Candida Questionnaire

CANDIDA QUESTIONNAIRE

History                                                            Point Score

1.      Have you taken tetracycline or other antibiotics for acne for one month or

longer?                                                                                                                              25

2.      Have you at any time in your life taken other “Broad-spectrum” antibiotics

for respiratory, urinary, or other infections for two months or longer, or in

short courses four or more times in a one-year period?                                                    20

3.      Have you ever taken a broad-spectrum antibiotic (even a single course)?                       6

4.      Have you at anytime in your life been bothered by persistent prostatitis,

vaginitis, or other problems affecting your reproductive organs?                                    25

5. Have you been pregnant…..

One time?                                3

Two or more times?                5

6. Have you taken birth control pills…

For six months to two years?              8

For more than two years?                   15

7. Have you taken prednisone or other cortisone type drugs….

For two weeks or less?                        6

For more than two weeks?                  15

8. Does exposure to perfumes, insecticides, fabric shop odors, and other chemicals

provoke…

Mild symptoms?                                 5

Moderate to severe symptoms?          20

9. Are your symptoms worse on damp, muggy days or moldy places?                                  20

10. Have you had athlete’s foot, ringworm, “jock itch,” or other chronic infections

of the skin or nails?

Mild to moderate?                              10

Severe or persistent?                           20

11. Do you crave sugar?                                                                                                         10

12. Do you crave breads?                                                                                                       10

13. Do you crave alcoholic beverages?                                                                                  10

14. Does tobacco smoke really bother you?                                                                           10

TOTAL SCORE FOR THIS SECTION                                                                            ______

_______________________________________________________________________________

For each of your symptoms, enter the appropriate figure in the point Score column.

If symptom is occasional or mild: score 3 points

If symptom is frequent and/or moderately severe: score 6 points

If a symptom is severe and/or disabling: score 9 points

Major Symptoms	Score
1. Fatigue or lethargy
2. Feeling of being drained
3. Poor Memory
4. Feeling “spacey” or “unreal”
5. Depression
6. Numbness, burning, or tingling
7. Muscle aches
8. Muscle weakness or paralysis
9. Pain and/or swelling in joints
10. Abdominal pain
11. Constipation
12. Diarrhea
13. Bloating
14. Persistent vaginal itch
15. Persistent vaginal burning
16. Prostatitis
17. Impotence
18. Loss of sexual desire
19. Endometriosis
20. Cramping and other menstrual irregularities
21. Premenstrual tension
22. Spots in front of eyes
23. Erratic vision

TOTAL SCORE FOR THIS SECTION                                                                ________

_________________________________________________________________________________

 

For each of your symptoms, enter the appropriate figure in the point Score column.

If symptom is occasional or mild: score 1 point

If symptom is frequent and/or Moderately severe: score 2 points

If a symptom is severe and/or Disabling: score 3 points

Other Symptoms	Score
1. Drowsiness
2. Irritability
3. Lack of coordination
4. Inability to concentrate
5. Frequent mood swings
6. Headache
7. Dizziness/loss of balance
8. Pressure above ears, feeling of head
swelling and tingling
9. Itching
10. Other rashes
11. Heartburn
12. Indigestion
13. Belching and intestinal gas
14. Mucus in stools
15. Hemorrhoids
16. Dry mouth
17. Rash or blisters in mouth
18. Bad breath
19. Joint swelling or arthritis
20. Nasal congestion or discharge
21. Postnasal drip
22. Nasal itching
23. Sore or dry throat
24. Cough
25. Pain or tightness in chest
26. Wheezing or shortness of breath
27. Urinary urgency or frequency
28. Burning on urination
29. Failing Vision
30. Burning or tearing of eyes
31. Recurrent infections or fluid in ears
32. Ear pain or deafness

TOTAL SCORE FOR THIS SECTION                                                                ________

_________________________________________________________________________________

Total Score from section one   ______

Total score from section two   ______

Total score for section three    ______

TOTAL ALL SECTIONS    ______

                                                                                                              Women           Men

Yeast- connected health problems are almost certainly present              >180            >140

Yeast-connected health problems are probably present                         120-180       90-140

Yeast-connected health problems are possibly present                           60-119         40-89

Yeast-connected health problems are less likely to be present                 <60               <40

Although the candida questionnaire can help, ultimately the best method for diagnosing candidiasis is clinical evaluation by a physician knowledgeable about yeast-related illness.

This questionnaire is from W. G. Crook M.D.,

The Yeast Connection (Vintage Books.)