The Better2Know Blog

What is Hepatitis C?

Hepatitis C is an infection with the hepatitis C virus (HCV). Estimates suggest over 250,000 people in the UK have been infected with hepatitis C, but 8 out of 10 don’t know they have it because they have no symptoms. About 75% of these people go on to develop a chronic hepatitis. Because it can take years, even decades, for symptoms to appear, many people (possibly 100,000 or more) remain unaware they have a problem. By the time they become ill and seek help, considerable damage has been done to the liver. This might have been prevented if the person had been diagnosed earlier. About 20-30 per cent of people clear the virus from their bodies – but in about 75 per cent of cases, the infection lasts for more than six months (chronic hepatitis C). In these cases, the immune system has been unable to clear the virus and will remain in the body long term unless medical treatment is given. Most of these people have a mild form of the disease with intermittent symptoms of fatigue or no symptoms at all.

About one in five people with chronic hepatitis C develops cirrhosis of the liver within 20 years. Hepatitis C virus is usually transmitted through blood-to-blood contact. One common route is through sharing needles when injecting recreational drugs – nearly 40 per cent of intravenous drug users have the infection and around 35 per cent of people with the virus will have contracted it this way. Similarly, having a tattoo or body piercing with equipment that has not been properly sterilised can lead to infection. Hepatitis C can be sexually transmitted, and it can be passed on through sharing toothbrushes and razors.

How is Hepatitis C treated?

Hepatitis C can be treated with pegylated interferon alpha and ribavirin. These drugs offer the best chance to clear the virus from the body, and are often used together as dual or combination therapy which has been shown to be effective in 55 per cent of cases. Some strains or genotypes of the hepatitis C virus are more likely to respond than others. Even if the virus isn’t completely cleared, the treatments can reduce inflammation and scarring of the liver. They may, however, cause side effects that some people find difficult to tolerate. Many people also find that complementary and lifestyle approaches help. There is little evidence these can reduce levels of the virus, but they may help to deal with symptoms and improve quality of life.

People with chronic hepatitis C infection should be seen by a hospital liver specialist who may recommend antiviral drug treatments either as single drug therapy or as combination therapy. Whether treatment is needed, and if so which type, depends on a number of factors. These include blood tests to identify which strain of hepatitis C infection is present and how well the liver is functioning, and a liver biopsy to establish whether cirrhosis is occurring.

If you want to know how to not catch an STI or STD, here are some top things to remember:

Not detecting Trichomonas can lead to the following complications:

Complications are rare with trichomoniasis. However, the infection can sometimes weaken the barrier of mucus in the cervix (the neck of the womb). This mucus barrier helps to protect women from developing infection in their reproductive organs. If the mucus is weakened, this increases your risk of developing HIV. It is therefore very important that you practise safe sex by always using a condom.

Source: NHS Choices

Gaydos and her colleagues study involved 7,593 U.S. women between the ages of 18 and 89 from women in 28 states and it is believed to be the largest and most in-depth analysis of the STD ever performed in the United States, complementing periodic national surveys of adolescents and individual city reports.

The test samples were collected from women in private clinics, emergency departments, hospitals, jails and community health STD clinics between July 1 and Dec. 30, 2010. Researchers used the latest genetic assay, a test that is almost 100 percent foolproof in detecting trichomonas, instead of traditional testing methods, which are only accurate about half the time.

Test samples showed women 50 and older had the highest trichomonas infection rate (13%), while women in their 40s were next (11%). The infection rate was 8.5% in women ages 18 and 19, dropping slightly to 8.3% for women in their 20s.

Overall, the survey results showed that 8.7% of all women tested positive for the STD. Infection rates were highest among black women of all ages, at 20%, more than three times the rate in white women (5.7%).

Source: Charlotte Gaydos, M.S., Dr.P.H., Johns Hopkins University

It is clear from the above that complications are thankfully rare, but untreated, the NHS itself makes clear that Trichomoniasis can increase the risk of contracting HIV, a life threatening condition.

Although the associated risks may be small, the incidence of this infection is relatively high. Better2Know is offering this test within the Platinum Screen to provide those patients selecting the Platinum Screen to be confident they know their status and can take appropriate measures to ensure they are not exposed to these risks at all.

Trichomonas Vaginalis is a protozoan, which is a small organisim similar to bacteria.  The Trichomonas protozoan can infect the vagina in women, and the urethra and occasionally the prostate gland males.  Trichomonas is normally passed on by sexual contact and is the third most common STI.

