Secondary nipple infection is quite common, especially that which is caused by Staphylococcus aureus. A study demonstrated that 54% of mothers with infants younger than one month, with cracked nipple and moderate to severe pain, tested positive for S. aureus. When S. aureus infection is suspected, the topical use of mupirocin at 2% or even systemic antibiotic therapy is recommended.16 A study showed that systemic antibiotic therapy (dicloxacillin) was highly efficient in the treatment of nipple infection caused by S. aureus, compared to other treatment schemes: guidance to improve the breastfeeding technique, topical mupirocin and topical fusidic acid. The treatment was better in terms of regression of symptoms and also prevented the development of mastitis: 25% of mothers with nipple infection caused by S. aureus not treated with systemic antibiotics developed mastitis whereas only 5% of treated mothers had the disease. Neifert recommends that the risks and benefits of systemic antibiotic therapy be weighed in relation to early weaning
due to persistent nipple pain and to the morbidity associated with puerperal mastitis.
Candidiasis
Breast infection caused by Candida albicans in the puerperium is quite common. Infection can be superficial or affect the lactiferous ducts, and often occurs in the presence of moist nipples (candida interacts with carbohydratecontaining substrates) and of lesions. Vaginal candidiasis, use of antibiotics, oral contraceptives and steroids and use of contaminated pacifiers increase the risk of breast candidiasis. Usually it is the infant who transmits the fungus, even if no symptoms are present.
Candida infection often is characterized by itching, burning sensation and .twinges. in the nipples, which persist after breastfeeding. The nipples usually have a reddish and shiny appearance. Some mothers complain of burning and twinges in the breasts.