Candidiasis (thrush) is a fungal infection caused by yeasts that belong to the genus Candida. There are many species of Candida yeasts that can cause infection in humans, the most common of which is Candida albicans.
Candidiasis genital infection is much more common in women than men, but when it does occur in males, candidiasis affects the head of the penis (the "glans penis," informally referred to as the helmet) and the foreskin, if present (the "prepuce").
The rash is also known as yeast infection, thrush, Candida, candidal balanitis, candidosis and moniliasis.
"Jock itch" does not refer to male thrush. Rather, this is an informal name for a different type of intimate fungal infection in men. Medically termed tinea cruris, jock itch affects the skin around the genitals, a groin infection that is caused by different fungi - Trichophyton or Epidermophyton.1
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You will also see introductions at the end of some sections to any recent developments that have been covered by MNT's news stories. Also look out for links to information about related conditions.
Here are some key points about male candidiasis. More detail and supporting information is in the main article.
- Although Candida normally lives on the skin and mucous membranes, if there is an overgrowth it can cause symptoms that vary depending on the part of the body affected.1
- While genital Candida infection mainly occurs in women, it can also occur in men when it causes an inflammation of the glans penis - balanitis.2
- Yeast infection, thrush, Candida, candidal balanitis, candidosis and moniliasis are other names that are used for the rash.
- Yeasts can live on any part of the body, but they most like to exist in warm, moist body areas such as the mouth, vulva, vagina, armpit, under the breasts, skinfolds, between the toes and behind the foreskin.
- Risk factors that make candidiasis more likely include antibiotics, corticosteroids, immunosuppression, diabetes, poor hygiene, using too many cleansing products.
- Genital candidiasis is not considered to be a sexually transmitted infection, although sexual transmission of Candida can occur during vaginal intercourse.
- In uncircumcised men, the moist, warm space underneath the foreskin is thought to promote yeast growth. It is reported to occur more frequently when hygiene is poor, but this is not always seen in practice.3
- Symptoms may include an itchy rash, red skin, swelling, irritation and itching around the head of the penis, lumpy discharge under the foreskin or pain when urinating and during sex.
- Oral or local antifungal treatments can be used to treat candidiasis.
- Thrush can be prevented and managed with good hygiene since yeast infections thrive in moist, warm places.
What is male candidiasis (thrush in men)?
Genital candidiasis is often referred to as "yeast infection" and is very common among women - almost three quarters of adult women will have at least one yeast infection in their lifetime. By comparison with women, the infection is uncommon in men.2
Candidiasis is a mycotic infection - an infection caused by a fungus, Candida in this case. In men, genital candidiasis affects the head of the penis (the glans penis) and, if present, the foreskin (prepuce).
As well as affecting the genitals, candidiasis infection can be found on other areas of skin or mucous membrane - for example, in the mouth, when it is known as oral thrush.
Causes of male candidiasis
Candidiasis is caused by a yeast fungus, Candida. The first description of the microorganism behind the infection was made over 170 years ago, in 1839, by a 29-year-old university lecturer called Bernhard von Langenbeck.3 He went on to become one of the most prominent surgeons of the 19th century.
Candida albicans, the thrush yeast. Left: in harmless cell form; Right: in disease-causing form with cells producing hyphae that penetrate tissue. Courtesy: Jim Deacon, The University of Edinburgh
Dr von Langenbeck described the species of fungus Candida albicans. This is the Candida yeast that is most commonly found in candidiasis although other species can also be involved in the fungal infection (Candida glabrata, for example).4
Candida fungi are found naturally inside the body and on the skin - it is normal for the microbe to be there. Every human being is colonized by the fungus - but at levels that do not usually cause problems. There is evidence of yeast on the penis in up to a fifth of men who do not have any signs or symptoms of balanitis.4,5
Candida albicans causes problems only under certain conditions that allow it to thrive and grow to numbers that result in candidiasis,5 with the fungal cells producing hyphae, structures that penetrate the tissue.6
Our immune system and natural ecology of bacteria normally keep the fungal population in check, but if this balance is disturbed, the fungus can thrive. An example of this is commonly seen with newborn babies that can be affected by thrush while they develop a balanced microbial flora.5
The following risk factors make candidiasis more likely:7,8
- Antibiotics - recent broad-spectrum antibiotic use, which causes a change in the balance of the normal microbial flora. This upsets the balance and allows the Candida to overgrow
- Taking medication that suppresses the immune system such as chemotherapy or corticosteroids
- Immunosuppression - weakened immunity reduces the body's defence against the fungus and so allows Candida to thrive. HIV infection is one example of something that weakens the immunity
- Diabetes, particularly if poorly controlled. Higher levels of blood sugar allow a more conducive environment for the yeasts to thrive6
- Uncircumcised men with poor hygiene - men who have not been circumcised have a moist, dark, warm space underneath the foreskin that is favorable for yeast growth
- Personal hygiene. Chronic local irritants such as bath foam, soaps, shower gels, lubricants, etc. can irritate the penis and lead to fungal infection, which is more likely on damaged skin. Not drying carefully after washing is also a risk factor because fungus can thrive on the penis in warm, moist conditions
- Poor nutrition
- Receiving renal dialysis.
Can men get thrush from a female partner?
While genital candidiasis in men - candidal balanitis - is generally sexually acquired,4 it is not classed a sexually transmitted infection (STI or STD) because it can be present in men who are not in a sexual relationship.9
Men who have a female partner with a genital yeast infection (termed vulvovaginal candidiasis in women) do not need to seek treatment themselves unless they also get symptoms, since sex does not necessarily result in transmission of the fungal infection to men.10
Men are recommended to avoid unprotected sex with a female partner until the woman's infection has cleared up after treatment.10
Symptoms of male candidiasis
Most Candida infestation is asymptomatic.