Trichomonas infection is one of the most common protozoal parasites and is a major cause of symptomatic vaginitis.  It is one of the most common yet curable STDs which can occur among sexually active men and women. The Trichomonas organism is most frequently transmitted through vaginal intercourse but can also be transmitted by vulva to vulva contact between two women.

Trichomonas can be tested with a urine sample and Better2Know can test for it on its own, or as part of our Platinum or Comfort Screens.

Trichomonas can be easily treated with a short course of antibiotics, and you can receive a prescription from a Better2Know doctor if you test positive.

Figures published by the HPA show the most common STIs and STDs in men who disclosed that they had sex with men.

The most common STI is Syphilis, which accounted for 2 in 3 of all positive diagnoses (so of those who did have an STI or STD, 2 out of 3 had syphilis).

40% of those who had and STI had gonorrhoea (therefore as you can see, some men will have had more than one infection), and around 10% had Chlamydia, syphilis, and genital warts.

There was a particularly high incidence in men who were HIV+ contracting further STIs and STDs, showing a worrying lack of precautions many men are taking to stop the spread of HIV and other STIs.

In the United States, the generation known as baby boomers (born between 1945 and 1965) have been urged to get a Hepatitis C blood test.  It is thought that less than a quarter of this generation have ever tested for the Hepatitis C virus.

In the USA, the Food and Drug Administration (FDA)‘s advisory panel has this week voted unanimously to take forward plans to allow an oral (using a saliva sample) to be sold over the counter in the United States. This test, made by Oraquick, takes 20 minutes to run, and although not as accurate as a blood test (such as those offered by Better2Know in the UK).

Better2Know understand that many of our patients are concerned about their confidentiality. We do not need your real name at any point, and we will not ask you for an address or your GP’s name.

There can be little doubt that by relieving someone’s anxiety over an STD or STI will have a positive impact on their well being and productivity. It is well understood that individuals who are preoccupied by health concerns underperform their peers who are not so concerned. Outputs improve in the knowledge ones health is sound, and there is much evidence of more comprehensive health screens contributing greatly to the mental well being of the individual. Bette2Know’s Platinum STD Screen will provide the patient with the knowledge they have been tested for a wide variety of possible infections, and this knowledge will give them confidence and set their minds to rest, with the concomitant improvements in productivity.

Mycoplasma Genitalium is a bacterium that can infect both men and women and can be passed on through sexual contact.  Mycoplasma is among the smallest free-living organisms.

A mycoplasma infection is a little known but very common STI / STD.  The mycoplasma bacterium is contagious both men and women, and it can be passed on between partners through genital contact and oral sex.

The symptoms of Mycoplasma can differ between men and women.  The infection can cause an inflamed urethra and burning and painful urination, it can lead to arthritis in men, but most frequently men will have no symptoms at all.

Women with Mycoplasma can experience vaginal itching and painful sexual intercourse.  Vaginal discharge and painful burning when urinating are another symptom, but many women are likely to have no symptoms at all.

The only way to know whether you have Mycoplasma, another STI or STD or a urinary infection is to get tested.  Better2Know tests for Mycoplasma with a urine sample and you can have this test on its own, or as part of our platinum, full or comfort screens.

Mycoplasma is treated with a short course of antibiotics.

Statistics published by the Health Protection Agency show that:

Young people (people under the age of 25, or those claiming to be!) have a high rate of testing positive for STIs and STDs in statistics published by the HPA.

The World Health Organisation (WHO) is looking into the use of mobile phone technology to help deliver health care in Africa including HIV/ AIDS related testing and treatment.

The HPA (Health Protection Agency) has published information on the percentage of the English population, aged between 15 and 24, who tooka Chlamydia test in 2010/2011:

1. London 42%
2. North East 36%
3. East Midlands 33%
4. West Midlands 32%
5. North West 31%
6. East 31%
7. South Central 30%
8. Yorkshire and the Humber 30%
9. South West 28%
10. South East 27%

The majority of tests were part of the nationwide chlamydia screening programme.

Better2Know does not report statistics into these programmes, as part of our promise of confidentiality to you.

Sadly many relationships have bumps or end when one or both partners have been unfaithful. The breakdown of a relationship is an emotional and stressful time. Although sometimes relationships can recover from these affairs of periods of infidelity. It is always a good idea not to risk your health and to have an STI and STD check so that you can take control of your health.

As part of our efforts to evaluate the Value for Money offered by the Better2Know tests, we recognise that it is vitally important to fully understand the concept of Value for Money, and note that this concept has been widely and rigorously explored in the context of Healthcare.

