South Yarra Doctor

02/10/2023

Syphilis, rarely seen a few decades ago, is on the increase. This is especially the case among gay and bis*xual men, Aboriginal and Torres Strait Islander people, and younger women. For this reason, a blood test is increasingly being recommended as part of STI screening. Syphilis is spread through direct contact with an intimate partner. It can also be spread from a pregnant mother to her unborn child, usually with very serious consequences.

Symptoms vary based on the infection stage, but there may be no symptoms at all, especially in the early stages. It is highly contagious when ge***al sores or rashes – which usually affect much of the body, are present.

Testing is usually done with a swab from any skin lesions (chancres) and by blood tests. Syphilis is curable and in the early stages only requires two long-acting antibiotic injections given at the same time but can lead to serious problems if left untreated in the longer term.

Recent studies have shown that the antibiotic Doxycycline is significantly effective as a ‘morning after’ pill in preventing syphilis and chlamydia transmission in high-risk gay and bis*xual men. It needs to be taken within 72 hours of condomless s*x and reduces transmission risk by around 80-90% for syphilis and chlamydia respectively. It is not usually effective against gonorrhoea due to high levels of antibiotic resistance.

Doxy-PrEP (pre-exposure prophylaxis) is also used in some cases for a period such as 3-6 months in gay and bis*xual men with numerous s*xual partners, to reduce their risk of catching these same diseases. There are still unanswered questions around potential consequences and Doxycycline does have several potential side-effects. Talk to your GP if you would like to discuss further and for personalised advice regarding your treatment options.

08/08/2022

Monkeypox continues to spread slowly in Australia with 22 cases now recorded in Victoria and 34 in NSW. A small number of cases have been spread locally, with a significant majority of cases having been acquired overseas in Europe and the USA.

Monkeypox vaccine appointments are now available in Victoria. Due to a very limited amount of vaccine availability at this early stage, strict eligibility criteria are in place. These criteria will be expanded as more vaccines become available.

More information is available at:

https://www.health.vic.gov.au/infectious-diseases/monkeypox -measures-for-monkeypox

https://thorneharbour.org/news-events/news/monkeypox/

01/08/2022

Monkeypox has recently been declared a disease of national significance in Australia. While the disease poses a significant risk in some circumstances, it is not expected to spread nearly as fast or extensively as COVID. Monkeypox is far less transmissible and harmful than COVID but still has the potential to lay you low for a few weeks. As of today there have only been 3 deaths outside of Africa due to monkeypox, and at least one of these was in a very immunocompromised person.

Worldwide there have been more than 21,000 cases of monkeypox, including 14,000 in Europe and 6,700 in the Americas. Australia has been relatively spared so far, with 45 cases, of which 25 have been in NSW. A large majority have been found in returned international travelers. Most cases have been among gay, bis*xual and other men who have s*x with men, aged 21 to 40 years.

Monkeypox has been endemic in parts of Africa for decades. It leapt into Europe and North America following two raves in Belgium and Spain. Monkeypox is spread mainly through skin to skin contact such as hugging and kissing (and much less commonly through bed sheets), so you will most likely only catch it from very close contacts. Infectious skin sores are the likely mode of transmission.

Symptoms include fever, body aches, chills, headache, fatigue, swollen lymph nodes, and a rash which may initially appear like a few pimples, blisters or sores. People can be contagious for weeks and the lesions can be extremely painful, so prevention is much better than treatment. Usually no specific treatment is required. If you are concerned you may have monkeypox, you should make a telehealth appointment with your GP or local s*xual health clinic and isolate yourself from others if possible.

A vaccine is available but is in limited supply and is only being provided for key at risk groups, including high-risk recent contacts and people at high risk of s*xual transmission. Anyone in a high risk category planning to travel to a country experiencing a significant outbreak should consider being vaccinated 4-6 weeks prior to departure. If you have any queries or concerns, please see your GP.

31/07/2022

This is my first post for some time – for many of us this has been an incredibly challenging time in many ways. The mental health of Australians has been incredibly strained through the last few years of COVID. Around 3.4 million of us are seeking help for our mental health each year, with 2.5 million of those people seeing their GP. Around 30% of us have been experiencing anxiety or depression. This figure is even higher for people in the LGBTQIA+ community with a staggering 45% experiencing anxiety.

Su***de rates have fortunately not increased despite the immense struggles many of us have faced. Despite this, nearly 40% of Australians report being close to someone who had died by or had attempted su***de. Sadly around 65,000 Australians make an attempt on their life each year and around 3,000 end their life this way. Su***de is also the leading cause of death for Australians 15 to 44 years of age.

