What Is Nipple Thrush?

A Yeast Infection of the Breast

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Nipple thrush is a type of yeast infection of the breast. It most commonly occurs during breastfeeding, although in rare cases it can occur in other times of life. Like oral thrush and vaginal thrush, nipple thrush is usually treated with topical antifungal medication.

Woman breastfeeding
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Nipple Thrush Symptoms

Symptoms of nipple thrush generally appear in the first six weeks after giving birth and include:

  • Bright red or pink tinge to the whole nipple(s)
  • Sore nipples
  • Burning pain in the nipples
  • Stabbing pain in the nipples
  • Shiny and/or flaky skin
  • Nipple sensitivity to touch
  • Oral thrush symptoms in the nursing infant, including white patches in the mouth and reluctance to feed
  • Difficulty with breastfeeding

Nipple thrush symptoms may be easily confused with other types of nipple pain caused by injury or infection.

Causes

Nipple thrush is caused by infection with a yeast (Candida). It most commonly occurs during breastfeeding, although in rare cases it can happen at other times of life. A variety of risk factors have been associated with the development of nipple thrush, including:

  • Vaginal yeast infection at the time of delivery
  • Antibiotic treatment during labor or the postpartum period
  • Using bottles within two weeks of birth
  • Pregnancy duration longer than 40 weeks

However, data on risk factors for nipple thrush is generally of low quality and based on self-report of diagnosis rather than clinically diagnosed thrush. There is a need for more systematic research on causes and risk factors for nipple thrush.

Diagnosis

Nipple thrush is usually diagnosed based on symptoms of both the parent and the infant. Healthcare providers may also test the nipples or the breast milk for the presence of yeast. However, many people have symptoms of nipple thrush without healthcare providers being able to find yeast on the breast or in the breast milk.

More sensitive tests can sometimes identify different Candida species, but these tests aren’t always clinically available. Therefore, at this time, symptoms remain the most effective way to diagnose nipple thrush.

Thrush is also considered a diagnosis of exclusion. In other words, healthcare providers eliminate other diagnoses to determine the condition is thrush.

Treatment

Nipple thrush is usually treated with a topical antifungal medication. Common antifungal medications include nystatin, miconazole, and clotrimazole. Gentian violet is also an antifungal treatment option.

Topical antibiotics may also be prescribed, as bacterial infection of the nipple is common in individuals with nipple fissures, which often occur alongside nipple thrush. For people with very inflamed nipples, topical steroids may be used as well.

In addition to treating the parent, it is important that the infant be treated at the same time. Oral nystatin or oral fluconazole are the most common medications used to treat infants with thrush. If only the mother or the infant is treated, the thrush is likely to recur.

Coping

Nipple thrush can make breastfeeding very painful. As such, one of the major issues associated with developing nipple thrush is that it can lead to parents choosing to discontinue breastfeeding sooner than they would otherwise choose to.

Fortunately, nipple thrush is usually quite responsive to treatment. If initial treatment is not successful, another antifungal medication may be tried.

Many types of Candida are resistant to one or more options for treatment. The problem of drug-resistant Candida is growing. Therefore, if you or your infant is being treated for thrush, it is important to complete the entire course of treatment and not stop when symptoms start to improve.

Should I Stop Nursing?

Many people who are diagnosed with nipple thrush have questions about whether they should stop nursing. They may be wondering if breastfeeding with thrush is dangerous for their infants. They may also be concerned that others will judge them for stopping breastfeeding before they otherwise might have.

To answer the first question: Nipple thrush is associated with oral thrush in the infant. However, oral thrush is a relatively common and generally mild infection. Oral thrush is not generally considered a reason parents need to stop breastfeeding, and in fact, they are encouraged to continue throughout an episode of thrush.

At the same time, parent and infant will both need to be treated appropriately, or there is a risk of the pair passing thrush back and forth between them.

To answer the second question: There are many reasons why people choose to stop breastfeeding. They may have difficulty integrating it into their lives, they may have problems getting enough nutrition into their infant, or they may experience pain and discomfort due to nipple thrush or other concerns.

While health professionals support breastfeeding as an ideal form of infant nutrition, sometimes it doesn’t work well for parents and their infants. Parents have the right to choose to discontinue breastfeeding.

That said, support is available to people who wish to continue breastfeeding but are experiencing difficulties. Talk to your healthcare provider about a referral to a lactation consultant or breastfeeding support group in your area.

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9 Sources
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  1. Goldstein L. Nipple thrush: how to identify and how to treat [published correction appears in Midwifery Today Int Midwife. 2015 Summer;114:68]. Midwifery Today Int Midwife. 2015;(113):18-19. 

  2. Amir LH, Donath SM, Garland SM, et al. Does Candida and/or Staphylococcus play a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia. BMJ Open. 2013;3(3):e002351. doi:10.1136/bmjopen-2012-002351

  3. Morrill JF, Heinig MJ, Pappagianis D, Dewey KG. Risk factors for mammary candidosis among lactating women. J Obstet Gynecol Neonatal Nurs. 2005;34(1):37-45. doi:10.1177/0884217504272814

  4. Merad Y, Derrar H, Belkacemi M, Drici A, Belmokhtar Z. Candida albicans mastitis in breastfeeding woman: an under recognized diagnosisCureus. 2020;12(12):e12026. doi:10.7759/cureus.12026

  5. Waldman RA, Finch J, Grant-Kels JM, Whitaker-Worth D. Skin diseases of the breast and nipple. Journal of the American Academy of Dermatology. 2019;80(6):1483-1494. doi:10.1016/j.jaad.2018.08.067

  6. Heller MM, Fullerton-Stone H, Murase JE. Caring for new mothers: diagnosis, management and treatment of nipple dermatitis in breastfeeding mothers. International Journal of Dermatology. 2012;51(10):1149-1161. doi:10.1111/j.1365-4632.2011.05445.x.

  7. Arendrup MC, Patterson TF. Multidrug-resistant Candida: epidemiology, molecular mechanisms, and treatment. J Infect Dis. 2017;216(suppl_3):S445-S451. doi:10.1093/infdis/jix131

  8. KidsHealth from Nemours. Oral thrush (for parents). Updated September 2019.

  9. Odom EC, Li R, Scanlon KS, Perrine CG, Grummer-Strawn L. Reasons for earlier than desired cessation of breastfeeding. Pediatrics. 2013;131(3):e726-e732. doi:10.1542/peds.2012-1295