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]