Chlamydia Archives

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- No
Are you aged between 18-60 years old?
- Yes
- No
Has this medication been previously prescribed to you by your GP?
- Yes
- No
Have you or your sexual partner had a positive chlamydia test?
- Yes
- No
- Diagnosis by Doctor or Sexual Health Clinic
- Positive chlamydia test
- Informed by sexual partner
Are you displaying any of the following symptoms?
- Yes
- No
- Blood in your urine ,
- Blood in your stools,
- Urinary tract infection
- Unexplained weight loss
- Pain when passing urine
- Genital Discharge
- Fever (more than 38 degrees)
- Pain in your lower abdomen
- Pain or discharge from your back passage
- Testicular pain or swelling (men only)
- Abdominal pain when having sex (women only)
- Abnormal bleeding (women only)
Are you currently taking any of the following medicines or any herbal or recreational drugs?
- Yes
- No
- Anti-coagulant medications (e.g. warfarin)
- Metoclopramide
- Etoposide (a cancer drug)
- Rifampicin or Rifabutin
- Tetracyclines
- Valproate or Barbiturates
- Carbamazapine or Phenytoin
- Ciclosporin or Ketoconazole.
Have you been diagnosed with any of the following?
- Yes
- No
- Depression or psychiatric disorders
- Epilepsy or Convulsions
- liver disease or Kidney disease
- SLE, Myasthenia Gravis or galactose intolerance.
- Allergy to doxycycline
Please tell us about any other medical conditions you are diagnosed with or if you take any other prescribed medication, over the counter medication or recreational products?
- Please enter N/A if not applicable.
Are you aware that:
- Yes
- No
- Doxycycline can reduce the effectiveness of the contraceptive pill. You should use condoms whilst taking Doxycycline and for 7 days after.
- You should always complete the prescribed course of capsules, even if your symptoms have improved.
- Doxycycline can make your skin more sensitive to sunlight, meaning you will burn very easily. You should wear strong sunscreen whilst taking this medicine.
- Alcohol can reduce the effectiveness of Doxycycline.
Do you understand that:
- Yes
- No
- Chlamydia is highly contagious and can be transmitted by having sex (vaginal, anal or oral).
- It is important to prevent the spread of chlamydia by avoiding sex until 7 days after all symptoms have cleared up and continuing to use a condom afterward.
- inform any sexual partner(s) of your chlamydia treatment.
- Treatment may take up to 14 days to clear your symptoms. We recommend that you have a full STI test 14 days after treatment to confirm it has been effective and that you are not suffering from any other STIs.
Do you agree to the following?
- Yes
- No
- You will read the patient information leaflet (provided with your medication or by following the relevant link)
- The treatment is solely for your own use
- All the information you have provided is accurate. You understand our prescribers can only base decisions on the information provided and that incorrect information can be detrimental to your health.
- We need to ensure that this medicine is suitable for the person it is intended for. Therefore may be required to contact you by phone/video call, If we are unable to speak to you when required your order may be delayed.
- I consent to receive treatment from My Pharmacy, and confirm that I have the mental capacity to do so. The decision about the treatment is for both the patient and the prescriber to consider, however, the final decision will always rest with the prescriber and is subject to approval. If treatment is not suitable, you will be signposted to another point of care.
- You will seek medical advice if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
- You will inform your GP with regards to this prescription (It is best practice to inform your GP of any private treatment you receive. All treatment is completely confidential).
Terms & Conditions
- I confirm that I am over 18 and I agree to the Terms and Conditions
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Doxycycline 100mg (14 Capsules)

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