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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 printer-friendly PDF of the 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

From William G. Crook, M.D., The Yeast Connection Handbook. Professional Books. Jackson, TN 1997-2000. Reprinted with permission.


Download printer-friendly PDF of the Candida Questionnaire