Questions and Answers

Disposable breath alcohol screening test

What does it test for?

Disposable breath alcohol screening tests are used for the detection of alcohol consumption.

The U-Test Alcohol Test provides a good indication of alcohol consumption and if the blood alcohol level of a person is above or below the legal driving limit.  It picks up any trace of alcohol and provides an indication of above or below (approximately) 0,5g/liter of blood.  It is for example approved for use by the French police.

Test principle

The disposable alcohol breath tester is a relatively simple device designed to show if one is above or below a defined Breath Alcohol Content (BrAC), in this instance, the legal driving limit.  The U-Test Alcohol Test uses an internationally accepted breath testing principle to indicate the consumption of alcohol.  The disposable tube contains white crystals that turn red in the presence of alcohol.  When a measured volume of breath is passed through the tube (after inflating the bag), and the colour of the crystals change from white to red it indicates the presence of alcohol in the breath.  If the colour change reaction is immediate (when reading the result), it indicates a breath alcohol level above the legal driving limit.  If the reaction from white to red crystals takes a couple of minutes, it indicates the presence of alcohol, but at a level below the legal driving limit.

Test limitations

It is important to remember that the test is a breath screening device and that the result is only an indication of the blood alcohol concentration.  Breath testing to establish a person’s blood alcohol content relies on the fact that air in the deep lung region contains an alcohol concentration directly related to the alcohol concentration in the blood.  The result obtained with this test does not provide an absolute measurement and cannot be used as evidence in a court of law.  Road safety legislation requires a blood alcohol concentration test to be done.

U-Test Alcohol provides a good indication of the blood alcohol level when properly used.  The accuracy of the test results may not be reliable if the test is not conducted according to the instructions.  E.g. the instructions state “do not do the test within 10 minutes of the last drink”.  Why is this important?  You can have alcohol in your saliva/ mouth or throat if the drink was recently consumed.  The U-Test Alcohol tester will give incorrect results until the breath sample contains alcohol only from the lungs.  So wait the 10 minutes and then test.

Test guidelines

• Do not do the test within 10 minutes of the last drink and do not smoke immediately before use.
• Do not use the test after the expiry date and do not re-use the test.
• It is normal for the crystals to get warm during operation.
• Do not immerse the test in any liquid.
• Dispose of the tube immediately after use.  Do not carry the used tubes in your pocket.
• Handle with care; keep out of reach of children.

Are there any other substances that affect the test result?

Claims are often made after a test has shown to be positive, that something other than alcohol has recently been eaten or drunk which caused the tester to show positive.

Certain medicines do contain alcohol in small quantities – and it is possible that someone who has recently swallowed such medicine will show positive in a test, because the medicine is still fresh in his mouth and throat.  The amount of alcohol contained in medicines is normally so small that it is unlikely to indicate positively after it has been absorbed by the body.

Similarly breath fresheners, chewing gum etc which may contain substances which react with the chemicals, are quickly dispelled from the mouth and not ingested into the system — so it is important not to test immediately after substances have been in the mouth.  Allow some time to elapsebefore testing the breath for alcohol which comes from the lungs.

Alcohol elimination from the body

A commonly used rule of thumb by many is that the body “on average” eliminates approximately one “drink” per hour.  This obviously differs from one individual to another and is generally also affected by the total amount consumed – as the liver itself slows down when presented with too much alcohol.  It is therefore quite possible for a person tested sometime after consuming alcohol to show positive.

It is significant to note that legislation does not concern itself with when the alcohol was consumed or whether it came out of a beer bottle or a cough mixture bottle.  It is about whether you have consumed alcohol and whether you are below or above the limit.

Benefits of disposable breath alcohol testers

• Accurate and reliable when used correctly.
• Indicate alcohol consumption and if above or below the driving limit.
• Inexpensive compared to other detection methods.
• Convenient as you can test yourself, anytime and anywhere.
• Easy storage – it is small and compact and fits easily into a trouser pocket, handbag or car.
• Hygienic – single use, disposable in general waste after use.
• Very easy to use.
• Rapid results.
• The bag supplied with the tester makes the test results more reliable as it contains the precise amount of breath to ensure correct results.
• No batteries, no calibration and no other accessories needed.
• No blood sample needed.

Can the testers be kept as evidence?

After administering the test we recommend that the results should be witnessed within a few minutes, the testimony of the witness recorded and the test disposed.  In addition a digital photo on date recording setting maybe taken.  If this is not possible, the tester may be kept as evidence for no longer than twelve hours after which the chemical absorbs moisture from the atmosphere and becomes so wet that the colour change creeps and fades in the tube.

It should be remembered that the chemicals contain very powerful oxidising agents and if allowed to drip out of the tube will cause damage to files, skin or clothes.

How can we be sure that the tester is working properly?

For a tester not to work, the chemicals inside the tube would somehow have been oxidised before the test.  This can happen if the tube had been accidentally opened or exposed to sunlight for a prolonged period.  Evidence of that can usually be clearly seen before the test.  If it has been opened the chemicals would be wet and if it had already been oxidised the chemicals would be discoloured before the test.

This is in fact an advantage of using a chemical tester.  With many of the electronic testers one never knows if it is working properly.

Pregnancy rapid diagnostic screening test

What is a pregnancy test and how does it work?

Pregnancy tests are designed to tell if your urine or blood contains a hormone called human chorionic gonadotropin (hCG).  This hormone is made right after a fertilized egg attaches to the wall of a woman’s uterus.  Once the egg implants in the uterine lining, hCG is produced and secreted by the placenta.

Types of pregnancy tests

There are two main types of pregnancy tests that can indicate if you’re pregnant: blood tests and urine tests.  Urine tests can be done at home or in a doctor’s office and blood tests which are done or requested from a doctor at a laboratory but are used less often than urine tests.  Blood pregnancy tests can detect pregnancy earlier than a urine pregnancy test, but with these tests it takes longer to get the results than with a urine pregnancy test.

How does a urine pregnancy test work?

Rapid diagnostic pregnancy tests detect the presence of the hormone hCG (human Chorionic Gonadotropin) in a woman’s urine.

It is a qualitative hCG test that simply checks if hCG is present in the urine or not.  It gives a “yes” or “no” answer to the question: “Are you pregnant?”  These tests can be done at home and is also used by the doctors to confirm pregnancy.

