Balanitis
- Glenn G. Fort, M.D., M.P.H
Basic Information
Definition
Balanitis is an inflammation of the superficial tissues of the penile head (glans penis). If the foreskin (prepuce) is involved, it is called balanoposthitis.
| ICD-10CM CODES | |
| B37.42 | Candidal balanitis |
| N48.1 | Balanitis |
Epidemiology & Demographics
Incidence (In U.S.)
More common in uncircumcised males and in diabetic patients
Prevalence (In U.S.)
One study reports that 11% of adult men seen in a urology clinic and 3% of male children (mostly uncircumcised) have balanitis.
Predominant Sex
Almost exclusive to males but can affect clitoris
Peak Incidence
All ages, especially in sexually active men. It occurs in ¼ of male sex partners of women infected with Candida.
Physical Findings & Clinical Presentation
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Itching and tenderness
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Pain, dysuria, and local edema and erythema
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Rarely, ulceration and lymph node enlargement
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Severe ulcerations leading to superimposed bacterial infections
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Inability to void: unusual, but a more distressing and serious complication
Etiology
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Causes include infectious agents, skin disorders, or miscellaneous.
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Infectious diseases: Candida species (40%), Neisseria gonorrhoeae, HPV, herpes simplex, Gardnerella vaginalis, Treponema pallidum (syphilis), HIV, Trichomonas, Staphylococcus aureus, anaerobic bacteria
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Skin disorders: circinate balanitis of Reiter’s syndrome, lichen sclerosis
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Miscellaneous: poor hygiene, causing erosion of tissue with erythema and promoting growth of Candida albicans (Fig. E1), trauma (zippers, urinary catheters), allergic reactions to condoms or medications
Diagnosis
Differential Diagnosis
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Leukoplakia
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Nummular eczema
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Balanitis xerotica obliterans
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Psoriasis
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Carcinoma of the penis
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Plasma cell balanitis (noninfectious)
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Erythroplasia of Queyrat
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Nodular scabies
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Circinate balanitis (Reiter’s syndrome)
Workup
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Sexually active males: assessment for evidence of other sexually transmitted diseases
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Biopsy if lesions do not heal
Laboratory Tests
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VDRL, HIV, NAATs for chlamydia and gonorrhea
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FBS, HBA1C to rule out diabetes
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Wet mount for Trichomonas
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KOH prep for yeast
Treatment
Nonpharmacologic Therapy
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Maintenance of meticulous hygiene
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Retraction and bathing of prepuce several times a day
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Warm sitz baths to ease edema and erythema
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Consideration of circumcision, especially when symptoms are severe or recurrent
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With Foley catheters, strict catheter care strongly advised
Acute General Rx
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Metronidazole 2 g PO as a single dose or fluconazole 150 mg PO × 1 or itraconazole 200 mg PO bid × 1 day
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Clotrimazole 1% cream applied topically twice daily to affected areas
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Bacitracin or Neosporin ointment applied topically 4 times daily
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With more severe bacterial superinfection: cephalexin 500 mg PO qid
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Topical corticosteroids added 4 times daily if dermatitis severe
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Patients with suspected urinary tract infections: trimethoprim-sulfa DS twice daily or ciprofloxacin 500 mg PO bid after obtaining appropriate cultures
Disposition
Balanitis is often self-limited and usually responds to conservative therapy; if it does not improve, consider circinate balanitis of Reiter’s syndrome, nodular scabies, and primary skin lesions including skin carcinoma.
Pearls & Considerations
Don’t forget about nodular scabies involving the prepubic area—examine the region carefully for burrows and tracks of Sarcoptes scabiei.
Referral
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For surgical evaluation for circumcision if symptoms are recurrent, especially if phimosis or meatitis occurs (note: Severe phimosis with an inability to void may require prompt slit drainage.)
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For biopsy to rule out other diagnoses such as premalignant or malignant lesions if lesions are not healing
Suggested Readings
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: Non-infectious inflammatory genital lesions. Clin Dermatol. 32:307–314 2014 24559568
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: Noninfectious penile lesions. Am Fam Physician. 81:167–174 2010 20082512
Related Content
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Balanitis (Patient Information)