>culturing milk for yeast and/or using swabs on
>the nipple/areolar surface.  What are the protocals for this?

There aren't any definite protocols for this. I can tell you what I did in
the study I did a couple of years ago.
"Microbiological samples were taken prior to breast-feeding, in order to
avoid contamination of the nipple by the baby's mouth. After cleaning with a
sterile water wipe, a cotton-tipped swab moistened with sterile normal
saline was rolled over the nipple and areola. The swab was then rolled
directly onto one third sector of a horse blood agar (HBA) plate and a
Sabouraud agar plate. Then 5-10 ml of breastmilk was hand-expressed into a
sterile container, and immediately transported to the laboratory where it
was cultured directly onto HBA and Sabouraud agar. A cotton-tipped swab
rubbed around the baby's oral mucosa, in particular the tongue area, and
then plated onto a third sector of a Sabouraud agar."

This has been published in Gynecologic and Obstetric Investigation
1996;41:30-34, Candida albicans: is it associated with nipple pain in
lactating women? Amir LH et al.

I did find more candida in the women with nipple pain, but most of the time
candida did not grow. I think a more sensitive method of detected candida is
needed. Clinically I don't take swabs; I tell people it is a clinical diagnosis.

Lisa Amir
GP / LC in Melbourne, Australia