Genital Herpes

Explain your symptoms or tell us how we can help today.*

Do you have allergies to any medications?*

Yes
No

If yes, please list any medications you have allergies to:

Are you pregnant or breastfeeding?*

Yes
No

Describe your recent sexual behavior:*

New sex partner
Unprotected sex
Multiple sex partners
Sex partner with sexually transmitted infection (STI)
None of the above

What area is affected?*

Penis
Scrotum
Vagina
Mouth/throat
Rectal

What symptoms have you been experiencing recently?*

Painful blisters or ulcers
Genital itching or irritation
Painful lumps or bumps in the groin
Burning during urination
Nausea or vomiting
Fatigue
Genital discharge
Fever or chills
I don’t have any of these symptoms

Please describe the genital discharge:*

White in color
Yellow in color
Green in color
Unusual smell
Fishy smell
Odorless

Please best explain the description of fever or chills:*

Feeling warm no measured temperature
Measured temperature of 100.8 degrees (fahrenheit) or higher
Severe uncontrollable chills (teeth chattering)

Unfortunately we cannot proceed with your request based on the information you have provided.

How Long have you been having these symptoms?*

Started today
1-3 days
4-7 days
Over 1 week

Have you ever been treated for genital herpes?*

Yes
No

How long ago?*

When were you first diagnosed with or exposed to genital herpes?*

In the last year
More than 12 months ago
I have never been diagnosed with herpes
I am unsure whether or not I have been exposed to herpes

Choose the option that best describes your herpes diagnosis or exposure:*

I was diagnosed with Herpes Simplex Virus 1 (HSV-1)
I was diagnosed with Herpes Simplex Virus 2 (HSV-2)
I was exposed to a sex partner who was diagnosed with Herpes Simplex Virus 1 (HSV-1)
I was exposed to a sex partner who was diagnosed with Herpes Simplex Virus 2 (HSV-2)

How many herpes outbreaks do you experience in a year?*

1 outbreak
2 to 3 outbreaks
4 to 9 outbreaks
More than 9 outbreaks
Never experienced an outbreak
I was exposed to a sex partner who was diagnosed with Herpes Simplex Virus 2 (HSV-2)

Smoker?*

Yes
No
Never

Alcohol use?*

Any medical family history?*

Yes
No

Please explain your medical family history:*

Do you have any medical conditions?*

Yes
No

Please explain your medical conditions:*

Have you ever had any surgeries or recent hospitalizations?*

Yes
No

Please explain your surgeries or recent hospitalizations:*

Do you currently take any medications, herbals, or supplements?*

Yes
No

Please list any medications, herbals, or supplements:*

Do you have a urinary catheter or foley catheter?*

Yes
No

Scan/Upload any Relevant Medical Images:

Max. file size: 32 MB.

Phone

This field is for validation purposes and should be left unchanged.

Consultation

Step 1 of 2

Before You Continue - Please Review Our Informed Consent Agreement

Get in Touch

Online

24 Hours a Day