Balanitis: Difference between revisions

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__NOTOC__
__NOTOC__
{{BalanitisV}}
{{Balanitis}}
{{CMG}}; {{AE}}{{VD}}
{{CMG}}; {{AE}}{{VD}}


{{SK}} Balanoposthitis
{{SK}} Balanoposthitis
* '''Please [[Zoon's Balanitis|click here]] to know more about [[Zoon's Balanitis]]'''
 
* '''Please [[Balanitis xerotica obliterans|click here]] to know more about [[Balanitis xerotica obliterans]]'''


==Overview==
==Overview==
Balanitis is [[inflammation]] of [[glans penis]]. When inflammation involve the [[foreskin]] and [[prepuce]], it is termed as [[balanoposthitis]]. Based on the etiology, balanitis can be mainly categorized into [[Infectious balanitis|infectious]], [[inflammatory dermatoses]], and [[penile carcinoma in situ]]. Patients with [[balanitis]] may present with asymptomatic or symptomatic lesions with [[itch]] or [[pain]] in the genital region. [[Risk factors]], [[pathogenesis]], clinical presentation, [[diagnosis]] and management varies from [[etiology]] to [[etiology]].  
Balanitis is [[inflammation]] of [[glans penis]]. When inflammation involves the [[foreskin]] and [[prepuce]], it is termed as [[balanoposthitis]]. Based on the etiology, balanitis can be mainly categorized into [[Infectious balanitis|infectious]], [[inflammatory dermatoses]], and [[penile carcinoma in situ]]. Patients with [[balanitis]] may present with asymptomatic or symptomatic lesions with [[itch]] or [[pain]] in the genital region. [[Risk factors]], [[pathogenesis]], clinical presentation, [[diagnosis]] and management varies from [[etiology]] to [[etiology]].


== Classification  ==
== Classification  ==
Line 14: Line 13:
There is no established classification system for Balantis. Based on the etiologies, Balanitis can be classified into:<ref name="pmid24828553">{{cite journal| author=Edwards SK, Bunker CB, Ziller F, van der Meijden WI| title=2013 European guideline for the management of balanoposthitis. | journal=Int J STD AIDS | year= 2014 | volume= 25 | issue= 9 | pages= 615-26 | pmid=24828553 | doi=10.1177/0956462414533099 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24828553  }}</ref>
There is no established classification system for Balantis. Based on the etiologies, Balanitis can be classified into:<ref name="pmid24828553">{{cite journal| author=Edwards SK, Bunker CB, Ziller F, van der Meijden WI| title=2013 European guideline for the management of balanoposthitis. | journal=Int J STD AIDS | year= 2014 | volume= 25 | issue= 9 | pages= 615-26 | pmid=24828553 | doi=10.1177/0956462414533099 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24828553  }}</ref>
* [[Infectious balanitis|Infectious]]  
* [[Infectious balanitis|Infectious]]  
* [[Inflammatory dermatoses]]  
* Non-infectious balanitis
* [[Penile carcinoma in situ]]  
:*[[Zoon's balanitis]]
:*[[Balanitis xerotica obliterans]]
 
== Causes ==
 
=== '''Infectious balanitis''' ===
'''Common causes of infectious balanitis''' 
 
'''Fungal'''
* [[Candida]] (most common cause)
'''Protozoal'''
* [[Trichomonas vaginalis]]
'''spirochaetes'''
* [[Treponema pallidum]]
'''Viral'''
* [[Herpes simplex]]
* [[Human papillomavirus|Human papilloma virus]]
 
==== Less common causes of infectious balanitis ====
'''Fungal'''
* [[Dermatophytosis]] 
* [[Pityriasis versicolor]]
* [[Histoplasma capsulatum]]
* [[Blastomyces dermatitidis]]
* [[Cryptococcus neoformans]]
 
==== Viral ====
* [[Varicella zoster virus|Varicella zoster virus (VZV)]]
 
==== Protozoal ====
* [[Entamoeba histolytica]]
* [[Leishmania|Leishmania species]]