Urine pregnancy tests detect hCG and indicate a positive result when the hCG level in the urine exceeds the sensitivity level of the test.  No test line will appear if the hCG level in the urine sample is below the sensitivity level.  This will indicate either a negative result for pregnancy or that the level of hCG is still below the detection limit of the test.

Does the hCG sensitivity of the pregnancy test matter?

The sensitivity of a pregnancy test determines how soon after conception pregnancy can be detected by the test.  Concentrations of hCG (human Chorionic Gonadotropin) are reported in milli International Units per ml or mIU/ml.  Pregnancy tests with a sensitivity of 20 mIU/ml are more sensitive than tests with a sensitivity of 50 to 100 mIU/ml.

High sensitivity, 20 mIU/ml tests, such as the U-Test Pregnancy, equates to early detection of pregnancy.  This means that you can begin testing accurately as early as eight days after conception or 2-3 days before expected menstruation.  The date of intercourse should not be viewed as the day of conception.  Conception can take place several days after the date of intercourse.

How accurate are urine pregnancy tests?

Rapid diagnostic pregnancy tests are screening tests for pregnancy and are about 99% accurate.

How accurate a home pregnancy test is depends on:

• How closely you follow instructions.  Each brand of pregnancy test works slightly differently, so it is important to read the instructions before use.
• The sensitivity of the pregnancy test.
• Correct product storage and handling.
• When you ovulate in your cycle and how soon implantation occurs.
• How soon after conception you do the test.
• There are circumstances and variables that may influence a pregnancy test result from fertility medications to the diluted urine sample.

Inaccuracies are most often traced to errors in doing the test or failure to follow instructions with care.  Results may also be more accurate if you do the test first thing in the morning when your urine is more concentrated.

Home pregnancy tests are easy to use, accurate, private, convenient and the products come with instructions.  Follow them closely for the most accurate results.

What does the pregnancy test result mean?

A positive result will indicate that you are pregnant.  This is true no matter how faint the line, colour or sign is.  If you get a positive result you should make an appointment with your doctor to discuss the next steps.

In very rare cases you can have a false-positive result.  You could have a false-positive result if blood or protein is present in your urine.  Certain medication such as some fertility medication or other medication that contains hCG, may cause false-positive results.  Biochemical pregnancy, ectopic pregnancy, menopause or problems with your ovaries might also contribute to misleading test results.

If you get a negative result you are likely not pregnant.  However, you may still be pregnant if:

• The test is past its expiration date.
• You did not follow the instructions correctly.
• You tested too soon.
• Your urine is too diluted because you drank large amounts of fluids right before the test.
• You are taking certain medications, such as diuretics.

What is HCG (hCG) levels?

HCG (hCG) is known as the pregnancy hormone, because it is produced by the cells that form the placenta and provide nourishment to the growing embryo.  It is released when a fertilized egg attaches itself to the lining of the uterus.

Generally, a woman’s hCG levels double every 72 hours.  HCG levels reach their peak in the first 8 to 11 weeks of pregnancy and then they tend to level off for the next two trimesters.  Therefore, in the first trimester (3 months) of pregnancy symptoms can be much stronger and intense.

HCG levels vary between individual women and whether they are carrying more than one embryo.  Implantation normally occurs 6-8 days post conception followed by a very low level of hCG.  The levels of hCG increase to about 30 mIU/ml after 10 days following fertilization (conception).  During the first missed period the level is generally between 50 -250 mIU/ml.

Why you should use first morning urine or hold urination?

Urine pregnancy tests detect hCG (human Chorionic Gonadotropin) and therefore it is best to use urine samples containing the highest amount of the hCG hormone:

• Diluted urine samples (from drinking high volumes of water or frequent urination) will reduce the level of hCG and influence the test accuracy.
• First morning urine is considered the ideal sample as it contains the highest concentration of hCG, given that you have not urinated frequently throughout the night.

If a pregnancy test is done later in the day, make sure that you do not urinate 3 to 4 hours before testing.

When should I take a home pregnancy test?

The product brand selected will indicate the test sensitivity.  If it is a 20 mIU/ml test such as U-Test Pregnancy you can begin testing accurately as early as eight days after conception or 2-3 days before expected menstruation.

Conception may take place several days after date of intercourse.  The date of intercourse should not be viewed as the day of conception (fertilization).

You improve your odds of getting an accurate result if you wait until after the first day of your missed period.  Why?  During early pregnancy the hCG concentration is very low.  The earlier you take the urine pregnancy test the lower is the hCG levels to detect.  Also keep in mind that the timing of your ovulation might vary from month to month and the fertilized egg can implant in the uterus at different times.  This can affect the timing of the hCG production and when it can be detected.  If your periods are irregular you might miscalculate when your period is due.

What is a biochemical pregnancy and why can it result in a false positive pregnancy test result?

Research indicates that 50 – 60% of all conceptions (fertilized eggs) do not develop into a normal pregnancy.  This is termed biochemical pregnancy.

A biochemical pregnancy occurs when the fertilized egg attaches to the uterine lining after conception and starts producing hCG, but later the egg is discarded by the body.  The term describes a very early miscarriage or pregnancy loss.  The menstrual cycle usually begins on time or a few days late.

A biochemical pregnancy can result in a false pregnancy test result if you tested early for pregnancy.

What does a faint line on a urine pregnancy test mean?

If you do the pregnancy test correctly and read it within the time frame, then a faint colour test line or weak test line (in comparison to the control line) indicates a positive result and it is very likely a positive pregnancy test.

Explanations for a faint positive test line include:

• You may be testing too early after conception and your hCG level may be below the detection level of the test.  Remember, hCG doubles every two days so wait and test again after 24 -48 hours using first morning urine to confirm the test result.
• The urine may be diluted due to frequent urination or a high consumption of liquids.  First morning urine is recommended for pregnancy testing as it contains the highest concentration of hCG.

HIV

What is the difference between HIV and AIDS?

HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Acquired Immunodeficiency Syndrome). The most advanced stage of HIV infection is AIDS.  AIDS can take from 2 to 15 years to develop if not treated, depending on the individual.

What does HIV do to the body?

The Human Immunodeficiency Virus targets the immune system.  It weakens people’s defence systems against infections and some types of cancer.  As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient.

Immune function is typically measured by CD4 cell count.

