Balanitis

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Definition

-  Inflammation of the glans penis +/- foreskin

-  Balanoposthitis = inflammation of glans & prepuce

 

Features

-  Less common in circumcised males

-  Common in children

-  6% uncircumcised males

-  3% circumcised males

 

Associated S/S

-  Tender, erythematous glans penis +/- swelling, warmth & discharge

-  Itching red, maculopapular lesions w circumferential scales + satellite lesions: Candida

-  Foreskin & shaft effected: bacterial more likely

-  Dysuria secondary to pain

-  Nappy rash: Candida

 

Causes

-  Bacterial

-  Prepubertal boys: Strep pyogenes, Staph & Gram –ve also possible

-  More likely if shaft & foreskin effected

-  Candida

-  Adults more common than bacteria

-  Most common in uncircumcised sexually active males

-  In peads if ass Nappy Rash

-  Non-infectious

-  No response to Abx or antifungals even if pathogens on MCS

-  Psoriasis

-  Lichen planus

-  Plasma cell balanitis

-  SCC

 

Ix

-  Swab for MCS

-  Less helpful in paeds

-  +/- Ix of female partner for Candida (usually not)

-  +/- Skin Bx if suspecting non-infectious cause

 

Mx

-  Washing under foreskin during showering

-  Strep pyogenes

-  Phenoxymethylpenicillin 500mg PO 6/24 for 10 days

-  Penicillin hypersensitivity Cephalexin 500mg PO 12/24 for 10 days

-  Penicillin anaphylaxis Roxithromycin 300mg PO Daily for 10 days

-  Candida

-  Topical cream: Clotrimazole, Miconazole, Nystatin..

-   + Hydrocortisone 1% cream topically BD

-  OR Fluconazole 150mg PO single dose if intolerant of creams

-  Paeds

-  Hydrocortisone 1% cream for mild cases

-  Pain Mx

-   Analgesia

-   Warm bath may assist dysuria, urinate in bath

-  If foreskin & shaft involved

-   Co-trimoxazole 4/20 mg/kg (max 160/800) 12/24

-   OR Amoxycillin 15mg/kg (max 500mg) 8/24

-  Circumcision in extreme cases if recurrent & relcalcitrant

-  Non-infectious

-  Soap substitute

-  Attention to personal hygiene

-  Bland emoliant

-  If ineffective consider psoriasis, lichen planus, plasma cell balanitis, SCC

-  Conisder referral to Urologist if present in circumcised male

-  Referal to Dermatologist if ?non-infectious

 

 

 

References

 

eTG: Balanitis, Feb 2009

RCH CPG: The Penis & Foreskin: www.rch.org.au/clinicalguide/cpg.cfm?doc_id=5153