Su***de may happen because a person feels traumatised, alone and isolated, and simply can’t see a light at the end of the tunnel. Many who struggle with their mental health feel they are alone in their suffering among their family and friendship group. The truth is often very different – it’s just that we don’t talk about our feelings and struggles. Many of us will know a person who has struggled, and then gone one to recover and even grown through that experience.

Living with anxiety, depression and other mental illnesses can be incredibly challenging and debilitating. Reaching out and asking for help can make a real difference, as can checking in on your friends who you know are doing it tough.

If you or anyone you know (in Australia) is in immediate danger please call 000, or if you are really struggling you can call Lifeline on 13 11 44 or your local Emergency Mental Health service. If you’re confronting anxiety or depression, you may like to chat with your friends about their experiences or make an appointment with your GP, a psychologist or counsellor.

23/12/2021

COVID immunisation will begin for Australian children from 5-11 years old from January 10, 2022. There will be 2 doses given 8 weeks apart, with the wider gap to boost efficacy and minimise adverse events. The dose for this age group is one-third that for adults and teens.

While there are no routine vaccinations usually given to this age group, the Pfizer paediatric vaccine can be given with any other childhood vaccine as this is unlikely to affect vaccine effectiveness. Australia has a 95% vaccination rate for 5 year olds, one of the highest in the world.

More than 5 million of these vaccinations have already been given to children in the USA, with severe side-effects rare based on preliminary data. Severe COVID infection is uncommon in children, with about 1 in 3200 developing paediatric multisystem inflammatory syndrome, and one Australian child who had other medical conditions sadly dying. Children very often pass on COVID to others, with nearly 70% unintentionally infecting family members after contracting COVID themselves.

ATAGI, the Australian Technical Advisory Group on Immunisation, has recommended that COVID vaccination should not be mandatory for children. Appointments for children to be vaccinated may be challenging to find initially, with many clinics focusing their resources on the adult booster program. If you have questions or concerns, your GP can help to answer these.

22/12/2021

Many of us have Private Health Insurance, for a variety of reasons. Despite reforms a few years ago to align policies between insurers and make them easier to compare, there can still be huge different in benefits. These inconsistencies mean that one insurer may pay much less for same medical procedure, resulting in higher out-of-pocket costs.

As an example, the benefit for an uncomplicated birth can vary by more than $564 ranging from around $1613 with NIB to more than $2178 under HCF’s no gap scheme. Similarly, a hip replacement may cos you $500 under a known gap arrangement, up to $1309 if there is no such arrangement, or even be free of charge under a no gap arrangement.

While it is important to look for inclusions in health insurance policies as well as the cost of the policy, it is also advisable to consider what your insurer would pay for procedures you may need. This is especially the case where you anticipate you may need to use your health insurance, such as if you are planning a pregnancy or where you are planning on sitting out a waiting period prior to surgery.

20/12/2021

Self-care is important as we approach the end of the year, and even moreso after the challenges of the last two years. Many of us have been left feeling anxious, drained and even overwhelmed.

Your wellbeing is important, regardless of the time of year. As Christmas approaches, we can feel like we are pulled in many different directions, juggling a myriad of demands, expectations and emotions.

Sometimes the best thing for you is to say no, and to set boundaries that are right for you. We are all allowed to stay safe, and this may mean staying home this week so we can be more confident of being able to spend Christmas Day with our loved ones.

15/12/2021

As our borders reopen, cases of influenza are expected to increase in Australia. There are still significant influenza outbreaks in some countries, so If you are flying overseas, it’s recommended:
✅ Anyone over 6 months of age who has not received a flu shot in 2021 should be vaccinated prior to departure
✅ If you’re returning from the northern hemisphere in late 2021 or early 2022, get a seasonal flu shot before you travel to Australia
✅ If you receive the 2021 flu shot in late 2021 or early 2022, you are still recommended to receive the 2022 formulation of the flu shot when it becomes available around late March

14/12/2021

13/12/2021

Telehealth will remain permanently as part of our healthcare system after it was introduced at the start of the coronavirus pandemic. After several short-term extensions, the Australian government today announced that telehealth would continue on an ongoing basis,

It is always best to see your GP for any health concerns, but telehealth can be very useful in some circumstances, such as:
• Mobility issues
• Caring for young children
• Inflexible workplaces
• Travelling away from home
• Contagious illnesses such as respiratory infections or gastroenteritis
• Discussing straightforward results

In order to access a Medicare rebate for a consultation, you must have had a face to face appointment with the doctor or at the clinic within the last 12 months (there are a small number of limited circumstances where these rules do not apply). Some services such as a Mental Health Care Plan or Chronic Disease Management (Care) Plan must be done in person or via a video consultation.

Additional mental health sessions will be available until at least December 2022, with Medicare subsidising up to 20 sessions per year to see a psychologist.

06/12/2021

COVID boosters will remain due at 6 months following your 2nd dose, with no changes to be made as a result of the Omicron variant.