{{familytree/start}}
==== Parasitic ====
{{familytree | | | | | | | | | | | | | | | | | A01 |A01='''Balanitis'''}}
* [[Sarcoptes scabiei]]  
{{familytree | | | | |,|-|-|-|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|-|.| | | }}
* [[Pediculosis]]
{{familytree | | | | B01 | | | | | | | | | | | B02 | | | | | | | | | B03 |B01='''Infectious'''|B02='''Inflammatory dermatoses'''|B03='''Premalignant(penile carcinoma in situ)'''}}
* [[Ancylostoma]]
{{familytree | | | | |!| | | | | | | | | | | | |!| | | | | | | | | | |!| | | }}
{{familytree | | | | |!| | | | | | | | | | | | |!| | | | | | | | | | |!| | | }}
{{familytree | | | | C01 | | | | | | | | | | | C02 | | | | | | | | | C03 |C01=[[Candida]] (albicans, krusei)<br>[[Streptococci]]<br>Anaerobes<br>[[Staphylococci]]<br>[[Trichomonas vaginalis]]<br>[[Herpes simplex virus]]<br>[[Human papillomavirus]]<br>[[Mycoplasma genitalium]]|C02=[[Lichen sclerosus]]<br>[[Lichen planus]]<br>[[Psoriasis]]<br>[[Circinate balanitis]]<br>[[Zoon's balanitis]]<br>[[Eczema]]<br>[[Allergic reactions]]|C03= [[Bowen's disease]]<br>[[Bowenoid papulosis]]<br>[[Erythroplasia of Queyrat]]}}
{{familytree/end}}


==Diagnosis and management==
==== Bacterial ====
<br>'''''Adopted from National Guideline on the Management of Balanoposthitis UK 2008'''''<br>
'''Gram negative bacteria'''
{| align=center
* [[Escherichia coli|E.coli]]
|-
* [[Pseudomonas]]
|
* [[Haemophilus|Haemophilus parainfluenzae]]
{{familytree/start |summary=Diagnostic and Management approach of balanitis and balanoposthitis}}
* [[Klebsiella]]
{{familytree | | | | | | | | | | | A01 | | A01=Balanitis/balanoposthitis}} 
* [[Neisseria gonorrhoeae|Neisseria gonorrhoea]]
{{familytree | | | | | | | | | | | |!| | |}}
* [[Haemophilus ducreyi]]
{{familytree | | | | | | | | | | | B01 | | B01=Take history and examine}}
* [[Mycoplasma genitalium]]
{{familytree | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | | }}
* [[Chlamydia]]
{{familytree | | | C01 | | | | | | | | | | | | | | C02 | |C01=Perpuce retracts|C02=Perpuce does not retract}}
* [[Ureaplasma]]
{{familytree | |,|-|^|-|-|-|-|.| | | | | | |,|-|-|-|^|-|-|.| |}}
* [[Gardnerella vaginalis]]
{{familytree | D01 | | | | | D02 | | | | | | D03 | | | | D04 |D01=Ulceration present|D02=Erythema,subpreputial discharge|D03=Prepuce scarred|D04=Prepuce swollen}}
* [[Citrobacter]]
{{familytree | |!| | | |,|-|-|^|-|.| | | | | |!| | | | | |!|}}
* [[Enterobacter]]
{{familytree | E01 | | E02 | | | E03 | | | | E04 | | | | E05 |E01=Follow genital ulcer protocol|E02=Fowl smelling|E03=No odour|E04=Refer to surgical opinion|E05=Treat as genital ulcer disease}}
 
{{familytree | |!| | | |!| | | | |!| | | | | |!| | | | | |!| | | |}}
==== Spirochaetes ====
{{familytree | |!| | | F01 | | | F02 | | | | |!| | | | | |!| | | | |F01=Metronidazole 400 mg bd|F02=Antifungal+1% Hydrocortisone cream apply bd}}
* Non-specific [[spirochaetal]] [[infection]]
{{familytree | |!| | | |!| | | | |!| | | | | |!| | | | | |!|}}
'''Gram positive organism'''
{{familytree | |`|-|-|-|^|-|-| G01 |-|-|-|-|-|^|-|-|-|-|-|'| | | | | | |G01=Review}}
* [[Streptococci|Haemolytic Streptococci(Group B Streptococci)]]
{{familytree | | | | | | | |,|-|^|-|.| | | | | | | | | | | | | | |}}
* [[Staphylococci|Staphylococci epidermidis/aureus]]
{{familytree | | | | | | | H01 | | H02 | | | | | | | | | | | | | | | |H01=If better discharge|H02=If not better 1) Reassess-try alternative pathway 2) Erythromycin 500 bd 3) Potent steroid cream}}
'''Acid fast bacilli'''
{{familytree/end}}
* [[Mycobacterium tuberculosis]]
|}
* [[Mycobacterium leprae]]
 
