II. Definitions
- Balanitis
- Glans penis inflammation or infection
- Posthitis
- Foreskin Inflammation or infection
- Balanoposthitis
- Foreskin and glans penis inflammation or infection
III. Epidemiology
- Incidence: 3% of uncircumsized males
IV. Pathophysiology
- Limited to uncircumsized males, especially if poor hygiene
- Results from irritant or infection
- Fungal infection (especially candida) is most common cause in all ages
- Higher risk in Diabetes Mellitus
- Bacterial Infection can also cause Foreskin Infection (especially in children)
V. Causes
-
Contact Dermatitis (Irritant Balanitis)
- Soap
- Bubble bath
- Fabric softeners
- Laundry detergent
- Infectious Balanitis
- Candida albicans (40% of cases)
- Gram-Negative Bacteria
- Trichomoniasis (Trichomonas Vaginalis)
- Group A Beta-hemolytic Streptococcus (may be passed via oral sex)
- Neisseria gonorrhoeae
- Chlamydia
- Gardnerella
- Anaerobic Bacteria
- Herpes Simplex Virus
- Human Papilloma Virus
- Primary Syphilis
- Erosive Balanitis (Chancre may be absent)
- Circinate Balanitis (geographic appearance) due to Reactive Arthritis (previously known as Reiter's Syndrome)
VI. Risk Factors
- Diabetes Mellitus
- Poor hygiene
- Irritants (See causes above)
VII. Findings: Signs and Symptoms
- Local pain and swelling at glans penis
- Discharge between foreskin and glans penis
- Pruritus
VIII. Differential Diagnosis
- Contact Dermatitis (as above)
- Infectious Balanitis (as above)
- Inflammatory Conditions
- Lichen Sclerosus
- Lichen Planus
- Psoriasis
- Eczematous Dermatitis
- Seborrhea
- Balanitis Xerotica Obliterans
- Chronic inflammation of peri-mucosal skin
- Circinate Balanitis (Reactive Arthritis)
- Urethral discharge may be present in Chlamydia infection
- Diarrhea may be present (e.g. Yersinia, Campylobacter, Shigella, Salmonella)
- Associated Arthritis, Conjunctivitis and Urethritis
- Premalignant Conditions
- Penile Carcinoma-in-situ (Bowen's Disease, Erythroplasia or Queyrat)
IX. Management
- Irritant Balanitis
- Sitz bath
- Retract foreskin and clean glans
- Consider brief topical Hydrocotisone 0.5%
- Infectious Balanitis (Candida most common source)
- Good hygiene
- Fungal causes (esp. adults)
- Topical Antifungal cream (e.g. Clotrimazole, Nystatin)
- Systemic Antifungals
- Fluconazole 150 mg orally for one dose
- Itraconazole 200 mg twice daily for one day
- Bacterial causes (esp. children)
- Topical Antibiotic (e.g. Bacitracin)
- Consider Metronidazole (Flagyl) 2 grams for 1 dose (adult dose) for anaerobic causes
- Cellulitis or erythema extends onto penile shaft
- First Generation Cephalosporin (e.g. Cephalexin or Keflex)
-
Circinate Balanitis (geographic pattern)
- Test Chlamydia Trachomatis PCR (and treat if present)
- Consider other causes of Reactive Arthritis
- Topical Corticosteroids
X. Prevention
- Foreskin hygiene
- Retract foreskin and clean with soap and water daily
-
Circumcision
- Indicated in recurrent foreskin-related infection
XI. References
- Marx (2002) Rosen's Emergency Medicine, Mosby, p. 2838
- Lisboa (2009) Int J Dermatol 48(2):121-4 +PMID:19200183 [PubMed]
- Lundquist (2001) Emerg Med Clin North Am 19(3):529-46 [PubMed]
- Pandya (2014) Indian J Sex Transm Dis AIDS 35(2): 155-7 [PubMed]
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Related Studies
Definition (MSHCZE) | Zánět žaludu a předkožky pohlavního údu. Je způsobena infekcí (kapavka, mykózy, trichomoniáza aj.), podrážděním chemikáliemi či poraněním. V nejlehčí a nejtypičtější formě se projevuje zarudnutím, svěděním, páchnoucím výtokem z předkožkového vaku. Může vzniknout akutní zánětlivá fimóza. Mykotická forma se vyskytuje častěji u cukrovky. Infekce se mohou přenášet pohlavním stykem (je pak nutná léčba obou partnerů). Léčí se podle vyvolávající příčiny, je třeba dodržovat hygienu. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
