About your Condition We need to understand more about your specific condition to help find the most suitable medication or advice to help you. Please can you answer the following questions. If you get stuck or need any help, you can contact us.
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Back Have you ever been previously diagnosed by a GP or GUM clinic with genital herpes?
Do you currently have symptoms of genital herpes? This includes some of the following; - Painful blisters in the genital area - Blisters that have become erosions or ulcers in the genital area - Tingling pain in the genital area, lower back, buttocks or legs Have you ever previously been treated for genital herpes?
Have you suffered with more than 6 repeat episodes of genital herpes within the last 12 months?
Are you currently experiencing any of the following symptoms? - Blood in your stools or urine - Unintentional weight loss - Night sweats - Fever - Pain when passing urine - Genital discharge Have you ever been diagnosed with any other medical conditions? This can include:
-Immune system conditions such as HIV -Liver or kidney issues Do you suffer with any allergies?
Do you currently take any medication? This includes herbal remedies and over the counter medication.
Are you currently pregnant, planning a pregnancy or breastfeeding?
Is there any other information you would like to share with our prescribing team? If so, please provide more information
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