Signs and symptoms of HIV

The symptoms of HIV vary depending on the stage of the HIV infection.

Many people living with HIV are unaware of their status until the later stages.  In the first few weeks after initial infection, people may experience no symptoms or an influenza-like illness.  These symptoms include fever, headache, rash or sore throat.

As the infection progressively weakens the immune system, other signs and symptoms can appear.  For example: swollen lymph nodes, weight loss, fever, diarrhoea and cough.

Without treatment, people could also develop severe illnesses such as tuberculosis (TB), cryptococcal meningitis and severe bacterial infections.  Cancers such as lymphomas and Kaposi’s sarcoma are also possible.

How do you get HIV?

A variety of body fluids from people infected with HIV can transfer the disease.  For example: blood, breast milk, semen and vaginal secretions.  A mother can also transmit HIV to her child during pregnancy and delivery.

Individuals cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands or sharing personal objects, food or water.

Risk factors for getting HIV

Behaviours and conditions that put individuals at greater risk of contracting HIV include:

• Having unprotected anal or vaginal sex.
• Having another sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhoea and bacterial vaginosis.
• Sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs.
• Receiving unsafe injections, blood transfusions and tissue transplantation, and medical procedures that involve unsterile cutting or piercing.
• Experiencing accidental needle stick injuries, for example among health workers.

Diagnosing HIV

HIV can be diagnosed through rapid diagnostic screening tests that provide same-day results.  These screening tests facilitates early diagnosis, treatment and care.  People can also use HIV self-tests to test themselves.

However, no single test can provide a full HIV diagnosis.  A confirmatory laboratory test is required, conducted by a qualified health worker.

Following a positive diagnosis, people should be retested before they are enrolled in treatment and care to rule out any potential testing or reporting error. Once a person diagnosed with HIV has started treatment with antiretroviral therapy (ART) they should not be retested, with for example a rapid diagnostic screening test.

How does a HIV rapid diagnostic screening test work?

Most widely-used HIV rapid diagnostic screening tests detect antibodies produced by the person as part of their immune response to fight HIV.

In most cases, people develop antibodies to HIV within 28 days of infection.  During this time, people experience the so-called “window” period.

The window period is when HIV antibodies haven’t been produced and when people may have had no signs of HIV infection, but they can transmit HIV to others as they are already infected with the virus.

If sourced from a reputable supplier, HIV rapid diagnostic screening tests are highly accurate and very sensitive.  It is important to read the instructions carefully.  Perform the test as instructed.  Intrepid the results only in the timeframe stipulated, not sooner or later.

Although the tests are easy to perform at home, it is advised not to do the test at home without seeking pre-test and post-test counselling.

What does a negative HIV rapid diagnostic screening test result mean?

A negative HIV rapid diagnostic screening test result indicates that there are no HIV antibodies present in your blood at the time when you did the test or it is below the detection limit.

Remember, after exposure to the HIV virus there is a time period known as a “window period” when you may be infected with the virus, but the HIV antibodies have not yet been produced by the body’s immune system or the concentration of antibodies are still too low to detect.  Therefore, if there was a possible exposure to the HIV virus and the test result is negative, the test must be repeated in 3 months.

What does a positive HIV rapid diagnostic screening test result mean?

A positive HIV rapid diagnostic screening test result indicates that HIV antibodies are present in the blood.

A diagnosis should not be based on the results of a single test, but should be confirmed by a medical professional in conjunction with other medical evidence.

If your screening test is positive, please contact your doctor or clinic as soon as possible for further advice, confirmatory laboratory testing and post-test counselling.

Cases of false positive HIV antibody test results are documented in the medical literature.  It is very rare.  Remember, viral antibody production is a normal, healthy response to infection.  It is an indication of immunity.  Antibodies alone are not used to diagnose a disease or predict illness. A variety of viruses, bacteria and other antigens can cause the immune system to make antibodies that can also react with a HIV antibody test.  When the antibodies produced in response to these other infections and antigens react with HIV proteins, a positive result is obtained. Many antibodies found in normal, healthy, HIV-free people can cause a positive reading on a HIV antibody test, including laboratory antibody tests. Just because a medical condition is on the list of potential causes, it doesn’t mean that it will definitely, or even probably, cause a false-positive test result. It depends on what antibodies the individual carries, as well as the characteristics of each particular test kit.

A false positive test result can have serious emotional consequences and this is one of the reasons why pre-test and post-test counselling is so important.

Antiretroviral therapy and HIV rapid diagnostic screening tests

HIV can be suppressed by antiretroviral therapy (ART). ART doesn’t cure the HIV infection, but suppresses viral replication within a person’s body.  This allows an individual’s immune system to strengthen and regain the capacity to fight off infections.

Antibodies to HIV appear shortly after HIV infection.  It usually increases over the first 6–12 months of infection.  ART can down-regulate the body’s antibody responses to the infection, meaning less antibodies are present in the blood.  A HIV rapid diagnostic screening tests detects these antibodies.  If they are lowered, it can result in a false test result.  This does not mean you are “cured” from HIV.  It means that the disease is under control as the result of ART.

Urinalysis

What is urinalysis?

Urinalysis is a test of your urine.  Basic urine analysis regularly forms part of routine screening at clinics, hospitals and in doctor’s rooms.

Urinalysis involves checking the appearance, concentration and content of urine.  Abnormal urinalysis results may point to a disease or illness.

Urine testing strips detects a wide range of disorders.  For example, urinary tract infections, kidney disease and diabetes.  A urinary tract infection can make urine look cloudy instead of clear.  Nitrite, a chemical produced by most bacteria suggests a bacterial infection.  Increased levels of protein in urine can be a sign of kidney disease.  A higher than normal glucose level can indicate diabetes and ketones can be sign of diabetic complication.

Unusual urinalysis results often require more testing to uncover the source of the problem.  The use of reagent strips is an initial screen for abnormalities in the urine.  These test results are an indication of a potential disease and it is not conclusive of a specific diagnosis.  Further testing and consultation with a healthcare professional is necessary to confirm the presence of a specific disease or health condition.

What is Specific Gravity (SG) and why is it important?

Specific Gravity (SG) indicates the concentration of urine.  SG dependents on the time the urine spends in the bladder.  It is an important factor for the accurate analysis of urine.

