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Shingles is a viral infection that affects a nerve or skin around it and is caused by the virus Varicella-Zoster. Varicella-Zoster is incidentally the same virus that causes Chickenpox. You will more than likely have had chickenpox during your childhood. Even though you would have recovered, the virus that caused Chickenpox remains inert and inactive in the body. When it becomes reactivated in adulthood, it causes Shingles.

Shingles typically lasts between two to six weeks and symptoms usually subside between two and four weeks. Most people get shingles only once, but it’s possible to get it two or more times. It’s important to note that not everyone who has had Chickenpox will develop Shingles.

What are the causes of Shingles?

Any factor that compromises your immune system, can trigger shingles:

• Stress
• Other illnesses or conditions
• Treatments like chemotherapy

It’s possible to have shingles more than once, but it’s very rare to get it more than twice.

What are the symptoms of Shingles?

The first signs that may indicate you have Shingles are:

• A general feeling of malaise
• Intense pain and tingling sensation in a particular area of your skin
• Fever (high temperature)
• Headache
• Chills
• Sensitivity to light

What is a Shingles rash?

A few days (2-3 days) after you experience the first symptoms, you may notice a blotchy red rash developing that wraps from the middle of the back to your breastbone. However, it can also appear anywhere on your body including your eyelids, face or genitals. The rash follows the path of the nerve where the virus has been dormant. The rash usually presents on one side of the torso only. If you notice it is on both sides, then it is unlikely to be Shingles.

This blotchy rash then develops into itchy fluid-filled blisters that eventually flatten, become yellowish in colour, dry out and scab. The skin can remain painful until the rash has gone and scabs may leave some slight scarring.

What is Shingles pain?

Pain is usually one of the first signs that may indicate you have shingles. The pain is usually localised in the affected area. The pain experienced can vary from individual to individual but it is generally constant, dull or burning; and the intensity of the pain can vary from being severe to mild. Also, it is notable that some people can experience pain without a rash ever developing.

When to get advice from a GP

You should contact your GP if you suspect you have Shingles and you:

• Haven’t had chickenpox before
• Have been exposed to someone who has chickenpox or shingles and you:
  • Are pregnant
  • Have a weakened immune system (the body’s natural defence system)
  • Are under 18 years old

If your GP is closed, phone 111.

Check if you qualify for FREE treatment with NHS Pharmacy First, without seeing your GP

You may qualify for treatment under the NHS Pharmacy First service, if you suspect you have shingles and you:

• Are 18 years or over

The NHS Pharmacy First service may not be suitable if:

Serious complications are suspected such as:

• Meningitis (neck stiffness, photophobia, mottled skin)
• Mastoiditis (pain, soreness, swelling, tenderness behind the affected ear(s))
• Brain abscess (severe headache, confusion or irritability, muscle weakness)
• Sinus thrombosis (headache behind or around the eyes)
• Facial nerve paralysis

Shingles affects the eyes

• Hutchinson’s sign — a rash on the tip, side, or root of the nose
• Visual symptoms
• Unexplained red eye

You are immunocompromised

• Shingles in severely immunosuppressed patient
• Shingles in immunosuppressed patients where the rash is severe, widespread or the patient is systemically unwell

There’s no cure for shingles, however, when identified early, shingles can be treated with prescription medications to shorten the infection and reduce the risk of complications. The NHS Pharmacy First service is available to all NowPatient users who are registered with the NHS in England. If you are exempt from paying for your prescriptions, the service and the treatments are provided free of charge. If you are not exempt from paying prescription charges, treatments are provided at the prevailing NHS prescription charge rate. There is no charge for consultations.

What NHS Pharmacy First treatments are available for Shingles?

Anti-viral treatments like aciclovir are very effective in reducing the intensity of pain and duration of Shingles. It can also help with reducing the chances of developing post-herpetic neuralgia (burning pain in nerves and skin). Treatment with aciclovir is most effective if started quickly.

How can I manage the symptoms of Shingles?

