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Candida Questionnaire and Score Sheet

 

Name: _________________________________________________ Age: _________

The questionnaire is designed for adults and the scoring system isn't appropriate for children. It lists factors in your medical history which promote the growth of Candida Albicans (Section A), and symptoms commonly found in individuals with yeast-connected illness (Sections B and C).

For each "Yes" answer in Section A, circle the point score in that section. Record your total score in the box at the end of the section. Then move on to Sections B and C and score as directed.

Filling out and scoring this questionaire should help you and your doctor evaluate the possible role of Candida in contributing to your health problems. Yet it will not provide an automatic "Yes" or "No" answer.

Section A: History

1.  Have you taken tetracyclines (Symycin, Panmycin, Vibramycin, Minocin, etc.) or other antibiotics for acne for one month or longer?  ........  25

2.  Have you, at any time in your life, taken other "broad spectrum" antiobiotics* for respiratory, urinary or other infections for 2 months or longer or in shorter courses 4 or more times in a 1-year period?  ........  20

3.  Have you taken a broad spectrum antiobiotic* -- even in a single course?  ........  6

4.  Have you, at anytime in your life, been bothered by persistant prostatitis, vaginitis, or other problems affecting your reproductive organs?  ........  25

5.  Have been pregnant ..
            2 or more times?  ........  5
            1 time?           ........  3

* Including Keflex, ampicillin, amoxicillin, Ceclor, Bactrim, and Septra. Such antibiotics kill off "good germs" while they are killing off those which cause infection.

6. Have you taken birth control pills ...
        For more than 2 years?  ........  15
        For 6 months to 2 years?  ........  8

7. Have you taken Prednisone, Decadron or other cortisone-type drugs ...
        For more than 2 weeks?  ........  15
        For 2 weeks or less?  ........  6

8. Does exposure to perfumes, insecticides, fabric shop odors, and other chemicals provoke ...        Moderate to severe symptoms?   ........   20
     Mild symptoms?  ........  5

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

10. Have you had athlete's foot, ring worm, jock itch, or other chronic fungus infections of the skin or nails?
       Have such infections been ...
                Severe or persistent?  ........  20
                Mild to moderate?      ........  10

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

Section B: Major Symptoms

For each of your symptoms, enter the appropriate figure in the point score column:

        Occassional or Mild                     3 points

        Frequent and/or Moderately Severe       6 points

        Severe and/or Disabling                 9 points

Add total score and record it in the box at the end of this section:

                                       Point Score                                           Point Score

1.  Fatigue or lethargy                 _______         13. Bloating                             _______

2.  Feeling of being "drained"          _______         14. Troublesome vaginal discharge        _______

3.  Poor memory                         _______         15. Persistent vaginal burning or itching ______

4.  Feeling "spacey" or "unreal"        _______         16. Prostatitis                          _______

5.  Depression                          _______         17. Impotence                            _______

6.  Numbness, burning, or tingling      _______         18. Loss of sexual desire                _______

7.  Muscle aches                        _______         19. Endometriosis                        _______

8.  Muscle weakness or paralysis        _______         20. Cramps and/or other menstrual

9.  Pain and/or swelling in joints      _______             irregularities                       _______

10. Abdominal pain                      _______         21. Premenstrual tension                 _______

11. Constipation                        _______         22. Spots in front of the eyes           _______

12. Diarrhea                            _______         23. Erratic vision                       _______

Section C: Other Symptoms For each of your symptoms, enter the appropriate figure in the point score column:

        Occassional or Mild                     1 point

        Frequent and/or Moderately Severe       2 points

        Severe and/or Disabling                 3 points

Add total score and record it in the box at the end of this section:

                                        Point Score                                          Point Score

1.  Drowsiness                          _______         17. Rash or blister in mouth             _______

2.  Irritability or jitteriness         _______         18. Bad breath                           _______

3.  Incoordination                      _______         19. Joint swelling or arthritis          _______

4.  Inability to concentrate            _______         20. Nasal congestion or discharge        _______

5.  Frequent mood swings                _______         21. Postnasal drip                       _______

6.  Headache                            _______         22. Nasal itching                        _______

7.  Dizziness/loss of balance           _______         23. Sore or dry throat                   _______

8.  Pressure above ears, feeling of                     24. Cough                                _______

    head swelling and tingling          _______         25. Pain or tightness in chest           _______

9.  Itching                             _______         26. Wheezing or shortness of breath      _______

10. Other rashes                        _______         27. Urinary urgency or frequency         _______

11. Heartburn                           _______         28. Burning or tearing of eyes           _______

12. Indigestion                         _______         29. Failing vision                       _______

13. Belching and intestinal gas         _______         30. Burning on urination                 _______

14. Mucus in stools                     _______         31. Recurrent infections or fluid in ears_______

15. Hemorrhoids                         _______         32. Ear pain or deafness                 _______

16. Dry mouth                           _______

 

        Total Score, Section C  _______

        Total Score, Section A  _______

        Total Score, Section B  _______

        GRAND TOTAL SCORE       _______

The Grand Total Score will help you and your doctor decide if your health problems are yeast-connected. Scores in women will run higher as 7 items in the questionaire apply exclusively to women, while only 2 apply exclusively to men.

      If your score is:         Symptoms are:

        180 (women)             Almost Certainly

        140 (men)               Yeast Connected

        120 (women)             Probably

        90 (men)                Yeast Connected

        60 (women)              Possibly

        40 (men)                Yeast Connected

 

        Less Than:

        60 (women)              Probably Not

        40 (men)                Yeast Connected

 

For a Holistic Candida Diet see our Candida Diet Page.