Medical Assessment for Genital Warts

To help us supply you with the most suitable treatment, please complete this online consultation.

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About You

Are you aged between 18 and 65?

Yes

We are unable to treat you if you are outside this age range. Please consult your GP or your local GUM clinic.

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Have you been diagnosed by your GP or GUM clinic with Genital Warts?

Yes

We are unable to treat you if you have not been diagnosed. Please consult your GP or your local GUM clinic.

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If you are of child bearing potential, are you using effective contraception?

Yes

We cannot supply you with treatment. Please consult with your GP or sexual health clinic.

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Your Symptoms

Are you experiencing any of the following?

unintentional weight loss
blood in your urine or stools
pain when urinating
urinary tract infections (UTI)
night sweats
fever
bleeding from the anus or urethra
discharge/ fluid from the wart
discharge from the penis or vagina
swollen lymph nodes
abnormal urine flow
change in the appearance of your warts since they were diagnosed by a medical prescriber
warts located internally (inside the urethra, vagina, cervix, rectum or anus)
anal warts
open, sores or wounds, broken skin or ulcers near your warts including broken skin following surgery
bleeding between periods or after sex (women only)
warts on foreskin
you have had your current outbreak for more than 18 months
your warts cover an area larger than 4 cm2

Yes

Consult your GP urgently. These symptoms indicate the possibility of a more serious illness.

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Your Health

Are you breastfeeding or pregnant or possibly pregnant?

Yes

We are unable to supply you with treatment. Please consult your GP.

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Do you have an allergy (hypersensitivity) to medicines containing imiquimod or podophyllotoxin?

Yes

We are unable to supply you with treatment. Please consult your GP.

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Have you been diagnosed with any of the following?

Liver problems
Kidney problems
Immunodeficiency/ immunocompromising conditions (eg. HIV, autoimmune conditions/ diseases)
Abnormal blood count
You have received an organ transplant
Your warts cover an area larger than 4 cm2
Reduced haematologic reserve
Any serious medical condition which may require immediate hospitalisation

Yes

We cannot supply you with treatment. Please consult your GP.

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Your Medication

Are you currently taking any medication (including over the counter, prescription or recreational drugs)?

Yes

Are you taking any of the following medications?

Any immunosuppressive medication
Any other treatment for genital warts

Yes

We are unable to supply you with treatment. Please consult your GP or doctor for more information.

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Agreement

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

Yes

You must agree to this before continuing. If you need assistance contact our customer support.

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Do you understand that it is best practice to maintain genital hygiene and avoid sexual contact whilst on treatment, but if you do have sexual contact, please wear a condom?

Yes

We cannot supply you with treatment. Please consult your GP.

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Do you understand that you should return to your GP or GUM clinic for an examination of your genital warts if they do not improve after 4 weeks of treatment with podophyllotoxin (Warticon) or 16 weeks of treatment with imiquimod (Aldara)?

Yes

You must agree to this before continuing. If you need assistance contact customer support.

Please complete this question.

Medical Assessment for Genital Warts

To help us supply you with the most suitable treatment, please complete this online consultation.

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