STI 101

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* 1. Name:

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* 2. What age category are you in?

Under 15

15-24

25-34

35-44

45-54

55-64

65+

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* 3. What is your gender?

Male

Female

Other

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* 4. Chlamyida and Gonorrhea are curable with prescribed medicine.

True

False

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* 5. Gardasil is a vaccine that helps prevent human papilloma virus (HPV).

True

False

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* 6. Over 75% of people will exhibit a sign or symptom when they have an STI.

True

False

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* 7. HIV stands for human immunodeficiency virus.

True

False

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* 8. What are the 3 progression stages of syphillis?

First, Second, Third

Primary, Secondary, Tertiary

Stage 1, Stage 2, Stage 3

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* 9. Hormonal contraceptives help protect against STIs.

True

False

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* 10. If you would like to be entered into the drawing for a gift card, please leave your contact information below!

Name

Email

Phone Number