Penile Thrush: Is It Possible?

When people talk about a yeast infection, they are most likely referring to a vaginal yeast infection. However, yeast infections can affect people with penises as well—and more often than you might think.

The condition, referred to as penile thrush or penile candidiasis, typically involves the head of the penis (glans) and the foreskin (prepuce). Symptoms include itching, redness, whitish patches, and bleeding. Antifungal drugs are commonly prescribed to treat the infection.

Is It Possible to Get Thrush on the Penis?

Penile thrush is more common in people with uncircumcised penises. The moist environment under the foreskin provides the fungus with the ideal conditions to grow. People with circumcised penises are less likely to get penile candidiasis unless they have a severely weakened immune system.

People with diabetes are also at an increased risk of fungal infections including balanitis (inflammation of the head of the penis).

Understanding Thrush

Thrush is the term commonly used to describe an infection involving a form of yeast called Candida albicans—an omnipresent fungus found throughout the body in healthy people, including in the mouth, gastrointestinal tract, genitals, and skin.

Other types of Candida can also cause thrush, but it's less common.

The immune system can usually keep the fungus in check, but when the immune system is low, the fungus can grow rapidly and establish an infection, which is called candidiasis.

Candidiasis can develop in the mouth (oral thrush), vagina (yeast infection), anus (anal thrush), and penis (penile thrush).

In people with severely compromised immune systems—such as those with advanced HIV— candidiasis can affect the skin, spread into the esophagus and lungs, and even move into the bloodstream and make its way into distant organs.

Cause and Risk Factors

The actual incidence of penile thrush is unknown—in part because many people do not seek treatment until their symptoms are severe. However, the condition is thought to be common.

Although penile candidiasis is not a sexually transmitted disease (STD), the fungus can be spread to the penis through sexual contact, including oral, vaginal, and anal intercourse.

There are several risk factors for penile thrush, including:

• Uncircumcised penis
• Poor penile hygiene
• Obesity
• Diabetes
• Nutritional deficiency (including vitamin A, vitamin B6, and iron)
• Being immunocompromised
• Prolonged use of antibiotics
• Immunosuppressant therapy
• Smoking
• Urinary catheters

Identifying Penile Thrush

Penile thrush is not uncommon—especially in people who are uncircumcised. When it occurs, it may not cause any symptoms (asymptomatic) or it may cause mild symptoms (such as itching) that are easily dismissed.

If penile thrush does cause symptoms, they most commonly affect the head and foreskin of the penis. These symptoms might include:

• Itchiness, burning, or soreness
• Reddened skin with a shiny appearance
• A blotchy rash with white patches, particularly in skin folds
• Sores, cracking, or bleeding foreskin
• A lumpy, foul-smelling discharge from under the foreskin
• Pain with urination (dysuria)
• Pain with sex

Related Complications

Penile thrush will often resolve on its own with little or no treatment. However, sometimes the infection can lead to severe complications that require aggressive medical intervention.

Balanitis

Balanitis is a condition characterized by inflammation of the glans and sometimes the foreskin.

Balanitis has many of the same features as penile thrush, but it tends to be more severe, often causing significant swelling and pain. The swelling can make it harder to pull back the foreskin.

Balanitis can also be caused by a local bacterial infection, STDs, psoriasis, eczema, and scabies, among other conditions.

Invasive and Systemic Candidiasis

On rare occasions, a yeast infection goes beyond the mouth and genitals and affects nearby or distant organs. When this happens, it's almost always in people with severely compromised immune systems. Without the means to control the overgrowth of Candida, the infection can become invasive.

Invasive candidiasis is a serious condition that can develop in the esophagus and other parts of the gastrointestinal tract as well as the lungs, skin, and lining of the abdomen (peritoneum).

If Candida enters the bloodstream, it can cause systemic disease and affect multiple organ systems. The condition, referred to as candidemia, is one of the most common causes of bloodstream infections in hospitalized patients. The liver, spleen, kidneys, heart, and brain are among the organs most commonly affected.

