Article Text

Download PDFPDF

Does Candida and/or Staphylococcus play a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia
  1. Lisa H Amir1,
  2. Susan M Donath2,
  3. Suzanne M Garland2,3,4,
  4. Sepehr N Tabrizi2,3,4,
  5. Catherine M Bennett5,
  6. Meabh Cullinane1,
  7. Matthew S Payne1,6
  1. 1Mother & Child Health Research, La Trobe University, Melbourne, Victoria, Australia
  2. 2Clinical Epidemiology and Biostatistics Unit, Murdoch Children Research Institute, Melbourne, Victoria, Australia
  3. 3Department of Molecular Microbiology, Microbiology and Infectious Diseases, Royal Women's Hospital, Melbourne, Victoria, Australia
  4. 4Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
  5. 5Deakin Population Health, Deakin University, Burwood, Victoria, Australia
  6. 6School of Women's and Infants’ Health, University of Western Australia, Crawley, Western Australia, Australia
  1. Correspondence to Assoc Prof Lisa Helen Amir; l.amir{at}


Objective To investigate Candida species and Staphylococcus aureus and the development of ‘nipple and breast thrush’ among breastfeeding women.

Design Prospective longitudinal cohort study.

Setting Two hospitals in Melbourne, Australia (one public, one private) with follow-up in the community.

Participants 360 nulliparous women recruited at ≥36 weeks’ gestation from November 2009 to June 2011. Participants were followed up six times: in hospital, at home weekly until 4 weeks postpartum and by telephone at 8 weeks.

Main outcome measures Case definition ‘nipple and breast thrush’: burning nipple pain and breast pain (not related to mastitis); detection of Candida spp (using culture and PCR) in the mother's vagina, nipple or breast milk or in the baby's mouth; detection of S aureus in the mother's nipple or breast milk.

Results Women with the case definition of nipple/breast thrush were more likely to have Candida spp in nipple/breast milk/baby oral samples (54%) compared to other women (36%, p=0.014). S aureus was common in nipple/breast milk/baby samples of women with these symptoms as well as women without these symptoms (82% vs 79%) (p=0.597). Time-to-event analysis examined predictors of nipple/breast thrush up to and including the time of data collection. Candida in nipple/breast milk/baby predicted incidence of the case definition (rate ratio (RR) 1.87 (95% CI 1.10 to 3.16, p=0.018). We do not have evidence that S aureus colonisation was a predictor of these symptoms (RR 1.53, 95% CI 0.88 to 2.64, p=0.13). Nipple damage was also a predictor of these symptoms, RR 2.30 (95% CI 1.19 to 4.43, p=0.012). In the multivariate model, with all three predictors, the RRs were very similar to the univariate RRs. This indicates that Candida and nipple damage are independent predictors of our case definition.

  • Primary Care

this is an open-access article distributed under the terms of the creative commons attribution non-commercial license, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. see: and

View Full Text

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.