What is the treatment for candidiasis of the penis?

Treatment for Candidiasis of the Penis

For penile candidiasis, topical antifungal agents such as clotrimazole cream applied twice daily for 7 days or a single oral dose of fluconazole 150 mg are recommended as first-line treatments. 1, 2

First-Line Treatment Options

Topical Treatments

• Clotrimazole cream: Apply twice daily for 7 days 3, 2
• Other topical azole creams (miconazole, econazole) can be used similarly

Oral Treatment

• Fluconazole: Single 150 mg oral dose 2
  • Equally effective as topical treatments (91-92% clinical cure rate)
  • Often preferred by patients with history of previous topical therapy 2

Treatment Algorithm

1. For uncomplicated cases (immunocompetent patients with mild symptoms):

   • Either topical azole cream for 7 days OR single dose oral fluconazole 150 mg
   • Patient preference may guide choice between oral vs. topical therapy

2. For complicated cases (severe infection, immunocompromised patients, diabetes):

   • Extend treatment duration to 14 days
   • Consider oral fluconazole 150 mg every 72 hours for 2-3 doses 1

3. For resistant or recurrent infections:

   • Test for antifungal susceptibility if available
   • Consider alternative antifungals like itraconazole or voriconazole 4
   • Evaluate for underlying conditions (diabetes, immunosuppression)

Special Considerations

Diabetic Patients

• Higher prevalence of candidal balanitis in diabetic patients 3
• May require longer treatment courses (14 days)
• Glycemic control should be optimized

Recurrent Infections

• Consider maintenance therapy similar to vulvovaginal candidiasis protocol
• Weekly fluconazole 150 mg for 6 months may be beneficial in recurrent cases 1
• Evaluate and treat sexual partners if recurrence is frequent

Drug Resistance

• Fluconazole resistance is increasingly reported 4, 5
• For resistant cases, itraconazole, voriconazole, or clotrimazole may be effective alternatives 4

Clinical Pearls and Pitfalls

• Sexual transmission: Candidal balanitis can be sexually transmitted; consider treating partners in recurrent cases 6
• Diagnostic confirmation: Visual examination plus microscopic analysis with KOH preparation or culture is recommended 7
• Hygiene measures: Advise patients on proper genital hygiene and to avoid irritants
• Uncircumcised men: More susceptible to candidal infections; proper cleaning under foreskin is important
• Follow-up: Consider follow-up in 1 month to confirm resolution, especially in complicated cases 2

Both topical and oral treatments show similar efficacy, with clinical cure rates around 90% and mycological eradication rates of 78-83% 2. Treatment choice can be guided by patient preference, with many preferring the convenience of a single oral dose over multiple days of topical application.