What is the recommended treatment for a male patient with a yeast infection?

Treatment of Male Yeast Infections

Genital Candidiasis (Balanitis)

For male genital yeast infections (candidal balanitis), a single oral dose of fluconazole 150 mg is equally effective as topical clotrimazole cream applied twice daily for 7 days, with 92% clinical cure rates and the advantage of single-dose convenience. 1

First-Line Treatment Options

• Oral fluconazole 150 mg as a single dose is highly effective, achieving clinical cure or improvement in 92% of patients with candidal balanitis 1
• Topical azole therapy (clotrimazole, miconazole, or other azoles) applied twice daily for 7 days is an equally effective alternative, with 91% cure rates 1
• Median time to relief of erythema is 6 days with fluconazole versus 7 days with topical clotrimazole 1

Patient Preference and Practical Considerations

• Most patients (12 of 15 in clinical trials) who had previously used topical therapy preferred oral treatment over topical applications 1
• Topical azoles are fungistatic (limiting growth but not killing fungi), while oral therapy provides systemic coverage 2
• Both regimens are well-tolerated with minimal adverse effects 1

Recurrent or Complicated Cases

• For recurrent genital candidiasis, consider maintenance therapy after initial treatment 3
• Patients with history of multiple previous episodes (within the past year) have higher relapse rates—9 of 36 patients on fluconazole with prior episodes experienced relapse versus only 2 of 33 on clotrimazole without prior history 1
• Eliminate predisposing factors: uncontrolled diabetes, antibiotic use, immunosuppression, and poor hygiene 3, 4

Urinary Tract Yeast Infections in Males

Asymptomatic Candiduria

Most asymptomatic candiduria in males does NOT require treatment unless the patient is neutropenic or undergoing urologic procedures. 5

• Removing indwelling catheters and unnecessary antibiotics clears candiduria in approximately 50% of asymptomatic patients 5
• Treatment is only indicated for high-risk patients: neutropenic individuals, those with symptoms, or those undergoing urologic manipulation 5

Symptomatic Cystitis (Bladder Infection)

For symptomatic urinary yeast infections, oral fluconazole 200 mg (3 mg/kg) daily for 2 weeks is the treatment of choice for fluconazole-susceptible organisms. 3, 5

• Catheter removal is mandatory if feasible—this is as important as antifungal therapy 5
• For fluconazole-resistant C. glabrata: Amphotericin B deoxycholate 0.3–0.6 mg/kg daily for 1–7 days OR oral flucytosine 25 mg/kg four times daily for 7–10 days 3, 5
• For C. krusei: Amphotericin B deoxycholate 0.3–0.6 mg/kg daily for 1–7 days 3, 5

Pyelonephritis (Kidney Infection)

For yeast pyelonephritis, oral fluconazole 200–400 mg (3–6 mg/kg) daily for 2 weeks is recommended for fluconazole-susceptible organisms. 3, 5

• Eliminate urinary tract obstruction—remove or replace nephrostomy tubes and stents if feasible 5
• For fluconazole-resistant C. glabrata: Amphotericin B deoxycholate 0.3–0.6 mg/kg daily with or without oral flucytosine 25 mg/kg four times daily 3, 5

Patients Undergoing Urologic Procedures

• Prophylactic treatment: Oral fluconazole 400 mg (6 mg/kg) daily OR Amphotericin B deoxycholate 0.3–0.6 mg/kg daily for several days before and after the procedure 3, 5

Critical Pitfalls to Avoid

• Do NOT treat asymptomatic candiduria in immunocompetent males—this leads to unnecessary antifungal exposure and potential resistance development 5
• Failure to remove catheters significantly reduces treatment success—catheter removal is equally important as antifungal therapy 5
• Bladder irrigation alone has high relapse rates and should only be used as adjunctive therapy for refractory resistant organisms 5
• Prevention is more effective than treatment—address predisposing factors including diabetes control, antibiotic stewardship, and hygiene 4