Herpes Survey

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View the experiences of others here.

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Submit the survey and include YOUR experiences
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Your Name (required)

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Subject

[your-subject]

Gender
MaleFemale


Age


Marital Status
MarriedSingle


Number of Sexual Partners


Transmission Prevention
CondomsFoamsAbstinenceNone


At what Age did you contract Herpes?


Are you a Herpes carrier?
YesNo


What type of Herpes do you have?
Type 1Type 2


What diagnostic test was used to determine the type of Herpes?
Living Cell Culture(PAP) smearOtherNone


Do you have any of the following herpes symptoms during lesion formation?
sharp painsmuscle achesswollen lymph glandsheadachesfever and general malaise


What treatments do you use for Herpes?
Prescription medicationOver-the-counter medicationPsychotherapyDiet/NutritionVitamins/HerbsStress ReductionNone


How frequently do you have outbreak recurrences?
1 time per 1-5 years4-7 times per year1-2 times per month


Average duration of Herpes recurrences
1-3 days4-7 days8-10 daysmore than 10 days


What do you feel causes your herpes outbreaks?
Stress at homeStress at workSunburnOther health problemsPoor nutritionVigorous sexual intercourseMenstrual cycleOver-tirednessDon't know causes


How has herpes affected your pregnancy plans?
0 (Not at all)1234 (A great deal)


Highest education level
Grade schoolSome high schoolHigh school graduateSome collegeCollege graduateSome graduate schoolGraduate degreeProfessional degree


Do you have a herpes experience you’d like share with others?


Regional Information:

City


State/Province


Country


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