There are conditions or situations that make a person more likely to get invasive candidiasis and candidemia.

Risk factors include:

• Advanced HIV infection
• Cancer chemotherapy
• Organ transplantation (including the use of immunosuppressants to prevent organ transplant rejection)
• Injecting drugs use
• Kidney failure and kidney dialysis
• Having a central venous catheter (CVC)
• The use of high-dose antibiotics in a hospital
• Having multiple abdominal surgeries
• Having spent time in an intensive care unit (ICU)
• Receiving total parenteral nutrition (TPN)

Home Remedies and Other Treatments

Most cases of penile thrush are not severe, but they can cause significant discomfort and stress. If the infection is mild, home remedies and over-the-counter (OTC) medications often help symptoms get better on their own. More serious infections may require medical treatment.

Home Remedies

There are some home remedies that may help clear or reduce the symptoms of penile thrush. The evidence supporting these remedies is lacking, but they are still embraced by people who prefer natural therapies or want to complement a prescribed therapy.

Some of the common home remedies for thrush are:

• Yogurt: Yogurt is a natural probiotic that may help control Candida overgrowth by increasing the concentration of healthy bacteria and yeast in affected tissues. A 2015 study in the Global Journal of Health Science suggested that the topical application of yogurt, honey, and a topical antifungal was more effective in relieving vaginal yeast infection symptoms than the antifungal alone.
• Tea tree oil: Tea tree oil is known to have significant antifungal properties. Research has suggested that tea tree oil, when applied to Candida albicans strains in the lab, might be more effective at inhibiting fungal growth than some of the more commonly used antifungals. However, a downside is that tea tree oil can cause irritation and contact dermatitis in some people.
• Coconut oil: Coconut oil has antifungal properties that may aid in the treatment of mild yeast infections. A 2016 study in the journal Scientifica reported that coconut oil applied to Candida albicans samples in the lab was as effective at inhibiting fungal growth as the antifungal drug Nizoral (ketoconazole).
• Apple cider vinegar: Apple cider vinegar is a centuries-old remedy that is used to treat certain skin infections, including acne. Studies have shown that apple cider vinegar can inhibit the growth of Candida in the lab, but it was not as effective as certain antifungals and could cause stinging and pain.

Over-the-Counter Drugs

Mild cases of penile thrush often respond to many of the same OTC antifungals that are used to treat athlete's foot or vaginal yeast infections. Most of these products are applied twice daily, and the duration of treatment is generally no more than seven days.

There are several OTC antifungals that can be used to treat penile thrush:

• Clotrimazole (sold as a generic or under the brand names Lotrimin AF, Monistat, Mycelex, and others)
• Miconazole (sold as a generic or under the brand names Desenex, Micatin, Ting AF, and others)

Most antifungal creams are well tolerated, with few, if any, side effects. In rare cases, a topical antifungal may cause a hypersensitive skin reaction.

Prescriptions

For severe or persistent infections, including Candida balanitis, stronger topical antifungals might be prescribed. These treatments can include 2% ketoconazole cream (sold under the brand name Nizoral and others), 1% econazole cream, and nystatin cream or ointment.

In some cases, a combination of a topical antifungal and oral antifungal is prescribed if the case is severe or resistant to conservative therapies.

Oral antifungal options include:

• Diflucan (fluconazole)
• Ecoza (econazole)

In some cases, only a single oral dose of the drug is needed to resolve a localized infection.

People with recurrent balanitis may benefit from circumcision. Studies have shown that the incidence of balanitis in circumcised people is 68% lower than in uncircumcised people.

In cases of invasive candidiasis and candidemia, high-dose intravenous antifungals for several weeks might be needed. The treatment typically includes the antifungals Cancidas (caspofungin), Eraxas (anidulafungin), or Mycamine (micafungin) as first-line therapy. Diflucan and amphotericin B (reserved for only severe fungal infections) might also be prescribed.