Should a male sex partner be treated for a woman's vaginal candidiasis (yeast infection)?

Treatment of Male Sex Partners for a Woman's Yeast Infection

Treatment of male sex partners is not recommended for women with vulvovaginal candidiasis (VVC) unless the male partner is symptomatic.

Understanding Vulvovaginal Candidiasis and Sexual Transmission

• VVC is not usually acquired through sexual intercourse, and routine treatment of sex partners is not recommended according to established guidelines 1
• The pathogenesis of VVC is primarily related to overgrowth of Candida species in the vagina rather than sexual transmission 1
• Approximately 75% of women will experience at least one episode of VVC in their lifetime, with 40-45% experiencing two or more episodes 1

When to Consider Partner Treatment

• A minority of male sex partners may develop balanitis, characterized by:
  • Erythematous areas on the glans of the penis 1
  • Pruritus (itching) or irritation of the penile area 1
• Only these symptomatic male partners benefit from treatment with topical antifungal agents 1
• Treatment should be directed at relieving the male partner's symptoms rather than preventing recurrence in the female 1

Evidence on Partner Treatment for Preventing Recurrence

• Research has shown that simultaneous treatment of asymptomatic male partners with antifungal medication does not significantly influence either cure rates or recurrence rates in women with vaginal candidiasis 2
• In a controlled study, the cure rate was 74% in the group with untreated partners versus 79% in the group with treated partners, showing no statistically significant difference 2
• Recurrence rates were actually higher in the treated partner group (61%) compared to the untreated partner group (53%), further supporting that partner treatment does not prevent recurrence 2

Special Considerations for Recurrent VVC

• For women with recurrent VVC (defined as four or more episodes per year):
  • Partner treatment may be considered, though evidence for this approach is limited 1
  • Sexual behaviors rather than the presence of Candida species in the male partner appear to be more associated with recurrences 3
  • Certain sexual practices like oral sex (cunnilingus) and use of saliva as lubricant have been associated with increased risk of recurrence 3

Management Algorithm

1. For women with uncomplicated VVC:

   • Treat the woman with appropriate antifungal therapy 1
   • Do not treat asymptomatic male partners 1

2. For male partners with symptoms of balanitis:

   • Treat with topical antifungal agents to relieve symptoms 1
   • Options include clotrimazole or miconazole creams 1

3. For women with recurrent VVC:

   • Consider comprehensive evaluation including vaginal cultures 1
   • Partner evaluation may be considered, though routine treatment is not strongly supported by evidence 2, 3
   • Address behavioral factors that may contribute to recurrence 3

Conclusion

The evidence clearly shows that treating asymptomatic male partners of women with VVC does not improve clinical outcomes or prevent recurrence. Treatment should be reserved for male partners who exhibit symptoms of balanitis or other Candida-related conditions.