U18 MSM C Do you live in West Sussex?*SelectYesNoSorry - your answer indicates that you are not eligible for online testing because you live out of area.Date of birth* Day Month Year Tell us your gender:*SelectMaleFemaleTransHow would you define your current gender?*SelectMale (including trans man)Female (including trans woman)Non-binaryOther not listedIs you gender the same as at birth?*SelectYesNo - not the same gender at birthYour answer indicates that you need a telephone consultation - please call 01903 285199 to book.Who do you have sex with?SelectI only have sex with menI only have sex with womenI have sex with men and womenDo you have any of the following symptoms of a Sexually Transmitted Infection?*A discharge from your genitals (penis, anus) A rash or spots around your penis Lumps or bumps in or around your genitals Pain when you pass urine Any sores or ulcers in or around your gentials Any other symptoms or concernsSelectYesNoYour answer indicates that you need a telephone consultation - please call 01903 285199 to book.Have you had sex with someone who you know to have had a Sexually Transmitted Infection in the last 3 months, not including genital herpes or warts?SelectYesNoI don't knowYour answer indicates that you need a telephone consultation - please call 01903 285199 to book.Have you been vaccinated for Hepatitis B?SelectYesNoI don't knowThe answer you have given indicates that you have an increased risk of acquiring Hepatitis B virus. This is a sexually transmitted infection that can cause liver disease. There is a free safe and effective vaccine that can protect you against Hepatitis B virus. Please call 01903 285199 to book a telephone consultation so we can tell you more about it.Have you been vaccinated for Hepatitis A?SelectYesNoI don't knowThe answer you have given indicates that you have an increased risk of acquiring Hepatitis A virus. This is a sexually transmitted infection that can cause liver disease. There is a free safe and effective vaccine that can protect you against Hepatitis A virus. Please call 01903 285199 to book a telephone consultation so we can tell you more about it.Have you been vaccinated for HPV?SelectYesNoI don't knowHPV is a sexually transmitted infection which can cause genital warts, anal, penile and throat cancer. The answer you have given indicates that you are eligible for HPV vaccine. This is a free safe and effective vaccine which reduces your risk of developing genital warts and HPV related cancers. Please call 01903 285199 to book a telephone consultation so we can tell you more about it.Have you had anal sex without a condom with a new or casual partner since your last sexual health check up?SelectYesNoThis may indicate that you are more at risk of a sexually transmitted infection including HIV. There are a number of interventions which an reduce your risk of STI's many of which are free and available through our clinics. You can continue to order an online test in the meantime and one of our Health Advisors will contact you via telephone to discuss further. When was the last time that you had unprotected (condomless) penetrative sex?SelectLess than 72 hours agoMore than 72 hours but less than 2 weeks agoMore than 2 but less than 12 weeks agoMore than 12 weeks agoNeverIf you are testing because you have had sex with someone new or you have a specific concern, please read the following information about window periods (When best to test):If you think you have been exposed to HIV and need Post Exposure Prophylaxis (PEP), following a risk in the past 72 hours call us on 01903 285199 to book an appointment.If you're not sure and want to find out whether you need PEP click hereChlamydia and Gonorrhoea may take up to 2 weeks to show up after infectionHIV may take up to 45 days to show up after infectionSyphilis and Hepatitis B may take up to 12 weeks to show up after infectionWe recommend testing after the window period, but if you feel unable to wait, please remember to repeat tests at a later date if concerned.HIV PrEP (Pre Exposure Prophylaxis) reduces the risk of becoming infected with HIV, for more information on how to access for free from our clinics click here or call 01903 285199.Take control of your sexual health and check yourself routinely - We recommend testing at least yearlyUsing condoms for sex will reduce the risks of catching and passing on STIs . You can access free condoms within our clinics or by joining the C Card Scheme If you are testing because you have had sex with someone new or you have a specific concern, please read the following information about window periods (When best to test):Chlamydia and Gonorrhoea may take up to 2 weeks to show up after infectionHIV may take up to 45 days to show up after infectionSyphilis and Hepatitis B may take up to 12 weeks to show up after infectionWe recommend testing after the window period, but if you feel unable to wait, please remember to repeat tests at a later date if concerned.HIV PrEP (Pre Exposure Prophylaxis) reduces the risk of becoming infected with HIV, for more information on how to access for free from our clinics click here or call 01903 285199Take