Genital Warts

About your health

Do you suffer from any allergies?
If you do, kindly explain them below

Yes

Women only: Are you pregnant or is there a possibility you may be pregnant or start breastfeeding while taking this medicaiton?

Yes

Are you taking any other medicines?

This could be prescription medication, over the counter or herbal remedies.

Yes

Acknowlegdements

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

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

Are you aware of the following?

- You should not use Warticon, Condyline or Aldara until the area to be treated has healed after previous drug or surgical treatment;

- Warticon and Condyline should not be used for more than 4 treatment cycles (in case of Aldara for more than 16 weeks) for a single outbreak of genital warts ;

- You should not use Warticon, Condyline or Aldara if you have used it before and suffered severe side effects or an allergic reaction;

- You should not put a dressing or plaster over an area treated with Condyline, Warticon or Aldara;

- You answered truthfully to all the questions and you are aware that any incorrect information you provided might present a danger to your health;

Yes

Can we share this information with your General practitioner?

Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.

Yes

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