Kidney failure can result in a low SG.  If there is no kidney failure then a SG below 1.020 – 1.025 indicates that the urine was not in the bladder for the required minimum of 2-3 hours.  So, all the test results will be incorrect.

Can you test refrigerated urine samples?

Yes.  Test fresh urine samples within 4 hours from collection.  Bring refrigerated urine samples to room temperature (15° – 30°C) before testing.

Uric acid

What is uric acid?

Uric acid is a waste by-product.  It forms when your body breaks down purines, that are found in some foods.  Purines also turn up when cells die and are taken apart.  Most of the uric acid leaves your body when you urinate.

What causes high levels of uric acid?

Primarily, hyperuricaemia or high levels of uric acid is the result of either the body producing too much uric acid or the kidneys not clearing it fast enough. Other causes for high levels of uric acid include:

• Certain cancers or chemotherapy that increases the turnover rate of cell death.
• Kidney disease reduces the clearing of uric acid out of your system, thus causing hyperuricemia.
• Certain medications can increase the levels of uric acid in the blood.  For example, immunosuppressive medication and water pills (diuretics).
• Endocrine or metabolic conditions, such as certain forms of diabetes or acidosis can cause hyperuricemia.

Foods that are high in purine include:

• All organ meats (such as liver), meat extracts and gravy.
• Seafood.
• Yeasts and yeast extracts (such as beer and alcoholic beverages).
• Asparagus, spinach, beans, peas, lentils, oatmeal, cauliflower and mushrooms.
• Drinks sweetened with fruit sugar (fructose).

The impact of alcohol consumption on uric acid

Alcohol use increases uric acid levels in three ways:

• Alcohol, like red meat and seafood, is high in purines.  When your body breaks down purines, the process releases uric acid.
• Alcohol also intensifying the body’s production of uric acid.  It increases the metabolism of nucleotides.  These are an additional source of purines for uric acid production.
• Alcohol also reduces the rate at which your body removes uric acid.

What is a uric acid test?

This test measures the amount of uric acid in your blood or urine.

For a uric acid urine test, you collect all urine passed in a 24-hour period (a 24-hour urine sample).  A laboratory then analyses the urine sample.

For a blood test there are two options. Collect a drop of blood from a finger prick and test it with a test strip and reader. This provides immediate results.  Alternatively, a blood test can also be done at a laboratory.

Normal uric acid levels are 2.4-6.0 mg/dL (female) and 3.4-7.0 mg/dL (male).

Gout

What is gout?

Gout is a form of inflammatory arthritis.

What causes gout?

Gout develops in some people who have high levels of uric acid in their blood.

Uric acid can form needle-like crystals in a joint.  Gout occurs when these urate crystals build-up in the joint.  As the crystals collect in the joint, it causes inflammation and intense pain, bringing about a gout attack.  This build-up often affects feet first.

A gout attack is the experience of sudden severe pain, tenderness, redness, warmth and swelling of a joint.  During a gout attack it can feel like your foot is on fire.

What are the stages of gout?

There are several stages of gout:

• The asymptomatic period is the time period before the first gout attack.  There are no symptoms, but blood uric acid levels are high and crystals are forming in the joint.
• Acute gout, or a gout attack, happens when something (such as a night of drinking) causes uric acid levels to spike or to release the crystals that have formed in the joint, triggering the attack.  The resulting inflammation and pain usually strike at night and intensify over the next 8 to 12 hours.  The symptoms ease after a few days.
• Interval gout is the time between gout attacks.  Although there’s no pain, the gout isn’t gone.  Crystals builds-up and low-level inflammation may damage joints.
• Chronic gout develops in people with gout whose uric acid levels remain high over a number of years.  Attacks become more frequent and the pain may not go away as it used to.  Joint damage may occur, which can lead to loss of mobility.  With proper management and treatment, it is possible to prevent this stage.

What happens if gout is not treated?

Although gout itself is not life-threatening, it is often associated with serious diseases:

• Repeated gout attacks can damage the affected joints.  Once the joints are damaged, the person may experience stiffness and limitation of motion even after the attack of gout is over.
• Untreated gout may cause disfiguring deposits of urate crystals to form under the skin in nodules called tophi (TOE-fie).  Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons along the back of your ankles.  Tophi usually aren’t painful, but they can become swollen and tender during gout attacks.
• Uric acid crystals can form kidney stones.  These stones may cause pain (colic), but more importantly, they can cause kidney damage through the repeated infection or obstruction to the flow of urine.

Gout risk factors:

• Genes: If family members have gout, you’re more likely to develop it.
• Other health conditions: High cholesterol, high blood pressure, diabetes and heart disease may raise your risk.
• Medications: Diuretic medications or “water pills” taken for high blood pressure can raise uric acid levels.  Some medicine that suppress the immune system taken by rheumatoid arthritis, psoriasis and transplant patients also impact uric acid levels.
• Gender and age: Gout is more common in men than women until around age 60.  Oestrogen plays a role in keeping uric acid levels low.  After menopause women’s uric acid levels approach those of men.
• Diet: Eating a diet rich in red or organ meat or seafood and drinking beverages sweetened with fruit sugar (fructose) increase levels of uric acid.
• Alcohol: For most people, more than 2 alcoholic drinks a day can increase the risk of gout.
• Obesity: Obese people are at a higher risk for gout and they tend to develop it at a younger age than people of normal weight.
• Gastric bypass surgery: Those who have undergone gastric bypass surgery have an increased risk.

What triggers a gout attack?

Medical or health triggers of gout:

• Joint injury.
• Surgery or sudden, severe illness.
• Infection.
• Taking certain medications.  E.g. diuretic medications for high blood pressure, leg swelling (oedema) or heart failure and cyclosporine.
• Starting uric acid lowering treatment.
• Chemotherapy.

Lifestyle triggers of gout:

• Crash diets and fasting.
• Drinking too much alcohol.
• Eating large portions of certain foods high in purines.
• Dehydration (not getting enough fluids).
• Drinking fructose sweetened beverages.
• Stress.

Ovulation

What is ovulation?

Ovulation is a part of the menstrual cycle.  It occurs when the ovary releases a mature egg.  The released egg travels down the fallopian tube where it may, or may not be fertilized by sperm.

