Urology Book



Aka: Balanitis, Posthitis, Balanoposthitis, Foreskin Infection, Foreskin Inflammation
  1. See Also
    1. Circinate Balanitis
    2. Balanitis Xerotica Obliterans
  2. Definitions
    1. Balanitis
      1. Glans penis inflammation or infection
    2. Posthitis
      1. Foreskin Inflammation or infection
    3. Balanoposthitis
      1. Foreskin and glans penis inflammation or infection
  3. Epidemiology
    1. Incidence: 3% of uncircumsized males
  4. Pathophysiology
    1. Limited to uncircumsized males, especially if poor hygiene
    2. Results from irritant or infection
    3. Fungal infection (especially candida) is most common cause in all ages
      1. Higher risk in Diabetes Mellitus
    4. Bacterial Infection can also cause Foreskin Infection (especially in children)
  5. Causes
    1. Contact Dermatitis (Irritant Balanitis)
      1. Soap
      2. Bubble bath
      3. Fabric softeners
      4. Laundry detergent
    2. Infectious Balanitis
      1. Candida albicans (40% of cases)
      2. Gram-Negative Bacteria
      3. Trichomoniasis (Trichomonas Vaginalis)
      4. Group A Beta-hemolytic Streptococcus (may be passed via oral sex)
      5. Neisseria gonorrhoeae
      6. Chlamydia
      7. Gardnerella
      8. Anaerobic Bacteria
      9. Herpes Simplex Virus
      10. Human Papilloma Virus
      11. Primary Syphilis
        1. Erosive Balanitis (Chancre may be absent)
    3. Circinate Balanitis (geographic appearance) due to Reactive Arthritis (previously known as Reiter's Syndrome)
      1. Chlamydia trachomatis (most common)
      2. Yersinia
      3. Campylobacter
      4. Shigella
      5. Salmonella
      6. Chlamydia pneumoniae
  6. Risk Factors
    1. Diabetes Mellitus
    2. Poor hygiene
    3. Irritants (See causes above)
  7. Findings: Signs and Symptoms
    1. Local pain and swelling at glans penis
    2. Discharge between foreskin and glans penis
    3. Pruritus
  8. Differential Diagnosis
    1. Contact Dermatitis (as above)
    2. Infectious Balanitis (as above)
    3. Inflammatory Conditions
      1. Lichen Sclerosus
      2. Lichen Planus
      3. Psoriasis
      4. Eczematous Dermatitis
      5. Seborrhea
      6. Balanitis Xerotica Obliterans
        1. Chronic inflammation of peri-mucosal skin
      7. Circinate Balanitis (Reactive Arthritis)
        1. Urethral discharge may be present in Chlamydia infection
        2. Diarrhea may be present (e.g. Yersinia, Campylobacter, Shigella, Salmonella)
        3. Associated Arthritis, Conjunctivitis and Urethritis
    4. Premalignant Conditions
      1. Penile Carcinoma-in-situ (Bowen's Disease, Erythroplasia or Queyrat)
  9. Management
    1. Irritant Balanitis
      1. Sitz bath
      2. Retract foreskin and clean glans
      3. Consider brief topical Hydrocotisone 0.5%
    2. Infectious Balanitis (Candida most common source)
      1. Good hygiene
      2. Fungal causes (esp. adults)
        1. Topical Antifungal cream (e.g. Clotrimazole, Nystatin)
        2. Systemic Antifungals
          1. Fluconazole 150 mg orally for one dose
          2. Itraconazole 200 mg twice daily for one day
      3. Bacterial causes (esp. children)
        1. Topical antibiotic (e.g. Bacitracin)
        2. Consider Metronidazole (Flagyl) 2 grams for 1 dose (adult dose) for anaerobic causes
        3. Cellulitis or erythema extends onto penile shaft
          1. First generation Cephalosporin (e.g. Cephalexin or Keflex)
    3. Circinate Balanitis (geographic pattern)
      1. Test Chlamydia Trachomatis PCR (and treat if present)
      2. Consider other causes of Reactive Arthritis
      3. Topical Corticosteroids
  10. Prevention
    1. Foreskin hygiene
      1. Retract foreskin and clean with soap and water daily
    2. Circumcision
      1. Indicated in recurrent foreskin-related infection
  11. References
    1. Marx (2002) Rosen's Emergency Medicine, Mosby, p. 2838
    2. Lisboa (2009) Int J Dermatol 48(2):121-4 +PMID:19200183 [PubMed]
    3. Lundquist (2001) Emerg Med Clin North Am 19(3):529-46 [PubMed]
    4. Pandya (2014) Indian J Sex Transm Dis AIDS 35(2): 155-7 [PubMed]
      1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553848/

Balanitis (C0004690)

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
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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

foreskin inflammation (C0849985)

Concepts Sign or Symptom (T184)
English Inflammation;foreskin, foreskin inflammation, inflammation of the foreskin
Derived from the NIH UMLS (Unified Medical Language System)

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