In addition to treating Shingles with antivirals like aciclovir, you can also treat the discomfort caused by shingles. Painkillers to ease discomfort caused by shingles. This includes:

• Paracetamol (over-the-counter)
• Ibuprofen (over the counter)
• Opioids (prescribed for severe pain)
• Antidepressants (prescribed for severe pain)

Other tips to manage the discomfort include:

• Use a cool damp cloth to soothe the skin and keep blisters clean
• Try calamine lotion to help relieve itching
• Keep the rash as clean and dry as possible
• Do not let dressings or plasters stick to the rash
• Do not use antibiotic cream – this slows healing
• Wear loose-fitting clothing

Should I avoid people if I have Shingles?

Always wash your hands after touching the blisters, as these are very infectious. In addition, during the infection, you should avoid:

• Pregnant women who have not had chickenpox
• Newborns or babies less than 1 month old (unless it’s your own baby)
• Immune-compromised people (weak immune system)
• People taking therapies including disease-modifying anti-rheumatic drugs (DMARDs, e.g. methotrexate) and biologic therapies (e.g. Adalimumab) or any other medication that reduces the immune system such as JAK-inhibitors, e.g. Baricitinib, Filgotinib, Tofacitinib and Upadacitinib

How can I prevent the spread of Shingles?

You can’t spread shingles to other people. However, people can catch chickenpox from you if they haven’t had it before. You are contagious until the last blister has dried and scabbed over. During the contagious phase, you should:

• Not go swimming
• Not play contact sports
• Not go work or school if your rash is weeping (oozing fluid) and can’t be covered
• Not share towels or flannels
• Avoid people who are at risk such as newborns, immunocompromised individuals, people taking immunocompromising drugs and pregnant women

What happens if I do not get treatment for Shingles?

Symptoms will persist for longer, there is a greater risk of post-herpetic neuralgia afterwards. The risk of complications is larger, such as blindness if the infection affects the face/eyes.

Is there a vaccine that can prevent Shingles?

Yes, the NHS recommends that adults turning 65, those aged 70 to 79 and those over 50 who are immunocompromised should be vaccinated.

The vaccine is called SHINGRIX and it is administered in two doses, two months apart. After vaccination, you may still develop Shingles, however, it will be milder and you will be less likely to get post-herpetic neuralgia.

What are the complications of Shingles?

Complications, although not common, can arise as a result of shingles. In fact, 1 in every 1000 cases of Shingles in adults over the age of 70, results in fatal complications. These complications are more likely if you have a compromised immune system, are taking immunocompromising drugs or are elderly.

Complications can include:

• Postherpetic neuralgia
• Eye problems
• Ramsay Hunt syndrome
• The rash becoming infected with bacteria
• White patches (a loss of pigment) or scarring in the area of the rash

Rare complications can include:

• Pneumonia (lungs)
• Encephalitis (brain)
• Transverse myelitis (spinal cord)
• Meningitis (brain, spinal cord)

Sources

• Mayo Clinic – Shingles, not just a band of blisters
• NHS Scotland – Shingles information page
• NHS – Shingles condition

Impetigo (im-puh-TIE-go) is a highly contagious bacterial skin infection which can affect anyone of any age although it is more common in infants and young children between 2 and 5 years of age. Indeed, it is the most common skin infection in young children in the UK.

Impetigo usually starts by presenting as red sores or blisters on the face, particularly around the nose and mouth. It can also appear on the hands and feet. The red sores may be harder to see on black or brown skin. After a week, the sores typically burst and develop into honey-coloured crusts or patches.

Impetigo can resolve within 7 to 10 days if it is treated with antibiotics.

What are the causes of Impetigo?

Impetigo is caused by two specific bacteria:

• Staphylococcus aureus
• Streptococcus pyogenes

The bacteria infects the skin by two routes:

• Cuts, insect bites or other skin injury (this is known as Primary Impetigo)
• Skin damage caused by eczema, scabies or head lice (this is known as Secondary Impetigo)

The bacteria can easily spread through close contact with someone who already has the infection. This can be through direct physical contact, or by sharing towels or flannels. Symptoms don’t present for at least 4 days and in some cases up to 10 days, therefore it can be easy to unintentionally spread it.