Men with genital candidiasis may experience an itchy rash on the penis.2 The online skin disease atlas Dermnet has a collection of pictures showing a range of example rashes on the penis caused by Candida.
Men with genital candidiasis may experience:7
Around the head of the penis:
- Red skin
- Irritation and soreness
- White patches on the skin.
- Thick, lumpy discharge under the foreskin, producing an unpleasant odour
- Difficulty pulling back the foreskin (phimosis).
- When passing urine
- During sex.
Tests and diagnosis
Men who have been diagnosed and treated for penile thrush before can try treating themselves if they get the same symptoms again. If the rash clears up, this confirms the diagnosis and avoids the need to see a doctor.7
If this is the first time a man has had symptoms, or there is no response to usual treatment, it is important to consult a doctor because professional diagnosis could rule out alternative problems (differential diagnosis) or underlying issues, such as diabetes, that predispose men to the infection.7
A full screen for sexually transmitted infections would be advisable.
It is usually sufficient for a doctor to ask questions about the rash (take a clinical history) and examine the penis to confirm a diagnosis of candidiasis,4 and this is how most clinics determine the problem.11
If the doctor is unsure of the diagnosis, suspects there may be another cause for the rash, or considers it to be a severe case, they may swab around glans penis and under the foreskin, and send this sample for laboratory culture of the organism and the typical microscopic appearance of the spores and hyphae.7 Another laboratory method involves pressing a slide against the affected area and sending this for evaluation under a microscope.11
Any persistent sores or ulcers that do not heal should be biopsied.
There is evidence of yeast in up to a fifth of men who do not have any signs or symptoms of balanitis.4
Treatments for male candidiasis
Many mild infections can clear on their own and do not require treatment. If symptoms relief is needed, then the Candida can be killed using antifungal topical creams or antifungal oral medication.
Thrush in men (candidal balanitis) is treated in the same way as it is in women (vulvovaginal candidiasis), although preparations for women are available in different forms, including a vaginal cream and vaginal tablet.7 Treatment is effective in 80% or 90% of cases.2,4
For men, oral or local treatments can be used. Diflucan is a capsule containing 150mg of the antifungal drug fluconazole. It is available either from the doctor or over the counter from the pharmacy, without a prescription being needed. A single capsule is all that is required.12
Another line of treatment available to men is a class of antifungal known as imidazole. Individual drugs in the class include:7
- Clotrimazole (numerous brands available)
- Econazole (generic only; no branded versions are available)
- Ketoconazole (numerous brands)
- Miconazole (numerous brands).
Creams are applied topically (directly onto the affected area), usually once a day for three to seven days. Whether locally applied or taken by mouth, both routes of drug treatment are equally effective.4
A cream known as nystatin, from a different class of antifungal and sold under numerous brand names, is also available for topical treatment, but it is less effective than the topical imidazoles above.4
If they have not had candidiasis symptoms before, it is recommended that men consult their doctor before treating themselves. Previously diagnosed men who get the same symptoms again can try treating the problem themselves before going to the doctor if this fails to work.7
Good hygiene prevents and helps treat thrush since yeast infections thrive in moist, warm places.
Help prevent or treat thrush by cleaning the penis regularly with plain warm water, ensuring it is dry afterwards. But avoid shower gels and soaps as they can worsen the problem
In men with a foreskin, poor hygiene underneath it can lead to the build-up of a cheesy-looking substance called smegma that can cause irritation.7
The following practical tips are given by England's National Health Service:7
- Help to clear up an infection by washing the penis carefully with warm water - a shower is better than a bath
- Avoid using perfumed shower gels or soaps on the genitals because they can cause irritation
- After washing, dry the penis carefully to deprive the fungus of the damp conditions that help it to thrive
- Wear loose-fitting cotton underpants to help keep the skin and penis dry and cool.
Studies have failed to show that treating the male partner of a female who has recurrent vulvovaginitis reduces attacks.8
Do probiotics work?
Women who get recurrent yeast infections often try probiotics and other alternative treatments,4 although there is no mention in the medical literature of men resorting to these options.
In women, the evidence over whether probiotics work or not - based on the theory that the Lactobacillus bacteria they contain may inhibit or reduce the growth of Candida fungus in the vaginal tract - is conflicting.4,13
Also, conventional treatment with itraconazole has been proven to be significantly more effective than a supplement containing the "friendly" bacterium Lactobacillus acidophilus.4 This probiotic has been shown to be helpful against bacterial vaginosis, however.13
Complications of penile thrush
Some men may be susceptible to fungal infection of the blood, known as invasive candidiasis, which is a medical emergency. Weakened immunity may mean that a man with genital thrush could become infected in the blood, and the fungus can then spread quickly throughout the body.7
Emergency treatment in hospital protects organs from the infection while antifungal drugs are administered to kill it. For some vulnerable men who have thrush, hospital may be advised as a precaution against their higher likelihood of getting the systemic infection.
This is a serious infection, which can be quickly fatal. Anyone with one or more risk factors should be on the alert for this infection, and should consider prophylactic treatment if their immunity is very low.
The following risk factors may make men with genital thrush prone to invasive candidiasis:7
- HIV infection
- Immunosuppressants, for example taken by transplant patients
- High-dose chemotherapy or radiotherapy treatment for cancer
- Having a central venous catheter (CVC) for medication
- Being on dialysis.
It is reported to be better to avoid sexual intercourse while there is any active infection present, although there is no clear evidence base to support this with Candida infection.