During ovulation, the walls of the uterus thicken to prepare for a fertilized egg.  If fertilized, the egg implants in the uterus to develop into a pregnancy.  If left unfertilized, the egg disintegrates and the uterine lining is shed about two weeks later, causing menstrual flow to begin.

A woman is most fertile around the time of ovulation.

When does ovulation occurs?

Ovulation as a rule occurs halfway through the menstrual cycle.  This is around day 14 of the average 28-day cycle counting from the first day of one period to the first day of the next.  However, not everyone has a textbook 28-day cycle, so the exact timing varies.  In general, ovulation follows in the 4 days before or the 4 days after the cycle’s midpoint.

The process of ovulation begins with the release of follicle-stimulating hormone (FSH).  This happens typically between days 6 and day 14 of the menstrual cycle.  This hormone helps the egg inside the ovary to mature.

Once the egg is mature, the body releases a surge of luteinizing hormone (LH), triggering the egg’s release.  Ovulation happens in the next 24 to 36 hours.

Ovulation lasts between 12 and 24 hours.  That’s how long the released egg is viable for fertilization.

How do I know when I am ovulating?

Beside charting the timing on a calendar, a woman has other clues that she could be ovulating:

• A change in vaginal secretions.  Looming ovulation can cause an increase in vaginal discharge.  This discharge is often clear, stretchy and it may even resemble raw egg whites.  After ovulation, the discharge decreases in volume and appears thicker or cloudier.
• A change in basal body temperature.  Keeping track of a woman’s basal body temperature for 2 to 3 menstrual cycles may help predict when she is fertile.  Basal body temperature is taken in the morning before you get out of bed.  Shortly after ovulating, many women show a slight increase in early morning body temperature.  A woman is most fertile during the 2 to 3 days before her temperature rises.
• Increase in LH.  About 24 to 36 hours before a woman ovulates, her levels of LH increases.  A rise in LH is a signal for the ovary to release an egg.  An ovulation kit can detect this hormone’s increase.  The ovulation kit tests a sample of urine in the days leading up to ovulation.  A rise in LH will show a positive result.

If you menstruate, it does not mean that you ovulate

The most misunderstood thing about ovulation, is the idea that if you are menstruating, it means you are ovulating.  This is not true.

If a woman gets her period on a monthly basis, but is not becoming pregnant, it may be because she is not ovulating.  An ovulation kit can be helpful to see whether a woman is, in fact, ovulating.  If the test shows that ovulation isn’t occurring, it’s best to check-in with your doctor.

Why am I not ovulating?

There are many reasons why a woman may have ovulation problems.

Some women, for example, have blocked fallopian tubes.  This may be due to pelvic inflammatory disease, endometriosis or surgery for an ectopic pregnancy.

An abnormal level of hormones can cause ovulation to be irregular or not occur at all, for example, polycystic ovary syndrome (PCOS).  Thyroid problems can also make the ovaries less likely to release an egg.

A woman who is underweight with a body mass index (BMI) of 18.5 or less may have irregular menstrual cycles.  This could also cause ovulation to stop.  Obesity can also lead to irregular periods and irregular ovulation.

Stress and excessive exercise can influence the timing of ovulation.  Emotional or physical stress may delay ovulation or prevent a woman from ovulating.  Getting too much or intense physical activity can also inhibit ovulation.

Problems with ovulation are just one possible cause for infertility.

Ovulation and fertility tests

Ovulation test kits, for example U-Test Ovulation, determines when there is a LH (Luteinizing hormone) surge.  The LH surge indicates when a woman will ovulate and thus when she is likely to conceive.

FSH (Follicle stimulating hormone) stimulates follicle development.  A fertility screening test, for instance U-Test Fertility, shows if the FSH levels are higher than expected.  This indicates a possible fertility issue.

What is luteinizing hormone (LH) and how does it assist with becoming pregnant?

LH is normally present in small amounts in urine.  It plays an important role in regulating ovulation and ovarian functions during the menstrual cycle.  About 12-30 hours before the ovarian follicle releases a mature egg, the level of LH rises rapidly (LH surge).  LH peaks at the mid-cycle.  The U-Test Ovulation test detects this LH surge.  Ovulation should occur within the next 24-36 hours.

The “fertile window” spans a 6-day period.  It is the 5 days before ovulation plus the day a woman ovulates.  The egg can only be fertilized in the 12 to 24 hours after it’s released.  However, sperm can live in the reproductive tract under ideal conditions up to 5 days.  So, if you have sex in the 3 days leading up to ovulation or on the day of ovulation itself, you may become pregnant.

What is follicle stimulating hormone (FSH) and what role does it play in fertility?

In women, FSH stimulates the growth and maturation of ovarian follicles during the menstrual cycle.  During the menstrual cycle, FSH plasma levels vary in response to estradiol and progesterone levels.  Shortly before ovulation we observe a significant rise in LH an FSH.  After ovulation, when the follicle has ruptured, the developed corpus luteum secretes estradiol and progesterone.  This decreases the level of LH and FSH back to the low levels prior to ovulation.

As the body ages, it produces less and less estrogen.  FSH levels then increase to 25 miU/ml or more as the hormone tries to stimulate the ovaries to produce a healthy egg.  Therefore, testing for FSH can help determine if a woman’s body produces too much FSH because of low estrogen levels.

An elevated FSH represents a reduced egg supply (in number of eggs remaining).  It might also reflect a compromise off egg quality.

FSH tests can provide useful information to women wanting to fall pregnant or who are concerned about their fertility, ovarian health and function.
U-Test Fertility aid women experiencing irregular menstrual cycles or having difficulty to conceive, to determine if this is related to elevated FSH levels or not.  FSH tests help in evaluating menstrual problems, irregular or absent menstrual periods and to evaluate fertility, perimenopause and menopause.

FSH testing for fertility should be carried out on day 3 of the menstrual cycle (2 days after the onset of menstruation).  Use first morning urine as it contains the highest concentration of the hormone.

Menopause

What is menopause?

Menopause is a normal condition that all women experience as they age.

The term menopause can describe any of the changes a woman goes through either just before or after she stops menstruating, marking the end of her reproductive period.

What causes menopause?

Normal changes in the reproductive and hormone system cause menopause.

A woman is born with a finite number of eggs stored in her ovaries.  As the egg supply ages, the body begins to ovulate less often.  This affects hormone levels.  As the hormone levels fluctuate it triggers changes in the menstrual period and other symptoms.  In time, oestrogen and progesterone levels drop so low that the menstrual cycle stops.

