Consultation

How do you know you need treatment for Chlamydia? Do any of the below apply to you?

1. Diagnosed by a home testing kit
2. Informed by a sexual partner
3. Diagnosis by a doctor or sexual health clinic

Have you taken treatment for chlamydia in the last 2 months?

Are you pregnant or breastfeeding?

Are you experiencing any of the following?

• Fever or night sweats
• Blood in your urine or stool
• Chest Pain
• Unintentional weight loss
• Urinary Tract Infection or pain when urinating
• Rectal discharge or discomfort
• Severe stomach pain
• Heavy/Painful periods

Do you have any of the following conditions?

• Heart conditions
• Kidney conditions
• Liver conditions
• HIV
• Other medical conditions

Do you understand that we can only prescribe this medication for the treatment of chlamydia?

Have you ever been diagnosed with any of the following?

• Systemic Lupus Erythematosus or a neuromuscular disease such as Myasthenia granvis
• Alcohol dependence
• Heart problems
• Liver or kidney problems
• Porphyria

Are you allergic to any medicines or other substances?

For instance peanuts or soya.

It is important that you contact your sexual partner(s) to let them know that they may have caught chlamydia. Please confirm that you understand

Do you have any allergies?

Do you understand that?

• You should take this medication as prescribed and complete the course, even if you feel better after a few days
• You should inform your recent sexual partners over the last 6 months of your diagnosis. If you are unable to do this, then you should visit your local GUM clinic for “partner notification”
• Chlamydia is highly contagious and can be transmitted by vaginal, anal and oral sex. You should read this information leaflet on how to practise safe sex
• You should wait at least 7 days after completing the treatment course before engaging in sexual activity
• You should test 14 days after completing the treatment course (a full STI test is recommended)
• If you are under the age of 25, you should also retest after 3-6 months of completing treatment, and also test regularly for STIs especially if you have more than one sexual partner
• You should seek medical advice if symptoms of chlamydia do not disappear after completing the treatment course
• Taking medication especially antibiotics, when you do not need them, may increase resistance. This means that they may not work if you need them in the future. You should only proceed if you are certain that you have chlamydia
• You should read the Patient Information Leaflet for your own knowledge and for common side effects, and report any side effects and changes in your health and body to your GP, and via the Yellow Card Scheme

Do you agree to the below?

• You will read the Patient Information Leaflet supplied with your medication
• You will contact us and inform your GP if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
• You are over 18 and the treatment is solely for your own use
• You have answered all the above questions accurately and truthfully and that incorrect information can be hazardous to your health
• You are aware the decision about your treatment are for both the prescriber and yourself to jointly consider during this consultation, but the final decision will always be the prescriber’s
• You will inform your GP that you have ordered this medication
• You agree that any treatment prescribed for you is for for your personal use only
• By continuing, you agree to our Terms & Conditions and Privacy Policy

What is the name of your GP surgery and do you consent to us contacting them about your treatment?

Do you consent to us accessing your GP records? This is advised so we can clinically assess suitability.