Do you treat yeast in the urine in males?

From the Guidelines

Yeast in the urine of males typically does not require treatment unless the patient has symptoms of a urinary tract infection or is at high risk for complications. Asymptomatic yeast in urine (candiduria) often represents colonization or contamination rather than true infection.

Key Considerations

• The presence of candiduria must be evaluated in the context of the particular clinical setting to determine its relevance and the need for antifungal therapy 1.
• If treatment is necessary due to symptoms or risk factors (such as immunosuppression, diabetes, or indwelling catheters), oral fluconazole 200mg on day 1 followed by 100mg daily for 7-14 days is the standard approach 1.
• For severe cases or fluconazole-resistant species, alternatives include amphotericin B bladder irrigation or intravenous echinocandins 1.
• Addressing underlying risk factors is crucial, including removing or changing urinary catheters if present, improving glycemic control in diabetics, and reducing unnecessary antibiotic use.
• Treatment decisions should be individualized based on symptoms, risk factors, and culture results to avoid unnecessary antifungal therapy which could promote resistance 1.

Risk Factors and Special Considerations

• Patients at high risk for complications, such as those with immunosuppression, diabetes, or indwelling catheters, may require more aggressive treatment 1.
• Neonates with very low birth weight and severely immunocompromised patients with fever and candiduria are at high risk for invasive candidiasis and may require treatment 1.
• Candiduria in the absence of a urinary catheter may be a manifestation of disseminated candidiasis in neutropenic patients with persistent unexplained fever and immunocompromised patients 1.

From the Research

Treatment of Yeast in Urine in Males

• Yeast in the urine, also known as candiduria, can be caused by various factors such as diabetes mellitus, indwelling urinary catheters, use of broad-spectrum antibiotics, urinary obstruction, and admission to intensive care units 2, 3, 4.
• The presence of Candida species in urine in asymptomatic patients does not warrant antifungal therapy, except in cases of neutropenic patients, very low-birth-weight infants, and patients undergoing urologic procedures 2, 3.
• For symptomatic infections, fluconazole is the treatment of choice, as it achieves high urinary levels 2, 3.
• Other treatment options, such as amphotericin B, flucytosine, and echinocandins, may be used in certain cases, but their effectiveness and urine concentrations vary 2, 3, 4.

Risk Factors and Clinical Considerations

• Conditions that predispose to candiduria include diabetes mellitus, antibiotic and corticosteroid therapy, as well as factors such as local physiology and disturbance of urine flow 4, 5.
• Clinical criteria alone are insufficient to distinguish reliably among different clinical types of candidal urinary tract infections, and the condition of the patient should be considered for determination of appropriate therapy 4.
• In most cases, candiduria is asymptomatic and follows a benign clinical course, with antifungal therapy only required in symptomatic or high-risk cases 5.

Treatment Approaches

• Removing predisposing factors, such as indwelling catheters and antibiotics, will clear candiduria in almost 50% of asymptomatic patients 3.
• For patients with symptomatic Candida urinary tract infections, a variety of treatment options are available, including fluconazole, amphotericin B, and flucytosine 3, 4.
• Newer azole agents and echinocandins are not recommended for the treatment of urinary tract infections since they fail to achieve adequate urine concentrations 3.