At Better2Know, we do enjoy BBC’s The Apprentice, and have enjoyed the challenges and the unique personalities of so many of the would be apprentices. In particular we like the challenges where the teams gets to choose products from various inventors to try to sell. This is always an interesting one, as you do wonder whether the inventors will always get good publicity from this if the teams present their product inadequately – or in poor German – how does that affect their product image?

The gay rights charity Stonewall has surveyed 6,900 gay and bisexual men in the UK about their experiences with the NHS.  Amongst the concerns raised were:

• That the patient was only interested in HIV or STD testing
• The patient was HIV+
• The patient had had a negative experience
• One third of respondents had never had an HIV Test
• 54% had never discussed HIV with a healthcare professional

Mental health issues can be more acute particularly in young gay or bisexual men, and these are often not looked into seriously by GPs.

Better2Know does not ask for your real name, and certainly does not need to know your sexuality.  There are a number of men who have sex with men who do not necessarily identify themselves as homosexual, and do not want to take advantage of HIV testing tailored to gay and bisexual people as they do not think it applies to them. A lot of money has been spent raising awareness of the importance of early diagnosis to start the right treatment and prevent further transmission. Alongside the point that gay people face so much prejudice in their lives that they are careful of whom they disclose their sexuality to, that we are left with a section of society who are at high risk and won’t test. Helping HIV and STI testing becoming a normal part of your sexual health is key to preventing new infections.

A study, in the 1 May 2012 Journal of Infections Diseases, says that the incidence of reinfection with Hepatitis C after the body has cleared the virus may be higher than previously thought.

Britain has high incidences of sexually active teens and harmful teenage drinking says a report published in The Lancet – a Medical Journal on Tuesday.

New World Health Organisation (WHO) guidelines published this month recommend that couples get tested for HIV together, and where one partner tests positive, they recommend starting treatment immediately (Anti Retro-Viral drugs [ARVs]) immediately to suppress the body’s response to the virus to help to prevent transmission to the other partner.  This is known as PrEP (Pre-Exposire Prophylaxis)

Dr Colm O’Mahony, a UK sexual health and HIV specialist, has said that diagnosing HIV earlier could save the health service ten of millions of pounds. Around one quarter of HIV sufferers do not know they have the condition and so are not practising safe sex. This is despite these people coming into contact with the health services constantly for a range of related illnesses such as gastroenterological conditions, as the health services are not routinely testing for HIV.

The UK’s Adult Industry Trade Association (AITA) said last Thursday that the U.K. performer who received an initial positive test result for HIV has been cleared in a follow-up test.

Hepatitis B is a viral infection of the liver, which can follow a variable course. Hepatitis B can be sexually transmitted, and you should get an STD test at an STD Clinic. The Hepatitis B Virus (HBV) can cause an acute illness that resolves itself quickly without causing long-term liver damage. However, in about 20% of cases it can cause a chronic illness that lasts more than six months, sometimes for life, with symptoms that come and go. In 15-40% of those with chronic infection cirrhosis, liver cancer or liver failure develop, and so the infection may eventually be fatal. The virus is usually transmitted through contact with infected blood or body fluids, and can be sexually transmitted. Only a tiny amount of blood is needed to transmit the virus because it is so infectious.

The Hepatitis B Virus may also be present in saliva, vaginal secretions, breast milk and other bodily fluids. In the UK, infection commonly occurs through unprotected sexual intercourse, the sharing of contaminated needles by drugs users, accidental injury with a contaminated needle (if needles used for tattooing, body piercing or acupuncture are contaminated) and sharing razors. You should make sure your STD test includes Hepatitis B if you are worried.

How is Hepatitis B treated ?

STD testing for Hepatitis B is a simple blood test, and is a quick STD test to do as part of your STD Screen. Your Hepatitis B STD test results will be available within one day of your sample being received in the laboratory.

There’s an effective vaccination to protect people from hepatitis B infection. It’s available from your GP or high street travel centres, who will advise you whether you need it. Family and other household members of an infected person should be vaccinated against Hepatitis B. Healthcare workers, the police, the emergency services and anyone who is likely to come in contact with infected blood through their job should also be vaccinated.

The majority of people with Hepatitis B don’t need specific treatment other than rest, and they eventually make a full recovery. However, it is important that the infection is monitored to check whether chronic disease develops, and the person is given advice about the risk of passing the infection on. If the infection lasts more than six months (chronic hepatitis infection, where the virus continues to actively reproduce in the body) you may need more specific drug treatment to reduce the risk of permanent liver damage (cirrhosis) and liver cancer. Your GP should refer you to a specialist in either liver disease or general digestive diseases. They may recommend treatment either with treatment with antiviral drug.

