History Point Score
1.
 Have you ever taken tetracycline or other antibiotics for acne for one month or longer? 25
2.
 Have you ever 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 one year? 20
3.
 Have you ever taken a "broad-spectrum" antibiotic (even a single course)? 6
4.
 Have you ever 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 in 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 to 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
_______
Major Symptoms
For each of your symptoms, enter the appopriate 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 symptom is severe and/or disabling score 9 points
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
_______
Other Symptoms
For each of your symptoms, enter the appopriate figure in the Point Score column.
       If symptom is occasional or mild score 1 points
       If symptom is frequent and/or moderately severe score 2 points
       If symptom is severe and/or disabling score 3 points
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 stool
_______
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 of deafness
_______
Total Score For This Section
_______
Point Score Totals
       Total from section one
_______
       Total from section two
_______
       Total from section three
_______
Total All Sections
_______
Results
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 questionaire can help, ultimately the best method for diagnosing candidiasis is clinical evaluation by a physician knowledgeable about yeast-related illness.

*Used with permission 2005.  Adapted from Dr. Crook's, The Yeast Connection Handbook, 15-19. www.yeastconnection.com