Menopause take place when the ovaries no longer release an egg every month and menstruation stop.

Menopause is as natural as menstruation, pregnancy and childbirth.  It is a normal part of growing older!  Normal menopause happens after the age of 40.

However, some women can go through menopause early.  Either as a result of surgery (for example hysterectomy) or damage to the ovaries (for instance chemotherapy).  Menopause that happens before 40, regardless of the cause, is called premature menopause.

How does normal menopause happen?

Menopause is gradual process with three stages:

• Perimenopause:  This typically begins several years before menopause.  It is when the ovaries gradually make less oestrogen.  The duration of perimenopause can’t be predicted in advance, but usually lasts from 2 to 8 years.  Perimenopause lasts up until menopause.  Menopause is the point when the ovaries stop releasing eggs.  In the last 1 to 2 years of perimenopause, the decrease of oestrogen hastens.  At this stage, many women have menopausal symptoms.
• Menopause:  It is the point when it’s been 12 months since a woman last had her menstrual period.  The ovaries stopped releasing eggs and produce small amounts of oestrogen.
• Post menopause:  These are the years after menopause.  During this stage, menopausal symptoms such as hot flashes ease for most women.  However, the health risks related to the loss of oestrogen rise as the woman ages.  Post-menopausal women are at an increased risk of osteoporosis and heart disease.

What is premature menopause and when does it occur?

Premature menopause is defined as menopause occurring before the age of 40.  This occurs naturally in approximately 1% of women.

Other causes of premature menopause include genetics, autoimmune disorders, cancer, thyroid disease and diabetes mellitus.

Premature menopause can be the result of medical procedures and other conditions:

• Premature ovarian failure.  Normally, the ovaries make both oestrogen and progesterone.  Changes in the levels of these hormones happen when the ovaries, for unknown reasons, prematurely stop releasing eggs.  When this happens before the age of 40, it’s called premature ovarian failure.  Unlike premature menopause, premature ovarian failure is not always permanent.
• Induced menopause.  Induced menopause is the result of the surgically removal of ovaries for medical reasons.  For instance, uterine cancer or endometriosis.  It can also result from damage to the ovaries caused by radiation or chemotherapy.

How do I know when I’m going through menopause?

Apart from to the typical symptoms of menopause, your doctor can do a blood test (FSH test) to determine menopause.  It also helps if you keep track of your periods and chart them as they become irregular.

Symptoms of menopause

Most women approaching menopause will have hot flashes.  Hot flashes are a sudden feeling of warmth that spreads over the upper body, often with blushing and some sweating.  The severity of hot flashes varies from mild in most women to severe in others.

Other common symptoms include:

• Irregular or skipped periods
• Insomnia
• Mood swings
• Fatigue
• Depression
• Irritability
• Racing heart
• Headaches
• Joint and muscle aches and pains
• Changes in libido (sex drive)
• Vaginal dryness
• Bladder control problems

Some women have none or only a few mild symptoms and others have severe symptoms that disrupt their sleep and lives.

Can I test for menopause?

Measuring the levels of follicle stimulating hormone (FSH) assist with diagnosing menopause.  FSH levels should normally be below 25mIU/ml, except during mid-cycle.

As oestrogen levels decline, FSH levels increase to 25mIU/ml or more as the hormone tries to stimulate the ovaries to produce a healthy egg.  Therefore, testing for FSH (such as U-Test Menopause) can help determine if the body produces too much FSH because of low oestrogen levels.  This points to lower fertility and menopause.

In both normal and premature menopause, the level of follicle stimulating hormone (FSH) rises.

Test limitations:

• As with all diagnostic tests, a final diagnosis should not be based on the result of a test alone.  It should be made in conjunction with other clinical evidence by your doctor.
• Using medication that contains hCG or LH may affect the test result.
• The test can give incorrect results if you are pregnant, used oral contraceptives recently or are receiving fertility treatment.
• The presence of a tumour in the hypothalamus may give a low FSH reading.
• Heavy intake of fluids before testing will dilute the hormone level in your urine.  Limit the amount of fluid intake for about 2 hours before you do the test.

Prostate cancer

Excluding melanoma of the skin and non-melanoma skin cancers, prostate cancer is the most common type of cancer found in men.

According to the 2014 National Cancer Registry 1 in 19 men are at the risk of prostate cancer in their lifetime in South Africa.

Men need to go for simple screening tests to detect prostate cancer.  Screening results in early detection and enables more effective treatment and a better chance of recovery.  Although most enlargements of the prostate are not cancerous regular screening is essential.

CANSA recommendations

• Routine prostate specific antigen (PSA) testing, annually, from age 40 for all men at high risk of prostate cancer.
• Routine prostate specific antigen (PSA) testing, annually, as from age 45 for all men who are at risk of prostate cancer.
• Routine prostate specific antigen (PSA) testing, at least once every 2 years, for all men from age 50.

This includes men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than 65 years).

What is the prostate?

The prostate is a gland.  It is about the size of a walnut.  The prostate lies between the base of the penis and the rectum immediately below the bladder.  It is an important part of the male reproductive system as it secretes fluid during ejaculation prolonging the lifespan of sperm.

The prostate gland surrounds a portion of the urethra.  The urethra is a tube that carries urine from the bladder to the tip of the penis.

What is prostate cancer?

Prostate cancer is a cancerous tumour that begins in the prostate gland.

Normally all human cells grow and divide to form new cells as the body needs them.  As cells age or become damaged they die, and new cells take their place.  In the case of prostate cancer, this orderly process of cell division breaks down and cells start to divide in an uncontrolled manner to form growths called tumours.  Cancerous tumours are malignant.  They can spread into or invade nearby tissues.  Apart from this as the tumours grow, cancer cells can break off from the original cancer and spread to distant parts of the body through the blood or lymphatic system to form new tumours.  This is called metastasis.

Some prostate cancers grow very slowly and may not cause symptoms or problems for years.  However, most prostate cancer cells make excessive amounts of a protein called prostate specific antigen (PSA).  In addition to prostate cancer PSA is also found in higher than normal levels in men with various other prostate conditions, for example benign prostatic hyperplasia (BPH) and prostatitis.

