- more common in African Americas and Hispanics
- usually occurs in uncircumcised males
- symptoms usually occur over 3-7 days
- presents as pain, tenderness, may have erythematous lesions, may have discharge, prutitis
- can progress to edema and scarring --> phimosis (tightening of the prepuce which constricts the opening of the foreskin)
- could result in systemic symptoms: joint pain, painful glands, sores on other parts of body, fatigue
Causes:
- infections: candida, anaerobes, aerobes (strep), STD's (HPV, HSV, trich, syphillis, gonorrhea), mycobacterium, HIV
- skin disorders/pemphigoid (psoriasis, seborrheic dermatitis)
- cicinate balanitis (lichen sclerosis/balanitis xerotica obliterans
- Zoon's balanitis
- carcinoma in situ
- poor hygiene
- fixed drug eruptions
- reactive arthritis
- obesity
- trauma
- contact dermatitis/irritant/allergy
Treatment:
candida infection:
- more common in men with diabetes mellitus --> poorly controlled blood glucose leads to proliferation of candida
- if not diagnosed with DM and presenting with balanitis --> work up for DM (may be undiagnosed)
- if no DM --> look for other reasons to be immunocompromised (HIV, etc.)
- usually candida albicans
- presents as painful and pruritic rash with burning
- diagnose with a culture
- treat topically for 1-3 weeks
- clotrimazole
- miconazole
- nystatin (only if suspect resistance to azoles)
- oral fluconazole 150 mg x 1 dose
bacterial infections:
- more commonly caused by anaerobes but could be caused by aerobes as well
- will present with foul-smelling discharge
- diagnose with culture
- oral antibiotics:
- metronidazole 500 mg BID x 7 days
- augmentin 375 mg TID x 7 days
- topical clindamycin BID until symptoms resolve
- if strep - treat based on susceptibility
poor hygiene:
- bathing twice daily with saline solution
dermatitis/allergy & fixed drug eruptions:
- may be caused by detergents, soaps, condoms, etc
- presents as erythema/edema , fixed drug eruptions present with lesions/plaques at time of administration of offending drug
- need to avoid agents/drugs
- fixed drug eruptions most common with tetracyclines, salicylates, hypnotics
- treat with topical 1% hydrocortisone cream twice daily
reactive arthritis:
- multisystem disorder -- can affect genitourinary tract, joints, and eyes
- caused by infections organisms (chlamydia, shigella, neisseria, salmonella, HIV)
- presents with prostatitis, discharge, painful urinating
- self-limited and can last months long
circinate balanitis
- 20-40% of men with reactive arthritis can develop this, but can occur without it
- presents as greyish/white ulcer lesions
- can be mistaken for psoriasis
- treat with 1% hydrocortisone cream
- self-limited and can last months long
complications -->
phimosis (abnormal constriction of opening in foreskin), generally not an emergency
can progress to paraphimosis (trapping of foreskin behind glans penis), urologic emergency
References:
Barrisford G. Balanitis and balnoposthitis in adults. UpToDate. O'Leary M (Ed). Accessed on 11 November 2016.
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