Candida
Questionnaire and Score Sheet
If
you’d like to know if your health problems are yeast connected, take
this comprehensive questionnaire.
Questions
in Section A focus on your medical history—factors that promote the
growth of Candida albicans and that frequently are found in people
with yeast-related health problems.
In
Section B you’ll find a list of 23 symptoms that are often present in
patients with yeast-related health problems. Section C consists of 33
other symptoms that are sometimes seen in people with yeast-related
problems—yet they also may be found in people with other disorders.
Filling
out and scoring this questionnaire should help you and your physician
evaluate the possible role Candida albicans contributes to your
health problems. Yet, it will not provide an automatic ‘‘yes’’ or
‘‘no’’ answer.
Section
A: History
Point Score
1.
Have you taken tetracyclines or other antibiotics for
acne
for 1 month (or longer)?
35
_________________________________________________________________________________________
2.
Have you at any time in your life taken broadspectrum
antibiotics
or other antibacterial medication for respiratory,
urinary
or other infections for two months or longer, or in
shorter
courses four or more times in a one-year period?
35
_________________________________________________________________________________________
3.
Have you taken a broad-spectrum antibiotic
drug—even
in a single dose?
6
_________________________________________________________________________________________
4.
Have you, at any time in your life, been bothered by
persistent
prostatitis, vaginitis or other problems affecting
your
reproductive organs?
25
_________________________________________________________________________________________
5.
Are you bothered by memory or concentration
problems—do
you sometimes feel spaced out?
20
_________________________________________________________________________________________
6.
Do you feel ‘‘sick all over’’ yet, in spite of visits to many
different
physicians, the causes haven’t been found?
20
_________________________________________________________________________________________
7.
Have you been pregnant...
Two
or more times?
5
One
time?
3
_________________________________________________________________________________________
8.
Have you taken birth control pills...
For
more than two years?
15
For
six months to two years?
8
_________________________________________________________________________________________
9.
Have you taken steroids orally, by injection or
inhalation?
For
more than two weeks?
15
For
two weeks or less?
6
_________________________________________________________________________________________
10.
Does exposure to perfumes, insecticides, fabric shop
odors
and other chemicals provoke . . .
20
Moderate
to severe symptoms?
5
Mild
symptoms?
_________________________________________________________________________________________
11.
Does tobacco smoke really bother you?
10
_________________________________________________________________________________________
12.
Are your symptoms worse on damp, muggy days
or
in moldy places?
20
_________________________________________________________________________________________
13.
Have you had athlete’s foot, ring worm, ‘‘jock itch’’ or
other
chronic fungous infections of the skin or nails?
Have
such infections been...
Severe
or persistent?
20
Mild
to moderate? 10
_________________________________________________________________________________________
14.
Do you crave sugar?
10
_________________________________________________________________________________________
TOTAL
SCORE, Section A
Section
B: Major Symptoms
For
each of your symptoms, enter the appropriate figure in the Point Score
column:
If
a symptom is occasional or mild ................................… 3
points
If
a symptom is frequent and/or moderately severe ......... 6 points
If
a symptom is severe and/or disabling ........................... 9 points
Add
total score and record it at the end of this section.
Point
Score
___________________________________________________________________________________
1.
Fatigue or lethargy
___________________________________________________________________________________
2.
Feeling of being ‘‘drained’’
___________________________________________________________________________________
3.
Depression or manic depression
___________________________________________________________________________________
4.
Numbness, burning or tingling
__________________________________________________________________________________
5.
Headache
__________________________________________________________________________________
6.
Muscle aches
__________________________________________________________________________________
7.
Muscle weakness or paralysis
__________________________________________________________________________________
8.
Pain and/or swelling in joints
___________________________________________________________________________________
9.
Abdominal pain
____________________________________________________________________________________
10.
Constipation and/or diarrhea
___________________________________________________________________________________
11.
Bloating, belching or intestinal gas
__________________________________________________________________________________
12.
Troublesome vaginal burning, itching or discharge
__________________________________________________________________________________
13.
Prostatitis
__________________________________________________________________________________
14.
Impotence
__________________________________________________________________________________
15.
