Candida is a genus of yeast-like fungi that colonizes approximately 50% of the population, primarily in the oropharynx, gastrointestinal and genitourinary tracts. There are more than 100 Candida species, the most common of which is Candida albicans. When a patient’s normal flora is altered or becomes imbalanced, Candida can proliferate, causing symptoms of a fungal infection.

The clinical manifestations of Candida infections vary depending on the system in which they occur.  In primary care, vulvovaginitis involving Candida is common among female patients. Symptoms include thick vaginal discharge, vaginal itching and burning with urination.

Recent antibiotic use or glucocorticoid use, having diabetes or HIV, or using an intrauterine device or diaphragm for contraception are all risk factors for Candida infection in women. Diagnosis is based on the presence of hyphae, or budding yeast, on microscopic examination with normal vaginal pH. An oral or vaginal antifungal is considered the treatment of choice for vulvovaginal Candida infections.

Fungal infections in general, especially those involving Candida, are more common in women than men. When male patients present with symptoms, the diagnosis can be more challenging.

I recently treated a 17-year-old male who reported erythema and itching in his groin for three weeks. He reported frequent physical activity and associated hydrosis, and said topical antifungals produced only minimal symptom relief.

Based upon this information, I included tinea cruris in the differential diagnosis. However, physical exam revealed significant erythema, not only to the bilateral skin on either side of the thighs, but to the scrotum as well. Because lesions associated with tinea cruris rarely involve the scrotum, I was able to rule out this condition and change my diagnosis to candidal intertrigo, a common cause of fungal infections in areas of the skin that contain hair follicles.

Both tinea cruris and candidal intertrigo should be managed with topical antifungals. Consider prescribing an oral antifungal for patients with persistent or severe infections.

This particular patient denied any associated endocrine symptoms or family history of diabetes, but reported similar skin lesions and symptoms three months prior to this most recent episode. This prompted me to evaluate his non-fasting glucose levels, which were elevated at 320 mg/dl, indicating type 2 diabetes. Be sure to consider the possibility of diabetes and other diseases that compromise the immune system in patients who present with fungal infections.

Leigh Montejo, MSN, FNP-BC, is a National Public Health Service Corp scholar completing her service commitment as a Family Nurse Practitioner at Tampa Family Health Centers Inc. in Florida. Her areas of interest include adolescent health, health promotion and improving access to healthcare in underserved populations.