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March 2020

Chronic Breast or Nipple Pain - Is it Intraductal Infection?

Dr FUNG Wai Han
General Practitioner


Breast pain is a very common problem among lactating mothers. Most is due to poor attachment, blocked ducts, mastitis, improper pumping, oversupply, etc. and mothers usually respond well to appropriate intervention. However, it is not uncommon to see mothers having chronic breast pain that respond poorly to the usual treatment regimen.    



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Key Messages:

1. Chronic breast pain may be indicative of intraductal infection, of which Candida is the most likely pathogen. However, in some cases, the infection may be bacterial or mixed.  

2. The diagnosis of bacterial intraductal infection relies mainly on clinical assessment. The proportion of positive bacterial culture from breastmilk or nipple swab is not high.

3. Bacterial intraductal infection is more likely if there is recurrent blockage of milk ducts.

4. The Academy of Breastfeeding Medicine recommends 2 to 6 weeks of oral antibiotic treatment for bacterial intraductal infection.

Editor-in-Chief: Dr Shirley Leung
Illustration: Ms Iris Leung, Iris's Workshop

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