Loss of sexual desire or feeling
__________________________________________________________________________________
16.
Endometriosis or infertility
____________________________________________________________________________________
17.
Cramps and/or other menstrual irregularities
___________________________________________________________________________________
18.
Premenstrual tension
__________________________________________________________________________________
19.
Attacks of anxiety or crying
___________________________________________________________________________________
20.
Cold hands or feet, low body temperature
___________________________________________________________________________________
21.
Hypothyroidism
___________________________________________________________________________________
22.
Shaking or irritable when hungry
___________________________________________________________________________________
23.
Cystitis or interstitial cystitis
__________________________________________________________________________________
TOTAL
SCORE, Section B
Section
C: Other Symptoms
For
each of your symptoms, enter the appropriate figure in the Point Score
column:
If
a symptom is occasional or mild .................................... 1
point
If
a symptom is frequent and/or moderately severe ......... 2 points
If
a symptom is severe and/or disabling ........................... 3 points
Add
total score and record it at the end of this section.
Point Score
1.
Drowsiness, including inappropriate drowsiness
_____________________________________________________________________________________
2.
Irritability
_____________________________________________________________________________________
3.
Incoordination
_____________________________________________________________________________________
4.
Frequent mood swings
_____________________________________________________________________________________
5.
Insomnia
_____________________________________________________________________________________
6.
Dizziness/loss of balance
_____________________________________________________________________________________
7.
Pressure above ears . . . feeling of head swelling
_____________________________________________________________________________________
8.
Sinus problems . . . tenderness of cheekbones or forehead
_____________________________________________________________________________________
9.
Tendency to bruise easily
______________________________________________________________________________________
10.
Eczema, itching eyes
______________________________________________________________________________________
11.
Psoriasis
_____________________________________________________________________________________
12.
Chronic hives (urticaria)
______________________________________________________________________________________
13.
Indigestion or heartburn
______________________________________________________________________________________
14.
Sensitivity to milk, wheat, corn or other common foods
_______________________________________________________________________________________
15.
Mucus in stools
______________________________________________________________________________________
16.
Rectal itching
_______________________________________________________________________________________
17.
Dry mouth or throat
_______________________________________________________________________________________
18.
Mouth rashes, including ‘‘white’’ tongue
______________________________________________________________________________________
19.
Bad breath
______________________________________________________________________________________
20.
Foot, hair or body odor not relieved by washing
______________________________________________________________________________________
21.
Nasal congestion or postnasal drip
______________________________________________________________________________________
22.
Nasal itching
______________________________________________________________________________________
23.
Sore throat
_______________________________________________________________________________________
24.
Laryngitis, loss of voice
_______________________________________________________________________________________
25.
Cough or recurrent bronchitis
_______________________________________________________________________________________
26.
Pain or tightness in chest
________________________________________________________________________________________
27.
Wheezing or shortness of breath
________________________________________________________________________________________
28.
Urinary frequency or urgency
________________________________________________________________________________________
29.
Burning on urination
________________________________________________________________________________________
30.
Spots in front of eyes or erratic vision
_________________________________________________________________________________________
31.
Burning or tearing eyes
_________________________________________________________________________________________
32.
Recurrent infections or fluid in ears
_________________________________________________________________________________________
33.
Ear pain or deafness
_________________________________________________________________________________________
TOTAL
SCORE, Section C
_______________________________________________________________
Total
Score, Section A
_______________________________________________________________
Total
Score, Section B
_______________________________________________________________
Total
Score, Section C
_______________________________________________________________
GRAND
TOTAL SCORE
_______________________________________________________________
The
Grand Total Score will help you and your physician decide if your health
problems are yeast-connected. Scores in women will run higher, as seven
items in the questionnaire apply exclusively to women, while only two
apply exclusively to men.
Yeast-connected
health problems are almost certainly present in women with scores more
than 180, and in men with scores more than 140.
Yeast-connected
health problems are probably present in women with scores more than 120,
and in men with scores more than 90.
Yeast-connected
health problems are possibly present in women with scores more than 60,
and in men with scores more than 40.
With
scores of less than 60 in women and 40 in men, yeasts are less apt to
cause health problems.
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