Balanitis

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management

Definition

Balanitis refers to inflammation of the glans penis (head of the penis). When the foreskin is also affected, it is known as balanoposthitis.

Aetiology

1. Infectious Causes:

  • Fungal (most common): Candida albicans – often seen in diabetic or immunocompromised individuals.
  • Bacterial:
    • Staphylococcus aureus, Group B Streptococcus (skin flora overgrowth).
    • Gardnerella vaginalis (linked to bacterial vaginosis in female partners).
  • Sexually Transmitted Infections (STIs):
    • Neisseria gonorrhoeae (gonorrhoea).
    • Chlamydia trachomatis.
    • Herpes simplex virus (HSV) (painful vesicles and ulcers).
    • Human papillomavirus (HPV) (genital warts may co-exist).

2. Non Infectious Causes:

  • Irritant contact dermatitis: soaps, perfumed products, latex condoms.
  • Psoriasis: chronic scaly plaques on the glans.
  • Lichen sclerosus (BXO): chronic skin condition causing scarring.
  • Reiter’s syndrome: reactive arthritis with urethritis, conjunctivitis, and balanitis.

Pathophysiology

  • Disruption of the normal skin barrier leads to microbial overgrowth.
  • Inflammatory response results in redness, swelling, and discomfort.
  • Prolonged inflammation can cause scarring and phimosis (tight foreskin).

Risk Factors

  • Poor genital hygiene.
  • Uncircumcised men (moist environment favours microbial growth).
  • Diabetes mellitus (high glucose levels encourage fungal infections).
  • Obesity (increased skin folds and moisture retention).
  • Sexually transmitted infections.
  • Use of irritants (e.g., perfumed soaps, spermicides).
  • Immunosuppression (e.g., HIV, long-term steroid use).

Signs and Symptoms

Local Symptoms:

  • Erythema (redness) and swelling of the glans.
  • Itching, burning, or soreness.
  • Thick, white curd like discharge (suggestive of Candida infection).
  • Foul smelling discharge (suggests bacterial cause).
  • Small ulcers or vesicles (suggestive of herpes or syphilis).

Systemic Symptoms (if severe):

  • Fever (uncommon, may suggest systemic infection).
  • Enlarged inguinal lymph nodes.

Investigations

  • Clinical examination: diagnosis often based on appearance.
  • Swab for microscopy, culture, and sensitivity (MC&S): If bacterial infection suspected.
  • Fungal culture: if Candida balanitis suspected.
  • Urine dipstick and glucose testing: to screen for diabetes.
  • STI screen: NAAT testing for Chlamydia and Gonorrhoea if STI is suspected.
  • Skin biopsy: rarely required but may be considered if lichen sclerosus is suspected.

Management

1. General Measures:

  • Improve hygiene: clean with warm water, avoid soaps and irritants.
  • Avoid tight clothing: reduces friction and moisture retention.

2. Infectious Balanitis:

  • Fungal (Candida balanitis):
    • Topical Clotrimazole 1% cream BD for 7 days.
    • Oral Fluconazole 150mg single dose (if severe or recurrent).
  • Bacterial balanitis:
    • Flucloxacillin 500mg QDS for 7 days (if Staphylococcal infection suspected).
    • Metronidazole 400mg BD for 7 days (if anaerobic infection suspected).
  • Sexually transmitted infections:
    • Chlamydia: doxycycline 100mg BD for 7 days.
    • Gonorrhoea: ceftriaxone 1g IM single dose.
    • Herpes: aciclovir 400mg TDS for 5–10 days.

3. Non-Infectious Balanitis:

  • Allergic/irritant balanitis:
    • Avoid soaps and irritants.
    • Use emollients (e.g., Dermol cream).
  • Lichen sclerosus (BXO):
    • Topical Clobetasol Propionate 0.05% cream OD for 4 weeks.
    • Urology referral if phimosis or scarring develops.
  • Psoriasis: mild topical corticosteroids (e.g., Hydrocortisone 1%).

4. Referral Criteria:

  • Recurrent or persistent balanitis despite treatment.
  • Suspicion of lichen sclerosus or penile malignancy.
  • Refractory cases requiring circumcision.
RenalmypanotesBalanitis