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Candida Survey This 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, record the point score in that section. Record your total score in the box at the end of the section. Then move to Section B and C and score as directed. Filling out and scoring this questionnaire should help you 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 Name: Email: (optional) (optional) 1) Have you taken tetracyclines (Symycin, Panmycin, Vibramycin, Minocin, etc.) Point Score or other antibiotics for acne for one month or longer? .........................25 pts. 2) Have you, at any time in your life, taken other "broad spectrum" antibiotics 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 pts. 3) Have you taken a broad spectrum antibiotic even in a single course?...6 pts. 4) Have you, at any time in your life, been bothered by persistent prostatitis, vaginitis, or other problems affecting your reproductive organs?.........25 pts. 5) Have you been pregnant ... 2 or more times?..............................................................................5 pts. 1 time?.............................................................................................3 pts. 6) Have you taken birth control pills... For more than 2 years?..................................................................15 pts. For 6 months to 2 years?.................................................................8 pts. 7) Have you taken Prednisone, Decadron or other cortisone-type drugs... For more than 2 weeks?..................................................................15 pts. For 2 weeks or less?.........................................................................6 pts. 8) Does exposure to perfumes, insecticides, fabric shop odors, and other chemicals provoke.... Moderate to severe symptoms?.............................................20 pts. Mild symptoms?.......................................................................5 pts. 9) Are your symptoms worse on damp, muggy days or in moldy places?..20 pts. 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 pts Mild to moderate?..................................................................10 pts. 11) Do you crave sugar?..........................................................................10 pts. 12) Do you crave breads?........................................................................10 pts. 13) Do you crave alcoholic beverages?...................................................10 pts. 14) Does tobacco smoke really bother you?............................................10 pts. Total Score, Section A --> Section B: Major Symptoms For each of your symptoms, enter the appropriate figure in the point score column: Occasional or mild...................................3 pts. Frequent and/or moderately severe .......6 pts Severe and/or disabling ..........................9 pts Point 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 ...................................... 10) Abdominal pain ........................... 11) Constipation ......................................... 12) Diarrhea ....................................................... 13) Bloating ....................................... 14) Troublesome vaginal discharge............ 15) Persistent vaginal burning or itching ............ 16) Prostatitis ................................... 17) Impotence ............................................ 18) Loss of sexual desire .................................... 19) Endometriosis ............................ 20) Cramps and/or other menstrual irregularities........... 21) Premenstrual tension ................................... 22) Spots in front of the eyes .......... 23) Erratic vision ....................................... Total Score, Section B --> Section C: Other Symptoms For each of your symptoms, enter the appropriate figure in the point score column: Occasional 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 1) Drowsiness .......................... 2) Irritability ....................................... 3) Inncoordination ...................................... 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 .............................. 32) Ear pain or deafness ................................. Total Score, Scetion C --> Total Score, Scetion A --> Total Score, Scetion 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 questionnaire 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 Yeast 90 (men) Connected 60 (women) Possibly 40 (men) Yeast Connected Less Than 60 (women) Probably not Home 40 (men) Yeast Connected |
