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Thrush, men

Introduction

Thrush is a term that is widely used to describe a range of infections caused by a type of fungus called Candida albicans. The medical term for thrush is candidiasis. Although thrush is usually associated with women, thrush infections are relatively common in men as well.

Candida albicans

Candida albicans occurs naturally in the body, particularly in warm, moist areas, such as the mouth and genitals. It normally does not cause any problems because it is kept under control by the immune system (the body’s natural defence against illness and infection) and other types of bacteria in the body. However,  there are  factors that can cause the fungus to multiply (grow) and lead to infection.

Thrush and STIs 

It is possible for thrush to spread during sexual intercourse, but it should be stressed that not all cases of thrush are caused in this way. It is therefore inaccurate to define thrush as a sexually transmitted infection (STI).

Many cases of thrush develop in men and women who are not sexually active. Similarly, if you are in a relationship and you get thrush from your partner, it does not necessarily mean that they have been having sex with other people.

Types of male thrush

The most common types of thrush in men are:

  • infection of the head (glans) of the penis – known as candida balanitis
  • infection of the inside the mouth – known as oral thrush
  • a general skin infection – known as a candidal skin infection

A less common, but much more serious, type of thrush occurs when the Candida albicans fungi pass into the bloodstream and start to spread throughout the body. This is known as invasive candidiasis.

People with a weakened immune system, either as a result of conditions such as HIV, or as a side effect of a treatment such as chemotherapy, are most at risk of developing invasive candidiasis. See Male thrush - complications for more information about invasive candidiasis.

The rest of this article will focus on the fungal infection of the skin and glans of the penis.

See the topics about Fungal nail infections, Oral thrush - adultsOral thrush - babies for information about these types of fungal infections.

How common is male thrush?

Thrush is a very common type of condition, particularly candida balanitis. It is estimated that 1 in 10 men who visit a sexual health clinic have balanitis.

Skin infections are less common in the general population, but are relatively widespread among certain groups of people such as:

  • those with a weakened immune system
  • those who are obese, as they often have large rolls of skin (an environment where fungi can often thrive)
  • people who have type 1 diabetes or type 2 diabetes – this is because the high levels of glucose that are associated with diabetes can encourage fungus to breed; also, people with diabetes tend to sweat more, which also encourages the fungus
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Symptoms

Candida balanitis

The symptoms of candida balanitis (a fungal infection of the head of the penis) include:

  • red skin around the head of the penis
  • swelling of the head of the penis
  • irritation and soreness of the head of the penis
  • thick, lumpy discharge under the foreskin
  • itchiness around the head of the penis
  • an unpleasant odour
  • pain when passing urine
  • difficultly retracting (pulling back) the foreskin of your penis (phimosis)
  • pain during sex

Candidal skin infection

Most candidal skin infections develop in areas of the body where different folds of skin come together, such as the:

  • armpits
  • groin
  • areas of skin between your fingers
  • skin between your genitals and anus (the opening where faeces are expelled from the body)

People who are obese are also at risk of developing a skin infection in between their rolls of skin.

The infection usually begins as a red and painful itchy rash. Small red spots can also develop on the rash. The affected skin may then scale over, producing a white-yellow curd-like substance. If the areas of skin between your fingers are affected, the skin becomes thick, soft and white.

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Causes

Candida albicans

Thrush is caused by the Candida albicans fungus. Many people have a small amount of the candida fungus in their bodies. However, it does not usually cause any problems because it is kept under control by the body’s immune system, and other harmless bacteria (so called ‘good bacteria’).

Thrush can develop whenever the good bacteria in your body (which keeps candida under control) is destroyed. For example, if you are taking antibiotics to treat an infection, the antibiotics will not distinguish between good and bad bacteria, and will fight off both types.

Also, if you are run down, and your immune system is weak, the candida fungus that causes thrush may multiply.

Personal hygiene

Candida tends to grow in warm and moist conditions. Therefore, you may develop thrush if you do not dry your penis carefully after washing.

Using perfumed shower gels and soaps can irritate your penis, making thrush more likely to develop. Candida also thrives on skin that is already damaged.

HIV, diabetes, and other conditions

Men who have HIV, diabetes or other conditions that weaken their immune system, are more at risk of developing thrush. This is because the infection develops very quickly and the weakened immune system is not strong enough to fight it off.

If your diabetes is uncontrolled (usually because you do not realise you have the condition), you are more likely to develop thrush. Typical signs of diabetes include:

  • excessive thirst
  • frequently needing to pass urine
  • weight loss

You should see your GP if you have these symptoms, or if you have thrush which keeps reccurring, even after treatment.

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Diagnosis

If you suspect that you have the symptoms of thrush (either affecting your penis or your skin) and you have no history of the condition, it is best to seek a diagnosis.

This is because there may be underlying factors that need further investigation. For example, you may have undiagnosed diabetes. Alternatively, your symptoms may be caused by something other than thrush, such as a bacterial skin infection.

If you have a previous history of thrush that has been diagnosed, you usualy do not need another diagnosis unless it fails to respond to treatment.

Thrush can be diagnosed by your GP or by visiting your nearest local sexual health or genito-urinary medicine (GUM) clinic. Find a clinic.

Your GP or a doctor at the GUM clinic can confidentially diagnose thrush by physically examining the head of your penis or the affected area of skin.

Further testing is usually only required if:

  • your symptoms are severe
  • your symptoms persist despite treatment
  • you have recurring episodes of thrush

Testing usually involves using a swab (a small plastic rod with a cotton ball on one end) to obtain a small tissue sample from the affected body part. The tissue will be tested for the presence of any infectious agents, such as the Candida albicans fungus.