Apart from children who are prone to impetigo, other groups can also be at high risk of developing impetigo:

• Diabetics
• People who are immunocompromised through conditions such as HIV
• People who are immunocompromised through taking medications that reduce their immune system.

What are the symptoms of Impetigo?

The first signs that indicate you may have Impetigo are:

• Red sores (non-bullous impetigo)
• Blisters (bullous impetigo)
• Sores or blisters that burst to form crusty patches

What is Bullous Impetigo?

Bullous impetigo begins with the appearance of fluid-filled blisters (bullae) which usually occur on the torso between the waist and neck, or on the arms and legs. The blisters can typically be 1 cm to 2 cm in dimension.

The blisters can spread quickly before bursting after a few days to leave a yellow crust which usually scabs and heals without leaving any scarring.

The blisters can be painful with the area of skin around them being itchy. Additional symptoms such as high temperature (fever) and swollen glands are also common in bullous impetigo cases.

Bullous Impetigo is less common than Non-Bullous Impetigo.

What is Non-Bullous Impetigo?

Non-bullous impetigo begins with the appearance of red sores. It presents around the nose and mouth although it can also affect other areas of the face and the limbs.

The sores burst relatively quickly and leave behind thick, honey-coloured crusts which are typically 2 cm in dimension. The honey-coloured crusts appear like cornflakes stuck to the skin. Once the crusts dry, they leave behind a red mark which usually fades without scarring. This can take between a few days and a few weeks.

The sores are not painful, although they can be itchy. To avoid spreading the infection, it is advisable not to touch or scratch the sores.

Additional symptoms such as a high temperature (fever) and swollen glands, are rare but can occur in more serious cases.

When to get advice from a GP

You should contact your GP if you suspect you have Impetigo and you have:

• Had treatment for impetigo but the symptoms changed or got worse
• Had impetigo before and it keeps coming back

Impetigo is very infectious. Check with the GP before you go into the surgery. They may suggest a phone consultation.

Check if you qualify for FREE treatment with NHS Pharmacy First, without seeing your GP

You can check your eligibility to use the NHS Pharmacy First service if you suspect you have Impetigo and you:

• Are 18 years or over
• Have not had Impetigo before

The NHS Pharmacy First service may not be suitable if:

• Serious complications suspected such as deeper soft tissue infection
• There is a risk of deterioration or serious illness
• You are immunocompromised and the infection is widespread

The NHS Pharmacy First service is available to all NowPatient users who are registered with the NHS in England. If you are exempt from paying for your prescriptions, the service and the treatments are provided free of charge. If you are not exempt from paying prescription charges, treatments are provided at the prevailing NHS prescription charge rate. There is no charge for consultations.

What NHS Pharmacy First treatments are available for Impetigo?

Treatment for Impetigo is recommended because it can reduce the length of the illness to around seven to 10 days and can lower the risk of cross-infecting others.

The main treatments prescribed are antibiotic creams or antibiotic tablets. These treatments are usually prescribed for a one-week course.

Individuals with diagnosed impetigo can return to work, school, or daycare if they:

• Have started antibiotic treatment; and
• Keep all sores on exposed skin covered

Do I have an increased risk of Impetigo?

Some people have an elevated risk of getting Impetigo, based on certain factors:

• Infections like Scabies can increase the risk of Impetigo
• Children and Infants between 2 years and 5 years of age
• People who participate in activities where cuts and scrapes are common can increase the risk of Impetigo
• Group contact with people who have Impetigo could increase the risk
• Poor personal hygiene

How can I prevent the spread of Impetigo?

If you have been diagnosed as having Impetigo, you should:

• Wash the sores with soap and water and cover them loosely with a gauze bandage or clothing
• Avoid scratching the sores or touching them
• Avoid contact with newborn babies or other infants until the risk of infection has passed
• Avoid preparing food until the risk of infection has passed
• Avoid playing contact sports until the risk of infection has passed
• Wash your hands frequently
• Not share flannels, sheets or towels with anyone who has impetigo
• Wash flannels, sheets or towels at a high temperature after use

What happens if I do not get treatment for Impetigo?

