What is the treatment for candidiasis in males?

Treatment for Candidiasis in Males

For male genital candidiasis (balanitis), topical azole antifungals applied for 7-14 days are the first-line treatment, with oral fluconazole 150 mg as a single dose serving as an effective alternative. 1

Genital Candidiasis (Balanitis)

First-Line Topical Treatment

• Apply topical azole antifungals (clotrimazole, miconazole, or other imidazoles) to the affected area 1-2 times daily for 7-14 days 1
• These agents are highly effective and available over-the-counter 1
• Topical nystatin can also be used, though azoles are generally preferred 1

Oral Treatment Options

• Oral fluconazole 150 mg as a single dose is equally effective and may be preferred for convenience 1
• Alternative oral regimens include:
  • Ketoconazole 400 mg daily for 5-7 days 1
  • Itraconazole 200 mg twice daily for 1 day, or 200 mg daily for 3 days 1

Important Clinical Considerations

• Treatment of male partners of women with recurrent vulvovaginal candidiasis remains controversial - research shows no significant benefit in cure or recurrence rates when treating asymptomatic male partners 2
• However, symptomatic male partners with visible balanitis should always be treated 1, 3
• Keep the affected area clean and dry, as moisture promotes fungal growth 1, 4

Cutaneous Candidiasis (Skin Folds, Intertrigo)

Topical Management

• Apply topical azoles (clotrimazole, miconazole) or polyenes (nystatin) to affected areas 1-2 times daily for 7-14 days 1, 4
• Keeping the area dry is critically important - this is as essential as the antifungal medication itself 1, 4
• Use absorbent powders to maintain dryness 4

For Resistant Cases

• If topical treatment fails after 7-14 days, use oral fluconazole 150-200 mg daily for 7-14 days 4

Oropharyngeal Candidiasis (Thrush)

Initial Treatment Options

• Oral fluconazole 100-200 mg daily for 7-14 days is preferred due to superior efficacy and convenience 1
• Alternative topical options include:
  • Clotrimazole troches 10 mg five times daily for 7-14 days 1
  • Nystatin suspension 100,000 U/mL (4-6 mL four times daily) or pastilles for 7-14 days 1
• Itraconazole oral solution 200 mg daily for 7-14 days is as effective as fluconazole 1, 5

For Refractory Cases

• If fluconazole fails, use itraconazole solution >200 mg daily (preferably 100 mg twice daily) 1, 5
• Amphotericin B oral suspension (1 mL four times daily of 100 mg/mL suspension) for cases unresponsive to azoles 1
• Intravenous amphotericin B 0.3 mg/kg/day as last resort 1

Esophageal Candidiasis

Systemic therapy is mandatory - topical treatment is ineffective 1

Preferred Treatment

• Fluconazole 200-400 mg daily orally for 14-21 days 1
• Itraconazole oral solution 200 mg daily is equally effective 1, 5

Alternative Options

• For patients unable to swallow: intravenous fluconazole, echinocandins, or amphotericin B 0.3-0.7 mg/kg/day 1
• For refractory disease: itraconazole solution >200 mg daily or intravenous amphotericin B 1

Critical Pitfalls to Avoid

• Do not treat asymptomatic colonization - many healthy individuals carry Candida without infection, and treatment should be based on clinical symptoms, not just positive cultures 6, 7
• Do not use ketoconazole or itraconazole capsules for oropharyngeal/esophageal candidiasis - they have variable absorption and are inferior to fluconazole 1
• Do not use topical therapy alone for esophageal candidiasis - it will fail 1
• Avoid prolonged or unnecessary suppressive therapy in immunocompetent patients, as this promotes antifungal resistance 1

Special Populations

For Immunocompromised Patients

• Consider longer treatment courses (14-21 days minimum) 1
• Suppressive therapy with fluconazole may be necessary for frequent recurrences, though this increases resistance risk 1
• Higher doses may be required for adequate response 1