You may also be referred for a series of blood and urine tests to check whether an underlying condition, such as diabetes, is making you more vulnerable to thrush.

Recurring thrush

If you have had thrush before, and you recognise your symptoms, over-the-counter (OTC) treatments from your pharmacist can help to clear up the infection.

If you keep getting thrush, or it does not clear up with treatment, visit your GP so that they can investigate the cause and recommend appropriate treatment.

If you are a heterosexual man, and you have thrush, it is likely that your partner may also have the condition. This is because the candida fungus commonly lives inside the vagina. Therefore, it is a good idea for both of you to get treatment in order to prevent the infection being passed back and forth between you.

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Treatment

The recommended first-line treatment for thrush is a type of anti-fungal cream called topical imidazole. Topical imidazoles work by breaking down the membranes (walls) of the fungi cells.

Examples of topical imidazoles include:

  • clotrimazole
  • econazole
  • ketoconazole
  • miconazole

Most of these medications are available from your pharmacist without a prescription. Your pharmacist can advise you on which treatment is most suitable for your needs.

The most common side effect of a topical imidazole is a mild burning sensation when you apply the cream.

In a few people, some topical imidazoles have caused a more severe burning sensation and a serious skin irritation. If this happens, stop using the cream and contact your GP for advice.

If you are having symptoms of itchiness, your GP may prescribe a corticosteroid cream as an additional treatment. Corticosteroids reduce levels of inflammation within the affected tissue. This should help to resolve the symptoms of itchiness.

Fluconazole

If your symptoms do not improve within 14 days, you may need an alternative antifungal medication. Fluconazole is one example of this type of medication, and it is available as a cream and as a tablet. Most products that contain fluconazole are available over-the-counter (OTC) without the need for a prescription.

Fluconazole works by destroying some of the enzymes (a type of protein that triggers useful chemical reactions inside the body) that fungi cells need to survive and reproduce.

The most common side effects of fluconazole are:

  • nausea
  • abdominal (tummy) pain
  • diarrhoea
  • flatulence (excessive wind)

Contact your GP for advice if your symptoms do not improve after 14 days of taking fluconazole. You may need to be referred to a dermatologist for specialist treatment. A dermatologist is a doctor who specialises in treating skin conditions.

Good hygiene

If you have thrush, practising good hygiene can help to clear up the infection. Wash the affected area carefully with warm water. Showers are a better option than baths. However, do not use perfumed shower gels, or soaps, on your genitals, because they can cause irritation.

After washing, make sure that you dry the affected area carefully because the candida fungus thrives in damp conditions. Wearing loose fitting cotton underwear can help to keep your skin and penis dry and cool, which helps to prevent the build up of the candida fungus on your skin and under your foreskin. 

Avoid having sex

If you have thrush, you should avoid having sex until the infection has cleared up. This is because during sex, the infection can be spread, or made worse.

If you have thrush, and you choose to have sex while you are treating the condition, using a condom will ensure that you do not pass the infection on to your partner.

Some heterosexual men get a mild form of balanitis (inflammation of the head of the penis) after having sex. This is probably caused by an allergy to the candida fungus in your partner’s vagina. However, it will usually clear up if your partner gets treatment.

See the topic about Balanitis for more information about this condition.

Gay men may also get thrush by having unprotected sexual intercourse. If you and your partner get treatment, it will usually clear up. Again, it is recommended that you avoid having sex until the infection has cleared up. If you choose to have sex, using a condom will help to prevent the infection from spreading to your partner.

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Complications

Invasive candidiasis

If you have a weakened immune system there is a risk that the candida fungus will spread into your blood. The infection can then quickly spread throughout your body affecting many of your organs. This type of infection is known as invasive candidiasis.

Known risk factors for invasive candidiasis include:

  • having HIV
  • having type 1 or type 2 diabetes
  • taking immunosuppressants – a type of medication that is used to stop the body rejecting newly donated organs
  • undergoing high-dose chemotherapy or radiotherapy
  • having a central venous catheter (CVC) – a tube that is directly implanted into your chest and used to administer medication; they are often used in order to avoid repeated painful injections during a long-term course of medication
  • having dialysis – a type of treatment where a machine is used to replicate the functions of the kidney and is commonly used to treat kidney failure

The symptoms of invasive candidiasis can be wide ranging, depending on what part of the body is affected by infection. However, initial symptoms of infection can include:

  • a high temperature (fever) of or above 38ºC (101.4ºF) 
  • shivering
  • nausea
  • headache

Get medical help immediately if you have thrush and any of the risk factors listed above, and you develop any of the above symptoms, over a short period of time.

Invasive candidiasis is a medical emergency that requires immediate admission to an intensive care unit (ICU). In an ICU, the functions of the body can be supported while the underlying infection is treated with injections of anti-fungal medications.

If you are thought to be particularly vulnerable to invasive candidiasis – for example, you have diabetes and you are on dialysis, your GP may recommend that you are admitted to hospital as a precaution if you develop a thrush infection.

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Prevention

Good personal hygiene

You will help to prevent thrush by having good standards of hygiene, such as cleaning your penis regularly, and using a condom while having sex with your partner (if they have thrush).

When washing, do not use perfumed shower gels, or soaps, on your genitals because they can cause irritation. Make sure that you always dry your penis properly after washing.

Also, wearing loose fitting cotton underwear can help to prevent moisture accumulating under your foreskin, which decreases the likelihood of the candida fungus multiplying.

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