Background: 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.
Objective: To compare direct impression of the glans on the agar surface of solid culture media with the collection of genital exsudate with cotton swab for the diagnosis of candida balanitis.
Methods: A prospective cross-sectional study was carried out during a 36-month period. STD 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.
Results: Among 478 men enrolled, 189 suffered from 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 to have candida balanitis is 8.9 (IC 95% 2.48-32.04) whenever the number of the Candida colonies recovered by direct impression was higher than ten.
Conclusions: Direct impression on CHROMagar Candida medium resulted in the highest Candida spp recovery rate. More than ten colonies yielded by impression culture was 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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