==== Anaerobes ====
* [[Bacteroides]]
 
=== '''Non-infectious balanitis''' ===
 
==== Inflammatory dermatoses conditions causing balanitis ====
* [[Lichen sclerosus]]
* [[Lichen planus]]
* [[Zoon's balanitis]]
* [[Psoriasis]]
* [[Reiter's Disease|Circinate balanitis]]
* [[Eczema]]
* [[Seborrhoeic dermatitis]]
* [[Fixed drug eruption]]
* Non-specific [[balanoposthitis]]
'''Penile carcinoma in situ causing balanitis'''
* [[Bowenoid papulosis]]
* [[Erythroplasia of Queyrat]]
* [[Bowen's disease]]


==Synopsis==
= Differential Diagnosis =
{| class="wikitable"
{| class="wikitable"
! colspan="3" |Symptoms
! colspan="3" |Symptoms
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|-
|-
|[[Candidiasis|Candida balanitis]]
|[[Candidiasis|Candida balanitis]]
|✖
| -
|✔
| +
|[[Erythematous]] [[Rash (patient information)|rash]] with soreness and/or [[itch]]
|[[Erythematous]] [[Rash (patient information)|rash]] with soreness and/or [[itch]]
|✔
| +
|✔
| +
|✖
| -
|-
|-
|[[Trichomonas vaginalis]]
|[[Trichomonas vaginalis]]
|✖
| -
|✔
| +
|Superficial erosive [[balanitis]] 
|Superficial erosive [[balanitis]] 
|✖
| -
|✔
| +
|✖
| -
|-
|-
|[[Treponema pallidum]]
|[[Treponema pallidum]]
|✖
| -
|✖
| -
|Multiple circinate lesions
|Multiple circinate lesions
|✔
| +
|✖
| -
|✖
| -
|-
|-
|[[Herpes simplex]]
|[[Herpes simplex]]
|✔
| +
|✔
| +
|Grouped [[vesicles]] on [[erythematous]] base
|Grouped [[vesicles]] on [[erythematous]] base
|✔
| +
|✔
| +
|✖
| -
|-
|-
|[[Human papillomavirus|Human papilloma virus]]
|[[Human papillomavirus|Human papilloma virus]]
|✖
| -
|✔
| +
|[[Warts]]  
|[[Warts]]  
|✖
| -
|✖
| -
|✖
| -
|-
|-
|[[Lichen sclerosus]]
|[[Lichen sclerosus]]
|✖
| -
|✔
| +
|White patches on glans
|White patches on [[glans]]
|✖
| -
|✖
| -
|✖
| -
|-
|-
|[[Lichen planus]]
|[[Lichen planus]]
|✖
| -
|✔
| +
|Purplish lesions on the [[penis]]
|Purplish [[lesions]] on the [[penis]]
|✖
| -
|✖
| -
|✖
| -
|-
|-
|[[Psoriasis]]
|[[Psoriasis]]
|✖
| -
|✔
| +
|Red scaly plaques
|Red scaly [[plaques]]
|✖
| -
|✔
| +
|✖
| -
|-
|-
|[[Reiter's Syndrome|Circinate]]
|[[Reiter's Syndrome|Circinate]]
|✔
| +
|✔
| +
|Greyish white areas on the [[glans]]
|Greyish white areas on the [[glans]]
|✖
| -
|✖
| -
|✖
| -
|-
|-
|[[Zoon's balanitis]]
|[[Zoon's balanitis]]
|✖
| -
|✔
| +
|Well-circumscribed orange-red glazed areas
|Well-circumscribed orange-red glazed areas
|✖
| -
|✖
| -
|✖
| -
|-
|-
|[[Eczema]]
|[[Eczema]]
|✖
| -
|✔
| +
|Mild non-specific [[erythema]] to wide spread [[edema]] of [[penis]].
|Mild non-specific [[erythema]] to wide spread [[edema]] of [[penis]].
|✖
| -
|✔
| +
|✔
| +
|-
|-
|[[Fixed drug eruption]]
|[[Fixed drug eruption]]
|✖
| -
|✔
| +
|Well demarcated and [[Erythema|erythematous]] lesions
|Well demarcated and [[Erythema|erythematous]] lesions
|✖
| -
|✔
| +
|✖
| -
|-
|-
|[[Bowen's disease]]
|[[Bowen's disease]]
|✖
| -
|✔
| +
|Multiple, small, well-demarcated [[Papillomatosis|papillomatous]] [[papules]]  
|Multiple, small, well-demarcated [[Papillomatosis|papillomatous]] [[papules]]  
|✖
| -
|✖
| -
|✖
| -
|-
|-
|[[Bowenoid papulosis]]
|[[Bowenoid papulosis]]
|✖
| -
|✔
| +
|Single or multiple, sharply demarcated associated with [[Scaling skin|scaling]] and crusting
|Single or multiple, sharply demarcated associated with [[Scaling skin|scaling]] and crusting
|✖
| -
|✖
| -
|✖
| -
|-
|-
|[[Erythroplasia of Queyrat]]
|[[Erythroplasia of Queyrat]]
|✖
| -
|✔
| +
|Velvety patches and [[plaques]] of [[keratinization]] on [[penis]].
|Velvety patches and [[plaques]] of [[keratinization]] on [[penis]].
|✔
| +
|✖
| -
|✖
| -
|}
|}
== References ==
== References ==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Balanitis]]
[[Category:Infectious diseases]]
{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Urology]]
[[Category:Emergency medicine]]

