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==Diagnosis and management==
==Diagnosis and management==
<br>'''''2008 UK National Guideline on the Management of Balanoposthitis''''' <br>
<br>'''''Adopted from National Guideline on the Management of Balanoposthitis UK 2008'''''<br>
{| align=center
{| align=center
|-
|-
Line 54: Line 54:
! colspan="3" |Symptoms
! colspan="3" |Symptoms
! colspan="4" |Signs
! colspan="4" |Signs
!
|-
|-
!
!
Line 63: Line 62:
!Erythema
!Erythema
!Swelling
!Swelling
!
!Key distinguishing features
|-
|-
|[[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]], blotchy [[erythema]] with small [[papules]] which may be eroded, or dry dull red areas with a glazed appearance
|-
|Anaerobic infection
|✔
|✔
|✔
|✖
|✔
|✔
|✖
|✖
|✖
|✖
|Foul smelling sub-preputial [[inflammation]] and [[discharge]]: in severe cases associated with [[swelling]] and inflamed [[inguinal lymph nodes]]
|-
|-
|Aerobic infection
|[[Trichomonas vaginalis]]
|✔
|✔
|✖
|✖
|✔
|✔
|✖
|Superficial erosive [[balanitis]] 
|✖
|✖
|Variable [[inflammatory]] changes including uniform [[erythema]] and [[edema]]
|-
|[[Trichomonas vaginalis]]
|✖
|✖
|✔
|✔
|✖
|✖
|
|✖
|✖
|✖
|Superficial erosive [[balanitis]] which may lead to [[phimosis]]
|-
|-
|[[Treponema pallidum]]
|[[Treponema pallidum]]
|✖
|✖
|
|✖
|✖
|
|Multiple circinate lesions
|✔
|✖
|✖
|✖
|✖
|✖
|Multiple circinate lesions which erode to cause irregular [[ulcers]] have been described in the late primary or early secondary stage. A [[Chancre|primary chancre]] may also be present.
|-
|-
|[[Herpes simplex]]
|[[Herpes simplex]]
|✔
|✔
|✔
|Grouped [[vesicles]] on [[erythematous]] base
|✔
|✔
|✔
|✔
|
|✖
|✖
|✖
|✖
|Grouped [[vesicles]] on [[erythematous]] base over [[Glans penis|glans]], [[prepuce]] and [[shaft]] which rupture to form shallow erosions. In rare cases primary [[herpes]] can cause a necrotic balanitis, with [[Necrotic|necrotic areas]] on the [[glans]] accompanied by [[vesicles]] elsewhere and associated with [[headache]] and [[malaise]].
|-
|-
|[[Human papillomavirus|Human papilloma virus]]
|[[Human papillomavirus|Human papilloma virus]]
|✖
|✖
|✔
|✔
|[[Warts]]
|✖
|✖
|
|✖
|✖
|✖
|✖
|✖
|[[Human papillomavirus|Papilloma virus]] may be associated with patchy or chronic [[balanitis]], which becomes acetowhite after the application of 5% [[acetic acid]]
|-
|-
|[[Lichen sclerosus]]
|[[Lichen sclerosus]]
|✖
|✖
|✔
|✔
|✖
|White patches on glans
|
|✖
|✖
|✖
|✖
|✖
|✖
|White patches on glans, which may often involve prepuce
|-
|-
|[[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 on the glans and foreskin.
|-
|-
|[[Eczema]]
|[[Eczema]]
|✖
|✖
|✔
|✔
|Mild non-specific [[erythema]] to wide spread [[edema]] of [[penis]].
|✖
|✖
|✖
|✔
|✖
|✔
|✖
|✖
|[[Eczema]] may present has 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, grey-brown, red, pink, or skin-colored papillomatous papules or small patches on the penile shaft, glans, or foreskin, vulva, and perianal area
|-
|-
|[[Bowenoid papulosis]]
|[[Bowenoid papulosis]]
|✖
|✖
|✔
|✔
|Single or multiple, sharply demarcated associated with [[Scaling skin|scaling]] and crusting
|✖
|✖
|✖
|✖
|✖
|✖
|✖
|✔
|Single or multiple red, shiny, slightly raised, sharply demarcated, velvety, non-healing plaques associated with scaling, crusting, and sometimes bleeding, affecting the mucosal surfaces of the penis.
|-
|-
|[[Erythroplasia of Queyrat]]
|[[Erythroplasia of Queyrat]]
|✖
|✖
|✔
|✔
|✖
|Velvety patches and [[plaques]] of [[keratinization]] on [[penis]].
|✔
|✔
|✖
|✖
|✖
|✖
|✔
|Red, sometimes slightly pigmented, scaly, moist, velvety patches and plaques of keratinization on penis.
|}
|}
{| class="wikitable"
!
!Fowl smelling discharge
!Circinate lesions
!Grouped vesicles present
