Risk factors for nipple yeast infection

Am I at risk of developing a nipple yeast infection?

Some mothers are more likely than others to develop a nipple yeast infection. The risk is higher if a mother has been using antibiotics or has frequent vaginal yeast infections, lowered immunity, or certain genetic factors. Some breast conditions favour the growth of yeast, including damaged nipples or large nipples that fold over in the bra. Using purified lanolin, other skin preparations, or breast covers that keep the nipple damp, also increases the risk. Having a baby with higher-than-normal mouth levels of a yeast from a group called Candida makes a nipple yeast infection more likely.

A) Risk factors for developing nipple yeast infection

Candida lives on and in us, generally without causing disease. The medical term for this is colonization. However, some mother-baby pairs are at an increased risk of having cause a nipple yeast infection because of personal factors, which can also increase the risk of having it return after being treated.

B) Lowered immunity to infection by Candida

Mothers with a history of frequent vaginal yeast infections may be more prone to nipple yeast infection. 

Some mothers have situations in which they are less able to fight infection by Candida. These include:

C) Having breast conditions favourable to the growth of Candida

Local conditions that damage skin or increase moisture can encourage the growth of Candida and can occur while breastfeeding. These include:

D) Having a baby with higher levels of Candida

A yeast bum infection.

Candida levels in the baby’s mouth can be increased if the baby:

  • Has thrush.
  • Is given antibiotics.
  • Uses a pacifier.
  • Is given infant formula (Holgerson 2013) however not all studies support this (Azevedo 2020).
  • Was born by vaginal birth (Azevedo 2020).
  • Was born vaginally to a mother who had a vaginal yeast infection at the time.

Such babies are also more likely to have a yeast bum infection.

If the baby has thrush and the mother is at an increased risk of nipple yeast infection, it is reasonable to treat the mother's nipples and areolas with an antifungal cream for ten days while the baby is treated. 

References

Azevedo MJ, Pereira ML, Araujo R, et al. Influence of delivery and feeding mode in oral fungi colonization - a systematic review. Microb Cell. 2020 Jan 7;7(2):36-45

Holgerson PL, Vestman NR, Claesson R, et al. Oral microbial profile discriminates breast-fed from formula-fed infants. J Pediatr Gastroenterol Nutr. 2013 Feb;56(2):127-36
 
Wang X, van de Veerdonk FL, Netea MG. Basic Genetics and Immunology of Candida Infections. Infect Dis Clin North Am. 2016 Mar;30(1):85-102