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Some research studies have found that people with multiple sclerosis (MS) have a higher risk of fungal infections, such as yeast infections, as compared to the general population. Many MyMSTeam members find that yeast infections impact them often. “Is anyone else dealing with chronic yeast infections?” one member asked.

Fungi and fungal spores are microorganisms commonly found in the environment that do not cause illness or infection in most people. However, for those with MS, several factors could be associated with an increased risk of fungal infection. These include immune dysfunction, an association between MS and fungal infections, and the use of disease modifying therapies (DMTs) to treat MS.

MS is a neurological disease that affects the central nervous system (CNS). In people with MS, proinflammatory immune cells mistakenly attack and damage the protective sheath surrounding nerves in a process known as demyelination. MS symptoms include numbness and tingling, difficulties with walking and movement, vision problems, and fatigue. There is no cure for MS, which is considered an autoimmune disease. Treatment is aimed at managing symptoms and slowing disease progression.

One MyMSTeam member wrote, “I have another yeast infection — probably two in the past year — and I used to never have problems with yeast infections. Has anyone else had this issue?” Another member asked, “Wondering if anyone knows if there's a correlation between MS and having recurrent yeast infections and jock itch-type symptoms?”

If you think you may have a fungal infection, it’s important to talk to your doctor to determine which treatment may be appropriate for you.

Common Types of Fungal Infections

Common types of fungal infections — or mycoses — that people with MS may experience are those from fungal species like Candida or tinea. A common Candida species includes Candida albicans (C. albicans), which causes vaginal candidiasis and thrush. Tinea infections include ringworm, athlete’s foot, and jock itch. Fungal infections usually develop when one comes into contact with the fungus in the environment, but sometimes fungal infections can be contagious and spread from person to person.

Vaginal Candidiasis

Vaginal candidiasis, sometimes called candidal vulvovaginitis, is more commonly known as a vaginal yeast infection. The condition is caused by the overgrowth of Candida fungus. Vaginal yeast infection symptoms include swelling, pain, small cuts in the vagina and vulva, a discharge that is thick and white, itching, and a burning sensation while urinating. Candidiasis can also occur in the penis, although it is less common and usually presents as an itchy rash.

Risk factors for vaginal yeast infections include diabetes, pregnancy, hormonal contraceptives, and a weakened immune response.

Vaginal yeast infections are typically treated with oral or topical antifungal medications over the course of several days. Medications for short-term treatment include miconazole (sold as the brand Monistat 3), an over-the-counter cream that is inserted into the vagina, and terconazole (sold as the brand Terazol 7), a prescription cream.

The drug fluconazole (Diflucan) is an oral medication for vaginal yeast infections that is taken as a single dose.

Thrush

Thrush is another type of yeast infection caused by the Candida fungus. Thrush is different from vaginal candidiasis in that it usually affects the mouth, throat, or esophagus. Symptoms include thick, white lesions in the mouth that look like cottage cheese, soreness and redness in the mouth and at the corners of the mouth, and loss of taste. In more severe cases, thrush can cause fevers and may spread to the skin, liver, or lungs. Risk factors include diabetes, dry mouth, smoking, and medications such as corticosteroids, antibiotics, and oral contraceptives.

People with weakened immune systems are at a higher risk for thrush, which is contagious. Common treatment includes antifungal medications that are applied to the inside of the mouth, such as clotrimazole (Lotrimin), miconazole (Micatin), and nystatin (Nyamyc). Fluconazole (Diflucan) may be advised for more serious cases.

“My throat is feeling a bit better. It's been bad for a month,” wrote a MyMSTeam member. “I'm taking antifungal medication.”

Tinea Infections

Tinea is the term for a group of closely related fungal infections that includes ringworm, nail fungus, athlete’s foot, and jock itch. They are caused by a fungus called dermatophytes, which thrives in moist areas and might live on the skin, hair, and nails. One type of tinea infection, ringworm, can occur on the scalp and may start as small sores that become flaky and scaly lesions. The scalp may ooze, or become swollen, discolored, or tender.

Ringworm on the skin may appear as a round patch that is red on lighter skin and gray or brown on darker skin. Ringworm in nails can appear as thickening, discoloring, or crumbling of the nails. Ringworm may be treated orally or topically with an antifungal ointment, shampoo, or syrup, depending on the particular condition.

“I have a ringworm infection,” one MyMSTeam member wrote. “My general practitioner says it's nothing major, but it is one of the skin infections I am now prone to.”

Athlete’s foot is a tinea infection that causes an itchy, scaly rash that often begins between the toes and can spread to other parts of the feet. The infection can also cause a burning sensation or blisters. Athlete’s foot can be treated effectively with over-the-counter medications. But if it persists, or if you have diabetes, it’s important to see a doctor.

Jock itch is a scaly, itchy rash that can occur on the genitals, buttocks, or inner thighs. Keeping affected areas dry and using over-the-counter medications can often relieve jock itch.

Fungal Infections and Disease-Modifying Therapies for MS

Disease-modifying therapies (DMTs) are a common form of treatment for MS. DMTs work by modifying and sometimes suppressing the functioning of the immune system. When the immune system is suppressed, one may be at an increased risk of infections, including fungal infections.

One research review found an association between some DMTs commonly used to manage MS and invasive fungal infections. Invasive fungal infections refer to those that are severe, systemic, and potentially life-threatening. However, taking DMTs does not mean you will definitely get a fungal or other type of infection, and the risk of fungal infection while taking DMTs is still considered to be low.

The referenced research study found that monoclonal antibody treatments and fingolimod were associated with invasive fungal infections more commonly than other DMTs. Aspergillosis, a rare disease which affects the respiratory system, and cryptococcal meningitis, which affects the brain, were the most likely invasive fungal infections observed. Monoclonal antibody treatments are a type of DMT used to treat MS. Some include:

• Natalizumab (Tysabri)
• Alemtuzumab (Lemtrada)
• Rituximab (Rituxan)
• Ocrelizumab (Ocrevus)
• Ofatumumab (Kesimpta)

While DMTs might suppress the immune system and increase one’s risk of infections, they are still highly effective treatment options for some people with MS. Your doctor will weigh the pros and cons of DMTs when determining a treatment plan for your MS. Furthermore, your doctors will monitor you for infections if they decide that DMTs are the best option for you.

New Frontiers: Fungal Infections and the Onset of MS

Neurology researchers have suggested the possibility that some type of infection — bacterial, viral, or fungal — may trigger the onset, or pathogenesis, of MS. However, no conclusive evidence as to the root cause of MS currently exists. A study from 2018 found evidence of fungal infections in CNS tissue of people with MS, but these findings do not prove that the fungal infections caused MS in study participants.

Understanding the underlying cause of MS could open new avenues for more effective treatments. However, at this point in time, the hypothesis that a fungal infection may lead to MS is still preliminary and the research is ongoing.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. Here, more than 185,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Do you have questions about yeast infections or other types of fungal infections and MS? Share your experiences or questions in the comments below, or start a conversation by posting on your Activities page.