It mostly affects women, but if it occurs in males, candidiasis affects the head of the penis and the foreskin. It can lead to inflammation of the head of the penis, known as balanitis.
Oral thrush affects the mucous membranes, for example, of the mouth.
Here are some key points about male candidiasis. More detail is in the main article.
- Candida normally lives on the skin and mucous membranes, but if too much grows, it can cause symptoms.
- Symptoms 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.
- Risk factors include the use of antibiotics or corticosteroids, immunosuppression, diabetes, poor hygiene, using too many cleansing products.
- Genital candidiasis is not considered a sexually transmitted infection (STI), but transmission can occur during vaginal intercourse.
- Oral or local antifungal treatments can be used to treat candidiasis.
- Good hygiene practices can help prevent it.
Thrush can cause discomfort in the genital area.
In men, thrush affects the head of the penis and, if present, the foreskin. It can also be found on other areas of skin or mucous membrane, for example, in the mouth. This is known as oral thrush.
There are often no symptoms, but if symptoms appear, there may be an itchy rash on the penis.
Around the head of the penis there may be:
- red skin
- irritation and soreness
- white patches
Symptoms affecting the foreskin include:
- thick, lumpy discharge under the foreskin, producing an unpleasant odor
- difficulty pulling back the foreskin
There may be pain during sex or when passing urine.
Many mild infections do not require treatment. Some medications are available, and there are also home remedies that may help.
Diflucan is a capsule containing 150 milligrams (mg) of the antifungal drug fluconazole.
It is available either from the doctor or over the counter (OTC) from the pharmacy. Only one capsule is needed.
Another type of antifungal is known as imidazole, a class of drugs that includes:
Creams are applied topically, directly onto the affected area, usually once a day for 3 to 7 days.
Nystatin is another topical antifungal. It is sold under numerous brand names, but it is less effective than the topical imidazoles.
A man who has not been treated for thrush previously should see a doctor before treating themselves.
Good hygiene prevents thrush and helps treat it.
Help prevent or treat thrush by cleaning the penis regularly with plain warm water, ensuring it is dry after. But avoid shower gels and soaps as they can worsen the problem
Tips for good hygiene include:
- washing the penis carefully with warm, running water
- not using perfumed shower gels or soaps on the genitals, because they can cause irritation
- drying the penis carefully after washing
- wearing loose-fitting cotton underpants to help keep the genital area dry and cool
In men with a foreskin, poor hygiene underneath it can lead to the build-up of a cheesy-looking substance called smegma. Smegma can cause irritation.
Do probiotics work?
Women who get recurrent yeast infections often try probiotics and other alternative treatments containing Lactobacillus bacteria, but there is conflicting evidence about whether or not this works, and no evidence that it works in men.
In rare cases, a man with weakened immunity who has genital thrush may develop invasive candidiasis. This is a fungal infection of the blood that can cause the fungus to spread quickly throughout the body.
This can be fatal, and it is a medical emergency.
Emergency treatment in hospital protects organs from the infection while antifungal drugs are administered to kill it.
Sometimes, if a man with weakened immunity develops thrush, he may be advised to go to the hospital, as a precaution against this systemic infection.
Factors that increase this risk include:
- HIV infection
- use of immunosuppressant drugs, for example, by transplant patients
- undergoing high-dose chemotherapy or radiotherapy treatment for cancer
- having a central venous catheter (CVC) for medication
- being on dialysis
Candidiasis is caused by a yeast fungus, Candida.
Candida fungi occur naturally inside the body and on the skin, but at levels that do not cause problems. The immune system keeps them in check.
However, if certain conditions disturb the balance, the fungus can thrive and candidiasis can develop. The fungal cells produce hyphae, structures that penetrate the tissue.
Risk factors that make candidiasis more likely include:
- use of broad-spectrum antibiotics, which can upset the balance of normal microbial flora and allow the Candida to overgrow
- taking medications that suppress the immune system, such as chemotherapy or corticosteroids
- having a weakened immune system, due, for example, to HIV or kidney dialysis
- poorly-managed type-1 or type-2 diabetes, because yeasts thrive more easily in higher levels of blood sugar
- obesity, especially if there are rolls of fat where yeast can thrive
- poor hygiene, especially if a man is not circumcised
- bath foam, soaps, shower gels, lubricants, and other products, which can irritate and damage skin of the penis, leaving it open to infection
- not drying carefully after washing, because the fungus can thrive in warm, moist conditions
- having a poor diet
Is it sexually transmitted?
Genital candidiasis is not classed as a sexually transmitted infection (STI). It is usually acquired through sexual activity, but it can develop without sexual contact. A partner with a fungal infection does not always transmit it.
However, men are advised to avoid unprotected sex with a female partner who has thrush until treatment has cleared up the infection.
Thrush may disappear without treatment. However, if it does not go away, and if treatment does not remove the infection, it is important to see a doctor to rule out other possible problems, such as diabetes, which can make infection more likely.
Screening for STIs may be appropriate.
If the rash is severe or if the doctor is unsure of the diagnosis or suspects an underlying cause, a swab from around glans penis and under the foreskin may be sent to the lab for testing.
If there are persistent sores or ulcers that do not heal, a biopsy may be necessary.