Does anyone have any literature that supports the idea that ongoing nipple pain can be caused by bacteria instead of fungus, without any other overt signs of infection ( pus, fever, even cracked nipples)?  I know that I have read that in many sources, including lactnet, but can't find any research to back it up.

PTP: saw a mom who has had ongoing intense nipple pain for 3 months, after 3 months of pain free nursing. Baby is growing beautifully. Both nipples hurt, but R much worse then left. Baby pops on and off breast t/ o feeding, and often clicks ( per mom, this did not happen at any time in the first few months of BF). Nipple looks round and not pinched when baby comes off; no signs of vasospasm either, or TT in baby. Hx of thrush and case of mastitis several months back. 

This sounds like like classic case of thrush. However, Mom tried gentian violet, to no avail, as well as probiotics, grapefruit seed extract, topical antifungal, and a dose of Diflucan. Baby was treated as well.  Mom thought pain was diminishing after first few days on Diflucan, but pain returned. Now she has what appears to be a bleb ( I did not see this; we spoke on phone yesterday).  I recommended possibly treating both orally, and recommended talking to her midwife. The midwife told her that it can't be bacterial bc she does not show any other symptoms, aside from nipple pain ( during after after BF). She did, however prescribe APNO, so in effect is also treating a possible bacterial, in addition to possible fungle infection, topically. I know that this could be a case of resistant candida as well.  Mom is also treating bleb. 

Any links to current research or thoughts appreciated. 

Thx!

Nina Isaac, MS, CCC-SLP, IBCLC, LLLL

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