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Tick-Borne Illness Screening

Horowitz MSIDS Questionnaire

A validated screening tool developed by Dr. Richard Horowitz to estimate whether current symptoms may reflect Lyme disease or another tick-borne infection. Answer each item honestly and your score and probability tier update live.

Section 1 of 4

Current symptoms & frequency

For each symptom, select how often it occurs over the past month. Choose N/A if it does not apply to you. Items left blank are treated as N/A.

Unexplained fevers, sweats, chills, or flushing
Unexplained weight change (loss or gain)
Fatigue, tiredness
Unexplained hair loss
Swollen glands
Sore throat
Testicular pain / pelvic pain
Unexplained menstrual irregularity
Unexplained breast milk production / breast pain
Irritable bladder or bladder dysfunction
Sexual dysfunction / loss of libido
Upset stomach
Change in bowel function (constipation or diarrhea)
Chest pain or rib soreness
Shortness of breath / cough
Heart palpitations, pulse skips, heart block
History of heart murmur or valve prolapse
Joint pain or swelling
Stiffness of the neck or back
Muscle pain or cramps
Twitching of the face or other muscles
Headaches
Neck cracks or neck stiffness
Tingling, numbness, burning, or stabbing sensations
Facial paralysis (Bell's palsy)
Eyes / vision (double, blurry)
Ears / hearing (buzzing, ringing, ear pain)
Increased motion sickness, vertigo
Lightheadedness, poor balance, difficulty walking
Tremors
Confusion, difficulty thinking
Difficulty with concentration or reading
Forgetfulness, poor short-term memory
Disorientation; getting lost, going to wrong places
Difficulty with speech or writing
Mood swings, irritability, depression
Disturbed sleep (too much, too little, early waking)
Exaggerated symptoms / worse hangover from alcohol
Section 2 of 4

Exposure & clinical history

Check each statement that applies to you. Each item carries a different point value based on its diagnostic weight.

Section 3 of 4

Day-to-day wellness

Thinking about the past 30 days, enter the number of days your physical and mental health were not good. Each answer maps to a 1–4 point band (0–5 days = 1 pt · 6–12 days = 2 pts · 13–20 days = 3 pts · 21–30 days = 4 pts).

Section 4 of 4

Composite symptom pattern

If all five of the following Section 1 symptoms are rated "All of the time" (3), an additional 5 points is added to your score: fatigue, forgetfulness/poor short-term memory, joint pain or swelling, tingling/numbness/burning/stabbing sensations, and disturbed sleep.

Status: Awaiting Section 1 responses.

Why this matters

Tick-borne illness is one of the most under-diagnosed contributors to long-running, multi-system symptoms. The HMQ is a published, statistically validated screen designed to surface the pattern fast: how many symptoms you carry, how they cluster, what your exposure history looks like, and how much your day-to-day quality of life is affected.

A higher score does not confirm Lyme disease. It signals that a structured tick-borne workup is likely to be high-value, and that any treatment plan should consider host factors (hormones, mitochondrial function, inflammation) alongside the infection itself.

The four probability bands

  • < 25Not likely. Below the Horowitz cut-off; persistent symptoms may still warrant a broader functional workup.
  • 25–44Possible. Pattern raises the question of a tick-borne process, especially with relevant exposure history.
  • 45–62Probable. In the validation study, confirmed Lyme patients clustered at or above this range.
  • ≥ 63Highly probable. Prompt structured evaluation for Lyme plus common coinfections is warranted.

A positive screen is not a diagnosis. It signals that a full Lyme/coinfection panel and a parallel look at hormonal, mitochondrial, and inflammatory systems is likely to be high-value.

A screen is the start, a proper evaluation is the answer.

A full Asymmetric Health workup considers infection load alongside hormones, mitochondrial function, inflammation, and cellular health, so that any tick-borne treatment plan is built around your physiology, not a questionnaire score alone.

See evaluation packages Schedule a free consultation

About the HMQ

What is the Horowitz MSIDS Questionnaire?

The HMQ is a 38-symptom, 4-section screening tool developed by Dr. Richard Horowitz to estimate the likelihood that a person's symptoms reflect Lyme disease or a related tick-borne infection. It was empirically validated by Citera, Freeman & Horowitz in the International Journal of General Medicine in 2017.

How is the score calculated?

Section 1 sums frequency ratings (0–3 per symptom, up to 114 points). Section 2 adds weighted points for exposure and history items (up to 34 points). Section 3 translates the past 30 days of physical and mental ill-health into 1–4 point bands (up to 8 points). Section 4 adds a +5 bonus when all five composite symptoms (fatigue, forgetfulness, joint pain, tingling/numbness, disturbed sleep) are rated 3. Maximum total is 161.

What do the four bands mean?

Below 25 is "not likely." 25–44 is "possible." 45–62 is "probable." 63 or above is "highly probable." In the 2017 validation study, patients with confirmed Lyme disease most often scored at or above the 45-point line.

I've had vague symptoms for years and no clear diagnosis. Does this apply to me?

Yes. The HMQ was specifically designed to catch the multi-system, migratory pattern that tick-borne illness tends to produce and that conventional single-specialty workups often miss. A long tail of unexplained fatigue, pain, cognitive, and neurologic symptoms is exactly what it screens for.

What happens if my score is high?

A high HMQ score warrants advanced tick-borne testing (chemiluminescence serology and PCR, ideally covering Lyme plus coinfections such as Babesia, Bartonella, Ehrlichia, and Anaplasma). At Asymmetric Health, that runs alongside a parallel look at hormones, mitochondrial function, and inflammation, since host factors determine how well any infection clears and how well the body repairs the downstream damage. Schedule a free consultation to map the right next step.

Is this a diagnostic test?

No. The HMQ is a screening tool, not a diagnostic one. A high score does not confirm Lyme or coinfection, and a low score does not rule it out. Diagnosis requires lab work, exposure history, and a clinician's interpretation in context.

Evidence & Sources

  1. Citera M, Freeman PR, Horowitz RI. Empirical validation of the Horowitz Multiple Systemic Infectious Disease Syndrome Questionnaire for suspected Lyme disease. Int J Gen Med. 2017 Sep 4;10:249–273. doi:10.2147/IJGM.S140224
  2. Horowitz RI. Why Can't I Get Better? Solving the Mystery of Lyme and Chronic Disease. St. Martin's Press; 2013.
  3. Jayaraman V, Krishna K, Yang Y, et al. An ultra-high-density protein microarray for high-throughput single-tier serological detection of Lyme disease. Sci Rep. 2020;10:18085. doi:10.1038/s41598-020-75036-2

Clinical Disclaimer: This questionnaire is a screening tool, not a diagnostic test. The HMQ estimates the probability that current symptoms may relate to a tick-borne infection. Other infectious, metabolic, hormonal, autoimmune, neurologic, and psychiatric conditions can produce overlapping symptoms. A high score does not confirm Lyme or coinfection; a low score does not rule it out. Always interpret in the context of a full clinical evaluation.