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| {{BalanitisV}}{{CMG}}{{AE}}{{VD}} | | {{BalanitisV}}{{CMG}}{{AE}}{{VD}} |
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| {{SK}}Candida balanitis, Candidal balanitis, Infectious balanoposthitis | | {{SK}}Candida balanitis, Candidal balanitis, Infectious balanoposthitis |
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| == Overview ==
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| [[Balanitis]] is [[inflammation]] of [[glans penis]]. When [[balanitis]] involves the [[foreskin]] and perpuce, it is termed as [[balanoposthitis]]. Studies have showed that [[Balanitis]] commonly occurs around 10% of the patient population visiting the [[Sexually transmitted disease|STD]] clinic, with infectious etiology responsible for around 50% of the cases. [[Risk factors]] for balanitis include [[Diabetes mellitus|diabetes]], [[Immunocompromised]], Age>40 yrs, tight [[foreskin]], sub-optimal hygienic maintenance, multiple sexual partners, and [[Circumcised|uncircumcised penis]]. Organisms could be part of the [[normal flora]] or [[Sexually transmitted infections|sexually transmitted]] or [[autoinoculation]], or via direct contact with infectious lesions. Patients may be asymptomatic or symptomatic presenting with [[itch]] or [[Pain|painful lesions]] in the [[Genital area|genital region]]. [[Diagnosis]] of the specific [[infectious balanitis]] is based on clinical presentation supported by [[Laboratory|laboratory findings]]. [[Infectious balanitis]] is treated with [[Antimicrobial|antimicrobials]]. [[Prognosis]] is usually good with treatment. [[Safe sex|Safe sex practices]] and maintaining proper penile hygiene are helpful in preventing infective balanitis.
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| ==Historical Perspective==
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| Balanitis is an ancient disease,The term Balanitis is derived from a Greek term balanos or acorn.
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| ==Classification==
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| There is no established classification system for Infectious Balanitis.
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| ==Pathophysiology==
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| Pathophysiology of Infectious balanitis varies from pathogen to pathogen:<ref name="pmid1156848">{{cite journal| author=Taylor PK, Rodin P| title=Herpes genitalis and circumcision. | journal=Br J Vener Dis | year= 1975 | volume= 51 | issue= 4 | pages= 274-7 | pmid=1156848 | doi= | pmc=1046564 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1156848 }}</ref><ref name="pmid6121604">{{cite journal| author=Cree GE, Willis AT, Phillips KD, Brazier JS| title=Anaerobic balanoposthitis. | journal=Br Med J (Clin Res Ed) | year= 1982 | volume= 284 | issue= 6319 | pages= 859-60 | pmid=6121604 | doi= | pmc=1496281 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6121604 }} </ref><ref>GENITOURINARY MEDICINE, Volume 72, Number 3: Pages 155-9,</ref><ref name="pmid20002652">{{cite journal| author=Lisboa C, Santos A, Dias C, Azevedo F, Pina-Vaz C, Rodrigues A| title=Candida balanitis: risk factors. | journal=J Eur Acad Dermatol Venereol | year= 2010 | volume= 24 | issue= 7 | pages= 820-6 | pmid=20002652 | doi=10.1111/j.1468-3083.2009.03533.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20002652 }} </ref><ref name="pmid248285532" /><ref>{{cite journal| author=Hernandez BY, Wilkens LR, Zhu X, Thompson P, McDuffie K, Shvetsov YB et al.| title=Transmission of human papillomavirus in heterosexual couples. | journal=Emerg Infect Dis | year= 2008 | volume= 14 | issue= 6 | pages= 888-94 | pmid=18507898 | doi=10.3201/eid1406.070616 | pmc=2600292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18507898 }}</ref><ref>Sobel JD (1985). "Epidemiology and pathogenesis of recurrent vulvovaginal candidiasis". Am. J. Obstet. Gynecol. 152 (7 Pt 2): 924–35. <nowiki>PMID 3895958</nowiki>.</ref>
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| {| class="wikitable"
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| !Pathogen
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| !Route of transmission
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| !Risk factors
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| !Virulence factors
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| |-
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| |[[Candidiasis|Candidal Balanitis]]
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| * [[Sexual transmitted infection|Sexual transmitted]]
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| * [[Opportunistic infection]]
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| * [[Diabetes]]
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| * [[Immunocompromised]]
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| * Age>40 yrs
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| * All strains of ''[[C. albicans]]'' possess a [[yeast]] surface mannoprotein. This allows the various strains to adhere to both the exfoliated and [[epithelial cells]].