Risk factors for prostate cancer

• Age: Age is the strongest risk factor for prostate cancer. Prostate cancer is very rare before the age of 40, but the chance of having prostate cancer rises rapidly after age 50.
• Family history: Prostate cancer seems to run in some families. Scientists found several inherited genes that seem to raise prostate cancer risk.
• Race/ethnicity: Prostate cancer occurs more often in African American men than in men of other races. Current evidence shows that this is applicable to South African black men. In black men, prostate cancer is also more aggressive or advanced.  It is not clear why this is so.
• Diet: Men who eat a lot of red meat or high-fat dairy products have a higher risk of getting prostate cancer.
• Obesity: Obese men diagnosed with prostate cancer often have advanced disease. This is more difficult to treat – with specific reference to belly fat.
• Use of anabolic steroids.
• High alcohol intake: Alcohol is a Group 1 carcinogen according to the International Agency for Research on Cancer (IARC).

Signs and symptoms of prostate cancer

Prostate cancer often occurs without any symptoms.

A variety of urinary symptoms may be tied in with prostate cancer.  This is due to the proximity of the prostate gland in relation to the bladder and urethra.  Depending on the size and location a tumour can press on and constrict the urethra inhibiting the flow of urine.

Some prostate cancer signs include:

• A slow and painful discharge of urine, drop by drop (straining to pass urine).
• Abnormally frequent urination, especially at night.
• Painful or burning sensation during urination or ejaculation.
• Bloody urine or semen.
• Trouble starting and stopping while urinating.
• Loss of bladder control (leaking urine).
• Decreased flow or velocity of urine stream.
• Erectile dysfunction or painful ejaculation.
• Swelling in the legs or pelvic area, numbness or pain in the back, hips or upper legs (thighs).

Screening for prostate cancer

Prostate screening tests include:

• Digital rectal exam (DRE): During a DRE your doctor inserts a gloved, lubricated finger into the rectum to examine the prostate.  The prostate is adjacent to the rectum.  If the doctor finds any abnormalities in the texture, shape or size of the gland he usually requests further tests.
• Prostate-specific antigen (PSA) test: The PSA test is a blood test that measures (quantitative) or detects (qualitative) the amount of prostate specific antigen (PSA) in the blood.  It’s normal for a small amount of PSA to be in the bloodstream.  However, if a higher than normal level is found it can indicate prostate infection, inflammation, enlargement or cancer.
• PSA testing combined with DRE helps identify prostate cancers at their earliest stages. Neither the PSA test nor the DRE provides enough information for your doctor to diagnose prostate cancer.  In abnormal test results the next step is a prostate biopsy.  Prostate biopsy removes samples of tissue for laboratory examination.  The biopsy results diagnose prostate cancer.

Source: Cancer Association of South Africa (CANSA) Fact Sheet on Prostate Cancer, researched and authored by Prof Michael C Herbst.

Prostate specific antigen (PSA) test

What is PSA?

Prostate specific antigen (PSA) is a protein produced by both cancerous (malignant) and non-cancerous (benign) prostate tissue.  During ejaculation the body produces PSA to liquefy semen that allows sperm to swim freely.

PSA is present in small quantities in the blood of men with healthy prostates.  Prostate cancer or other prostate conditions often elevates PSA levels.

What is a PSA test?

A quantitative PSA test (laboratory) measures the amount of PSA in the blood.  A finger prick test (qualitative) detects if the PSA levels are higher than a certain level in the blood.

It’s normal to have a small amount of PSA in the blood.  PSA rises slightly as men get older and the prostate gets bigger.  An elevated PSA level can indicate a problem with the prostate, but not necessarily cancer.

A PSA test is a screening test or aid to identify potential prostate problems.  A finger prick test, e.g. U-Test PSA detects PSA concentrations 4ng/ml or higher.  Visit your doctor if the test result is positive.

PSA levels can be elevated in men with prostate cancer.  However, many non-cancerous conditions also increase the PSA level.  The PSA test detects high levels of PSA in the blood, but doesn’t provide precise diagnostic information about the condition of the prostate.

What is a raised PSA level?

The amount of PSA in the blood is measured in nanograms of PSA per millilitre of blood (ng/ml).  PSA levels can range from 1ng/ml to hundreds of ng/ml.  There is no specific normal or abnormal level of PSA in the blood and levels vary over time in the same man.  For example, PSA increases as men get older.  In addition, various other factors can cause a man’s PSA level to fluctuate.

According to CANSA PSA levels is considered raised if:

• It is 3ng/ml or higher in patients aged 50–59.
• If it is 4ng/ml or higher in patients aged 60–69.
• If it is 5ng/ml or higher in patient aged 70 or over.

In general, the higher a man’s PSA level the more likely it is prostate cancer.  Moreover, a continuous rise in a man’s PSA level over time may also be a sign of prostate cancer.

When should I do a PSA test?

PSA is not a unique indicator of prostate cancer.  However, it is prostate specific and also detects prostatitis or benign prostatic hyperplasia.

PSA increases as men age, when the prostate enlarges, or becomes inflamed and when prostate cancer is present.

There are also momentary bumps in PSA after for example a digital rectal examination (DRE), or ejaculation and vigorous exercise especially bike riding.  Urinary tract infections, a recent prostate biopsy and having a urinary catheter passed may also raise PSA levels for a short period of time.

Obesity and certain medications lower the PSA reading and can cause a false negative result.

Professional organizations vary in their recommendations about who should get a PSA screening test.  Discuss with your doctor the benefits, limitations and potential risks of the PSA test.  Then make an informed decision.

Benefits of the test:

• A PSA test aids in the early detection of prostate cancer before any symptoms appear.
• A PSA test assists picking- up a fast-growing cancer at an early stage when treatment may stop the cancer spreading and causing problems.
• Slow-growing prostate cancer might not need treatment. Regular check-ups including PSA tests helps keeping an eye on the cancer.  This can avoid or delay the side effects of treatment.
• Having regular PSA tests benefits men who are more at risk of prostate cancer. This helps to spot any changes in the PSA level which might be a sign of prostate cancer.