Your booster can be given 5 months after your 2nd dose in limited circumstances:
- If you are at greater risk of severe COVID, such as due to immunosuppression, during a COVID outbreak
- If you are travelling overseas and will be away when your COVID booster is due, or
- In outreach programs, such as to nursing homes, where access is limited.

Your GP is best placed to answer any questions regarding your COVID booster. You can book for your booster at your GP, pharmacy or vaccination hub, although some hubs are now closing and you will need a letter from your GP to confirm your eligibility to have your booster before 6 months.

23/11/2021

Research is increasingly supporting the use of zinc lozenges and sprays as an effective prophylactic and treatment for mild to moderate respiratory infections.

A review of 28 studies covering 5400 patients showed that using zinc reduces the risk of developing mild to moderate symptoms consistent with influenza or the common cold by around 30%. Zinc reduced symptom duration by 2 days and was associated with a significant reduction in symptoms by day 3.

The risk of serious reactions to zinc is low, but annoying side-effects are relatively common. These include nausea, mouth irritation and soreness. Ongoing research is needed to better establish ideal formulations and doses. Zinc is available in nasal sprays and gels, lozenges, tablets and liquids, often in combination with other products such as Vitamin C or garlic.

22/11/2021

The booster program for COVID vaccines has launched in Australia. The booster is due 6 months after receiving the 2nd dose, meaning most people will be due for a booster in the first half of 2022. Those who received their 2nd dose by May, such as some healthcare practitioners and aged care residents, are already due for their booster dose. The small number of people who needed a 3 dose course due to immunosuppression are not recommended to have a booster at this stage. A booster dose is also not currently recommended for teenagers under the age of 18.

The Pfizer vaccine is recommended for booster doses, regardless of which vaccine was received initially. The AstraZeneca vaccine can be given as an alternative in some cases, while Moderna may be approved for use as a booster in the coming months. Side-effects are variable, but roughly comparable to when receiving the 2nd Pfizer dose.

Boosters can be given with the influenza (flu vaccination). There is virtually no influenza currently in the community due to quarantine requirements, although this is likely to change with quarantine-free travel. You can still receive this year’s influenza vaccination until February – this is strongly advised if you are travelling overseas.

22/11/2021

Having treated a patient who suffered from a very nasty case of gastroenteritis after eating raw oysters, I strongly endorse this message.

22/11/2021

Some people believe that vaccination has minimal effects on the risk of spreading COVID-19 to others. The evidence suggests however that unvaccinated people are 20 times more likely to transmit COVID-19.

This accounts for the fact that unvaccinated people are more likely to be infected, and that while infected, they tend to have a higher viral load (number of viral particles) that vaccinated people who have breakthrough infections.

25/10/2021

Many people have questions about who should have a 3rd dose of a COVID vaccination. The additional dose is advised in people who have a reduced response to vaccination due to being immunosuppressed.

In summary:
- Active haematological malignancy
- Non-haematological malignancy with current active treatment including chemotherapy, radiotherapy, and/or hormonal therapy
- Solid organ transplant with immunosuppressive therapy
- Haematopoietic stem cell transplant recipients or chimeric antigen receptor T-cell therapy within 2 years of transplantation
- Immunosuppressive therapies, including high dose corticosteroid treatment, multiple immunosuppressants where the cumulative effect is considered to be severely immunosuppressive, selected anti-rheumatic drugs, biologic & targeted therapies
- Primary immunodeficiency
- Advanced or untreated HIV
- Long term haemodialysis or peritoneal dialysis

An individual with an unlisted condition should be considered for a 3rd dose where the treating doctor has assessed the patient as having a similar level of severe immunocompromise to the these conditions, and where the benefits of a 3rd dose of COVID-19 vaccine outweigh the risks.

Booster doses are also on the way but these are offered because your immunity to vaccines decreases over time. We are waiting for an official announcement on these, which will reportedly be offered from 6 months after your 2nd dose. If you have any questions, your GP is a great place to find out more.

25/10/2021

October is Breast Cancer Awareness Month. Breast cancer is now the most diagnosed cancer in the world.

1 in 7 Australian women are likely to be diagnosed with breast cancer in their lifetime.
Early detection saves lives and localised breast cancer has a 99% survival rate if detected early.

Regular self-examination is an important first step. BreastScreen Victoria provides free mammograms to women and trans and gender diverse people with no breast symptoms. These are recommended every 2 years from 50 years of age, and in some circumstances from 40 years old. If you have delayed screening due to COVID, now is a great time to get up to date.

Remember the steps you can take to reduce your risk of breast cancer:
- Alcohol in moderation
- Avoiding smoking
- Maintaining a healthy weight
- Eating a healthy diet
- Keeping active