Penis

Balanitis

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Balanitis, Posthitis, Balanoposthitis, Foreskin Infection

  • Definition
  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
  • Epidemiology
  1. Incidence: 3% of uncircumsized males
  • 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)
  • 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. Group A Beta-hemolytic Streptococcus
    4. Neisseria gonorrhoeae
    5. Chlamydia
    6. gardnerella
  3. Circinate Balanitis
    1. Reiter's Syndrome
  • Predisposing factors
  1. Diabetes Mellitus
  2. Poor hygiene
  3. Irritants (See causes above)
  • Signs and Symptoms
  1. Local pain and swelling at glans penis
  2. Discharge between foreskin and glans penis
  3. Pruritus
  • 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
      3. Cellulitis or erythema extends onto penile shaft
        1. First generation Cephalosporin (e.g. Cephalexin or Keflex)
  • Prevention
  1. Foreskin hygiene
    1. Retract foreskin and clean with soap and water daily
  2. Circumcision
    1. Indicated in recurrent foreskin-related infection
  • References
  1. Marx (2002) Rosen's Emergency Medicine, Mosby, p. 2838
  2. Lundquist (2001) Emerg Med Clin North Am 19(3):529-46 [PubMed]