Impetigo is not usually serious and it will improve within a week of treatment or within 2-3 weeks if you are not treated,

What are the complications of Impetigo?

Although rare, some complications of impetigo can be serious. These include::

• Cellulitis
• Scarlet Fever (rare bacterial infection)
• Guttate Psoriasis (a non-infectious skin condition)
• Septicaemia (sepsis – infection of blood)
• Staphylococcal scalded skin syndrome (SSSS)
• Post-Streptococcal Glomerulonephritis (infection of blood vessels in Kidney)
• Scarring

Sources

• CDC – Impetigo
• NHS Scotland – Impetigo
• NHS – Impetigo condition

Sinuses are small air-filled cavities or sacs located throughout the body. The most commonly known Sinuses are those that are located in the skull, near the nose. There are four paired cavities which are connected by narrow passages. These cavities are located between the eyes and behind the forehead, nose, and cheekbones.

Sinusitis or sinus infection is a medical term used to describe the inflammation of the mucous membranes that line the sinuses and is usually caused by an infection or irritants like allergens.

Sinusitis is fairly common and most cases usually resolve within 2-3 weeks and don’t require any treatment.

What are the causes of Sinusitis?

Sinusitis can be caused by:

Infections

Most adults will get colds or upper respiratory tract infections up to three times a year. Both viral and bacterial infections cause swelling of the tissues inside the nose and thickening of the normal mucus. This slows down or even stops proper sinus drainage and infection in the sinus may ensue.

Irritants

Air pollution, smoke and chemical irritants, for example, some sprays containing pesticides, disinfectants and household detergents, may cause swelling and blockage of the lining of the nose causing a narrowing of the drainage opening from the sinuses. This can once again lead to impairment of sinus drainage and consequent infection.

Allergies

Allergies can cause inflammation inside the nose. Common symptoms of an allergic reaction include nasal stuffiness, runny nose, sneezing and itchy watery eyes. Allergies are responsible for asthma in some patients and may also cause nasal stuffiness making the asthma more difficult to control.

Structural problems

Occasionally structural problems within the nasal cavity can cause a narrowing. Some of these can as a result of trauma while others may develop during the growth period. Occasionally the structural narrowing can be so severe that mucus builds up behind these areas of blockage giving rise to sinus infection.

What are the symptoms of Sinusitis?

Sinusitis is characterised by one or more of the following symptoms:

• Runny nose with thick yellow or green mucus
• Postnasal drip (mucus dripping down your throat)
• Blocked or stuffy nose
• Pressure around your nose, eyes and forehead, which gets worse when you move your head around or bend over
• Pressure or pain in your teeth
• Pressure or pain in your ears
• High temperature (Fever)
• Halitosis (bad breath)
• Cough
• Headache
• Tiredness
• Sounding nasal when speaking

Is Sinusitis contagious?

Sinusitis itself is not contagious. However, the viruses and bacteria that can cause it are. Always follow good handwashing and personal hygiene practices.

When to get advice from a GP

You should contact your GP if you suspect you have Sinusitis and you have:

• Had four or more annual episodes without persistent symptoms in the
• intervening periods
• symptoms that last for more than 12 weeks (indicates possible Chronic Sinusitis)
• An anatomic defect(s) causing nasal obstruction
• Nasal polyps

Check if you qualify for FREE treatment with NHS Pharmacy First, without seeing your GP

You can check your eligibility to use the NHS Pharmacy First service if you suspect you have Sinusitis and you:

• Are 18 years or over

The NHS Pharmacy First service may be suitable if you have:

• Nasal blockage (obstruction/congestion) OR
• Nasal discharge (anterior/posterior nasal drip)

AND ONE or more of the following:

• Facial pain/pressure (or headache) OR
• Reduction (or loss) of the sense of smell (in adults) OR
• altered speech indicating nasal obstruction, and tenderness, swelling or redness over the cheekbone or periorbital areas
• Symptoms that have been present for 10 days or more with little improvement

The NHS Pharmacy First service is available to all NowPatient users who are registered with the NHS in England. If you are exempt from paying for your prescriptions, the service and the treatments are provided free of charge. If you are not exempt from paying prescription charges, treatments are provided at the prevailing NHS prescription charge rate. There is no charge for consultations.

