BALANITIS

BALANITIS - James P. Miller, MD; Timothy L. Black, MD
BASICS
DESCRIPTION
• Balanitis: Inflammation of glans penis
• Posthitis: Inflammation of the foreskin
• System(s) Affected: Reproductive; Skin/Exocrine
ALERT
Geriatric Considerations
Condom catheters can predispose to balanitis.
Pediatric Considerations
Oral antibiotics predispose male infants to Candida balanitis.
GENERAL PREVENTION
• Proper hygiene and avoidance of allergens
• Circumcision
EPIDEMIOLOGY
• Predominant age: Adult
• Predominant sex: Male only
RISK FACTORS
• Presence of foreskin
• Morbid obesity
• Poor hygiene
• Diabetes
• Nursing home environment
ETIOLOGY
• Allergic reaction (condom latex, contraceptive jelly)
• Infections (Candida albicans, Borrelia vincentii, streptococci, trichomonas)
• Fixed drug eruption (sulfa, tetracycline, barbital)
• Plasma cell infiltration (Zoon balanitis)
• Autodigestion by activated Pancreatic transplant exocrine enzymes

DIAGNOSIS
SIGNS AND SYMPTOMS
History
• Pain
• Drainage
• Dysuria
Physical Exam
• Erythema
• Edema
• Discharge
• Ulceration
• Plaque
TESTS
Lab
• Microbiology culture
• Wet mount
• Serology for syphilis
• Serum glucose
Diagnostic Procedures/Surgery
Biopsy, if persistent
Pathological Findings
Plasma cells infiltration with Zoon balanitis
DIFFERENTIAL DIAGNOSIS
• Leukoplakia
• Lichen planus
• Psoriasis
• Reiter syndrome
• Lichen sclerosus et atrophicus
• Erythroplasia of Queyrat
• Balanitis xerotica obliterans (BXO)
TREATMENT
GENERAL MEASURES
• Appropriate health care: Outpatient
• Warm compresses or sitz baths
• Local hygiene
MEDICATION (DRUGS)
• Fungal
- Clotrimazole (Lotrimin) 1% b.i.d.
- Nystatin (Mycostatin) b.i.d.-q.i.d.
- Fluconazole 150 mg single dose (1)[B]
• Bacterial
- Bacitracin q.i.d.
- Neomycin-polymyxin B-bacitracin (Neosporin) q.i.d.
- If cellulitis, cephalosporin or sulfa drug PO or parenteral
- Dermatitis
- Topical steroids q.i.d.
- Zoon balanitis
- Topical steroids q.i.d.
• BXO
- 0.05% Betamethasone b.i.d. (2)[B]
- 0.1% Tacrolimus b.i.d. (3)[C]
• Contraindications: Refer to manufacturer's profile for each drug.
• Precautions: Refer to manufacturer's profile for each drug.
• Significant possible interactions: Refer to manufacturer's profile for each drug.
SURGERY
Consider circumcision as preventive measure
FOLLOW-UP
DISPOSITION
Admission Criteria
• Uncontrolled diabetes
• Sepsis
Discharge Criteria
Resolution of problem
Issues for Referral
Recurrent infections or development of meatal stenosis
PROGNOSIS
Should resolve with appropriate treatment
COMPLICATIONS
• Meatal stenosis
• Premalignant changes from chronic irritations
• Urinary tract infections
PATIENT MONITORING
• Every 1-2 weeks until etiology has been established
• Persistent balanitis may require biopsy to rule out malignancy or BXO
REFERENCES
1. Stary A, Soeltz-Szoets J, Kiegler C, et al. Comparison of the efficacy and safety of oral fluconazole and topical clotrimazole in patients with candida balanitis. Genitourin Med. 1996;72:98-102.
2. Kiss A, Csontai A, Pirot L, et al. The response of Balanitis xerotica obliterans to local steroid application compared to placebo in children. J Urol. 2001;165:219-220.
3. Pandher BS, Rustin HMA, Kaisary AV. Treatment of Balanitis Xerotica Obliterans with topical tacrolimus. J Urol. 2003;170:923.
MISCELLANEOUS
See also: Reiter Syndrome