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Posted: 22 Jun 2013 06:30 PM PDT

Most common sexually-transmitted diseases can be passed on through the practice of oral sex.

HOLLYWOOD actor Michael Douglas recently brought international attention to the possibility of developing throat cancer through oral sex via an interview with UK's The Guardian newspaper earlier this month.

Although later refuted by the 68-year-old actor's spokesman, Douglas had said that his throat cancer was a result of a human papillomavirus (HPV) infection contracted through his performance of cunnilingus. (See Oral sex terms)

He was diagnosed with stage 4 throat cancer in August 2010, and underwent an intensive course of chemotherapy and radiotherapy. He has been cancer-free since then.

Now, oral sex is quite a popular form of sexual activity across the world.

The Durex Sexual Wellbeing Survey 2007/08, which surveyed over 26,000 people in 26 countries, including Malaysia, found a high incidence of oral sex across all age groups. This includes 48% of respondents over the age of 55. (See Who's doing it)

Overall, 55% of respondents in the survey had received oral sex, while 57% reported giving it.

Around one-fifth of respondents also said that they would like to receive oral sex, and 16% shared that they would like to perform it. In both cases, more men than women responded positively.

In Malaysia, fellatio, like anal sex, is deemed an illegal act as "carnal intercourse against the order of nature" under Section 377A of the Penal Code, and carries a maximum penalty of 20 years jail and whipping.

However, this law is seldom, if ever, enforced for consensual adult sexual activity, and remains largely unknown by the Malaysian public.

Consultant obstetrician and gynaecologist Dr Wong Pak Seng opines that oral sex is a normal sexual activity, and an accepted practice among sexually-active adults.

"If you speak to a psychologist, (they will say) it is basically an expression of love. If a couple is intimate, it is considered very normal," he says.

However, he notes that, as with any sexual activity, people need to take the necessary precautions when having oral sex with an unfamiliar partner.

This is because unprotected oral sex can also result in a sexually-transmitted disease (STD), although the risk is less than when having vaginal or anal sex.

According to Durex's Global Face of Sex 2012 report, around one in five Malaysians (21.4%) have experienced STDs, although it did not state how they got the infection.

Dr Wong says: "The risk of contracting STDs from oral sex is very real, especially if the person performing the act has cuts or sores in their mouth; if ejaculation takes place in the mouth; and if the individual receiving oral sex has an STD.

"The risk is primarily for the person performing the oral sex. Oral sex is unlikely to expose the receptive partner to STDs unless the active partner has significant amounts of blood in their mouth."

He also cautions that the skin barrier in our genitals is rather fragile, and small cuts or tears might be present without us even realising it.

As with vaginal or anal sex, protection can be taken by using a male or female condom, or a dental dam – a thin sheet of plastic, while having oral sex.

In general, there are seven types of STDs that can be contracted via oral sex.

Chlamydia

Research has shown that around half of males and 70-80% of females with chlamydia show no symptoms at all, while the time period for symptoms to manifest can vary between weeks to years in others.

Because of that, this disease caused by the bacteria Chlamydia trachomatis, is one of the most common STDs.

Among the symptoms that chlamydia patients can have are pain during urination, unusual discharge from the vagina or penis, pain during sex for women and in the testicles for men, as well as bleeding after sex or between periods for women.

If left untreated, chlamydia can result in reactive arthritis, infertility, pelvic inflammatory disease in women, as well as urethritis and epididymitis in men.

The good news is that it can be easily treated with antibiotics.

The bad news is that patients can be easily reinfected if they continue having sex with untreated infected partners.

Gonorrhoea

This is another STD caused by a bacteria – in this case, Neisseria gonorrhoeae, which inhabits the mucous membranes of the reproductive system, urethra, mouth, anus, throat and eyes in an infected person.

The most common symptom for gonorrhoea is purulent discharge, says Dr Wong. This usually appears within days of the infection.

However, some patients may not have any symptoms at all, or mistake it for a bladder or vaginal infection.

Untreated gonorrhoea results in the same complications as chlamydia, except for arthritis, but also includes disseminated gonococcal infection, which can be life-threatening.

Also like chlamydia, gonorrhoea can be easily treated, although antibiotic resistance is a growing concern.

Reinfection is also possible.

Hepatitis

The three most common types of this viral disease are hepatitis A, B and C.

According to Dr Wong, hepatitis A is akin to food poisoning, as it is usually contracted through the ingestion of food or water that has been contaminated by an infected person's faecal matter.

It can be transmitted through oral sex when a person does anilingus on an infected partner, as the act involves the anal region.

Meanwhile, hepatitis B is passed on through exposure to bodily fluids, which include semen, vaginal secretions and blood. According to the US Centers for Disease Control and Prevention (CDC), hepatitis B is 50-100 times more infectious than the human immunodeficiency virus (HIV).