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| * Several [[virulence factors]] of [[Candida]] are implicated in [[Balanitis]]. These include [[Proteolytic enzyme|proteolytic enzymes]], [[toxins]] and [[phospholipase]]. [[Proteolytic enzyme|Proteolytic enzymes]] destroy the [[proteins]] that normally impair [[fungal]] invasion
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| |-
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| |[[Anaerobic organism|Anaerobic Infection]]
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| * [[Sexually transmitted disease|Sexually transmitted]]
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| * Extension from the peri-rectal area
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| * Orogenital [[Sex (activity)|sex]]-[[saliva]] as a lubricant during [[coitus]]
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| .
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| * Tight [[foreskin]]
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| * sub-optimal penile hygienic maintenance
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| |[[Anaerobic]] [[Gram-negative bacilli|gram-negative rods]] produce various [[toxins]], [[proteases]], [[elastase]], and other [[virulence factors]]
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| |-
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| |[[Aerobic organism|Aerobic]]
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| [[Aerobic organism|Infections]]
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| * [[Sexually transmitted]]
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| * [[Autoinoculation]] from other sites
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| * Uncircumcised penis
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| * [[Diabetes]]
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| * [[Immunocompromised]]
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| |Adherence to [[epithelial cells]], [[Biofilm|biofilm production]], surface hydrophobicity, [[phospholipase C]] and [[protease]] activity
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| |-
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| |[[Trichomonas vaginalis]]
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| |[[Sexually transmitted]]
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| * Multiple sexual partners
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| * Unprotected sexual activity
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| * Co-existing [[venereal diseases]]
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| |Adherence, contact-independent factors, [[hemolysis]] and acquisition of host [[macromolecules]] have been shown to play a role in the [[pathogenesis]] of this infection
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| |-
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| |[[Treponema pallidum|Treponema]]
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| [[Treponema pallidum|pallidum]]
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| |Transmitted via direct contact with the infected lesion (sexual contact)
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| |[[Risk factors]] include:<ref name="pmid2356911">{{cite journal| author=Rolfs RT, Goldberg M, Sharrar RG| title=Risk factors for syphilis: cocaine use and prostitution. | journal=Am J Public Health | year= 1990 | volume= 80 | issue= 7 | pages= 853-7 | pmid=2356911 | doi= | pmc=1404975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2356911 }}</ref><ref name="pmid17675391">{{cite journal| author=Zhou H, Chen XS, Hong FC, Pan P, Yang F, Cai YM et al.| title=Risk factors for syphilis infection among pregnant women: results of a case-control study in Shenzhen, China. | journal=Sex Transm Infect | year= 2007 | volume= 83 | issue= 6 | pages= 476-80 | pmid=17675391 | doi=10.1136/sti.2007.026187 | pmc=2598725 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17675391 }}</ref><ref name="pmid15247352">{{cite journal| author=Hook EW, Peeling RW| title=Syphilis control--a continuing challenge. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 2 | pages= 122-4 | pmid=15247352 | doi=10.1056/NEJMp048126 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15247352 }}</ref><ref name="pmid16205297">{{cite journal| author=Buchacz K, Greenberg A, Onorato I, Janssen R| title=Syphilis epidemics and human immunodeficiency virus (HIV) incidence among men who have sex with men in the United States: implications for HIV prevention. | journal=Sex Transm Dis | year= 2005 | volume= 32 | issue= 10 Suppl | pages= S73-9 | pmid=16205297 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16205297 }}</ref><ref name="pmid25514173">{{cite journal| author=Solomon MM, Mayer KH| title=Evolution of the syphilis epidemic among men who have sex with men. | journal=Sex Health | year= 2015 | volume= 12 | issue= 2 | pages= 96-102 | pmid=25514173 | doi=10.1071/SH14173 | pmc=4470884 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25514173 }}</ref><ref name="pmid24927712">{{cite journal| author=Hakre S, Arteaga GB, Núñez AE, Arambu N, Aumakhan B, Liu M et al.| title=Prevalence of HIV, syphilis, and other sexually transmitted infections among MSM from three cities in Panama. | journal=J Urban Health | year= 2014 | volume= 91 | issue= 4 | pages= 793-808 | pmid=24927712 | doi=10.1007/s11524-014-9885-4 | pmc=4134449 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24927712 }}</ref><ref name="newell">Newell, J., et al. "A population-based study of syphilis and sexually transmitted disease syndromes in north-western Tanzania. 2. Risk factors and health seeking behaviour." Genitourinary medicine 69.6 (1993): 421-426.</ref>
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| Multiple sexual partners, prostitution, illicit drug use, unprotected sex
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| men who have sex with men, residence in highly prevalent areas, [[Human Immunodeficiency Virus (HIV)|HIV]] infection, presence of other [[STI]]<nowiki/>s, previous history of STIs, [[intravenous drug]] use, health care professionals who are predisposed to occupational risk, and low socioeconomic status.
