Our doctors would now like to check your suitability for this product

Important

This questionnaire forms the basis of your online consultation. Please be honest and if you are unsure about any of your answers, please verify the information with your GP before using the service:

I am 18 years old or above.
I am using this service on my own behalf and of my own free will. Any treatment or advice is for my sole use only.
Please see your GP or go to a sexual health clinic if you have been a victim of sexual assault or violence

I confirm the above statements are true

Confirm Appropriate Test

Our commitment to you is that we will deal with your assessment in a sensitive and professional way and make sure that any data you provide is kept confidentially. We will provide safe, evidence-based advice to best look after your health.

If this is the first time you are being tested for STIs we would advise being tested for Chlamydia, Gonorrhoea, HIV and Syphilis.

Please confirm your gender identity

Female (including trans woman)

Male (including trans man)

Non-binary

Other

Sex of patient record when filling in questionnaire (U=not logged in yet)

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

Yes

Prefer not to say

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

Yes

Prefer not to say

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

Yes

Prefer not to say

Please check that you have ordered the most appropriate STI test kit. If your gender identity is not the same as the sex you were assigned at birth, you may need to purchase more than one test kit. If you are unsure which kit to order, please send us a message through your patient record. Please do not order a STI test kit on behalf of someone else. Please check box to confirm that you understand.

Who do you have sex with?

Men

Women

Both

Sexual Health

Have you had unprotected sex in the last 5 days?

Yes

Have you had unprotected sex with someone known to have HIV in the last 72 hours?

Yes

If you have been exposed to HIV infection within the last 72 hours you may need Post Exposure Prophylaxis (PEP) treatment. This medication reduces the chances of catching HIV after exposure.
PEP is recommended in these circumstances;

If the partner was HIV positive and not on treatment
- You had anal sex without a condom
- You were penetrated vaginally without a condom
- You shared injecting needles

If you had a partner of unknown HIV status belonging to a group at high risk of HIV (e.g. Gay man or from Africa/ SE Asia)
- You were penetrated anally without a condom
- If you shared injecting needles

PEP is not recommended if
- Your HIV positive partner has undetectable virus levels on treatment
- Human bites
- Another person’s semen gets in your eye
- You had oral sex (Mouth to vagina/penis)

Please tick here to confirm you understand this.

Symptoms

Most people with a STI have no symptoms and don't know they have one. Sometimes symptoms disappear but you may still have an infection and pass it on. If you have no symptoms but are concerned that you have a STI, you should get tested.

If you have certain symptoms, you may need to attend a sexual health clinic for further advice and treatment. This is important to stop you developing serious complications.

Do you have any symptoms that you think are due to a sexually transmitted infection?

No - I just want a check-up

Yes

Do you have any of the following symptoms? Please select all that apply

Unusual discharge from the vagina

Unusual vaginal bleeding e.g. heavy, between periods or during/after sex

Lower abdominal or pelvic pain

Painful sex

Pain, bleeding or discharge from the rectum

Genital ulcers or sores

Genital lumps or bumps

Fever

Symptoms

If you have certain symptoms, you may need to attend a sexual health clinic for further advice and treatment. This is important to stop you developing serious complications.

Do you have any symptoms that you think are due to a sexually transmitted infection?

No - I just want a check-up

Yes

Do you have any of the following symptoms? Please select all that apply

Painful or swollen testicles

Unusual discharge from the penis

Lower abdominal or pelvic pain

Pain, bleeding or discharge from the rectum

Genital ulcers or sores

Genital lumps or bumps

Fever

Symptoms

If you have certain symptoms, you may need to attend a sexual health clinic for further advice and treatment. This is important to stop you developing serious complications.

Do you have any symptoms that you think are due to a sexually transmitted infection?

No - I just want a check-up

Yes

Do you have any of the following symptoms? Please select all that apply

Painful or swollen testicles

Unusual discharge from the penis

Unusual discharge from the vagina

Unusual vaginal bleeding e.g. heavy, between periods or during/after sex

Lower abdominal or pelvic pain

Painful sex

Pain, bleeding or discharge from the rectum

Genital ulcers or sores

Genital lumps or bumps

Fever

Symptoms

If you have certain symptoms, you may need to attend a sexual health clinic for further advice and treatment. This is important to stop you developing serious complications.

Do you have any symptoms that you think are due to a sexually transmitted infection?

No - I just want a check-up

Yes

Do you have any of the following symptoms? Please select all that apply

Painful or swollen testicles

Unusual discharge from the penis

Unusual discharge from the vagina

Unusual vaginal bleeding e.g. heavy, between periods or during/after sex

Lower abdominal or pelvic pain

Painful sex

Pain, bleeding or discharge from the rectum

Genital ulcers or sores

Genital lumps or bumps

Fever

Symptoms

If you have certain symptoms, you may need to attend a sexual health clinic for further advice and treatment. This is important to stop you developing serious complications.

Do you have any symptoms that you think are due to a sexually transmitted infection?

No - I just want a check-up

Yes

Do you have any of the following symptoms? Please select all that apply

Painful or swollen testicles

Unusual discharge from the penis

Unusual discharge from the vagina

Unusual vaginal bleeding e.g. heavy, between periods or during/after sex

Lower abdominal or pelvic pain

Painful sex

Pain, bleeding or discharge from the rectum

Genital ulcers or sores

Genital lumps or bumps

Fever

Pregnancy

You may be pregnant if:

Your period is late
You feel pregnant
You're not using contraception
You've had sex without a condom
You haven't taken your contraception properly e.g. missed pills
You haven’t had a normal period within 3 weeks of taking the emergency contraception pill
You haven’t had a normal period within 3 weeks of having the emergency IUD fitted
You started hormonal contraception soon after using emergency contraception

A pregnancy test will be accurate if the test is done 3 weeks after the last time you had unprotected sex.

Are you currently pregnant?

Yes

Have you had an abortion or termination of pregnancy in the past month?

Yes

Have you recently had sex with someone who has an STI (excluding HIV)?

Yes

Have you had sex while under the influence of alcohol or drugs?

Yes

Do you use recreational drugs?

Yes

Travel

Having unprotected sex with partners from the following regions, may increase your risk of exposure to HIV, Hep B and Hep C:

Sub Saharan Africa
East and South East Asia
Pacific Islands
South America and Caribbean
Southern parts of Eastern and Central Europe
Middle East
Indian Subcontinent

Have you had unprotected sex with any partners from a country with a high risk of HIV, Hep B and Hep C?

Yes

Have you had sex with an injecting drug user?

Yes

Have you had sex with a commercial sex worker or are you a sex worker?

Yes

Are you HIV positive?

Yes

Have you completed treatment for syphilis?

Yes

Consent

I have responded honestly and provided complete and accurate information that reflects my up to date medical history and information, so that the doctor can safely assess and advise me.
I fully understand all the questions and information provided. If I am unsure about any aspect of the service I will contact Lloyds Online Doctor before proceeding.
I understand the side effects, effectiveness and alternatives to the treatment I am requesting.
I understand the importance of notifying my GP about medicines and advice I may receive from this service so they can continue to provide safe medical care.
I understand this consultation will form part of my Online Doctor medical record and will be kept in line with the relevant retention period.
I have read, understand and agree to the latest terms and conditions and privacy policy.
If I have further questions in relation to my sexual health or wellbeing, I will contact my GP or healthcare professional.

I confirm the above statements are true

Important

Confirm Appropriate Test

Sexual Health

Consent

% of questionnaire complete

We're always here for you, day and night, with support, advice and healthcare essentials for you and your family.