However, the risk of becoming a carrier for life decreases according to the age of infection. For example, 90% of hepatitis B infants will develop chronic infections, compared to 6-10% of those infected over the age of five.

Of the three, hepatitis C is the least likely to be passed on through oral sex, as it is transmitted through blood.

However, hepatitis C is also the most dangerous virus, as two-thirds of the 75-85% of patients who develop chronic infections go on to have chronic liver disease, compared to 15-25% of hepatitis B patients.

Symptoms for all three infections only present after a certain period of time, during which the infected person can still pass on the virus to other people.

For hepatitis A, symptoms usually appear two to six weeks on average after exposure; hepatitis B, 90 days; and hepatitis C, six to seven weeks.

More importantly, around 30% of hepatitis B patients have no symptoms at all, and this percentage increases to 70-80% for hepatitis C.

There is no treatment for any of these three infections, although most people manage to recover on their own if they get an acute infection.

Patients develop immunity to each virus if they manage to completely clear it from their body.

Vaccines are available for hepatitis A and B. There is none for hepatitis C.

Herpes

This disease is caused by two viruses: herpes simplex type 1 and type 2, and results in cold sores in the mouth and/or genital area.

The virus is spread through a break in the skin that comes into contact with the cold sores or infected fluid.

Herpes is a lifelong condition, as there is no cure for it; nor is there a vaccine currently available. Patients usually experience periodic outbreaks, which will decrease over time.

According to Dr Wong, the first outbreak in females can be "excruciating", while subsequent episodes are usually not painful.

However, he says that male patients often mistake herpetic lesions for accidental small cuts or sores.

The tricky thing about herpes is that patients often shed the virus without any obvious cold sores. In addition, many patients experience no symptoms or mistake it for another condition, so they don't even know they have it.

Herpes can be treated symptomatically, but patients need to be extremely vigilant about practising safe sex and informing their sexual partners to prevent passing it along.

HIV

This virus that leads to the acquired immune deficient syndrome (AIDS) surely needs no introduction.

Like hepatitis B, it is also transmitted through bodily fluids, and can be passed on through unprotected oral sex.

Some people develop a flu-like illness a few weeks after the initial exposure, but this is usually mistaken for the common cold or flu, and many don't have any symptoms at all.

The more serious symptoms usually only develop years after the infection, during which time, the patient remains infectious.

HPV

Commonly known as the virus that causes cervical cancer, Douglas' recent interview highlighted HPV's association to throat cancer.

Dr Wong says: "HPV is very common. In a sexually-active female population, 80% of them will have it."

With over a hundred types of HPVs out there, he adds that most infections are naturally cleared by our immune system; according to the CDC, 90% of HPV infections will be cleared within two years.

Dr Wong explains that HPV infection only becomes a problem when it cannot be cleared, as its continuing presence in the body can cause normal cells to turn cancerous.

Infection can also result in genital warts, which appear as a small bump or groups of bumps in the genital area that may resemble a cauliflower.

HPV is transmitted through contact with bodily fluids, mucous membranes and infected genital skin, and can be passed on even when there are no visible symptoms.

While there is no cure for the virus itself, the resulting medical conditions can be treated individually.

There are vaccines for HPV-16 and 18, which cause 70% of cervical cancers, as well as HPV-6 and 11, which cause 90% of genital warts. HPV-16 is also the most common cause of viral-associated throat cancer.

Syphilis

Caused by the bacteria Treponema pallidum, this STD has various stages, and can cause neurological damage, as well as death, if not treated.

The first symptom of this disease is usually the appearance of painless, firm, round sores known as chancres, which occurs on average within 21 days of exposure.

These chancres will appear at the site of the infection, which can be on the genitals, rectum, anus, lips or mouth.

They will heal by themselves, even without treatment, and are often missed.

However, without the appropriate treatment, the syphilis will move on to the second stage, which involves skin rashes and large, white, raised sores in the mouth, vagina or anus.

Again, this stage may resolve without treatment, but the patient will go on to experience the third stage, which can occur decades after the initial infection, and can result in death.

At any stage, the bacteria can also invade and damage the nervous system.

Treatment is with penicillin, and reinfection is possible if the recovered patient has sex with another infected person.

According to Dr Wong, this STD is no longer so common in Malaysia, and mainly occurs in the lower socioeconomic group.

ORAL SEX TERMS

Oral sex: The act of stimulating the genitalia of a sex partner with the mouth, lips and/or tongue through licking, sucking and/or kissing.

Cunnilingus: The act of stimulating the female genitalia, which includes the vulva, vagina and clitoris, with the mouth, lips and/or tongue.