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| |[[Treponema Pallidum]] uses [[fibronectin]] molecules to attach to the [[endothelial]] surface of the [[vessels]] in organs resulting in [[inflammation]] and obliteration of the small blood vessels causing [[vasculitis]] ([[endarteritis obliterans]])
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| |-
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| |[[Herpes simplex]]
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| |Often transmitted sexually or direct contact with droplet or infected secretions entering thorough [[skin]] or [[Mucous membrane|mucous membranes]].
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| * Multiple sexual partners
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| * Low [[socio-economic status]]
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| * Inhibition of [[MHC class I|MHC Class I]]
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| * Impairing funtion of [[Dendritic cell|dendritric cells]]
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| |-
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| |[[Human papilloma virus]]
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| |Usually transmitted via the [[Sexual|sexual route]] to the human host.
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| |[[Risk factors]] responsible for sexual transmission of [[Human papillomavirus|HPV]] include:
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| Number of sex partners<ref name="pmid21414655">{{cite journal |vauthors=Bell MC, Schmidt-Grimminger D, Jacobsen C, Chauhan SC, Maher DM, Buchwald DS |title=Risk factors for HPV infection among American Indian and white women in the Northern Plains |journal=Gynecol. Oncol. |volume=121 |issue=3 |pages=532–6 |year=2011 |pmid=21414655 |pmc=4498572 |doi=10.1016/j.ygyno.2011.02.032 |url=}}</ref><ref name="pmid14702152">{{cite journal |vauthors=Tarkowski TA, Koumans EH, Sawyer M, Pierce A, Black CM, Papp JR, Markowitz L, Unger ER |title=Epidemiology of human papillomavirus infection and abnormal cytologic test results in an urban adolescent population |journal=J. Infect. Dis. |volume=189 |issue=1 |pages=46–50 |year=2004 |pmid=14702152 |doi=10.1086/380466 |url=}}</ref>, acqusition of new partner<ref name="pmid21414655">{{cite journal |vauthors=Bell MC, Schmidt-Grimminger D, Jacobsen C, Chauhan SC, Maher DM, Buchwald DS |title=Risk factors for HPV infection among American Indian and white women in the Northern Plains |journal=Gynecol. Oncol. |volume=121 |issue=3 |pages=532–6 |year=2011 |pmid=21414655 |pmc=4498572 |doi=10.1016/j.ygyno.2011.02.032 |url=}}</ref>
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| | |
| , having non monogamous sex partner<ref name="pmid9217656">{{cite journal |vauthors=Koutsky L |title=Epidemiology of genital human papillomavirus infection |journal=Am. J. Med. |volume=102 |issue=5A |pages=3–8 |year=1997 |pmid=9217656 |doi= |url=}}</ref><ref name="pmid12543621">{{cite journal |vauthors=Winer RL, Lee SK, Hughes JP, Adam DE, Kiviat NB, Koutsky LA |title=Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students |journal=Am. J. Epidemiol. |volume=157 |issue=3 |pages=218–26 |year=2003 |pmid=12543621 |doi= |url=}}</ref>, starting sexual activity in young age<ref name="pmid9217656">{{cite journal |vauthors=Koutsky L |title=Epidemiology of genital human papillomavirus infection |journal=Am. J. Med. |volume=102 |issue=5A |pages=3–8 |year=1997 |pmid=9217656 |doi= |url=}}</ref>, vaginal delivery and multiple deliveries<ref name="pmid9464728">{{cite journal |vauthors=Tseng CJ, Liang CC, Soong YK, Pao CC |title=Perinatal transmission of human papillomavirus in infants: relationship between infection rate and mode of delivery |journal=Obstet Gynecol |volume=91 |issue=1 |pages=92–6 |year=1998 |pmid=9464728 |doi= |url=}}</ref>, age over 40 for women<ref name="pmid21495248">{{cite journal |vauthors=Ting J, Kruzikas DT, Smith JS |title=A global review of age-specific and overall prevalence of cervical lesions |journal=Int. J. Gynecol. Cancer |volume=20 |issue=7 |pages=1244–9 |year=2010 |pmid=21495248 |doi= |url=}}</ref>, history of [[Chlamydia infection|Chlamydia]] infection<ref name="pmid9332762">{{cite journal |vauthors=Kjaer SK, van den Brule AJ, Bock JE, Poll PA, Engholm G, Sherman ME, Walboomers JM, Meijer CJ |title=Determinants for genital human papillomavirus (HPV) infection in 1000 randomly chosen young Danish women with normal Pap smear: are there different risk profiles for oncogenic and nononcogenic HPV types? |journal=Cancer Epidemiol. Biomarkers Prev. |volume=6 |issue=10 |pages=799–805 |year=1997 |pmid=9332762 |doi= |url=}}</ref>, and long term [[Oral contraceptive|OCP]] use<ref name="pmid1649312">{{cite journal |vauthors=Ley C, Bauer HM, Reingold A, Schiffman MH, Chambers JC, Tashiro CJ, Manos MM |title=Determinants of genital human papillomavirus infection in young women |journal=J. Natl. Cancer Inst. |volume=83 |issue=14 |pages=997–1003 |year=1991 |pmid=1649312 |doi= |url=}}</ref>
