Nipple infections

Sore nipples are often caused by attachment issues. Once you fix the cause, the pain usually goes away. If pain continues or starts after a period of comfortable feeding, it may be due to an infection.

You might have a nipple infection if:

• Your baby is attaching and feeding well, but you still have nipple pain after the first week.
• The pain starts after you’ve been feeding comfortably for a while.
• Other causes, like tongue-tie, have been ruled out.

About 1 in 10 breastfeeding mums experience nipple or breast pain that isn’t linked to breast inflammation or mastitis. The pain is often described as burning, stabbing, knife-like, shooting, or sharp.¹

Nipples can get infected with germs, just like any other part of your body. Bacteria, viruses, and fungi live on healthy skin and usually don’t cause problems. But sometimes they can cause an infection, especially if the nipple skin is damaged or broken. Sometimes, infections happen even if your nipples aren’t damaged and look fine.

It can be hard to know which germ is causing the infection, as different germs can cause similar signs and symptoms. If you think you have an infection, see your doctor for diagnosis and treatment.

You might notice:

• cracks that don't heal

• redness 

• shiny areas 

• flaky or white spots

• pus-like fluid or clear fluid coming from the nipple 

Or there may be no outward signs but you may have:

• sore nipples that are very sensitive, especially to light touch
• an itchy breast or nipple
• stabbing or burning pain
• deep pain or throbbing inside the breast
• pain that spreads to your arm or back
• pain that starts during a feed and lasts for a while afterwards

• See your doctor for diagnosis and treatment. Treatment depends on what’s causing the infection. You might need a cream or, in some cases, tablets.
• Your doctor will also check for other conditions, like dermatitis, which can have similar symptoms.
• Keep breastfeeding or feeding your baby expressed breastmilk. It’s usually safe to feed your baby while you have a nipple or breast infection.
• Any milk you express while you have a nipple or breast infection is usually safe to feed your baby² (see below about herpes infections).

Thrush spreads easily. If you’re being treated for thrush, your baby’s mouth is usually treated too, even if there are no symptoms. This helps stop the infection passing back and forth.

• If you have vaginal thrush or your baby has nappy rash, these can be treated at the same time.
• Good hygiene is important until the thrush is gone:
• Wash your hands well before and after feeds and nappy changes.
• Wash towels, bras, and cloth breast pads often in hot water and dry them in the sun.
• Use a laundry product for sensitive skin and rinse well.
• Boil dummies and any toys that go in your baby’s mouth. Put away anything that can’t be boiled.

For more information, see the Royal Women’s Hospital, Victoria fact sheet on Breast and nipple thrush.

If you notice a blister or sore on your nipple or the darker area around it, it’s important to have it checked by your doctor.

Some blisters, such as a white spot, are not caused by infection. Read more about these in our article: White spot.

Other types of blisters or sores may be caused by an infection. This includes the herpes simplex virus, which also causes cold sores. 

If your doctor thinks the sores may be a herpes infection, they may advise you not to breastfeed from the affected breast until the sores have healed.³ You will need to express milk from that breast to help maintain your milk supply, but this milk must be thrown away. Your doctor will guide you on treatment and when you can safely resume feeding from that breast.

If your other breast is unaffected, it will usually be safe to feed from that side. Keep any sores covered and be extra careful about cleanliness.