!Becomes aceto white on application of 5% acetic white
!Purplish lesion
!Pinpoint redder spots
!Failure to respond to treatment
!Key distinguishing features
|-
|[[Candidiasis|Candida balanitis]]
|✖
|✖
|✖
|✖
|✖
|✖
|✖
|[[Erythematous]] [[Rash (patient information)|rash]] with soreness and/or [[itch]], blotchy [[erythema]] with small [[papules]] which may be eroded, or dry dull red areas with a glazed appearance
|-
|Anaerobic infection
|✔
|✖
|✖
|✖
|✖
|✖
|✖
|Foul smelling sub-preputial [[inflammation]] and [[discharge]]: in severe cases associated with [[swelling]] and inflamed [[inguinal lymph nodes]]
|-
|Aerobic infection
|✖
|✖
|✖
|✖
|✖
|✖
|✖
|Variable [[inflammatory]] changes including uniform [[erythema]] and [[edema]]
|-
|[[Trichomonas vaginalis]]
|✖
|✖
|✖
|✖
|✖
|✖
|✖
|Superficial erosive [[balanitis]] which may lead to [[phimosis]]
|-
|[[Treponema pallidum]]
|✖
|✔
|✖
|✖
|✖
|✖
|✖
|Multiple circinate lesions which erode to cause irregular [[ulcers]] have been described in the late primary or early secondary stage. A [[Chancre|primary chancre]] may also be present.
|-
|[[Herpes simplex]]
|✖
|✖
|✔
|✖
|✖
|✖
|✖
|Grouped [[vesicles]] on [[erythematous]] base over [[Glans penis|glans]], [[prepuce]] and [[shaft]] which rupture to form shallow erosions. In rare cases primary [[herpes]] can cause a necrotic balanitis, with [[Necrotic|necrotic areas]] on the [[glans]] accompanied by [[vesicles]] elsewhere and associated with [[headache]] and [[malaise]].
|-
|[[Human papillomavirus|Human papilloma virus]]
|✖
|✖
|✖
|✔
|✖
|✖
|✖
|[[Human papillomavirus|Papilloma virus]] may be associated with patchy or chronic [[balanitis]], which becomes acetowhite after the application of 5% [[acetic acid]]
|-
|[[Lichen sclerosus]]
|✖
|✖
|✖
|✖
|✖
|✖
|✖
|White patches on glans, which may often involve prepuce
|-
|[[Lichen planus]]
|✖
|✖
|✖
|✖
|✖
|✖
|✖
|Purplish lesions on the penis
|-
|[[Psoriasis]]
|✖
|✖
|✖
|✖
|✔
|✖
|✖
|Red scaly plaques
|-
|[[Reiter's Syndrome|Circinate]]
|✖
|✔
|✖
|✖
|✖
|✖
|✖
|Greyish white areas on the [[glans]]
|-
|[[Zoon's balanitis]]
|✖
|✖
|✖
|✖
|✖
|✔
|✖
|Well-circumscribed orange-red glazed areas on the glans and foreskin.
|-
|[[Eczema]]
|✖
|✖
|✖
|✖
|✖
|✖
|✖
|[[Eczema]] may present has mild non-specific [[erythema]] to wide spread [[edema]] of [[penis]].
|-
|[[Fixed drug eruption]]
|✖
|✖
|✖
|✖
|✖
|✖
|✖
|Well demarcated and [[Erythema|erythematous]] lesions.
|-
|[[Bowen's disease]]
|✖
|✖
|✖
|✖
|✖
|✖
|✔
|Multiple, small, well-demarcated, grey-brown, red, pink, or skin-colored papillomatous papules or small patches on the penile shaft, glans, or foreskin, vulva, and perianal area 
|-
|[[Bowenoid papulosis]]
|✖
|✖
|✖
|✖
|✖
|✖
|✔
|Single or multiple red, shiny, slightly raised, sharply demarcated, velvety, non-healing plaques associated with scaling, crusting, and sometimes bleeding, affecting the mucosal surfaces of the penis.
|-
|[[Erythroplasia of Queyrat]]
|✖
|✖
|✖
|✖
|✖
|✖
|✔
|Red, sometimes slightly pigmented, scaly, moist, velvety patches and plaques of keratinization on penis.
|}
== References ==
== References ==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 19:51, 21 February 2017

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

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, 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]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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


Adopted from National Guideline on the Management of Balanoposthitis UK 2008

 
 
 
 
 
 
 
 
 
 
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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Synopsis

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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