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| |Linked to [[epithelial]] [[differentiation]] and maturation of host [[keratinocytes]], with [[transcription]] of specific [[Gene|gene products]] at every level.<sup>[[Human papillomavirus pathophysiology|[2][3]]]</sup>
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| |}
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| ==Causes==
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| Causes of Infectious balanitis include:<ref>GENITOURINARY MEDICINE, Volume 72, Number 3: Pages 155-9,
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| June 1996.
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| </ref><ref>International Journal of Research in Health Sciences. Jan–Mar 2014 Volume-2, Issue-1</ref><ref name="pmid248285532" /><ref name="pmid26396455" /> {{familytree/start}}
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| {{familytree | | | | | | | A01 | | | | | | | | | | | | | | | |A01=Balanitis}}
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| {{familytree | |,|-|-|-|v|-|^|-|v|-|-|-|-|-|-|.| | | | | | | | | | }}
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| {{familytree | |!| | | |!| | | |!| | | | | | |!| | | | | | | | | | | | | }}
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| {{familytree | B01 | | B02 | | B03 | | | | | B04 | | | | |B01=Fungal|B02=Virus|B03=Parasite/Protozoal|B04=Bacteria}}
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| {{familytree | |!| | | |!| | | |!| | |,|-|-|-|+|-|-|-|v|-|-|-|.|}}
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| {{familytree | |!| | | |!| | | |!| | |!| | | |!| | | |!| | | |!|}}
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| {{familytree | C01 | | C02 | | C03 | |C04| | C05 | | C06 | | C07 | |C01=Candida (albicans, krusei)<br> Dermatophytosis <br>Pityriasis versicolor<br>Histoplasma capsulatum<br>Blastomyces dermatitidis<br>Cryptococcus neoformans|C02=Herpes simplex virus<br>Varicella zoster virus (VZV)<br>Human papilloma virus (HPV)|C03='''Protozoal'''<br>Entamoeba histolytica<br>Trichomonas vaginalis<br>Leishmania species<br>'''Parastic'''<br>Sarcoptes scabiei var hominis<br>Pediculosis<br>Ankylostoma species|C04='''Gram negative bacteria'''<br>E.coli, Pseudomonas, Haemophilus parainfluenzae, Klebsiella, Neisseria gonorrhoea, Haemophilus ducreyi, Mycoplasma genitalium, Chlamydia, Ureaplasma, Gardnerella vaginalis, Citrobacter, Enterobacter<br>|C05='''Spirochaetes'''<br>Treponema pallidum, Non specific spirochaetal infection<br>|C06='''Gram positive organism'''<br> Haemolytic Streptococci(Group B Streptococci), Staphylococci epidermidis/aureus|C07='''Acid fast bacilli'''<br> Mycobacterium tuberculosis, Leprosy<br>'''Anaerobes'''<br>(Bacteroides)}}
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| {{familytree/end}}
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| ==Epidemiology ==
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| ==== Epidemiology ====
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| * There are no comprehensive studies, studying the [[incidence]] and [[prevalence]] in general population. A recent study has shown that balanitis commonly occurs around 10% of the patient population visiting the [[STD]] clinc, with [[infectious]] etiology responsible for around 50% of the cases.<ref name="pmid8707315">{{cite journal| author=Edwards S| title=Balanitis and balanoposthitis: a review. | journal=Genitourin Med | year= 1996 | volume= 72 | issue= 3 | pages= 155-9 | pmid=8707315 | doi= | pmc=1195642 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8707315 }}</ref>
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| * [[Candidiasis|Candida]] being the most common cause responsible for 30-35% of cases.<ref name="pmid8566986">{{cite journal| author=Dockerty WG, Sonnex C| title=Candidal balano-posthitis: a study of diagnostic methods. | journal=Genitourin Med | year= 1995 | volume= 71 | issue= 6 | pages= 407-9 | pmid=8566986 | doi= | pmc=1196117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8566986 }}</ref>
