Symptoms occur when the natural balance of normal germs in and on our body is changed. This may be caused by medications such as antibiotics or steroids or by illness such as diabetes or HIV infection. There is no obvious cause for the imbalance which causes the fungus to overgrow. Usually the symptoms are confined to the vagina or nipples of nursing mothers and to the mouth and diaper area of babies.
A rare and life-threatening form of candida infection occurs when the fungus gets into the bloodstream. This can affect the whole body. It is extremely uncommon and occurs only when a person’s normal immune defence has been seriously reduced. In people who are otherwise healthy, candida causes its problems on the surface of the skin or on the membranes of the mouth or vagina. While these symptoms are very unpleasant, they are neither dangerous nor disabling to a healthy individual.
It is not uncommon for babies to have light colored areas on the palate and in the back part of the lower and upper gums. These are nothing to worry about. There may also be a white coating on the tongue that is not necessarily yeast.
When yeast overgrowth appears in a baby’s mouth, one can look for a few obvious signs. These include white patches that look like milk stuck onto the inner cheeks and inner surface of the lips. These appear to be patchy, lacy or filmy and can be wiped off. Often a change in the baby's nursing behaviour is the first sign of candida in the mouth (thrush). The baby suddenly nurses poorly, latching eagerly on to the breast, then backing away as if something is wrong.
In these cases, the baby should be checked carefully for yeast. Other causes of discomfort must be ruled out. These would include ear infection, bladder infection, excess gas or injury. The mother's nipples should also be treated if a baby has yeast infection in the mouth. Treatment includes special drops which are prescribed by a doctor and are given every three hours, preferably after every feeding. The drops can be given by a dropper or applied on a clean, large baby swab. Treatment may take seven to 14 days, but if the thrush does not seem to be getting better, the doctor should be consulted.
Another type of treatment may be tried in these cases. Very rarely, treatment may include gentian violet. This should be used for only a limited time and under a doctor's close supervision. It is very messy and may cause side-effects.
Diaper rashes, as every mother knows, are common and most will respond to zinc cream in a few days. However, diaper rash caused by Candida will not go away when treated with regular creams. This type of rash is usually at its worst around the anus and deep in skin folds. It takes the form of irregular-shaped, red patches. Around the red areas, scattered on the healthy skin, are red spots and small patches called satellite lesions. Babies with this infection are treated with an antifungal and air is allowed to circulate to the area.
Several creams are available through your doctor to treat these irritating rashes. Rarely, a baby may react to one product or not respond to treatment. A change to a different cream and a check on the diagnosis is in order.
Breast-feeding should be an enjoyable experience for a mother. She should not have any nipple pain. A little tenderness during feeding may be normal in the first few days while mother and baby are learning correct position and latching on, but this should soon be resolved.
If pain persists and cracks appear, the mother may want to contact her family doctor or a health professional with special training in helping mothers breastfeed (this person is called a lactation consultant). These experts will check the baby’s latch. A baby who latches correctly won't cause damaged nipples.
Pain is always a sign something is wrong. One condition that causes pain for the breast-feeding mother is nipple yeast. This problem produces pain very different from that caused by an incorrect latch. There is a burning feeling, along with shooting pain deep into the breast in all directions. The pain is worst after feedings and may last from 15 to 60 minutes. The nipples may look red, with fine deep cracks like paper cuts around the nipple. The nipples and areolae may be slightly swollen and shiny, or they may look quite normal. Diagnosis is based on these symptoms.
A nursing mother with these symptoms could contact a lactation consultant or her family doctor. These professionals can assess the feeding technique recommend antifungal treatment for both mother and baby. It is essential to treat both the mother and the baby so that reinfection does not occur at every feed. The mother's nipples and areolae must be treated with a prescription cream about every three hours or, even better, after each feeding to coincide with the antifungal drops given to the baby.
Nipple yeast is more likely to occur in mothers who have had vaginal yeast, particularly at the end of pregnancy or since delivery. Those who have been on antibiotics in the previous months or had nipple damage due to incorrect latch are at high risk. Those with diabetes are more prone to candida infection in general.
Hygiene measures - such as washing hands after using the bathroom or changing diapers - may help. All items that contact the nipple or the baby's mouth should be sterilized once daily, either by boiling for five minutes or putting through the hot cycle in the dishwasher.
Breast pads, particularly disposable pads, should be avoided because they hold warmth and moisture on the nipple which encourages candida. If the mother has nipple yeast, milk should not be pumped and stored as candida is not destroyed by freezing. However, milk may be pumped and given to the baby the same day.
In resistant cases where the pain persists for a week or more in spite of treatment, oral antifungal tablets may be required. These must be prescribed by a doctor. Some should not be used by nursing mothers so be certain to tell your doctor that you are breast-feeding. Nipple yeast is often very slow to respond. It may take up to two weeks to improve. Treatment should continue for at least one week after the symptoms have disappeared completely to reduce the chance of recurrence.
Yeast infections, while rarely a threat to long term health, are common and can be very painful. Early diagnosis and proper treatment with creams and drops are usually effective, but sometimes stronger medications may be needed.
As with most medical conditions, an ounce of prevention is worth a pound of cure. To reduce the risk of yeast infection, avoid unnecessary antibiotics, eat a healthy diet and keep clothing, including diapers, loose for good air circulation. For nursing mothers, learn the correct breastfeeding technique to prevent nipple damage that may lead to candida infection.