MEN'S HEALTH MATTERS:Over the last seven years, the number of cases of TB has been increasing
Q I HAVE RECENTLY been diagnosed with pulmonary tuberculosis. I thought this disease had been eradicated. Is it common? What are the risks of me spreading this disease to others in my family? How long will I have to take my treatment for and are there any side effects to the treatment? Are there any long-term problems with having this disease?
ATuberculosis was never eradicated from Ireland and over the last seven years the number of cases has been increasing. This is of concern and needs to be addressed. A new problem has emerged in that there are now a lot of multiple drug-resistant cases of TB. These cases are especially difficult to treat, with lots of side effects.
Yes it is possible that others may have caught the disease from you, and if this is the case then they must be treated. By the time a patient is diagnosed with tuberculosis, members of their family have a 50/50 chance of having caught the infection from them. Most people who catch the infection never actually get the disease. The infection "goes to sleep" and doesn't wake up and this is called latent TB infection.
There is a big difference between having tuberculosis disease and latent TB infection. People with latent TB infection cannot transmit the infection to other people - however, they are treated to prevent them from becoming ill.
People with tuberculosis disease in their lungs, however, can transmit it to other people and we find with each case we see that about 12 other people have become infected. These other people are contacts, and they can be offered medication to keep them well.
The treatment for tuberculosis disease takes, at the very least, six months, but may take longer and the medications do have some side effects. These side effects are usually very manageable and include upsetting the liver. For that reason we advise patients to avoid taking alcohol and drugs such as paracetamol that may upset the liver for the duration of their therapy. In addition, one of the drugs may cause pins and needles in the fingers and toes and to prevent this, vitamin B6 is given.
If the tuberculosis pneumonia that you suffer from has affected a significant amount of the lung then you may have long-term problems once the TB has been eradicated. This may manifest itself with a chronic cough productive of sputum because of damage to the tubes in the lungs. In rare cases these can cause coughing up blood, and repeated chest infections. Fortunately, most patients do not endure long-term problems.
Q I am 57 years old and recently noticed a red lump on the tip of my penis. My GP referred me to a urologist who arranged for a biopsy and this turned out to be cancerous. I have never heard of cancer of the penis before.
AThere are a variety of causes of lumps on the penis and cancer (squamous cell carcinoma of the penis) is one of them. This is a very rare cancer and more often develops in uncircumcised men and generally starts as a small growth or redness on the head of the penis, which is noticed when the foreskin is pulled back. The vast majority of men with a red patch will not have a cancer. Factors that can increase the risk of developing penile cancer include: penile warts, multiple sexual partners and poor personal hygiene.
A biopsy of the penis is usually performed using a local anaesthetic. This sample will then be analysed in the laboratory to see if there is a cancer present. Depending on the size of the tumour, most cancers will need surgery but occasionally small cancers can be treated with microsurgery, laser, radiation or circumcision. For cancers confined to the head of the penis, usually an operation to remove the tumour by removing a part of the penis is performed. The patient will pass water through the remainder of the penis. If the tumour extends down the shaft of the penis, a total penectomy (removing the entire penis) may have to be undertaken and in this situation the water passage will open on to the skin behind the scrotum and it will be necessary to sit down to pass urine.
Prior to surgery, a Cat scan will be performed to see if the cancer has spread. Occasionally in addition to surgery chemotherapy or radiotherapy may be required.
• This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from Dr Joe Keane consultant respiratory physician, St James's Hospital, Dublin and Mr Ronan Long, specialist registrar in urology, Galway University Hospitals