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| ==Screening==
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| There is no established [[screening]] guidelines for Infectious Balanitis.
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| ==Natural History, Complications, and Prognosis==
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| ===Natural history===
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| If left untreated, Infectious balanitis may result in complications, which include [[pain]], [[phimosis]], and urinary retention.<ref name="pmid248285532">{{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>
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| ===Complications===
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| Complication of Infectious balanitis include:<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>
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| * [[Pain]]
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| * Erosions
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| * [[Fissures]]
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| * [[Phimosis]]
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| * [[Paraphimosis]]
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| * Painful [[erection]]
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| * Reduced urinary flow
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| * [[Urinary retention]]
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| ===Prognosis===
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| [[Prognosis]] is good with treatment.
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| ==Diagnosis==
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| ==== History and symptoms ====
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| Patients may be asymptomatic or symptomatic presenting with [[itch]], or painful lesions in the [[Genital area|genital region]].
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| [[Physical examination]]
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| {| class="wikitable"
| |
| ! colspan="2" |Clinical features of Infectious balanitis<ref name="pmid26396455">{{cite journal| author=Pandya I, Shinojia M, Vadukul D, Marfatia YS| title=Approach to balanitis/balanoposthitis: Current guidelines. | journal=Indian J Sex Transm Dis | year= 2014 | volume= 35 | issue= 2 | pages= 155-7 | pmid=26396455 | doi=10.4103/0253-7184.142415 | pmc=4553848 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26396455 }} </ref>(adopted from the Indian journal of sexually transmitted diseases and AIDS)
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| |-
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| |[[Candidiasis|Candidal Balanitis]]
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| |[[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
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| |-
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| |[[Anaerobic organism|Anaerobic Infection]]
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| * Foul smelling sub-preputial [[inflammation]] and [[discharge]]: in severe cases associated with [[swelling]] and inflamed [[inguinal lymph nodes]]
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| * Preputial edema, superficial erosions: milder forms also occur
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| |-
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| |[[Aerobic organism|Aerobic]]
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| [[Aerobic organism|Infections]]
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| |Variable [[inflammatory]] changes including uniform [[erythema]] and [[edema]]
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| |-
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| |[[Trichomonas vaginalis|Trichomonas vaginalis]]
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| |Superficial erosive [[balanitis]] which may lead to [[phimosis]]
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| |-
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| |[[Treponema pallidum]]
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| |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
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| |-
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| |[[Herpes simplex]]
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| |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]] accompained by [[vesicles]] elsewhere and associated with [[headache]] and [[malaise]].
