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Questionnaire
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1
Have you, at any time in your life taken a course of antibiotics ?
No
Yes
2
Have you, at any time in you life either:
taken antibiotics continuously for a month or more or
taken four or more courses of antibiotics within 12 months ?
No
Yes
3
Are your symptoms worse on damp, muggy days or in mouldy places ?
No
Yes
4
Do you crave sugar ?
No
Yes
5
Do you have a feeling of being "drained" ?
No
Occational or mild
Frequent or moderately severe
Severe or disabling
6
Are you bothered by burning, itching or tearing of eyes ?
No
Occational or mild
Frequent or moderately severe
Severe or disabling
7
Are you bothered with vaginal burning, itching or discharge (do you have similar symptoms from the penis) ?
No
Occational or mild
Frequent or moderately severe
Severe or disabling
