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Balanitis
FUNDAMENTAL DESCRIPTION
Inflammation and/or infection of the glans penis. Balanoposthitis encompasses inflammation of the prepuce. This chapter will examine the infectious etiologies.
Epidemiology
Frequency
• Sexual exposure; heightened prevalence in men with female partners suffering from Candida vaginitis. • Balanitis in young boys frequently occurs alongside diaper dermatitis.
RISK FACTORS • Men who are uncircumcised
• Diabetes, particularly new-onset diabetes • For Candida, both colonization and infection age serve as independent risk factors
• Comprehensive-spectrum antibiotics
• Immunodeficiency • Inadequate hygiene
GENERAL PREVENTION • Circumcision • Proper hygiene • Treatment of sexual partner(s) diagnosed with Candida vaginitis or Trichomonas CAUSES
The pathogens implicated in infectious balanitis include, among others:
• Candida species • Trichomonas species • Anaerobic bacteria/Bacteroides species/Gardnerella vaginalis • Chlamydia • Neisseria gonorrhoeae • Human papillomavirus (HPV) • Herpes simplex virus (HSV) • Treponema pallidum
• Mycoplasma • Mycobacterium [Bacillus Calmette–Guerin (BCG)]
• Streptococcus (groups A and B) • Staphylococcus aureus
Borrelia burgdorferi (Lyme illness) • Entamoeba histolytica
DIAGNOSIS • Pain and soreness • Erosions • Erythema • Pruritus • Pustules • Foul odor of the glans penis associated with anaerobic infections • Swelling
DIAGNOSTIC TESTS AND INTERPRETATION Laboratory
• Fungal preparations typically signify Candida.
• A recent study demonstrated that direct impression on CHROMagar Candida medium as a sampling technique yielded a higher quantity of Candida spp than swabs.
• A wet mount may reveal Trichomonas.
• Wet mount preparation for Gardnerella.
• Evaluate the urethral discharge for sexually transmitted infections.
• Titers or cultures to detect HIV, HPV, and HSV. • Glucose assessment to exclude diabetes mellitus.
DIFFERENTIAL DIAGNOSIS • Noninfectious etiologies of balanitis - Irritants, including soaps
– Inadequate hygiene – Trauma – Contact dermatitis – Circinate balanitis – Lichen sclerosus – Lichen planus – Zoon's balanitis – Erythroplasia of Queyrat – Pemphigus – Pemphigoid – Bowen's illness
– Leukoplakia – Fixed drug eruption – Psoriasis, especially inverse psoriasis – Paget’s illness – Nummular eczema – Scabies – Squamous cell carcinoma
ADDITIONAL TREATMENT
Comprehensive Strategies
• Maintain proper hygiene by retracting the foreskin and gently cleansing the glans penis.
Local treatment for Candida balanitis involves the application of topical imidazoles. 1% hydrocortisone cream may serve as an adjunctive treatment.
• Administer oral fluconazole for severe Candida balanitis. • Trichomonas is susceptible to metronidazole.
• Concurrently treat sexual partner(s) for Candida or Trichomonas.
• Manage anaerobic infections with oral metronidazole, oral amoxicillin/clavulanate, or topical clindamycin cream.
CONTINUING TREATMENT POST-CARE SUGGESTIONS
Patients require monitoring by a physician for signs of recurrence or the onset of diabetes.
COMPLICATIONS
• Phimosis • Paraphimosis • Preputial fissure • Scarring
FUNDAMENTAL DESCRIPTION
Inflammation and/or infection of the glans penis. Balanoposthitis encompasses inflammation of the prepuce. This chapter will examine the infectious etiologies.
Epidemiology
Frequency
• Sexual exposure; heightened prevalence in men with female partners suffering from Candida vaginitis. • Balanitis in young boys frequently occurs alongside diaper dermatitis.
RISK FACTORS • Men who are uncircumcised
• Diabetes, particularly new-onset diabetes • For Candida, both colonization and infection age serve as independent risk factors
• Comprehensive-spectrum antibiotics
• Immunodeficiency • Inadequate hygiene
GENERAL PREVENTION • Circumcision • Proper hygiene • Treatment of sexual partner(s) diagnosed with Candida vaginitis or Trichomonas CAUSES
The pathogens implicated in infectious balanitis include, among others:
• Candida species • Trichomonas species • Anaerobic bacteria/Bacteroides species/Gardnerella vaginalis • Chlamydia • Neisseria gonorrhoeae • Human papillomavirus (HPV) • Herpes simplex virus (HSV) • Treponema pallidum
• Mycoplasma • Mycobacterium [Bacillus Calmette–Guerin (BCG)]
• Streptococcus (groups A and B) • Staphylococcus aureus
Borrelia burgdorferi (Lyme illness) • Entamoeba histolytica
DIAGNOSIS • Pain and soreness • Erosions • Erythema • Pruritus • Pustules • Foul odor of the glans penis associated with anaerobic infections • Swelling
DIAGNOSTIC TESTS AND INTERPRETATION Laboratory
• Fungal preparations typically signify Candida.
• A recent study demonstrated that direct impression on CHROMagar Candida medium as a sampling technique yielded a higher quantity of Candida spp than swabs.
• A wet mount may reveal Trichomonas.
• Wet mount preparation for Gardnerella.
• Evaluate the urethral discharge for sexually transmitted infections.
• Titers or cultures to detect HIV, HPV, and HSV. • Glucose assessment to exclude diabetes mellitus.
DIFFERENTIAL DIAGNOSIS • Noninfectious etiologies of balanitis - Irritants, including soaps
– Inadequate hygiene – Trauma – Contact dermatitis – Circinate balanitis – Lichen sclerosus – Lichen planus – Zoon's balanitis – Erythroplasia of Queyrat – Pemphigus – Pemphigoid – Bowen's illness
– Leukoplakia – Fixed drug eruption – Psoriasis, especially inverse psoriasis – Paget’s illness – Nummular eczema – Scabies – Squamous cell carcinoma
ADDITIONAL TREATMENT
Comprehensive Strategies
• Maintain proper hygiene by retracting the foreskin and gently cleansing the glans penis.
Local treatment for Candida balanitis involves the application of topical imidazoles. 1% hydrocortisone cream may serve as an adjunctive treatment.
• Administer oral fluconazole for severe Candida balanitis. • Trichomonas is susceptible to metronidazole.
• Concurrently treat sexual partner(s) for Candida or Trichomonas.
• Manage anaerobic infections with oral metronidazole, oral amoxicillin/clavulanate, or topical clindamycin cream.
CONTINUING TREATMENT POST-CARE SUGGESTIONS
Patients require monitoring by a physician for signs of recurrence or the onset of diabetes.
COMPLICATIONS
• Phimosis • Paraphimosis • Preputial fissure • Scarring
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