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Candida Questionnaire and Score Sheet

This questionnaire lists factors in your medical history that promote the growth of the common yeast, Candida albicans (Section A), and symptoms commonly found in individuals with yeast-connected illness (Sections B and C).

For children, there is a different questionnaire. (For instance, a child does not have to have taken any antibiotics to have yeast problems.)

Important Information:
Please read before taking Candida Questionnaire

Filling out and scoring this questionnaire should help you and your physician evaluate how Candida albicans may be contributing to your health problems. However, it will not provide an automatic yes or no answer. A comprehensive history and physical examination are important. In addition, laboratory studies, x-rays, and other types of tests may also be appropriate.

Download/print PDF of this Candida Questionnaire

Section A: History Point Score

For each YES answer in Section A, circle the Point Score. Total your score, and record it at the end of the section. Then move on to Sections B and C, and score as directed.

	Point score
Have you taken tetracyclines (Sumycin, Panmycin, Vibramycin, Minocin,etc.) or other antibiotics for acne for 1 month (or longer)?	50
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 for shorter periods 4 or more times in a 1-year span?	50
Have you taken a broad spectrum antibiotic drug — even for one period?	6
Have you, at any time in your life, been bothered by persistent Prostatitis, Vaginitis, or other problems affecting your reproductive organs?	25
Have you been pregnant 2 or more times?	5
Pregnant 1 time?	3
Have you taken birth control pills for more than 2 years?	15
Taken birth control pills 6 months to 2 years?	8
(I would add 30 Pts if around the time you started to take birth control pills, you had a general decline in your health.)	30
Taken these drugs 2 weeks or less?	6
Does exposure to perfumes, insecticides, fabric shop odors, or other chemicals provoke moderate to severe symptoms?	20
Does exposure produce symptoms?	5
Are your symptoms worse on damp, muggy days or in moldy places?	20
Have you had athlete's foot, ringworm, "jock itch" or other chronic fungus infections of the skin or nails that have been severe or persistent?	20
Mild or moderate?	10
Do you crave sugar?	10
Do you crave breads?	10
Do you crave alcoholic beverages?	10
Does tobacco smoke really bother you?	10
Total Score, Section A

Section B: Major Symptoms

**The use of nasal or bronchial sprays containing cortisone and/or other steroids promotes overgrowth in the respiratory tract.

If a symptom is frequent and/or moderately severe, score 6 Pts.

If a symptom is severe and/or disabling, score 9 Pts.

If a symptom is occasional or mild, score 3 Pts.

	Point score
Fatigue or lethargy
Feeling of being "drained"
Poor memory
Feeling "spacey" or "unreal"
Inability to make decisions
Numbness, burning or tingling
Insomnia
Muscle aches
Muscle weakness or paralysis
Pain and/or swelling in joints
Abdominal pain
Constipation
Diarrhea
Bloating, belching or intestinal gas
Troublesome vaginal burning, itching or discharge
Prostatitis
Impotence
Loss of sexual desire
Total Score, Section B

Section C: Other Symptoms*

*While the symptoms in this section occur commonly in patients with yeast-connected illness, they also occur commonly in patients who do not have Candida.

If a symptom is occasional or mild, score 3 Pts.

If a symptom is frequent and/or moderately severe, score 6 Pts.

If a symptom is severe and/or disabling, score 9 Pts.

	Point score
Drowsiness
Irritability or jitteriness
In coordination
Inability to concentrate
Frequent mood swings
Headaches
Dizziness/loss of balance
Pressure above ears, feeling of head swelling
Tendency to bruise easily
Chronic rashes or itching
Psoriasis or recurrent hives
Indigestion or heartburn
Food sensitivity or intolerance
Mucus in stools
Rectal itching
Dry mouth or throat
Rash or blisters in mouth
Bad breath
Foot, hair, or body odor not relieved by washing
Nasal congestion or post nasal drip
Nasal itching
Sore throat
Laryngitis, loss of voice
Cough or recurrent bronchitis
Pain or tightness in chest
Wheezing or shortness of breath
Urinary frequency, urgency or incontinence
Burning on urination
Spots in front of eyes or erratic vision
Burning or tearing of eyes
Recurrent infections or fluid in ears
Ear pain or deafness

Total Score, Section C
Total Score, Section B
Total Score, Section A
Grand Total Score (add totals from Sections A, B, and C)

The Grand Total Score will help you and your physician decide if your health problems are yeast-connected. Scores for women will run higher, as 7 items in this questionnaire apply exclusively to women, while only 2 apply exclusively to men. Check your total score to the table below.

Point Score Table	Women	Men
Yeast-connected health problems are almost certainly present	Over 180	Over 140
Yeast-connected health problems are probably present	Over 120	Over 90
Yeast-connected health problems are possibly present	Over 60	Over 40
Yeast are less apt to cause health problems	Less than 60	Less than 40