What NHS Pharmacy First treatments are available for Sinusitis?

If your Sinusitis symptoms persist for more than 10 days and you do not have a weakened immune system due to a particular health condition or medication that suppresses your immune system, then you may qualify to be treated under the NHS Pharmacy First service.

If the Pharmacy First clinician suspects that your Sinusitis needs treatment, then they may prescribe the following medications:

• Steroid nasal sprays or drops to reduce the swelling in your sinuses
• Antibiotics. However, this is not common as sinusitis is usually caused by a virus, not bacteria

Mild Sinusitis can be treated without seeing a GP by:

• Getting plenty of rest
• Drinking plenty of fluids
• Taking analgesia like paracetamol or ibuprofen (do not give aspirin to children under 16)
• Avoiding triggers like certain allergens
• Avoid smoking
• Cleaning your nose with a saltwater solution
• Using over-the-counter remedies like decongestant nasal sprays or drops that can unblock your nose
• Using antihistamines, if the cause of your Sinusitis is an allergy

To clean your nose with a saltwater solution, use the following method:

1. Boil a pint of water
2. Let the water cool
3. Mix 1 teaspoon of table salt with 1 teaspoon of bicarbonate of soda into the water.
4. Now wash your hands
5. While standing over a sink, cup the palm of 1 hand and our a small amount of the solution you made, into it
6. Sniff the water into one nostril. Then breathe through your mouth and allow the water to pour back into the sink. Avoid letting the water trickle to the back of your throat
7. Repeat the steps above, 3 times a day until your symptoms are more comfortable

If your Sinusitis does not resolve, you should contact your GP who may refer you to an ear, nose and throat (ENT) specialist if you:

• Still have sinusitis after 3 months of treatment
• Keep getting sinusitis
• Only have symptoms on 1 side of your face

Sources

• NHS – Sinusitis condition
• Cleveland Clinic – Sinusitis
• Newcastle hospitals – Sinusitis

A sore throat is defined as the feeling of pain anywhere in the throat. It can be characterised by painful swallowing. Usually, there is nothing to worry about and it typically resolves within a week.

Although mostly caused by viruses, such as the cold or flu virus, approximately 5-25% of adult sore throats are caused by a bacterial infection from group A Streptococcus (group A strep).

What are the causes of Sore Throat?

Sore throats can be caused by:

• Viruses, such as the cold or flu virus
• Tonsillitis (inflammation of the tonsils)
• Strep throat (also called streptococcal pharyngitis caused by bacterial group A Streptococcus)
• Smoking
• Mouth breathing at night while you sleep
• Pollution
• Allergies to pets, pollens and moulds
• Mononucleosis
• Sinus infections
• Acid reflux

What are the symptoms of a Sore Throat?

Symptoms of an acute sore throat can vary depending on the cause. However, you may experience one or more of the following:

• Pain or a scratchy sensation in the throat
• Pain that worsens with swallowing or talking
• Difficulty swallowing
• Sore, swollen glands in your neck or jaw
• Swollen, red tonsils
• White patches or pus on your tonsils
• A hoarse or muffled voice

How can I self-manage a Sore Throat?

You can use the following self-care methods to soothe a sore throat and shorten how long it lasts:

• Gargle with warm, salty water (not suitable for children)
  • Dissolve half a teaspoon of salt in a glass of warm water (warm water helps salt dissolve)
  • Gargle with the solution, then spit it out (do not swallow it)
• Drink plenty of water
• Eat cool or soft foods
• Avoid smoking or smoky places
• Suck ice cubes, ice lollies or hard sweets
• Rest
• Take paracetamol or ibuprofen
• Take medicated lozenges containing a local anaesthetic, antiseptic, or anti-inflammatory medicine
• Use anaesthetic spray (although there’s little proof they help when used on their own)
• Use a sore throat gargle (like Sanderson’s Throat Specific)

When to get advice from a GP

You should contact your GP if you suspect you have a Sore Throat and:

