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Candida
Questionnaire and Score Sheet
If
you’d like to know if your health problems are yeast connected, take
this comprehensive questionnaire. 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: HistoryScore
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.
In coordination _____________________________________________________________________________________ 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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