Fellatio: The act of stimulating the male genitalia, which includes the penis and testicles, with the mouth, lips and/or tongue. Also known colloquially as a blowjob.

Anilingus: The act of stimulating the anus with the mouth, lips and/or tongue. Also known colloquially as rimming.

New guidelines for hypertension

Posted: 22 Jun 2013 06:31 PM PDT

Landmark clinical guidelines introduced at Europe's biggest blood pressure conference in Milan.

LIFESTYLE factors, lack of awareness by both patients and physicians, hesitancy in initiating and intensifying drug treatment, and healthcare structural deficiencies are amongst the reasons for the increasing problem of high blood pressure in Europe, according to new joint guidelines issued a few days ago by the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC).

The guidelines, which recommend several significant changes to hypertension treatment, were launched at the European Society of Hypertension congress in Milan, Italy (which took place from June 14 to 17, 2013), with simultaneous online publication in the peer-reviewed journals Journal of Hypertension, the European Heart Journal, and Blood Pressure.

First produced in 2003, the original version of the joint ESH/ESC guidelines for the management of arterial hypertension became one of the most highly-cited medical papers in the world. The 2013 guidelines – which replace the 2007 edition – give state of the science recommendations which show how the hypertension landscape has changed, and indicate what needs to be done to reduce mortality and morbidity from high blood pressure and associated conditions.

Hypertension has been described as "the leading global risk for mortality in the world". It continues to affect between 30 and 45% of the European population. The authors of the guidelines express disappointment that this figure has remained high since the 2003 edition. "We really need to raise awareness of the condition," said Professor Giuseppe Mancia. "This is a condition that can be controlled if treated properly."

According to the report, "lifestyle changes are the cornerstone for the prevention of hypertension", including reduction of salt (to roughly half present levels) and alcohol, as well as maintaining a healthy body weight, regular exercise, and the elimination of smoking.

Additionally, patients and doctors must be aware that once hypertension has developed, it can be treated with drug therapy.

The guidelines highlight the lack of awareness of the potential problems of hypertension amongst patients, with poor long-term adherence to treatment, and the "inertia" of doctors, who don't take appropriate action when confronted with patients with uncontrolled blood pressure.

The authors state that "despite overwhelming evidence that hypertension is a major cardiovascular risk, studies show that many are still unaware of the condition, that target blood pressure levels are seldom achieved".

They also note that there are wide variations in hypertension care in Europe, but that team-based care, with greater nurse involvement, has a better record of success than more standard care.

The 2013 Task Force reviewed all relevant data since the last revision (in 2007), with 18 specific diagnostic and therapeutic areas identified as containing significant change.

A major development is the decision to recommend a single systolic blood pressure target of 140 mmHg for almost all patients. This contrasts with the 2007 version which recommended a 140/90 mmHg target for moderate to low risk patients, and 130/80 mmHg target for high risk patients. "There was not enough evidence to justify two targets," said Professor Robert Fagard (Leuven, Belgium).

Other changes include:

*An increasing role for home blood pressure monitoring, alongside ambulatory blood pressure monitoring.

*A greater emphasis on assessing the totality of risk factors for cardiovascular and other diseases. For example, most people with hypertension also have additional risk factors such as organ damage, diabetes, and other cardiovascular risk factors. These need to be considered together before initiating treatment, and during the follow-up.

*Special emphasis on specific groups, e.g. diabetics, the young, the elderly, and drug treatment of the over 80s. Women are also considered separately, e.g. during pregnancy. Special consideration is given to new treatments such as renal denervation for resistant hypertension – which is described as "promising", although more trials are called for.

*New guidance on how and when to take anti-hypertensive drugs. The report indicated no treatment for high normal blood pressure, no specific preference for single drug therapy, and an updated protocol for drugs taken in combination.

The guidance takes a liberal attitude to choice of first step drugs, noting the evidence that the beneficial effect of hypertension depends largely on blood pressure lowering.

Rather than presenting a hierarchy of drugs (a generic first, second, third choice and so on), the approach taken promotes individualised treatment, i.e. to help physicians decide which drugs to give in which clinical/demographic condition.

The guidelines were developed over an 18 month period. Task Force members from both societies met several times to finalise the content, which was reviewed twice by a group of 40 European reviewers in addition to the internal reviewers.

Commenting, Professor Mancia, ESH Co-Chairperson of the Guidelines Task Force, said: "This is certainly the most important current overview to consider the totality of hypertension treatment; it will form the basis of hypertension care for the foreseeable future.

"The WHO has already recognised hypertension as the leading global risk for mortality in the world, and as we identified in the document, the public needs to be more aware of just how common hypertension is. Not only that, doctors and patients need to recognise that we have good treatments which can control hypertension".