We have over 300 STD clinics across the UK, all of which can do HIV tests. To find the clinic nearest you, use our STD test clinic finder to discover where to get an HIV test.

We have two main HIV tests:

We have the most advanced HIV testing available including an HIV test which is very accurate just ten days after your risky event. This is called our 10 day HIV test, and is part of our Early Detection Screen.

We also have an HIV test for 28 days after your risky event – this is called the 28 day HIV test and is available on its own, or as part of our other STD screening packages. If you are at risk of HIV, you should consider other STD tests including Chlamydia, gonorrhoea, syphilis, herpes and HPV. This 28 day HIV test tests for HIV types 1 and 2 (which are detectable from 90 days, and might be the HIV test you are familiar with) as well as the p24 antigen which is detectable from 28 days and so this test is called the HIV duo test.

What is Syphilis?

Syphilis is a sexually transmitted infection caused by a potentially life-threatening bacterium that also increases the likelihood of acquiring or transmitting HIV. It is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Congenital syphilis causes irreversible health problems or death in as many as 40% of all live babies born to women with untreated syphilis. There are three stages of syphilis: Primary, Secondary and Latent. Primary is marked by a sore that left untreated, progresses to the Secondary stage which includes rashes, fever, swollen glands, sore throat, hair loss, headaches, and muscle aches. The Latent stage progresses unknown to the carrier, eventually damaging internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints.

As part of your STD screening programme, make sure you include a Syphilis STD test. STD testing for syphilis is a simple blood test.

How is Syphilis treated?

Syphilis can be cured with antibiotics. You can receive a prescription from any of the Better2Know clinics. If left untreated, Syphilis can cause miscarriages, premature births, stillbirths, or death of newborn babies. There is also risk of deformities, delays in development, or seizures along with many other problems such as rash, fever, swollen liver and spleen, anaemia, and jaundice. Rarely, the symptoms of syphilis go unseen in infants so that they develop the symptoms of late-stage syphilis, including damage to their bones, teeth, eyes, ears, and brain. Increased risk of becoming infected with HIV is also a feature. Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated, so it is important to get an STD test including syphilis regularly.

Better2Know can continue to provide support to you if your STD test – including your HIV test – is positive for an STD or STI at one of our partner clinics.

All the STDs and STIs we test for are covered (including HIV) so that you know your options for what to do next. Better2Know STD tests are private, confidential (we won’t tell anyone your results) and anonymous (we don’t need your real name), all our STD results have fast results between one and five days depending on the STD tests that you choose to have.

STD testing for the human papillomavirus (HPV) – a virus most women will encounter at some point in their lives – followed by a smear test if they are HPV positive, provides the most effective approach for cervical screening, new research shows today.

The study, published in the British Journal of Cancer*, gave around 26,000 women both smear and HPV tests to determine how best to use HPV testing for cervical screening.

Up to 8 out of 10 people in the UK will be infected with the HPV virus at some point in their lives.

Having an STD test that includes HPV is an important part of your healthcare programme. If you are at risk of HPV, you may also be at risk of having other STDs, so it is important to have a full and regular STD Screening programme to include STD tests for: Chlamydia, gonorrhoea, HIV, Hepatitis B, herpes and syphilis.

Previous studies have shown that HPV testing could be more effective at picking up women with severe cervical cell changes, but there have been some outstanding questions about how an HPV based programme should be implemented. For example, it has been unclear how best to manage women with positive results from an HPV STD test.

Having carried out these tests, researchers looked at how likely women with different combinations of test results were to have severe cervical cell changes – known as CIN3.

They concluded that using HPV testing as the first line screening test, as well as smear testing for women who received a positive HPV result, could improve the performance of an HPV test for cervical screening.

Using this combination approach would mean that only women with the highest risks of having CIN3 were referred for further tests – reducing unnecessary examinations and picking up more serious cervical cell changes.

Dr Chris Meijer, study author based at the VU University Medical Centre in Amsterdam, said: “From a health-economic perspective cervical screening with a primary, stand-alone HPV test seems to be preferable based on this study.

“But a smear test is still a very useful way to estimate a woman’s risk of severe cervical changes and can help maximise the benefits of HPV testing in a cervical screening programme.”

Under the new screening process proposed by the researchers, women with a negative HPV test had an extremely low risk of CIN3, regardless of their smear test result, and so could safely return to routine screening every five years.

Those who had a positive HPV test, and whose smear test results showed abnormal changes in the cervix, had a 42 per cent chance of having CIN3 and would be sent for a colposcopy to examine the cervix more closely.

