by Jack Newman, MD, FRCPC
Fluconazole (Diflucan) is a synthetic antifungal agent which can be used for the treatment of a variety of Candida albicans infections. For the breastfeeding mother in particular, it can be used to treat recurrent Candida infections of the nipples, and, if such an thing exists, Candida infections of the milk ducts.
Candida (yeast) infections of the nipple and ducts
Candida infections of the nipples may occur any time while the mother is breastfeeding. Candida albicans likes warm, moist, dark areas. It lives normally on us, and 90% of babies are colonized by it within a few hours of birth. It only becomes a problem under certain circumstances.
Candida infections of the skin or mucus membranes are more likely to occur when there is a breakdown in the integrity of the skin or mucus membrane; another reason why a good latch is very important from the very first day. Many Candida infections would, perhaps, not have occurred, if the mother had not had sore nipples and a breakdown of the skin of the nipples and areola. The oozing of serum which occurs often in cracked nipples turns Candida albicans from its harmless form to a disease causing form.
The widespread use of antibiotics also encourages the overgrowth of Candida albicans. Many pregnant women, women in labour, and new mothers, as well as their babies receive antibiotics, sometimes with very little justification.
Diagnosis of Candida infections of the nipples and/or ducts
There is no good test which helps makes the diagnosis. A positive culture from the nipple(s) proves little. Neither does a negative culture. The best way to make a diagnosis is by history.
The presence or absence of a Candida infection in the baby is not helpful. A baby may have thrush all over his mouth, but the mother have no pain. A mother may have the classic symptoms of a Candida infection of the nipples, and the baby have no thrush or diaper rash.
The typical symptoms of a Candida infection of the nipples are:
Treating Candida Infections
Our first approach to treating these infections is gentian violet. It is safe, works rapidly, and almost always, though there seems to have been a decrease in its effectiveness over the past few years. A good response to gentian violet confirms that the mother’s nipple pain is caused by Candida since little else will respond to gentian violet. It thus also justifies the use of fluconazole, if needed.
