balanitis
Last reviewed 01/2018
Definitions:
- balanitis - inflammation of the glans penis
- posthitis - inflammation of the foreskin
- balanoposthitis - inflammation of the glans penis and foreskin
Balanitis is common in young boys with a non-retractile foreskin and in the elderly where there may be predisposing factors such as malignancy or diabetes. The organisms most commonly involved are faecal bacteria and candida.
Presentation is with irritation or pain in the penis and discharge from beneath the foreskin. Inflammation is visible. Recurrent balanitis may cause a phimosis with disturbance of micturition.
Management:
- treatment depends on the cause
- anyone with balanitis should be advised to (1):
- avoid contact with any potential skin irritants (e.g. soap)
- keep area clean by bathing twice daily with a weak saline solution while symptoms persist
- anyone with balanitis should be advised to (1):
- in consideration of men with acute balanitis
- refer all men with acute balanitis and suspected urethritis, ulceration,
or lymphadenopathy to a genito-urinary medicine clinic (2)
- with the exception of recurrent ulceration due to herpes simplex in someone with an established diagnosis
- refer all men with acute balanitis and suspected urethritis, ulceration,
or lymphadenopathy to a genito-urinary medicine clinic (2)
- swab the sub-preputial space prior to starting empirical treatment (2)
- balanitis secondary to candida responds to topical antifungal cream
or oral antifungal treatment
- in adults, treatment options include:
- topical imidazole e.g. econazole, ketoconazole, sulconazole,clotrimazole 1% or miconazole 2% applied twice a day till the symptoms resolve
- oral fluconazole - 150mg stat if symptoms are severe
- topical nystatin - in case of resistance and allergy to imidazole (3)
- topical terbinafine
- in children, treatment options include
- a topical imidazole e.g. clotrimazole, econazole, ketoconazole, miconazole, sulconazole
- topical nystatin
- recommended that treatment with a topical antifungal should be continued for 2-3 days after clinical cure
- in adults, treatment options include:
- bacterial balanitis may require oral antibiotic treatment (e.g. flucloxacillin or erythromycin)
- sometimes a combined steroid/antibiotic cream (e.g. hydrocortisone acetate
1%, fusidic acid 1%) or combined antifungal/steroid cream (e.g. hydrocortisone
1%, clotrimazole1%) is used to reduce inflammation caused by infection
- topical corticosteroid should be applied until the inflammation has
cleared
- twice a day for up to 2 weeks (3)
- topical corticosteroid should be applied until the inflammation has
cleared
Referral for consideration for circumcision may be necessary once the inflammation has settled.
Older patients should be tested for diabetes.
Reference:
- (1) CEG (2001) National guideline on the management of balanitis. Clinical Effectiveness Group (Association for Genitourinary Medicine and the Medical Society for the Study of Venereal Diseases).
- (2) Balanitis (CKS 2007).
- (3) British Association for Sexual Health and HIV. 2008 UK National Guideline on the Management of Balanoposthitis
foreskin retraction (natural history)