Treatment of Fungal Penile Infection (Candidal Balanitis)
First-Line Treatment: Topical Antifungals
For uncomplicated fungal penile infections (candidal balanitis), apply topical clotrimazole 1% cream or miconazole 2% cream to the affected area twice daily for 7-14 days. 1
- The CDC specifically recommends topical antifungal agents as first-line therapy for male partners with balanitis characterized by erythematous areas on the glans with pruritus or irritation 1
- Most uncomplicated cases respond within 7-14 days of topical therapy 1
- Topical agents cause minimal systemic side effects, though local burning or irritation may occur in some patients 1
When to Use Oral Therapy
Reserve oral fluconazole 150 mg as a single dose for patients with severe symptoms or recurrent infections. 1
- Do NOT use oral azoles as first-line therapy for uncomplicated penile candidal infections—topical therapy is equally effective with fewer systemic risks and drug interactions 1
- Oral fluconazole interacts with calcium channel antagonists, warfarin, cyclosporine, oral hypoglycemics, phenytoin, protease inhibitors, and many other medications 1
Management of Treatment-Resistant Cases
For documented fluconazole-resistant infections, oral itraconazole is the preferred alternative when in vitro susceptibility testing confirms sensitivity. 1, 2
- Consider non-albicans species (particularly Candida glabrata) in refractory cases, as these may require longer treatment duration or alternative agents 1
- Antifungal susceptibility testing should be obtained when treatment failure occurs or with prior azole exposure 1
- A documented case of fluconazole- and terbinafine-resistant C. albicans balanitis was successfully treated with oral itraconazole after the isolate showed sensitivity to itraconazole, voriconazole, clotrimazole, and amphotericin B 2
Management of Recurrent Infections
For recurrent genital candidiasis, eliminate predisposing factors including uncontrolled diabetes, antibiotic use, immunosuppression, and poor hygiene practices. 3
- Consider maintenance therapy after initial treatment for patients with recurrent infections 3
- Evaluate for underlying conditions such as diabetes mellitus that may predispose to recurrent infections 1
Sexual Partner Management
Treatment of female sexual partners is not routinely recommended unless the woman has recurrent vulvovaginal candidiasis. 1
- Candidal balanitis is not typically sexually transmitted, though it can occur in male partners of women with vulvovaginal candidiasis 1
Follow-Up Recommendations
Patients should return for follow-up only if symptoms persist or recur after completing the initial treatment course. 1