• You have a very high temperature, or you feel hot and shivery
• You have a weakened immune system – for example, because of an underlying health condition like diabetes or if you are being treated with immunosuppressive medications

You should go to A&E or Call 999 if:

• Are drooling – this can be a sign of not being able to swallow
• Are making a high-pitched sound as you breathe (called stridor)
• There are signs of inflammation of the epiglottitis (flap of tissue at the back of the throat) – the pain may be severe and you may have difficulty breathing and difficulty swallowing

Check if you qualify for FREE treatment with NHS Pharmacy First, without seeing your GP

You can check your eligibility to use the NHS Pharmacy First service if you suspect you have a Sore Throat and you:

• Are 18 years or over

And you have ONE or more of the following symptoms:

• A raised temperature (above 38C)
• Pain when swallowing
• Red, inflamed tonsils
• White, streaky patches on the tonsils

The NHS Pharmacy First service may NOT be suitable if:

• You have a weakened immune system – for example, because of an underlying health condition like diabetes or if you are being treated with immunosuppressive medication.
• Your sore throat symptoms been persisting for 12 months or have you had 7 episodes of sore throats over the last year
• Have difficulty breathing or are unable to swallow

The NHS Pharmacy First service is available to all NowPatient users who are registered with the NHS in England. If you are exempt from paying for your prescriptions, the service and the treatments are provided free of charge. If you are not exempt from paying prescription charges, treatments are provided at the prevailing NHS prescription charge rate. There is no charge for consultations.

What NHS Pharmacy First treatments are available for a Sore Throat?

You do not normally need antibiotics for a Sore Throat because they will not usually relieve your symptoms or speed up your recovery. You will only be considered for antibiotics if you or show signs of having a bacterial infection. Remember, most Sore Throats are viral in nature and will NOT respond to antibiotics.

What happens if I do not get treatment for a Sore Throat?

The vast majority of cases of Sore Throat are viral in nature and usually resolve within a week, without treatment.

Sources

• Mayo Clinic – Sore Throat symptoms and causes
• NHS – Sore Throat condition
• Clinical Pathways – Acute Sore Throat
• Wikipedia – Sore Throat

A urinary tract infection (UTI) is one of the most common bacterial infections (caused by the bacteria Escherichia coli – E. coli) that can occur in women between the ages of 16 and 64. Approximately half of women have at least one UTI in their lifetime, and 20-30% have two or more. In fact 25% of women who have a UTI can have a recurrent episode within 3-6 months and 40% have a recurrence within 12 months. It’s worth remembering that a UTI is not a gynaecological disease.

What is the urinary tract?

The urinary tract is the body’s drainage system for removing urine. It consists of 4 components:

• Kidneys – these are small, bean-shaped organs on the back of your body, above your hips. The kidneys filter water and waste products from your blood, which becomes urine.
• Ureters – these are thin tubes that carry urine from your kidneys to your bladder.
• Bladder – this is a balloon-like organ that stores urine before it leaves your body.
• Urethra – this is a tube that carries pee from your bladder to the outside of your body.

What are the types of Urinary Tract Infections (UTIs)?

UTIs are clinically classified as being either:

• Uncomplicated – a bacterial Infection of the bladder that is not associated with structural or functional abnormality of the urinary tract and where the individual has no underlying chronic conditions such as diabetes, is not immunocompromised, has not had recent urologic surgery, or is not pregnant
• Complicated – a bacterial Infection that is linked with a condition, such as a structural or functional abnormality of the urinary tract, or the presence of an underlying disease

What are the different types of uncomplicated Urinary Tract Infections (UTIs)?

Uncomplicated UTIs normally affect individuals who are otherwise healthy and have no structural or functional abnormality of the urinary tract. Uncomplicated UTIs are further classified into either:

• Uncomplicated lower UTIs (acute cystitis – affecting bladder)
• Uncomplicated upper UTIs (acute pyelonephritis – affecting kidneys)

Uncomplicated UTIs usually resolve within a few days, with or without treatment. Treatment with antibiotics can however reduce the length of the episode by a day or two and can also prevent complications.

What are the causes of uncomplicated UTIs?

