Molly

IME the most likely cause of nipple pain and damage that goes on and on is
a bacterial infection, not thrush, and usually S Aureus.  I usually ask if
a nipple swab or culture of the milk can be done to establish what the
organism is and which antibiotic will be effective. When I practised in
Harare I had a succession of mothers whose nipples tested positive for S
Pyogenes.  I find that topic antibacterials don't work at all by the way...

Here are a couple of the articles I've collected over the years:

Clinical Lactation 2014, at
http://www.clinicallactation.org/sites/default/files/articlepdf/Article%203%20106-115.pdf

Stephen Graves' study - cultured pink sore nipples and found mostly
Staph...treatment
for Staph eliminated the problem in most cases, and in one third washing
with soap 2-3x per day was sufficient to eliminate it.

http://www.racgp.org.au/afp/200307/20030705graves.pdf


I regret I don't have a link to this, but I believe this was one of the
first articles to identify staph infections as a more likely cause of
ongoing nipple damage - Livingstone VH, Willis CE, Berkowitz J.
Staphylococcus aureus and sore nipples. Can Fam Physician. 1996
Apr;42:654-9.  This article concluded that mothers with infants younger
than 1 month who complained of moderate to severe nipple pain and who had
cracks, fissures, ulcers, or exudates had a 64% chance of having positive
skin cultures and a 54% chance of having S aureus colonization. There is
also a high association between staphylococcal infection on the nipple and
mastitis and nipple damage provides a route of entry into the breast, and
accompanying nipple pain may predispose to compromised breast drainage by
shortening breastfeeds and/or lengthening intervals between feeding.


I hope you can help to expand this doctor's knowledge.


Pamela Morrison IBCLC

Rustington, England

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