BALANITIS – Causes and Risk Factors, Clinical Manifestations and Management
Balanitis is an inflammation that affects the head of the penis. A similar condition, balanoposthitis, refers to inflammation of the head of the penis and the foreskin. It occurs primarily in uncircumcised men. Poor hygiene may lead to an accumulation of smegma (foul-smelling substance) that irritates the skin of the penile head, ultimately causing inflammation and swelling.
Most common in men over 40 years old, Balanitis is a condition affecting about 11% of adult men and 3% of children. Balanitis is characterized by a shiny red or reddish orange area. It can also present as a yellow patch with pinpoint spotting.
CAUSES AND RISK FACTORS OF BALANITIS
In almost every instance balanitis results from the presence of a foreskin, which may be redundant and phimotic, thereby predisposing to infections. This preputial cloak harbors beneath it normally desquamating epithelial cells, glandular secretions, and mycobacterium smegmatis and provides a warm, moist culture medium for any incidental organisms that may be present.
- Infection from bacteria (Borrelia vincentii, streptococci) or fungus (Candida albicans)
- Poor hygiene in uncircumcised men
- Allergy to chemicals in clothing, contraceptive cream, and condom latex
- Reaction to certain medications
- Tight foreskin and trauma or minor injury to the foreskin and penis
- Diabetes and obesity
- Taking a course of antibiotics (which can encourage bacteria to grow)
- Sexual partner affected by candidal vaginitis
- Various viruses and organisms can cause balanitis. These include HPV (human papilloma virus), strep, candida, gonorrhea, Chlamydia and syphilis
- Several other diseases, including Reiter’s syndrome and lichen sclerosis et atrophicus, can also produce balanitis
- The inflammation can be due to infection, harsh soaps, or failure to properly rinse soap off while bathing
CLINICAL MANIFESTATIONS
Occurring only in uncircumcised men, balanitis causes the following symptoms:
- Redness, swelling and tenderness of the penile head
- Inflammation of the foreskin
- Discharge from the penis
- Impotence
- Swelling
- Difficulty with passing urine
- Inability to retract the foreskin
- Enlarged lymph glands in the groin
- Chills and fever (rare)
- Burning on urination (rare)
MANAGEMENT
Treatment depends on the underlying cause. The common interventions are:
- Infection requires the relevant antibiotic or antifungal drug. Oral antibiotics can be required for severe cases and often in children
- Apply bacitracin (not Neosporin) for pediatric patients if bacterial infection is suspected
- Potassium permanganate solution (1 in 10,000 dilutions) is nearly always beneficial when used to wash the penis but causes temporary purple discoloration
- Steroid creams of mild to moderate strength are used in short-term courses for non-infective eczematous or inflammatory skin conditions. Balanitis occurring with skin diseases may respond to steroid creams.
- Phimosis and paraphimosis sometimes require circumcision to prevent recurrence
Taking appropriate hygiene measures can help prevent future bouts of balanitis, such as retracting the foreskin daily and adequately cleaning and drying the head of the penis. In addition, it is important to avoid strong soaps or chemicals, especially those known to cause a skin reaction. Use warm-water soaks to relieve pain. Aspirin or acetaminophen is administered to relieve minor pain and fever. Avoid sexual intercourse during treatment. Resume normal activities when the infection is cured.
BALANITIS – Causes and Risk Factors, Clinical Manifestations and Management