Uncomplicated UTIs are caused by bacteria such as E. coli entering your urinary tract. Because women have a shorter urethra than men, the bacteria are more likely to travel to the bladder or kidneys and cause an infection.

Factors that can increase the risk of getting Uncomplicated UTI?

The following factors can increase your risk of getting an uncomplicated UTI:

• Frequent sexual activity
• New sexual partners
• Some types of birth control
• Menopause

How to prevent Uncomplicated UTIs?

UTIs can’t always be prevented, however, it is possible to reduce your risk of getting one. The following are things you can do to prevent a UTI:

• Keep the genital area clean and dry
• Wipe from front to back when you go to the toilet
• Drink plenty of fluids, particularly water – so that you regularly urinate during the day and do not feel thirsty
• Wash the skin around the vagina with water before and after sex
• Urinate as soon as possible after sex
• Explore different birth control options – Some types of birth control might promote an overgrowth of harmful bacteria including:
  • Diaphragms
  • Non-lubricated condoms
  • Spermicides
  • Spermicide condoms

What are the symptoms of Uncomplicated UTI?

Symptoms of an Uncomplicated UTI may include:

• Pain or a burning sensation when passing urine (dysuria)
• Needing to pass urine more often than usual
• Needing to pass urine more often than usual during the night (nocturia)
• Needing to pass urine suddenly or more urgently than usual
• Urine that looks cloudy
• Blood in your pee
• Lower tummy pain or pain in your back, just under the ribs
• A high temperature, or feeling hot and shivery
• A very low temperature below 36C

Is an Uncomplicated UTI contagious?

Uncomplicated UTIs are not contagious and cannot be sexually transmitted.

When to get advice from a GP

You should contact your GP if you suspect you have a UTI and you:

• Have symptoms of a urinary tract infection (UTI) for the first time
• Have a child has symptoms of a UTI
• Are a man with symptoms of a UTI
• Are pregnant and have symptoms of a UTI
• Are caring for an older, frail person who may have symptoms of a UTI
• Have symptoms of a UTI after surgery
• Have symptoms that get worse or do not improve within 2 days
• Have symptoms that come back after treatment
• Are immunosuppressed because of an underlying condition or because of treatment e.g chemotherapy
• Have associated vaginal discharge

You should seek an emergency GP appointment or Call NHS 111 immediately if you experience the following symptoms:

• Have a very high temperature, or feel hot and shivery
• Have a very low temperature below 36C
• Are confused or drowsy
• Have pain in the lower tummy or in the back, just under the ribs
• Can see blood when you pass urine

Check if you qualify for FREE treatment with NHS Pharmacy First, without seeing your GP

You can check your eligibility to use the NHS Pharmacy First service if you suspect you have an uncomplicated UTI and you:

• Are a biological female aged between 18 years and 64 years

And you have ONE or more of the following symptoms:

• Dysuria (burning pain when passing urine)
• New nocturia (needing to pass urine in the night)
• Urine cloudy to the naked eye (visual inspection by pharmacist if practicable)

The NHS Pharmacy First service is available to all NowPatient users who are registered with the NHS in England. If you are exempt from paying for your prescriptions, the service and the treatments are provided free of charge. If you are not exempt from paying prescription charges, treatments are provided at the prevailing NHS prescription charge rate. There is no charge for consultations.

What NHS Pharmacy First treatments are available for Uncomplicated UTIs?

Although many cases of Uncomplicated UTIs tend to self-resolve, you may find that the symptoms may warrant treatment. You have a number of self-care and referral options:

• Purchase an over-the-counter painkiller from a store
• Refer to the NowPatient NHS Pharmacy FIrst service where you will be assessed and possibly given a prescription for a short course of antibiotics
• If there are warning signs and you are not eligible to use the NHS Pharmacy First service, then self-refer to a GP

It’s important to take all the medicine you’re prescribed, even if you start to feel better.

Sources

• Urinary tract infections: epidemiology, mechanisms of infection and treatment options
• Symptomatic treatment of uncomplicated lower urinary tract infections in the ambulatory setting: randomised, double blind trial
• NHS – Urinary Track Infections
• Cleveland Clinic – Urinary Track Infections
• NHS – Cystitis

If you get bitten or stung by an insect, it can cause a red, swollen lump to develop at the site of the bite or sting.  While this is not usually serious and can heal quickly, in some cases the site can become infected or even trigger a serious allergic reaction.

