Symptoms and Treatment of Scrotal Yeast Infection
Scrotal yeast infections are characterized by pruritus (itching), erythema (redness), and sometimes a white discharge, and should be treated with topical antifungal medications such as clotrimazole, miconazole, or other azole creams applied directly to the affected area. 1
Symptoms
Scrotal yeast infections (candidiasis) typically present with the following symptoms:
- Persistent itching or burning sensation in the scrotal area 2, 3
- Redness of the scrotum, which may extend to the base of the penis 4, 2
- White discharge or scaling may be present 2
- Skin may appear edematous (swollen) 2
- Lichenification (thickened skin) can develop in chronic cases 2
- Hyperalgesia (increased sensitivity to pain) in the affected area 4
- Vaginal soreness, vulvar burning, and dyspareunia may be present in female partners if they also have yeast infection 1
Diagnosis
Diagnosis of scrotal yeast infection involves:
- Clinical examination showing characteristic erythema and possible white discharge 1
- Microscopic examination using 10% potassium hydroxide (KOH) preparation to visualize yeast cells or pseudohyphae 1
- Fungal culture may be performed to identify the specific Candida species, with C. albicans being the most common pathogen 5, 6
- Normal pH testing (≤4.5) in vaginal infections, which may help differentiate from other conditions 1
- Ruling out other causes of scrotal pruritus through appropriate laboratory testing 3
Treatment
Topical Treatments (First-line)
- Azole antifungal creams applied directly to the affected area 1:
- Clotrimazole 1% cream applied twice daily for 7-14 days
- Miconazole 2% cream applied twice daily for 7 days
- Butoconazole 2% cream applied for 3 days
- Tioconazole 6.5% ointment as a single application
Oral Treatment (Alternative)
- Fluconazole 150 mg oral tablet as a single dose 1
- This may be preferred in cases where topical application is difficult or infection is severe 1
Additional Management
- Maintain good hygiene of the genital area 2, 6
- Keep the area dry, as moisture promotes yeast growth 5, 2
- Avoid tight-fitting clothing that can increase moisture and heat 3
- Treat sexual partners if they also have symptoms of yeast infection 5
- Control blood glucose levels in patients with diabetes, as hyperglycemia promotes yeast growth and recurrence 5, 6
Risk Factors
Several factors can predispose individuals to scrotal yeast infections:
- Diabetes mellitus, especially with poor glycemic control 5, 6
- Recent antibiotic use, which disrupts normal flora 5, 6
- Immunosuppression (HIV, medications, etc.) 5, 6
- Poor hygiene, particularly in uncircumcised men 5
- Warm, moist environment under the foreskin in uncircumcised men 5
- Corticosteroid use 5
- Tight-fitting clothing that increases heat and moisture 3
Special Considerations
- For recurrent infections, especially in diabetic patients, maintaining euglycemia is crucial 5
- Test-of-cure after treatment completion is generally unnecessary given high efficacy rates of antifungal treatments 5
- In cases of treatment failure, consider:
- Poor adherence to treatment
- Reinfection from an untreated partner
- Incorrect diagnosis
- Resistant Candida species (e.g., C. glabrata, which is more common in type 2 diabetes) 5