Candida Self-Test

ABOUT US

EDC MEMBERSHIP

HEALTH CARE

SKIN CARE

HAIR CARE

HOME CARE

CONTACT

HOME

This questionnaire is designed for adults and the scoring system isn't appropriate for children. Scores in women will run higher, as seven symptoms/conditions apply exclusively to women, while only 2 apply exclusively to men.

In SECTION A it lists factors in your medical history which promote the growth of Candida alibicans. SECTIONS B and C deal with symptoms commonly found in individuals with a yeast-connected illness.

Please answer every question in each section. Then move on to each section and submit only if all questions have been answered.

Completing this questionnaire and receiveing your results should help you and your health professional evaluate the possible role of Candida in contributing to your health problem. Yet it will not provide an automatic "Yes" or "No" answer.

SECTION A: HISTORY

Have you taken tetracyclines or other antibiotics for acne for 2 months or longer?	YES NO
Have you, at any time in your life, taken other "broad spectrum" antibiotics* for repiratory, urinary or other infections? This means for 2 months or longer, or as in shorter courses of 4 or more times in a 1 year period. *(Includes: Keflex, Ampicillin, Amoxicillian, Ceclor, bactrim and Septra)**	YES NO
Have you, at any time in your life, been troubled by persistent vaginal problems or had 3 or more episodes of vaginitis in a year?	YES NO
Have you ever been pregnant?	No Once More
Have you taken birth control pills?	No 6-24 months More than 2 yrs.
Have you taken prednisone, Decadron (R) or other cortisone-type drugs?	No 2 weeks or less 2 weeks or more
Does exposure to perfumes, insecticides, fabric shop oders and other chemicals provoke symptoms?	None Mild Moderate/Severe
Are your symptoms worse on damp, muggy days or in moldy places?	YES NO
Have you had persistent athlete's foot, "jock itch" or other chronic fungous infections of the skin or nails? Have such infections been persistent or moderate?	None Mild Severe
Do you crave sugar?	YES NO
Do you crave breads?	YES NO
Do you crave alcoholic beverages?	YES NO
Does tobacco smoke REALLY bother you?	YES NO

SECTION B: MAJOR SYMPTOMS

For each symptom which follows, choose "mild" if the symptom occurs occasionally, "moderate" if the symptom occurs frequently, and "severe" if the symptom is persistent and/or disabling.

Fatigue or Lethargy	None Mild Moderate Severe
Feeling of being "drained"	None Mild Moderate Severe
Poor Memory	None Mild Moderate Severe
Feeling "spacey" or "unreal"	None Mild Moderate Severe
Depression	None Mild Moderate Severe
Numbness, burning or tingling	None Mild Moderate Severe
Muscle aches	None Mild Moderate Severe
Muscle weakness or paralysis	None Mild Moderate Severe
Pain and or swelling joints	None Mild Moderate Severe
Abdominal pain	None Mild Moderate Severe
Constipation	None Mild Moderate Severe
Diarrhea	None Mild Moderate Severe
Bloating	None Mild Moderate Severe
Troublesome vaginal discharge	None Mild Moderate Severe
Persistent vaginal burning or itching	None Mild Moderate Severe
Prostatitis	None Mild Moderate Severe
Impotence	None Mild Moderate Severe
Loss of sexual feelings	None Mild Moderate Severe
Endometriosis	None Mild Moderate Severe
Dysmenorrhea	None Mild Moderate Severe
Premenstrual tension	None Mild Moderate Severe
Spots in front of eyes	None Mild Moderate Severe
Erratic vision	None Mild Moderate Severe

SECTION C: OTHER SYMPTOMS

While the symptoms in this section occur commonly in patients with yeast-connected illness, it should be noted that they also occur in individuals who do not have Candida. For each symptom which follows, choose "mild" if the symptom occurs occasionally, "moderate" if the symptom occurs frequently, and "severe" if the symptom is persistent and/or disabling.

Drowsiness	None Mild Moderate Severe
Irritability or jitteriness	None Mild Moderate Severe
Lack of coordination	None Mild Moderate Severe
Frequent mood swings	None Mild Moderate Severe
Headache	None Mild Moderate Severe
Dizziness / loss of balance	None Mild Moderate Severe
Pressure above ears/feeling of head swelling and tingling	None Mild Moderate Severe
Inability to concentrate or insomnia	None Mild Moderate Severe
Rectal itching	None Mild Moderate Severe
Hives, Eczema, other rashes	None Mild Moderate Severe
Heartburn	None Mild Moderate Severe
Indigestion	None Mild Moderate Severe
Belching and intestinal gas	None Mild Moderate Severe
Mucus in stools	None Mild Moderate Severe
Hemorrhoids	None Mild Moderate Severe
Dry mouth	None Mild Moderate Severe
Mouth rashes, blisters, white tongue	None Mild Moderate Severe
Bad breath	None Mild Moderate Severe
Joint swelling or arthritis	None Mild Moderate Severe
Nasal congestion or discharge	None Mild Moderate Severe
Postnasal drip	None Mild Moderate Severe
Nasal itching	None Mild Moderate Severe
Sore or dry throat	None Mild Moderate Severe
Cough	None Mild Moderate Severe
Pain or tightness in chest	None Mild Moderate Severe
Wheezing or shortness of breath	None Mild Moderate Severe
Urgency or urinary frequency	None Mild Moderate Severe
Burning on urination	None Mild Moderate Severe
Failing vision	None Mild Moderate Severe
Burning, itching or tearing of eyes	None Mild Moderate Severe
Recurrent ear infections	None Mild Moderate Severe
Fluid in ears	None Mild Moderate Severe
Ear pain or deafness	None Mild Moderate Severe
Sensitivty to milk, wheat, corn or other common foods	None Mild Moderate Severe
Other symptoms	None Mild Moderate Severe