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What genitals do you have?

Small white, pigmented or skin-coloured lumps, either as a single bump or in a group. The lumps might feel rough and cauliflower-like, or they can be smooth and flat. They do not hurt but they can be itchy. 

Small blisters which burst and leave painful sores. You might also notice tingling or itching in the area, or find it painful when you pee.

Little groups of small, shiny bumps. These are typically smooth and firm. The bumps are not painful or itchy.

A raised, itchy rash that looks like red pimples. This might be harder to see on darker skin. The itchiness gets worse at night. 

Small white or flesh-coloured lumps around the head of the penis. These are not a sign of infection, they’re a normal, natural part of your genitals. You do not need treatment.

Something else. Any symptoms that do not match the descriptions above.

Which best describes your symptoms?

Have the lumps ever changed colour or bled, are they larger than 4cm across or are any of them inside the anus, vagina or penis?

Is there a chance you could be pregnant, or are you trying to get pregnant?

How long have you been experiencing this current episode or outbreak?

Have you ever had a diagnosis of genital herpes confirmed by a swab test?

Have you been diagnosed with genital warts before?

Where were you diagnosed?

Which clinic was it?

Which GP was it?

What was the name of the service?

What type of genital herpes were you diagnosed with?

When did you last use any prescription treatment on this area?

What treatment have you used in the past?

Do you get any symptoms before ulcers appear, known as a prodrome?

Please tell us more

Where are your warts?

Are they painful?

Is it painful?

Have you picked, scratched or squeezed the sores recently?

How does this affect you?

Are any of the blisters open and oozing liquid?

How many times a year do you experience this?

Are you having any other problems?

What problems are you having?

Have you spoken to a clinic, pharmacy or GP about this outbreak?

Please let us know when you spoke with them and what advice they gave you.

Do you give us permission to refer you to a local sexual health service if you need in-person care?

Is there anything else we should know?

How would you describe your gender identity?

How would you describe your gender?

Is your gender identity the same as the sex you were assigned at birth?

Who do you have sex with?

How would you describe your sexual orientation?

Which of these describes you best?

Which country were you born in?

Have you had unprotected sex within the last 5 days?

Do you have any medical problems?

Please specify

Do you take any medication regularly?

Are you allergic to lactose?

I can tolerate the small amounts of lactose in pills

I can NOT take pills with small amounts of lactose

Can you tolerate small amounts of lactose?

Are you allergic to peanuts?

Are you allergic to soy?

I can take medication that contains soybean oil

I have a severe nut allergy and need to discuss alternative options

Do you need soy-free medication?

Are you allergic to oestrogens in combined hormonal contraceptives?

Are you allergic to progestogens in hormonal contraceptives?

Are you allergic to doxycycline?

Are you allergic to azithromycin?

Are you allergic to aciclovir?

Are you allergic to podophyllotoxin?

Are you allergic to imiquimod?

Are you allergic to any other medications or foods?

What are you allergic to?

Are you breastfeeding?

Is there a chance you could be pregnant?

Are you trying to conceive?

What method of contraception are you using?

Have you ever had any other health conditions, illnesses, major surgery or medical treatment that we should know about?

Please tell us more.

Does anyone in your life make you feel scared or unsafe?

Do you feel down or depressed?

Is your partner a lot older than you?

Has anyone given you something, like gifts or money, for sex?

Have you been pressured into sex?

Do you feel scared or uncomfortable with anyone you have sex with?

Have you been sexually assaulted?

Some communities practise female circumcision or cutting, where the female genitals are deliberately cut or changed. Has this happened to you?

Are there any girls or young women in your household whose cutting, closing or circumcision might be planned?