But if smear test results in HPV positive women were normal, the researchers calculated that the woman had a five per cent risk of CIN3. This is too high a risk to safely return to normal screening, but not high enough to warrant an immediate colposcopy, and so the researchers recommended a follow-up smear in a year to monitor the cell changes.

If the result of this second test was also normal, the woman had a 1.6 per cent risk of CIN3 – which is low enough to return to routine screening.

If the second smear result was abnormal, the researchers said there was a 25 per cent risk of CIN3 and the woman would be referred for colposcopy.

Since 2008 in the UK, girls aged 12-13 have been vaccinated against two types of HPV which account for over 70 per cent of cervical cancers in the UK.
HPV testing can still be useful – even among women who have been vaccinated – to catch cervical cell changes caused by other HPV types. It can also protect women who haven’t been fully vaccinated.

More research will be needed to confirm the best strategy for cervical screening when most women have been vaccinated.

Sara Hiom, director of information at Cancer Research UK, said: “This study provides a very useful insight into how HPV testing could work if it were used as a major part of cervical screening.

“The findings help answer some of the questions that would need to be considered should the UK refine its highly effective cervical screening programme.

“The process outlined in this study would need to be fully tested to see if it is as effective as the study results suggest, and to establish some of the practicalities of using this combination of tests in the UK screening setting.

“The UK’s cervical screening programme already saves about 5,000 lives every year, but as with most tests, it is not perfect. So we welcome any new evidence which can help make cervical screening even more effective.”

* Rijkaart, D., Berkhof, J., van Kemenade, F., Coupe, V., Rozendaal, L., Heideman, D., Verheijen, R., Bulk, S., Verweij, W., Snijders, P., & Meijer, C. (2012). HPV DNA testing in population-based cervical screening (VUSA-Screen study): results and implications British Journal of Cancer DOI: 10.1038/bjc.2011.581

Genital warts are caused by HPV. The Human Papillomavirus (HPV) is the most common STI in the UK. It is a sexually transmitted virus, which causes genital warts. HPV can also cause changes in a woman’s cervix and is the single biggest cause of cervical cancer in women.

In addition to cervical cancer, HPV can also cause vulval, anal and other types of cancer. Many types of HPV exist, but only about 30 of them can cause genital warts. There are now vaccines that can prevent infection from certain types of HPV.

The warts begin as small red or pink growths and can grow as large as four inches across.  At this size, they can interfere with intercourse and childbirth. They may also be either flat or resemble raspberries, or cauliflowers in appearance. Growths may also be hidden or undetectable. Genital warts may enlarge during pregnancy due to hormones. If the warts become large enough, they could become an obstacle to delivery, requiring a caesarean section. In some instances, warts are passed from mother to child during childbirth, leading to a potentially life-threatening condition for newborns in which warts develop in the throat (laryngeal papillomatosis).

Persistent HPV (Genital Wart) infections are now recognised as the major cause of cervical cancer.  They may play a role in some cancers of the anus, vulva, vagina, and penis. Studies have also found that oral HPV infection is a strong risk factor for oropharyngeal cancer.  This is a cancer that forms in tissues of the oropharynx, which is the middle part of the throat and includes the soft palate, the base of the tongue, and the tonsils.

It is important that STD testing for HPV is done regularly. For women, this STD test needs an internal swab, for men there does need to be a visible wart to swab as part of the STD test.

How is HPV and Genital Warts treated?

As HPV is a virus, there is no cure. In other words, once you contract the virus it cannot be removed with medicine although most people’s bodies get rid of the virus naturally over time.

The symptoms of HPV, including Genital Warts, can be treated. If you have visible warts, then these can typically be removed with lasers, creams, surgery or frozen (cryotherapy). Recently, two vaccines have been developed for immunizing against certain types of HPV. Gardasil is currently recommended in the UK.

Better2Know can organise an STD test for 30 types of the HPV virus, with STD clinics nationwide, we will have a clinic near you that can see you quickly, get your STD test results in five days and you do not have to give your real name.

A number of patients across Scotland and England may have been given the incorrect results from their syphilis STD tests for tests performed November 2010 and September 2011. Better2Know does not use the laboratory where the wrong results came from, and we want to reassure our patients that your STD test results were correct.

There are about 5,000 new cases of syphilis in the UK each year. If you are worried about your STD test result, Better2Know can provide you a syphilis test with results one day after the sample is received in the laboratory. We have over 80 clinics across the UK, where you can get STD tests and an HIV test.

Regular testing for all STDs, including HIV is encouraged if you are sexually active.