Limitations and risks of a PSA test:

• Obesity and certain medications lower the PSA levels and can cause a false negative result.
• Besides cancer other conditions can raise PSA levels. This includes an enlarged prostate (benign prostatic hyperplasia or BPH) and an inflamed or infected prostate (prostatitis).  Also, PSA levels normally increase with age.  PSA levels can also be temporarily elevated.
• The PSA test can miss prostate cancer. Often men with fast-growing prostate cancer have normal PSA levels.  Not all men with prostate cancer have raised levels of PSA.
• Slow-growing prostate cancer may never cause any problems or shorten life. But being diagnosed with cancer could cause worry or lead to treatment.  Treatments for prostate cancer have side effects that affect one’s daily life.  These include urinary and bowel problems and problems getting and keeping an erection.

Malaria

What is malaria?

Malaria is a life-threatening disease.  Infected female mosquitoes pass on the parasite to people through their bites causing the disease.

The parasite Plasmodium falciparum is the main source of malaria.  There are 4 other plasmodium parasite species: Plasmodium ovale, vivax, malariae and knowlesi.

Who gets malaria?

Any person living in or traveling to a country where malaria occurs is at risk.

Where does malaria occur?

Malaria occurs across the globe in tropical and sub-tropical areas.  Malaria is currently a problem in Asia, Africa, Central and South America.

Within South Africa, malaria appears mainly in Northern and Eastern Mpumalanga, Northern KwaZulu-Natal and the border areas of Northern and North West provinces.

Malaria is also a threat to travellers visiting the lower lying areas of Swaziland, Mozambique, Zimbabwe and most of Botswana.  Northern Namibia is a malaria area.

Malaria is seasonal in South Africa.  It is at its highest during the warmer and wetter months of November to April.  The risk reduces during May to October.  However, a low risk does not mean that there is no risk!

How do you get malaria?

When the female mosquito bites a person with malaria, she becomes infected.  When this mosquito then bites you, she injects the malaria parasite into your body.  The parasites attack your red blood cells and invade the liver causing malaria.

Transfusion of blood from infected people can bring about malaria.  Another source is the use of contaminated needles or syringes.

What are the symptoms of malaria?

Symptoms of malaria include:

• Flu like feeling.
• Fever.
• Chills or shivering.
• Sweating.
• Generalized body ache.
• Tiredness.
• Headache.
• Nausea, vomiting, loss of appetite and diarrhoea may also occur.

Malaria may cause anaemia and jaundice (yellow colouring of the skin and eyes) due to the loss of red blood cells.

Young children usually show symptoms of fever, tiredness, loss of appetite and vomiting.

Why is malaria dangerous?

Plasmodium falciparum is the main cause of malaria in South Africa.  It is potentially the most dangerous type of malaria and can prove rapidly fatal.

Cerebral malaria is extremely serious, with the victim becoming delirious and entering a coma.  Cerebral malaria is frequently fatal.

Symptoms may develop as soon as 7 days after entering a malaria area and as long as 6 months after leaving a malaria area.

All persons possibly exposed to malaria that develops influenza-like illnesses or fever within 7 days after entering a malaria area should seek immediate medical attention.  This is irrespective of the time of year, or whether or not prophylactic medicine was taken.  Malaria symptoms may not be dramatic and are easily mistaken for flu.

It is extremely important that all suspected cases of malaria should receive immediate medical attention.

How soon do symptoms occur?

The time between the infective mosquito bite and the development of malaria symptoms can range from 7 to 30 days depending on the type of parasite involved.

When infection occurs by blood transfusion the incubation period depends on the number of parasites transferred but is usually less than 2 months.

When and for how long is a person able to spread malaria?

Untreated or inadequately treated malaria cases may be a source of mosquito infection for 1 to 3 years depending on the strain of Plasmodium. Direct person-to-person transmission does not occur.

Stored blood products can remain infective for 16 days.

What medicine should I take to prevent malaria?

Your doctor, travel clinic or pharmacist can advise you as to what medicine to take to reduce the risk of getting malaria.

Avoiding mosquito bites is more important than using preventative medication

• Avoid exposure to mosquitoes during the early morning and early evening hours.  It is the hours of greatest mosquito activity.
• Wear appropriate clothing (long-sleeved shirts, socks and long trousers), especially when you are outdoors.
• Apply generous amounts of insect repellent frequently to exposed skin.
• Spray mosquito repellent on clothing to prevent mosquitoes from biting through thin clothing.
• Use a mosquito net over your bed.  Treat the net regularly with an insecticide.
• Cover windows and doorways with screens.
• Close windows and doors at night.  Use a ceiling fan or air-conditioner.
• Spray the inside of the house with an insecticide for flying insects at dusk, especially the bedrooms after closing the windows.
• Burn mosquito mats or coils in living areas and bedrooms during the night.
• Stay in well-constructed, well ventilated and well-maintained buildings.

How do I know if I have malaria?

The period between the bite of an infected mosquito and the start of illness is usually 7 to 21 days.  Anti-malaria (prophylactic) medicine can lengthen the period.

All persons potentially exposed to malaria that develops influenza-like symptoms or fever within 7 days after entering a malaria area, should seek immediate medical attention.  This is regardless of the time of year or whether or not prophylactic medicine was taken.  Malaria symptoms may not be dramatic and are easily mistaken for flu.

It is extremely important that all suspected cases of malaria receive urgent medical attention.

A laboratory test confirms if malaria parasites are in your blood.  However, this test takes time.  Due to the urgency of obtaining a diagnosis, a rapid diagnostic screening test for malaria is helpful.  This screening test does not require experienced personnel or equipment. The test results are immediately available.

Malaria rapid diagnostic screening tests

Malaria rapid diagnostic screening tests (RDTs) detect in the blood, of people infected by malaria, specific antigens produced by the parasites.

Some malaria RDTs detect only one species (Plasmodium falciparum), while others, for example U-Test Malaria, identify multiple species (Plasmodium falciparum, vivax, malariae and ovale).

RDTs are relatively simple to perform and interpret.  A finger-prick provides the blood needed for the test.  It enables a reliable detection of malaria infections particularly in remote areas.  Do the test anywhere and at any time!

U-Test Malaria is fast and easy to use.  It gives a result within 15 to 30 minutes.  The single test kit includes all the items needed to perform the test.  It includes a finger pricker (lancet) and a sterile swab.

A healthcare professional should confirm a positive result.  It is important to remember that due to the long incubation period (7 to 21 days), before the start of the illness, that a negative test result does not completely rule out the possibility of malaria.  If the symptoms continue, repeat the test after a few days.