Professor Fagard, ESC Co-Chairperson of the Guidelines Task Force, commented: "We are very happy to publish these comprehensive evidence-based guidelines. It's the right time to carry out this revision, as we are able to include many significant studies and many new results since the previous version. We have included many of the gold standard randomised controlled trials (RCT) studies, but at the same time, we have graded all the evidence so that clinicians can see how strong the evidence base is for each recommendation. The important thing now is for physicians put these recommendations into use".

The full Guidelines is available for downloading at http://www.escardio.org/guidelines-surveys/esc-guidelines/Pages/arterial-hypertension.aspx.

Heck, it’s a painful neck!

Posted: 22 Jun 2013 06:34 PM PDT

Pain in the region of the neck can be due to many reasons.

NECK pain can be a disabling condition, with a life time course marked by periods of well being and worsening of symptoms.

The estimated incidence of neck pain ranges from 10-21%. There is a higher incidence noted in office and computer workers. The prevalence is higher in women, in high-income countries and in urban areas.

The cause of neck pain can be divided into two main groups – those arising from joints, ligaments and muscles of the neck, and those involving the cervical nerve roots or spinal cord.

Neck pain may be caused by the following:

*Injury or degeneration affecting muscles or ligaments and soft-tissue strain.

*Inflammation due to rheumatoid arthritis and ankylosing spondylitis.

*Infection due to discitis, epidural abscess and meningitis.

*Infiltration by tumours.

There are some risk factors which can contribute to the onset of acute neck pain, such as the nature of occupation, stress at work, psychosocial nature of the work environment and smoking.

Involvement in a motor vehicle accident is not a risk factor for developing neck pain, but those who develop neck pain soon after such an accident are at greater risk of developing chronic neck pain.

Finding the cause of neck pain begins with a detailed history, physical examination and the use of several diagnostic tests. These tests are used to find out the cause of your pain and not to make your pain better.

X-rays of the neck are usually the first step and will help determine if more tests are needed. The MRI is commonly used to evaluate the spine because it can show abnormal areas of the soft tissues around the spine. It is done to find tumours, herniated discs, or other soft-tissue disorders.

The CT scan is most useful when a condition that only affects the bones of the spine is suspected.

A bone scan is used to help locate the affected area of the spine.

Blood tests are done to look for infection or arthritis.

Problems originating in areas other than the spine may also cause neck pain.

These include cardiac pain, complex regional pain syndrome, entrapment syndromes, rotator cuff pathology and thoracic outlet syndrome

You should seek medical advice and treatment when there is:

*Continuous and persistent neck pain.

*Severe intractable or increasing pain.

*Radiating pain down the arms.

*Pain accompanied by headaches, numbness, tingling, or weakness.

*New symptoms before the age of 20 years or after 55 years.

*Weakness involving more than one area or loss of sensation involving more than one dermatome.

Multimodal treatments include passive mobilisation or manipulation in combination with either exercise alone or exercise with thermal modalities and education. These are more effective than single modality approaches.

In an acute injury, lie down on your back with a thin pillow. This will relieve the pressure and relax any tight muscles. Ice will help decrease swelling and muscle spasms.

After an injury, your neck will become stiff. Initiating gentle movements as soon as possible will help to regain full range of motion, reduce pain from swelling and muscle spasms, and prevent your muscles from becoming weak.

Stretching exercises can help to relax the neck muscles and restore range of motion. Strengthening and stabilising exercises help to regain good posture as your neck needs the support of the neck, shoulder, and trunk musculature.

Maintain proper postural alignment throughout the day in order to decrease any strain created on your neck.

Diagnostic and therapeutic injections of local anaesthetics and steroids can help in severe acute cases. When non-operative methods have failed, surgery can be carried out to remove the pain generator and correct any pathological condition.

This can be done in a minimally invasive fashion with the use of microscopes and endoscopes.

Relieving the pressure on the spinal cord and nerve roots can help alleviate pain. Motion-preserving surgery can reduce the wearing out of adjacent neck levels. Fusion becomes necessary in cases of neck instability.

Some preventive measures can be undertaken to prevent worsening or onset of neck pain. Maintain a good posture by holding your head up and keeping your shoulders back and down. Use the chair arm rests to keep the arms supported.

Avoid sitting in the same position for prolonged periods of time.

Take periodic 10 minute breaks from the desk. Avoid looking up or down at a computer monitor – adjust it to eye level.

Sleep with your neck in a neutral position by using a small pillow under the nape of your neck.

Relax yourself as stress, tension and worry can tighten muscles and cause more pain. Stay at work or return to work as soon as possible even if the pain hasn't completely gone.

And expect the neck pain to get better by staying positive!

This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail starhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.

Kredit: www.thestar.com.my

Ahad, 23 Jun 2013

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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