your GP as soon as possible if you suspect that you or your child has
measles, even if you're not completely sure.

It's best to phone before your visit, as your GP surgery may need to make
arrangements to reduce the risk of spreading the infection to others.

You should also see your GP if you've been in close contact with someone
who has measles and you've not been fully vaccinated or haven't had the
infection before – even if you don't have any symptoms yet.

Treating measles
There's no specific treatment for measles, but the condition usually improves
within 7 to 10 days. Your GP will probably suggest taking things easy at home
until you're feeling better.

Stay away from work or school for at least four days from when the measles
rash first appears to reduce the risk of spreading the infection.

You should also try to avoid contact with people who are more vulnerable to
the infection, such as young children and pregnant women.
Relieving symptoms
If the symptoms of measles are causing discomfort for you or your child, there
are some things you can do to treat these while you wait for your body to fight
off the virus.

Controlling fever and relieving pain

Paracetamol or ibuprofen can be used to reduce a high temperature (fever)

and relieve any aches or pains if your child is uncomfortable.

Liquid infant paracetamol can be used for young children. Aspirin should not
be given to children under 16 years old.

Speak to your pharmacist if you're not sure which medications are suitable for
your child.

Drink plenty of fluids

If your child has a high temperature, make sure they drink plenty of fluids as
they may be at risk of dehydration.

Keeping hydrated may also help reduce throat discomfort caused by

coughing.

Treating sore eyes

You can gently clean away any crustiness from your child's eyelids and lashes
using cotton wool soaked in water.

Closing curtains or dimming lights can help if bright light is hurting their eyes.

Treating cold-like symptoms

If your child has cold-like symptoms, such as a runny nose or a cough, there
are a number of things you can do to help them feel more comfortable.

For example, it might help your child if they sit in a hot, steamy bathroom. Or
you could put a wet towel on a warm radiator to moisten the air, which may
help ease your child's cough.

Drinking warm drinks, particularly ones containing lemon or honey, may also
help to relax the airways, loosen mucus, and soothe a cough. Honey should
not be given to babies under 12 months.
Spotting signs of serious illness
If you or your child has measles, you should keep an eye out for any signs of
the serious complications that can sometimes develop.

Signs of a more serious problem include:

 shortness of breath
 a sharp chest pain that feels worse with breathing
 coughing up blood
 drowsiness
 confusion
 fits (convulsions)
Go to your nearest accident and emergency (A&E) department or call 999 for
an ambulance if you or your child develop any of these symptoms.

Liver disease
Overview
There are more than 100 different types of liver disease, which together affect
at least 2 million people in the UK.

The liver
The liver is the second largest organ in the body. It works hard, performing
hundreds of complex functions, including:

 fighting infections and illness

 removing toxins (poisons), such as alcohol, from the body
 controlling cholesterol levels
 helping blood to clot (thicken)
 releasing bile, a liquid that breaks down fats and aids digestion
Liver disease doesn't usually cause any obvious signs or symptoms until it's
fairly advanced and the liver is damaged.

At this stage, possible symptoms can include loss of appetite, weight loss and
jaundice.
Types of liver disease
Listed below are some specific types of liver disease. The links provide more
detailed information about each type.

 Alcohol-related liver disease – where the liver is damaged after years of

alcohol misuse, this can lead to cirrhosis (scarring of the liver)
 Non-alcoholic fatty liver disease – a build-up of fat within liver cells,
usually seen in overweight people or those who are obese
 Hepatitis – which is inflammation (swelling) of the liver caused by a viral
infection or exposure to harmful substances such as alcohol
 Haemochromatosis – an inherited disorder where there's a gradual
build-up of iron in the body, usually around the liver
 Primary biliary cirrhosis – a rare, long-term type of liver disease that
damages the bile ducts in the liver
It’s important to note that all types of liver disease can cause cirrhosis
(scarring of the liver), not just alcohol-related liver disease.

Significant health problem

In the UK, liver disease is on the increase. Three of the main causes of liver
disease are:

 obesity
 undiagnosed hepatitis infection
 alcohol misuse
These causes of liver disease are all preventable so it's important to make
sure:

 you're a healthy weight for your height; you can read more about BMI
 you avoid drinking excessive amounts of alcohol; read more
about alcohol units
 take the appropriate measures to prevent getting hepatitis, such as
getting vaccinated if you're at risk