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| |-
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| |[[Human papilloma virus]]
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| |[[Human papillomavirus|Papilloma virus]] may be associated with patchy or chronic [[balanitis]], which becomes acetowhite after the application of 5% [[acetic acid]]
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| |}
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| ====Laboratory findings====
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| {| class="wikitable"
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| ! colspan="2" |Laboratory findings<ref name="pmid26396455">{{cite journal| author=Pandya I, Shinojia M, Vadukul D, Marfatia YS| title=Approach to balanitis/balanoposthitis: Current guidelines. | journal=Indian J Sex Transm Dis | year= 2014 | volume= 35 | issue= 2 | pages= 155-7 | pmid=26396455 | doi=10.4103/0253-7184.142415 | pmc=4553848 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26396455 }} </ref>(adopted from the Indian journal of sexually transmitted diseases and AIDS)
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| |-
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| |[[Candidiasis|Candidal Balanitis]]
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| |[[Urinalysis]] for [[glucose]]
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| Sub-preputial culture/swab for [[Candidiasis|primary candidiasis/]][[candidal]] superinfection to be done in all cases
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| Investigation for [[Human Immunodeficiency Virus|HIV]] or other causes of [[immunosuppression]] should be performed
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| |-
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| |[[Anaerobic organism|Anaerobic Infection]]
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| |
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| *[[Gram stain]] may show fusiform/mixed [[bacterial]] picture
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| *Sub-preputial culture wet prep or [[Nucleic acid test|NAAT]](to exclude other causes)
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| *[[Gardnerella vaginalis|G. vaginalis]] is a [[facultative anaerobe]] which may be isolated
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| *Swab for [[Herpes simplex virus|HSV]] infection if [[Ulcer|ulcerated]]
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| |-
| |
| |[[Aerobic organism|Aerobic]]
| |
| [[Aerobic organism|Infections]]
| |
| |Sub-preputial culture
| |
| [[Streptococci|Streptococci spp]]. and [[Staphylococcus aureus|S. aureus]] have both been reported as causing balanitis
| |
| |-
| |
| |[[Trichomonas vaginalis|Trichomonas vaginalis]]
| |
| |Wet preparation from the subpreputial sac demonstrates the organism
| |
| [[Culture collection|Culture]] and [[NAAT]] can also be carried out
| |
| |-
| |
| |[[Treponema pallidum]]
| |
| |[[Dark field microscopy]], TP [[NAAT]] and [[DFA-TP]] will confirm the [[diagnosis]]. This should ideally be done every case.
| |
| [[Treponema pallidum hemagglutination assay (TPHA) test|TPHA]] coupled with non-[[Treponema|treponemal]] [[Serology|serological]] tests though of limited value, should be performed since they are useful for follow-up
| |
| |-
| |
| |[[Herpes simplex]]
| |
| |Tissue scraping from base of erosion subjected to [[Tzanck test|Tzanck smear]] [[IgG]] and [[IgM]] for [[HSV]] cell culture and [[PCR]]-preferred [[HSV]] tests for persons who seek medical treatment for [[Genital ulcer disease|gential ulcers]] or other [[mucocutaneous]] lesions
| |
| |-
| |
| |[[Human papillomavirus|Human papilloma virus]]
| |
| |Diagnosed clinically
| |
| |}
| |
| | |
| ==Treatment==
| |
| {| class="wikitable"
| |
| ! colspan="3" |Treatment<ref name="pmid26396455">{{cite journal| author=Pandya I, Shinojia M, Vadukul D, Marfatia YS| title=Approach to balanitis/balanoposthitis: Current guidelines. | journal=Indian J Sex Transm Dis | year= 2014 | volume= 35 | issue= 2 | pages= 155-7 | pmid=26396455 | doi=10.4103/0253-7184.142415 | pmc=4553848 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26396455 }} </ref>(adopted from the Indian journal of sexually transmitted diseases and AIDS)
| |
| |-
| |
| !
