Balanoposthitis

• Balanitis = inflammation of the glans penis

  Posthitis = inflammation of the prepuce (foreskin)

  In clinical practice both areas are often affected and the term 'balanoposthitis may be used (shortened to balanitis)
• Infective causes:

  • Fungi e.g. candida
  • Bacterial e.g. sexually transmitted infections
  • Viral e.g. HSV
• Non-infectious causes:

  • Inflammatory skin conditions e.g. allergic contact dermatitis, lichen sclerosus
  • Malignant conditions e.g. squamous cell carcinoma
  • Miscellaneous e.g. trauma, poor hygiene
• Possible complications depend on the underlying cause:

  • Phimosis and paraphimosis.
  • Urinary symptoms due to urethral meatal stenosis and urethral stricture.
  • Sexual dysfunction.
  • Penile intraepithelial neoplasia and malignancy.
• Clinical features:

  • Penile discomfort and itch, bleeding, urethral discharge
  • Urinary symptoms
  • Sexual dysfunction
  • Redness and swelling of the glans penis and/or foreskin with possible sup-preputial discharge, fissuring or ulceration
• Assessment:

  • Ask: hygiene, potential irritants, underlying skin conditions, sexual history and any causes for immunosuppression
  • Examination of the penile skin and genital area
  • Sub-preputial swaps for candida and bacterial culture
  • Arrange STI screen if clinically indicated
  • Arranging blood testing for HbA1c and HIV if balanitis is severe or persistent
• Treatment:

  • Hygiene advice - regularly retract prepuce, gently clean and thoroughly dry
  • Fungal - topical imidazole cream or oral fluconazole
  • Bacterial - topical (mupirocin 2%) or oral antibiotics (guided by guidelines or swab results) depending on severity
  • Topical hydrocortisone cream can be used in addition to other treatment for fungal/bacterial infection if there is severe inflammation
  • Dermatitis - topical hydrocortisone
  • Lichen sclerosus - strong steroid ointment