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

Treatment of Yeast Infections in Men

Topical azole antifungals applied twice daily for 7-14 days are the first-line treatment for male genital yeast infections (balanitis). 1, 2

Clinical Presentation

Male yeast infections typically manifest as balanitis with the following features:

• Erythematous (red) areas on the glans penis 3, 2
• Pruritus (itching) and irritation 3, 2
• Discomfort and inflammation 2

First-Line Treatment Options

Topical Antifungal Agents (Preferred)

The following topical azole regimens are recommended by the CDC and Infectious Diseases Society of America:

• Clotrimazole 1% cream applied twice daily for 7-14 days 2
• Miconazole 2% cream applied twice daily for 7 days 2
• Tioconazole 6.5% ointment as a single application 2
• Terconazole 0.4% cream applied for 7 days 2

These topical agents are fungistatic (azoles) and work by limiting fungal growth while epidermal turnover sheds the organisms from the skin surface. 4

Treatment Duration

• For uncomplicated infections: 7-14 days of topical therapy is typically sufficient 2
• For severe or recurrent infections: extended treatment duration may be necessary 2
• Longer initial therapy (7-14 days rather than single-dose) is recommended if recurrent infections occur 2

Alternative Treatment for Resistant Cases

If standard topical azoles fail or resistance is suspected:

• Oral itraconazole may be used for fluconazole- and terbinafine-resistant Candida albicans penile infections 5
• Amphotericin B, voriconazole, or clotrimazole are alternatives for resistant organisms 5
• Do NOT use azole therapy in patients with recent azole exposure or prophylaxis, as this increases resistance risk 1

Special Considerations

Side Effects

• Topical agents usually cause minimal systemic side effects 2
• Local burning or irritation may occur with topical applications 3, 2
• If oral agents are used, be aware of potential drug interactions with anticoagulants, calcium channel blockers, protease inhibitors, oral hypoglycemic agents, and phenytoin 2

Partner Treatment

• Treatment of sexual partners is generally NOT recommended for isolated episodes 3, 2
• Routine notification or treatment of sex partners is not warranted, as vulvovaginal candidiasis is not typically acquired through sexual intercourse 3
• However, treatment of partners may be considered in cases of recurrent infection 2

Recurrent Infections

• For recurrent genital candidiasis, eliminate predisposing factors including uncontrolled diabetes, antibiotic use, immunosuppression, and poor hygiene 1, 6
• Consider maintenance therapy after initial treatment for recurrent cases 6

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 1, 6
• Removing indwelling catheters and unnecessary antibiotics clears candiduria in approximately 50% of asymptomatic patients 6, 7

Symptomatic Cystitis

• Oral fluconazole 200 mg daily for 2 weeks is the treatment of choice for fluconazole-susceptible organisms 6
• Catheter removal is mandatory if feasible 6
• 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 6

Pyelonephritis

• Oral fluconazole 200-400 mg daily for 2 weeks for fluconazole-susceptible organisms 6
• Eliminate urinary tract obstruction by removing or replacing nephrostomy tubes and stents if feasible 6

Critical Pitfalls to Avoid

• Do NOT treat asymptomatic candiduria in immunocompetent males - this leads to unnecessary antifungal exposure and potential resistance development 6
• Failure to remove catheters significantly reduces treatment success - catheter removal is equally important as antifungal therapy 6
• Bladder irrigation alone has high relapse rates and should only be used as adjunctive therapy for refractory resistant organisms 6

Follow-Up

Patients should return for follow-up only if symptoms persist or recur within 2 months of treatment. 3, 2