From the Guidelines
Yes, a candidal infection can be transmitted from a female to a male partner and back to the female, creating a "ping-pong" effect. When a woman has a vaginal yeast infection (typically caused by Candida albicans), the fungus can transfer to her male partner during intercourse, who may develop symptoms like penile rash, itching, or burning (balanitis) 1. The male partner can then reinfect the female during subsequent sexual contact, even after she has been treated. To prevent this cycle, both partners should be treated simultaneously when recurrent infections occur. For women, typical treatments include over-the-counter antifungal medications like clotrimazole (Gyne-Lotrimin), miconazole (Monistat), or prescription fluconazole (Diflucan) 150mg as a single oral dose 1. Men may use topical antifungal creams like clotrimazole or miconazole applied to the penis for 7-14 days. Some key points to consider in the treatment and prevention of candidal infections include:
- The diagnosis of vulvovaginal candidiasis should be confirmed by a wet-mount preparation with use of saline and 10% potassium hydroxide to demonstrate the presence of yeast or hyphae and a normal pH (4.0–4.5) 1.
- Uncomplicated infection can be effectively treated with either single-dose fluconazole or short-course fluconazole for 3 days, both of which achieve >90% response 1.
- Complicated vulvovaginal candidiasis requires that therapy be administered intravaginally with topical agents for 5–7 days or orally with fluconazole 150 mg every 72 hours for 3 doses 1.
- Recurrent vulvovaginal candidiasis, defined as ≥4 episodes of symptomatic infection within one year, is usually caused by azole-susceptible C. albicans, and treatment should begin with induction therapy with a topical agent or oral fluconazole for 10–14 days, followed by a maintenance azole regimen for at least 6 months 1. Couples should abstain from sexual activity or use condoms during treatment and until symptoms resolve completely. This recommendation is based on the understanding that Candida can colonize male genitalia without causing symptoms, allowing for reinfection even when the man appears asymptomatic. Key considerations in managing candidal infections include the potential for azole resistance, particularly in cases of recurrent infection, and the importance of treating both partners simultaneously to prevent the "ping-pong" effect of reinfection 1.
From the Research
Transmission of Candidal Infection
- A candidal infection can be transmitted from a female to a male partner and back to the female, as evidenced by the presence of Candida species in the male partners' oral cavities, penile coronal sulcus, and seminal fluid 2.
- The study found that 23.2% of male partners had oral cavity colonization, 16% had penile coronal sulcus colonization, and 14.4% had seminal fluid colonization with Candida species 2.
- Treatment of the male partner's Candida colonization was found to be important in preventing recurrent vulvovaginitis, with a lower recurrence rate observed in couples where the male partner was treated 2.
Treatment and Recurrence
- Simultaneous treatment of the male partner with Ketoconazole did not significantly influence the cure rate or recurrence rate in women with vaginal candidiasis 3.
- However, another study found that treatment of the male partner's Candida colonization was associated with a lower recurrence rate of vulvovaginitis 2.
- The use of antifungal agents such as fluconazole, itraconazole, and clotrimazole has been shown to be effective in treating vaginal candidiasis, with varying degrees of success 4, 5.
Antifungal Sensitivity
- In vitro antifungal sensitivity testing has shown that Clotrimazole, Fluconazole, and Nystatin are effective against Candida species, with Clotrimazole being the most effective 6.
- The study found that Clotrimazole was effective against 70% of Candida species, while Fluconazole was effective against 36.2% and Nystatin was effective against 63.5% 6.