The images below show insect bites that have become infected.

What are the symptoms of an infected insect bite?

Symptoms of an infected insect bite may include:

• Pus (in or around the bite)
• Swollen glands
• Increased pain, swelling and redness (in or around the bite)

What should I do if I get bitten or stung by an insect?

If you have been bitten or stung by an insect you can do the following:

• Put an ice pack wrapped in a cloth or a clean cloth soaked in cold water on the bite or sting for at least 20 minutes, if it’s swollen
• Keep the area raised if you can
• Take painkillers such as paracetamol or ibuprofen if the sting is painful
• Use antihistamines to relieve any itching (but do not use antihistamine cream if you had caterpillar hairs on your skin)
• Use a hydrocortisone cream to reduce itching and swelling

How can I prevent being bitten or stung by insects?

You’re more likely to be bitten or stung if you work outdoors or regularly take part in outdoor activities, such as camping or hiking.

Using insect repellent and keeping your skin covered when outdoors will help you avoid being bitten or stung.

Try not to panic if you come across wasps, hornets or bees, and back away slowly. Don’t wave your arms around or swat at them.

When to get advice from a GP

You should contact your GP if you suspect you have been bitten or stung by an insect and:

• Your symptoms get worse or are not getting any better
• You were stung in your mouth or throat, or near your eyes
• You have tummy pain and are being sick
• You feel dizzy or lightheaded
• A large area around the bite or sting becomes red and swollen
• You have a high temperature and swollen glands
• You were stung more than once
• You’ve had a serious allergic reaction to an insect bite or sting before
• The bite or scratch was caused by animal(s)
• The bite was caused by human(s)
• The bite was caused by a tick in the UK and signs of Lyme disease such as erythema migrans (bullseye) rash
• The bite or sting occurred while travelling outside of the UK with concern of insect-borne diseases e.g. malaria, tick-borne encephalitis
• The bite or sting was caused by an unusual or exotic insect

You should go to A&E or Call 999 if develop any of the following symptoms:

• Wheezing or difficulty breathing
• Nausea, vomiting or diarrhoea
• A fast heart rate
• Dizziness or feeling faint
• Difficulty swallowing (dysphagia)
• Confusion, anxiety or agitation

Check if you qualify for FREE treatment with NHS Pharmacy First, without seeing your GP

Most insect bites are not serious and will get better within a few hours or days, and do not require treatment with antibiotics.

You can check your eligibility to use the NHS Pharmacy First service if you suspect you have an Infected Insect Bite and you:

• Are 18 years or over
• It has been at least 48 hours since you were bitten or stung.

And you have THREE or more of the following symptoms:

• Redness of skin
• Pain or tenderness to the area
• Swelling of skin
• The skin surrounding the bite feels hot to touch

The NHS Pharmacy First service may NOT be suitable if:

• The bite or scratch was caused by animal(s)
• The bite was caused by human(s)
• The bite was caused by a tick in the UK and signs of Lyme disease such as erythema migrans (bullseye) rash
• The bite or sting occurred while travelling outside of the UK with a concern of insect-borne diseases e.g. malaria, tick-borne encephalitis
• The bite or sting was caused by an unusual or exotic insect

The NHS Pharmacy First service is available to all NowPatient users who are registered with the NHS in England. If you are exempt from paying for your prescriptions, the service and the treatments are provided free of charge. If you are not exempt from paying prescription charges, treatments are provided at the prevailing NHS prescription charge rate. There is no charge for consultations.

What NHS Pharmacy First treatments are available for an Infected Insect Bite?

You do not normally need antibiotics for an insect bite because they will not usually relieve your symptoms or speed up your recovery. You will only be considered for antibiotics if you could have an infection associated with your insect bite.

Sources

• NHS Scotland – Insects Bites and Stings
• Clinical Pathways – Infected Insect Bites
• NHS – Insect Bites and Stings