What is the treatment for scrotum bleeding and burning associated with a yeast infection?

Treatment for Scrotal Bleeding and Burning with Yeast Infection

For scrotal yeast infection (candidal balanitis) causing burning and bleeding, apply topical antifungal therapy with clotrimazole 1% cream or miconazole 2% cream twice daily to the affected scrotal and penile skin for 7-14 days, addressing any bleeding sites with local pressure and wound care as needed. 1, 2

Immediate Assessment Required

Before initiating treatment, you must distinguish between simple candidal infection and life-threatening conditions:

• Rule out necrotizing infection (Fournier's gangrene) if there is fever, toxemia, foul-smelling discharge, subcutaneous gas, or rapidly spreading erythema—this requires immediate surgical debridement and is not treated with antifungals alone 3, 4
• Exclude traumatic bleeding sources such as angiokeratomas (small dark red papules that can bleed spontaneously) or other vascular lesions 5
• Verify candidal infection by looking for characteristic white discharge, erythematous areas on the glans/scrotum, pruritus, and burning—microscopy with KOH preparation showing yeasts or pseudohyphae confirms diagnosis 1, 6, 2

First-Line Treatment Protocol

Topical antifungal therapy is the primary treatment for candidal balanitis:

• Clotrimazole 1% cream applied to affected scrotal and penile skin twice daily for 7-14 days 1, 6
• Miconazole 2% cream applied twice daily for 7 days as an alternative 1, 6
• Terconazole 0.4% cream for 7 days if other azoles fail 1

The CDC guidelines specify these topical azole regimens achieve 80-90% cure rates for uncomplicated candidal infections 1, 7

Managing the Bleeding Component

Address bleeding separately from the infection:

• Apply direct pressure to any actively bleeding sites 5
• Keep the area clean and dry between antifungal applications 2
• If bleeding persists or recurs, consider vascular lesions (angiokeratomas) requiring dermatology referral for laser treatment 5

When to Escalate Treatment

Consider systemic therapy if:

• Symptoms persist after 7-14 days of topical therapy—this indicates complicated infection requiring oral fluconazole 150 mg, repeated after 3 days 6
• Widespread dermatophytic or candidal involvement beyond the scrotum is present 2
• Patient is immunocompromised (HIV, diabetes, immunosuppression)—same topical regimen initially, but lower threshold for systemic therapy 1, 6

Partner Management

Sexual partner treatment is generally not required for candidal balanitis, as this is not typically sexually transmitted 1, 6. However, if the partner has symptomatic vulvovaginal candidiasis with pruritus and white discharge, treat with topical azoles for 7 days 1, 7

Resistant or Recurrent Cases

If symptoms recur within 2 months or fail to improve within 3 days:

• Obtain fungal culture to identify non-albicans species (C. glabrata) or antifungal resistance 1, 8
• For fluconazole-resistant Candida albicans, switch to oral itraconazole 200 mg daily, which has shown effectiveness in resistant penile infections 8
• Verify compliance with the full treatment course 6
• Consider uncontrolled diabetes or other host factors 6

Critical Pitfalls to Avoid

• Do not delay surgical consultation if necrotizing infection is suspected—antibiotic therapy alone is inadequate and the condition is life-threatening 3, 4
• Do not use oral fluconazole in pregnant partners—only 7-day topical azole therapy is safe in pregnancy 7, 6
• Do not assume all scrotal bleeding is from infection—vascular lesions and trauma must be excluded 5
• Do not use nystatin as first-line therapy—topical azoles are significantly more effective 7