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 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:

• Infectious
• Non-infectious balanitis

Causes

Infectious balanitis

Common causes of infectious balanitis

Fungal

• Candida(most common cause)

Protozoal

• Trichomonas vaginalis

spirochaetes

• Treponema pallidum

Viral

• Herpes simplex
• Human papilloma virus

Less common causes of infectious balanitis

Fungal

• Dermatophytosis 
• Pityriasis versicolor
• Histoplasma capsulatum
• Blastomyces dermatitidis
• Cryptococcus neoformans

Viral

• Varicella zoster virus (VZV)

Protozoal

• Entamoeba histolytica
• Leishmania species

Parasitic

• Sarcoptes scabiei
• Pediculosis
• Ancylostoma

Bacterial

Gram negative bacteria

• E.coli
• Pseudomonas
• Haemophilus parainfluenzae
• Klebsiella
• Neisseria gonorrhoea
• Haemophilus ducreyi
• Mycoplasma genitalium
• Chlamydia
• Ureaplasma
• Gardnerella vaginalis
• Citrobacter
• Enterobacter

Spirochaetes

• Non-specific spirochaetal infection

Gram positive organism

• Haemolytic Streptococci(Group B Streptococci)
• Staphylococci epidermidis/aureus

Acid fast bacilli

• Mycobacterium tuberculosis
• Mycobacterium leprae

Anaerobes

• Bacteroides

Non-infectious balanitis

Inflammatory dermatoses conditions causing balanitis

• Lichen sclerosus
• Lichen planus
• Zoon's balanitis
• Psoriasis
• 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

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.	✔	✖	✖