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Medical Assessment for Genital Herpes Management

Complete this short online consultation so our medical team can show you suitable treatments.

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Tell us about yourself
Are you aged between 18 and 65?
Have you been diagnosed by your GP or GUM clinic with Genital Herpes (HSV-1 or HSV-2)?
About Your Symptoms
Are you experiencing any of the following?
  • thrush
  • unintentional weight loss
  • chest pain
  • blood in your urine
  • pain when urinating
  • blood in your stools
  • urinary tract infections (UTI)
  • night sweats
  • fever
Your Current Medication
Are you breast feeding or pregnant or possibly pregnant?
Do you have an allergy (hypersensitivity) to medicines containing Aciclovir or Valciclovir or Famaciclovir or Penciclovir?
Have you been diagnosed with any of the following?
  • Liver problems
  • Kidney problems
  • Immunodeficiency conditions (eg. HIV)
  • Nervous system abnormalities
  • Any serious medical condition which may require immediate hospitalisation
Your Health Information
Are you currently taking any medication (including over the counter, prescription or recreational drugs)?
Patient Declaration & Agreements
Do you agree to the following?
  • You will read the patient information leaflet supplied with your medication
  • You will contact us and inform your GP of your medication if you experience any side effects of treatment, you start new medication and/or your medical conditions change during treatment
  • The treatment is solely for your own use
  • You have answered all the above questions accurately and truthfully
  • You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health
  • You understand that whilst decisions relating to your treatment are made jointly between you and the prescriber, the final decision to issue a prescription will always be with the prescriber.
Do you understand that if your symptoms do not improve after 7 days you must see your doctor?
Do you understand that you should drink water regularly during your treatment? This will help reduce side effects that can effect your kidneys or nervous system.
Do you understand that you should maintain genital hygiene and avoid sexual contact during your outbreak?