Latest revision as of 20:35, 29 July 2020

Balanitis Microchapters

Patient Information

Overview

Classification

Infectious balanitis
Non-infectious balanitits
Zoon's balanitis
Balanitis xerotica obliterans

Causes

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vishal Devarkonda, M.B.B.S[2]

Synonyms and keywords: Balanoposthitis


Overview

Balanitis is inflammation of glans penis. When inflammation involves the foreskin and prepuce, it is termed as balanoposthitis. Based on the etiology, balanitis can be mainly categorized into infectious, inflammatory dermatoses, and penile carcinoma in situ. Patients with balanitis may present with asymptomatic or symptomatic lesions with itch or pain in the genital region. Risk factors, pathogenesis, clinical presentation, diagnosis and management varies from etiology to etiology.

Classification

There is no established classification system for Balantis. Based on the etiologies, Balanitis can be classified into:[1]

Causes

Infectious balanitis

Common causes of infectious balanitis

Fungal

Protozoal

spirochaetes

Viral

Less common causes of infectious balanitis

Fungal

Viral

Protozoal

Parasitic

Bacterial

Gram negative bacteria

Spirochaetes

Gram positive organism

Acid fast bacilli

Anaerobes

Non-infectious balanitis

Inflammatory dermatoses conditions causing balanitis

Penile carcinoma in situ causing balanitis

Differential Diagnosis

Symptoms Signs
Malaise Pruritus Skin lesions Regional lymphadenopathy Erythema Swelling
Candida balanitis - + Erythematous rash with soreness and/or itch + + -
Trichomonas vaginalis - + Superficial erosive balanitis  - + -
Treponema pallidum - - Multiple circinate lesions + - -
Herpes simplex + + Grouped vesicles on erythematous base + + -
Human papilloma virus - + Warts - - -
Lichen sclerosus - + White patches on glans - - -
Lichen planus - + Purplish lesions on the penis - - -
Psoriasis - + Red scaly plaques - + -
Circinate + + Greyish white areas on the glans - - -
Zoon's balanitis - + Well-circumscribed orange-red glazed areas - - -
Eczema - + Mild non-specific erythema to wide spread edema of penis. - + +
Fixed drug eruption - + Well demarcated and erythematous lesions - + -
Bowen's disease - + Multiple, small, well-demarcated papillomatous papules - - -
Bowenoid papulosis - + Single or multiple, sharply demarcated associated with scaling and crusting - - -
Erythroplasia of Queyrat - + Velvety patches and plaques of keratinization on penis. + - -

References

  1. ↑ Edwards SK, Bunker CB, Ziller F, van der Meijden WI (2014). "2013 European guideline for the management of balanoposthitis". Int J STD AIDS. 25 (9): 615–26. doi:10.1177/0956462414533099. PMID 24828553.

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