Balanitis
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | Example Management | References
Definition
Balanitis is an inflammation of the glans penis. When the foreskin is also affected, the condition is referred to as balanoposthitis. This condition can cause significant discomfort and may affect both children and adults.
Aetiology
Balanitis can result from various causes, including:
- Infections: Bacterial (e.g., Staphylococcus, Streptococcus), fungal (e.g., Candida), and viral infections.
- Poor hygiene: Accumulation of smegma under the foreskin can lead to irritation and infection.
- Allergic reactions: To soaps, detergents, or latex.
- Skin conditions: Such as eczema, psoriasis, or lichen planus.
- Diabetes: Poorly controlled diabetes can predispose individuals to infections, including balanitis.
- Phimosis: A tight foreskin that cannot be retracted can lead to poor hygiene and infections.
Pathophysiology
Balanitis involves inflammation of the glans penis, which can result from infection, irritation, or an allergic reaction. The inflammation causes redness, swelling, and pain. In cases where an infection is present, the pathogen triggers an immune response, leading to further inflammation and symptoms such as discharge and itching.
Risk Factors
- Poor personal hygiene.
- Uncircumcised males.
- Diabetes mellitus.
- Use of irritating substances such as certain soaps or lotions.
- History of skin conditions like eczema or psoriasis.
- Sexual activity: Increased risk of sexually transmitted infections (STIs).
Signs and Symptoms
- Redness and swelling of the glans penis.
- Itching or irritation.
- Pain or discomfort, particularly during urination or sexual activity.
- Discharge from under the foreskin.
- Foul odour.
- Phimosis: Difficulty retracting the foreskin if it is involved.
Investigations
- Clinical history and physical examination.
- Swab of the affected area: To identify any infectious agents (bacterial, fungal, or viral).
- Urinalysis: To rule out concurrent urinary tract infection.
- Blood tests: Including blood glucose levels to check for diabetes.
- Biopsy: In persistent or atypical cases to rule out malignancy or specific dermatological conditions.
Management
Primary Care Management
- Improving hygiene: Regular cleaning of the glans and foreskin with water and gentle soap.
- Topical treatments: Antifungal creams (e.g., clotrimazole) for suspected Candida infections, antibiotic creams for bacterial infections.
- Hydrocortisone cream: A mild steroid cream (e.g., hydrocortisone 1%) can reduce inflammation and discomfort.
- Combination treatments: Hydrocortisone/miconazole cream for mixed infections and inflammation.
- Oral medications: For more severe infections, oral antibiotics or antifungals may be prescribed.
- Emollients: To soothe and protect the skin if irritation is present.
- Patient education: Importance of good hygiene, avoiding irritants, and managing underlying conditions such as diabetes.
- Referral to a specialist: If symptoms persist or if there are complications such as phimosis or recurrent infections.
Specialist Management
- Further diagnostic evaluation: Including swabs, biopsies, and blood tests if necessary.
- Advanced treatments: Topical or systemic corticosteroids for inflammatory conditions, more potent antifungals or antibiotics if needed.
- Surgical intervention: Circumcision in cases of recurrent balanitis or phimosis.
- Management of complications: Addressing any complications such as scarring or strictures.
- Multidisciplinary care: Involving dermatologists, urologists, and diabetes specialists if necessary.
Example Management for Balanitis
A patient presenting with redness, swelling, and itching of the glans penis should be advised on proper hygiene, including regular cleaning with water and gentle soap. If a fungal infection is suspected, a topical antifungal cream such as clotrimazole should be applied twice daily for 1-2 weeks. For bacterial infections, a topical antibiotic such as fusidic acid may be prescribed. Hydrocortisone cream (1%) can be used to reduce inflammation and discomfort. Combination creams such as hydrocortisone/miconazole can be used for mixed infections. If symptoms persist or there are signs of a more severe infection, oral antibiotics or antifungals may be needed. Referral to a specialist is recommended if there are recurrent episodes, phimosis, or if initial treatment fails. Regular follow-up is essential to ensure resolution of symptoms and to manage any underlying conditions such as diabetes.
References
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