| |
| !Preferred regimen
| |
| !Alternative regimen
| |
| |-
| |
| |[[Candidiasis|Candidal Balanitis]]
| |
| |[[Clotrimazole|Clotrimazole cream]] 1%
| |
| [[Miconazole|Miconazole cream]] 2%
| |
| |[[Fluconazole]] 150 mg stat orally
| |
| [[Nystatin]] cream-if resistance suspected topical [[clotrimazole]]/[[miconazole]] with 1% [[hydrocortisone]]-if marked [[inflammation]]
| |
| |-
| |
| |[[Anaerobic organism|Anaerobic Infection]]
| |
| |Advice about genital hygiene
| |
| [[metronidazole]] 400 mg twice daily for 1 week
| |
| | |
| Milder cases- topical [[metronidazole]]
| |
| |Coamoxiclav([[amoxycillin]]/[[clavulanic acid]]) 375 mg 3 times daily for 1 week
| |
| [[Clindamycin]] cream applied twice daily until resolved
| |
| |-
| |
| |[[Aerobic organism|Aerobic]]
| |
| [[Aerobic organism|Infections]]
| |
| |Usually topical
| |
| Triple combination ([[clotrimazole]] 1%, [[Beclometasone dipropionate (nasal)|beclometasone dipropionate]] 0.025%, gentamicinsilfate 0.3%) applied once daily
| |
| | |
| Severe cases-systemic antibiotics
| |
| | |
| [[Erythromycin]] 500 mg QDS for 1 week
| |
| | |
| Co-amoxiclav([[amoxycillin]]/[[clavulanic acid]] 375 mg 3 times daily for 1 week
| |
| |Alternative regimens depend on the sensitivities of the organisms isolated
| |
| |-
| |
| |[[Trichomonas vaginalis|Trichomonas vaginalis]]
| |
| |[[Metronidazole]] 2 g orally single dose
| |
| [[Secnidazole]] 2 g orally single dose
| |
| |[[Metronidazole]] 400 mg orally twice a day for 7 days
| |
| |-
| |
| |[[Treponema pallidum]]
| |
| |Single IM administration of 2.4 MU of [[Benzathine penicillin G|benzathine penicillin]]
| |
| [[Doxycycline]] 100 mg orally BID for 2 weeks or
| |
| | |
| [[Tetracycline]] 500 mg orally QID for 2 weeks or
| |
| | |
| [[Erythromycin]] 500 mg QID or
| |
| | |
| [[Ceftriaxone]] 1 g IM/IV daily for 8-10 days
| |
| |
| |
| |-
| |
| |[[Herpes simplex]]
| |
| |[[Acyclovir]] 400 mg orally 3 times a day for 7-10 days or
| |
| [[Acyclovir]] 200 mg orally 5 times a day for 7-10 days or
| |
| | |
| [[Famciclovir]] 250 mg orally 3 times a day for 7-10 days or
| |
| | |
| [[Valacyclovir]] 1 g orally twice a day for 7-10 days
| |
| |
| |
| |-
| |
| |[[Human papillomavirus|Human papilloma virus]]
| |
| |'''Patients applied'''
| |
| [[Podophyllotoxin]](podofilox) 0.5% or gel-twice daily for three consecutive days, but no more than 4 weeks or [[Imiquimod]] 5% cream-applied at bedtime 3 times/week for a maximum of 16 weeks, and must be left in place for 6-10 h following application or [[Sinecatechins]] 15% ointment
| |
| | |
| '''Provider-administered'''
| |
| | |
| [[Podophyllin]] resin 20% in a compound tincture
| |
| | |
| of [[benzoin]]-once a week for 6-8 week or
| |
| | |
| [[Cryotherapy]] with liquid [[nitrogen]] ot cryoprobe.
| |
| | |
| Repeat applications every 1-2 weeks or
| |
| | |
| TCA/bichloroacetic acid-80-90% once per week for an average course of 6-10 weeks or
| |
| | |
| Surgical removal either by tangential scissor excision, tangential shave excision, [[curettage]], or [[electrosurgery]].
| |
| |
| |
| |}
| |
| | |
| ==Prevention==
| |
| ===Primary Prevention===
| |
| [[Primary prevention]] of Infectious balanitis include:<ref name="pmid26396455" />
| |
| * [[Safe sex|Safe sex practices]]
| |
| * Maintaining proper penile hygiene
| |
| | |
| ===Secondary prevention===
| |
| There are no specific [[Secondary prevention|secondary preventive]] measures for [[Infectious balanitis|Infective balanitis]]
| |
| | |
| ==References==
| |
| {{Reflist|2}}
| |