Balanitis is inflammation of the glans.
Balanoposthitis is balanitis with concurrent inflammation of the foreskin.
Most commonly acute fungal infection or occasionally bacterial infection.
Differentials to consider (esp if slow to improve) – cancer, psoriasis, HPV or other infections.
Pre-disposing factors:
- Uncircumcised (particular with phimosis)
- Poor hygiene
- Smegma accumulation
- Diabetes
- Immunosuppression
Presentation:
- Erythematous glans +/- discharge, odour and oedema
- Itching and pain
Common organisms:
- Candida albicans
- Streptococcus
- Staphylococcus aureus
- Gardnerella vaginalis
- Anaerobes
- HSV
- T. pallidum
Management:
- Topical anti-fungal (i.e. clotrimazole 1 %) BD on dried glans until symptoms resolve
- +/- topical steroid (e.g. Resolve cream – miconazole + hydrocortisone)
- Generalised advice – wash under foreskin with water, avoid soaps
- Consider circumcision in recurrent cases
- Consider biopsy if non-resolving erythema
Zoon’s balanitis
Also known as plasma cell balanitis. Occurs in uncircumcised men from third decade onwards.
Smooth, moist, erythematous well-circumscribed papules and plaques on the glans. Also described as shiny red plaques with speckled areas – cayenne pepper spots.
Shallow erosions may be present. Can go large to a couple cm.
Usually cured by circumcision, can try topical steroids.