Definition (NCI) | An infectious or non-infectious inflammatory process that affects the glans penis. Symptoms include redness and pain of the glans penis and foreskin and discharge. |
Definition (MSH) | Inflammation of the head of the PENIS, glans penis. |
Concepts | Disease or Syndrome (T047) |
MSH | D001446 |
ICD10 | N48.1 |
SnomedCT | 266572002, 155928003, 198021000, 198020004, 371163003, 44882003 |
English | Balanitides, BALANITIS, balanitis (diagnosis), balanitis, Balanitis [Disease/Finding], penile inflammation, Inflammation;penis, penis inflammation, inflammation of penis, inflammation penis, inflammatory disorders of penis, inflammatory disorders of penis (diagnosis), Penisitis, Penis inflamed, Penis inflammation, Balanitis NOS, Inflammation of penis, Inflammatory disorder of penis (disorder), Inflammatory disorder of penis, Balanitis (disorder), disease (or disorder); penis, inflammatory, inflammation; penis, penis; inflammation, Balanitis [Ambiguous], Balanitis, inflammation of the penis |
French | BALANITE, Balanite SAI, Inflammation pénienne, Balanite |
Portuguese | BALANITE, Balanite NE, Inflamação do pénis, Balanite |
Spanish | BALANITIS, Balanitis NEOM, Inflamación de pene, balanitis (trastorno), balanitis, inflamación del pene, trastorno inflamatorio del pene (trastorno), trastorno inflamatorio del pene, Balanitis |
German | BALANITIS, Penisentzuendung, Balanitis NNB, Balanitis |
Swedish | Balanit |
Czech | balanitida, balanopostitida, zánět žaludu a předkožky penisu, Balanitida NOS, Zánět penisu, Balanitida |
Finnish | Balaniitti |
Russian | BALANIT, БАЛАНИТ |
Polish | Zapalenie żołędzi |
Norwegian | Forhudsbetennelse, Balanitt |
Dutch | balanitis, onsteking penis, balanitis NAO, aandoening; penis, inflammatoir, ontsteking; penis, penis; ontsteking, Balanitis |
Hungarian | Penis gyulladás, balanitis k.m.n., Balanitis |
Italian | Balanite NAS, Infiammazione del pene, Balanite |
Japanese | 亀頭炎, 亀頭炎NOS, キトウエンNOS, 陰茎炎症, キトウエン, インケイエンショウ |
Ontology: Balanoposthitis (C0004691)
Concepts | Disease or Syndrome (T047) |
MSH | D001446 |
ICD9 | 607.1 |
ICD10 | N48.1 , N47.6 |
SnomedCT | 198024008, 198020004, 46090001 |
English | BALANOPOSTHITIS, Balanoposthitis NOS, balanoposthitis, balanoposthitis (diagnosis), Balanoposthitis NOS (disorder), Penis and sheath inflamed, Inflammation of penis and sheath, Balanoposthitis (disorder), Balanoposthitis |
Italian | Balanopostite |
Japanese | 亀頭包皮炎, キトウホウヒエン |
German | Balanoposthitis, BALANOPOSTHITIS |
French | BALANO-POSTHITE, Balanoposthite |
Portuguese | BALANOPOSTITE, Balanopostite |
Spanish | BALANOPOSTITIS, balanopostitis, SAI (trastorno), balanopostitis, SAI, balanopostitis (trastorno), balanopostitis, Balanopostitis |
Czech | Balanopostitida |
Korean | 귀두포피염 |
Hungarian | Balanoposthitis |
Dutch | Balanoposthitis, balanoposthitis |
Ontology: Posthitis (C0235640)
Concepts | Disease or Syndrome (T047) |
SnomedCT | 198022007, 44318002 |
English | POSTHITIS, Posthitis, posthitis, Prepuce inflamed, Inflammation of prepuce, Posthitis NOS, Posthitis (disorder), Posthitis, NOS |
French | POSTHITE, Posthite SAI, Posthite |
German | POSTHITIS, Posthitis, Posthitis NNB |
Portuguese | POSTITE, Postite NE, Postite |
Spanish | POSTITIS, Postitis, Postitis NEOM, postitis (trastorno), postitis |
Czech | Postitida, Postitida NOS |
Dutch | posthitis, voorhuidonsteking NAO |
Hungarian | Posthitis k.m.n., Posthitis |
Italian | Postite NAS, Postite |
Japanese | 包皮炎, ホウヒエンNOS, 包皮炎NOS, ホウヒエン |
Ontology: foreskin inflammation (C0849985)
Concepts | Sign or Symptom (T184) |
English | Inflammation;foreskin, foreskin inflammation, inflammation of the foreskin |