Balanitis

Template:BalanitisV 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

• Please click here to know more about Zoon's Balanitis
• Please click here to know more about Balanitis xerotica obliterans

Overview

Balanitis is inflammation of glans penis. When balanitis involve 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:

• Infectious
• Inflammatory dermatoses
• Penile carcinoma in situ

Balanitis

Infectious

Inflammatory dermatoses

Premalignant(penile carcinoma in situ)

Candida (albicans, krusei) Streptococci Anaerobes Staphylococci Trichomonas vaginalis Herpes simplex virus Human papillomavirus Mycoplasma genitalium

Lichen sclerosus Lichen planus Psoriasis Circinate balanitis Zoon's balanitis Eczema Allergic reactions

Bowen's disease Bowenoid papulosis Erythroplasia of Queyrat

Diagnosis and management

2008 UK National Guideline on the Management of Balanoposthitis 

Balanitis/balanoposthitis                                                                 Take history and examine                                                                                               Perpuce retracts                           Perpuce does not retract                                                                                                   Ulceration present         Erythema,subpreputial discharge           Prepuce scarred       Prepuce swollen                                                                         Follow genital ulcer protocol   Fowl smelling     No odour       Refer to surgical opinion       Treat as genital ulcer disease                                                                         Metronidazole 400 mg bd     Antifungal+1% Hydrocortisone cream apply bd                                                                                                               Review                                                                                                                                                                 If better discharge   If not better 1) Reassess-try alternative pathway 2) Erythromycin 500 bd 3) Potent steroid cream

Differential Diagnosis

	Erythema	Discharge	Fowl smelling discharge	Circinate lesions	Grouped vesicles present	Becomes aceto white on application of 5% acetic white	White patches	Purplish lesion	pinpoint redder spots	Red scaly plaques	Failure to respond to treatment
Candida Balanitis	✔					✖		✖	✖		✖
Anaerobic Infection			✔			✖		✖	✖		✖
Aerobic Infection	✔	✔				✖		✖	✖		✖
Trichomonas vaginalis						✖		✖	✖		✖
Treponema paliidum						✖		✖	✖		✖
Herpes simplex					✔	✖		✖	✖		✖
Human papilloma virus						✔		✖	✖		✖
Lichen sclerosus						✖		✖	✖		✖
Lichen Planus						✖		✖	✖		✖
Psoriasis						✖		✔	✖		✖
Circinate						✖		✖	✖		✖
Zoon's balanitis						✖		✖	✔		✖
Eczema						✖		✖	✖		✖
Allergic reaction						✖		✖	✖		✖
Bowen's disease						✖		✖	✖		✔
Bowenoid papulosis						✖		✖	✖		✔
Erythroplasia of Queyrat						✖		✖	✖		✔