I find that women who have prolonged deep burning breast pain esp after 
nursing or pumping  have a bacterial lactiferous duct infection. These 
women tend to improve by 0-40%  with fluconazole for whatever reason, 
perhaps because yeast joins in to create a coinfection when there is a 
dysbiosis in the breast.
I normally confirm my suspicions by doing a breast exam. Usually these 
women are tender on manual expression, and the breasts are tender on 
breast palpation (a general breast exam). They describe having more 
plugged ducts than usual, and their let-down feels painful, more than usual.
They oftentimes will report intermittent mastitis, but not always, and 
about 75% will have a history at some point of nipple cracks and scabs, 
and/or bleeding. Their breastmilk cultures usually reveal coag negative 
staph, but at least 25% grow out coag + staph. Occasionally in my 
geographic area the staph is MRSA, but in those instances, the women 
tend to have purulent nipple lesions or an abscess.
I normally treat these women with antibiotics for at least 4-6 weeks 
(often longer), until the pain is fully gone. There will be little 
change the first 2 weeks of antibiotics, it takes at least 3-4 weeks to 
see the pain markedly improve (75-80%).
Treating this infection is like treating prostatitis in men. It is hard 
to prove other than finding a tender prostate on exam. The dx is mainly 
in the history-taking.
I would love to find something other than antibiotics to treat this 
infection, such as proper probiotics, but so far I have not found 
anything else as effective in the 19 years that I've been treating this 
syndrome. I've tried GSE, lactobacillus and other probiotics, fish oil, 
antiinflammatories, and nothing has helped like antibiotics.
BTW, this bacterial lactiferous duct infection has been very well 
described in the bovine literature. Farmers and dairy science folks have 
been working on this problem for years.
Anne Eglash MD
Clinical Associate Professor
Dept of Family Medicine
University of Wisconsin School of Medicine and Public Health
600 N. 8th St.
Mount Horeb, WI, 53572
608-437-3064 (O)
608-437-4542 (fax)

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