control of your sexual health and check yourself routinely - We recommend testing at least yearlyUsing condoms for sex will reduce the risks of catching and passing on STIs . You can access free condoms within our clinics or by joining the C Card Scheme If you are testing because you have had sex with someone new or you have a specific concern, please read the following information about window periods (When best to test):Chlamydia and Gonorrhoea may take up to 2 weeks to show up after infectionHIV may take up to 45 days to show up after infectionSyphilis and Hepatitis B may take up to 12 weeks to show up after infectionWe recommend testing after the window period, but if you feel unable to wait, please remember to repeat tests at a later date if concerned.HIV PrEP (Pre Exposure Prophylaxis) reduces the risk of becoming infected with HIV, for more information on how to access for free from our clinics click here or call 01903 285199Take control of your sexual health and check yourself routinely - We recommend testing at least yearlyUsing condoms for sex will reduce the risks of catching and passing on STIs . You can access free condoms within our clinics or by joining the C Card Scheme Since your last sexual health check up, have you ever been paid for sex or received money, drink or drugs in exchange for sex?SelectYesNoThis may indicate that you are more at risk of a sexually transmitted infection including HIV. There are a number of interventions which an reduce your risk of STIs, many of which are free and available through our clinics. You can continue to order an online test in the meantime and one of our Health Advisors will contact you via telephone to discuss further.Since your last sexual health check up, have you injected drugs, used 'chems' for sex (eg methadrone, GHB, crystal methamphetamine)?SelectYesNoThe answer you have given indicates that you have an increased risk of acquiring Hepatitis C virus. This is a viral infection that causes liver disease. Most people will have no symptoms so you may not realise that you have the infection unless you test for it. There is treatment available therefore we recommend that you attend one of our clinics for testing. Chemsex is associated with an increased risk of STI's, drug dependency and psychosexual problems. Please call us on 01903 285199 to book a telephone consultation.Since your last sexual health check-up have you had unprotected sex with someone who is NOT from the UK, Australia, USA or Western Europe?SelectYesNoThis may indicate that you are more at risk of a sexually transmitted infection including HIV. There are a number of interventions which an reduce your risk of STI's many of which are free and available through our clinics. You can continue to order an online test in the meantime and one of our Health Advisors will contact you via telephone to discuss further. Since your last sexual health check-up have you injected drugs or had sex with someone who injects drugs?SelectYesNoYour answer indicates that you need a telephone consultation - please call 01903 285199 to book. Since your last sexual health check-up, have you had sex with someone who you knew was HIV positive and not on effective HIV treatment?SelectYesNoIf you think have had sex with a person who has HIV and is not taking effective treatment in the past 72 hours, you can attend one of the sexual health clinics to discuss post exposure prophylaxis (PEP) call us on 01903 285199 to make an appointment Are any of your sexual partners more than 4 years older or younger than you, or in a position of trust (e.g teacher, police officer, youth worker)?SelectYesNoHas someone you’ve had sex with physically hurt you, made you feel scared or controlled you?SelectYesNoHave you felt unable to say no to sex?SelectYesNoHave you ever been involved in sending or receiving messages of a sexual nature, or does someone have sexual pictures of you?SelectYesNoHave you ever gone missing from home or care?SelectYesNoHave you tried to hurt yourself or self-harm?SelectYesNoAre you involved with any other agencies or professionals (e.g. social worker or mental health team)?SelectYesNoFrom your responses it looks like you are able to access the STI test kit online - please provide the following details to receive one through the post:First name:* Surname: Your full address and postcode:*Postcode:* Your mobile number:*Please provide a mobile number to receive reminders and results by text. We will not use your personal details for any other purpose or share them with any other organisation. Your ethnic origin:All demographic information submitted is held confidentially and for statistical purposes onlySelectWhite BritishWhite IrishAny other white backgroundCaribbeanAfricanAny other black backgroundChineseIndianPakistaniBangladeshiAny other Asian backgroundWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other mixed backgroundI do not wish to answer this questionYour country of birth: How did you hear about online testing?SelectOur websiteSocial mediaGoogle/other search engineWord of mouthOther NHS serviceEvent at school/college/universityPoster/other advertisementOther
