Direct impression on agar surface as a diagnostic sampling procedure for candida balanitis

Department of Microbiology, Faculty of Medicine, Hospital S João, Alameda Prof Hernani Monteiro, Porto 4202-451, Portugal.
Sexually transmitted infections (Impact Factor: 3.4). 10/2009; 86(1):32-5. DOI: 10.1136/sti.2009.037820
Source: PubMed


The diagnosis of candida balanitis should be based upon both clinical and mycological data. The procedure of material collection is a critical issue to confirm or rule out the clinical diagnosis of candida balanitis.
To compare direct impression of the glans on the agar surface of solid culture media with the collection of genital exudates with cotton swab for the diagnosis of candida balanitis.
A prospective cross-sectional study was carried out during a 36-month period. Sexually transmitted disease clinic attendees with balanitis and asymptomatic men were included. Specimens for yeast culture were collected from the glans penis and inner preputial layer using the direct impression on CHROMagar candida medium and by swabbing with a sterile cotton swab.
Among 478 men enrolled, 189 had balanitis. The prevalence of candida balanitis was 17.8% (85/478) confirmed after culture by direct impression; the swab method detected only 54/85 (63.5%) of these men. Of the 289 asymptomatic men, 36 (12.5%) yielded Candida spp; the swab method detected only 38.9% of these men. The risk of having candida balanitis is 8.9 (IC 95% 2.48 to 32.04) whenever the number of candida colonies recovered by direct impression was greater than 10.
Direct impression on CHROMagar candida medium resulted in the highest Candida spp recovery rate. More than 10 colonies yielded by impression culture were statistically associated with candida balanitis. This method shows the ideal profile for sampling the male genital area for yeasts and should be included in the management of balanitis.

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    • "A cut-off value of 10 Candida colonies cultured using direct impression has been correlated with the signs and symptoms of balanitis (Lisboa et al., 2010a; 2010b). However, the concentration of Candida organisms that should be considered pathological rather than representing the endogenous genital microbial population has not yet been established (Lisboa et al., 2010b). Although PCR assays are increasingly common in the laboratory, they are of limited use for the diagnosis of candidal infections because Candida comprises a portion of the male genital flora (Tabrizi et al., 2006). "
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