Balanoposthitis

Overview:

Balanoposthitis is the inflammation of the glans and prepuce. It is a descriptive phrase, not a diagnostic one. It is classified as a form of dermatosis that arises within the folds of the skin. Balanoposthitis cannot occur in a circumcised individual. However, balanitis or the inflammation of the glans can. Balanoposthitis may occur for various reasons, which can be roughly categorised as inflammatory, infective, or precancerous.

Balanoposthitis may occur at any age and in anyone with an uncircumcised penis. It is not to be mistaken for balanitis or phimosis. Balanitis occurs when only the head of the penis swells due to inflammation, while phimosis makes it hard to retract the foreskin on the penis. Moreover, phimosis can be a symptom of both balanitis and balanoposthitis.

Penile yeast infections are typically the main cause of balanoposthitis. The fungus responsible for it is known as the candida fungus and is found in minimal quantities in the human body. Nevertheless, non-infectious diseases are also seen to cause balanoposthitis. These can include eczema, chronic balanitis, injuries, trauma, psoriasis, and reactive arthritis.

Those with diabetes have a much higher chance of contracting the infection due to their weakened immune system. Moreover, obesity and inadequate glucose control may also put an individual at risk of a yeast infection and balanoposthitis. Inversely, frequent balanoposthitis may signal the possibility of type 2 diabetes in the individual.

However, it is curable and not fatal. Depending on the irritation, a general physician may suggest antibiotics, antifungal creams, or corticosteroid creams. In addition, doctors recommend maintaining appropriate hygiene by washing and drying the foreskin and avoiding any allergens or irritants.

Types of Balanoposthitis:

Balanoposthitis can be of several types based on the origin of the infection. Some of them have been elaborated upon below:

Anaerobic Bacterial Infection: Erythema, oedema, and discharge with a foul odour should raise suspicions of an anaerobic bacterial infection. Milder cases of these infections can be managed using topical metronidazole. However, severe cases require oral antibiotics, such as oral metronidazole.

Bacterial Balanoposthitis: If there is significant erythema and preputial discharge that is either transudative or exudative, bacterial balanoposthitis is a massive possibility. Streptococcus pyogenes and Staphylococcus aureus are the two common aerobic bacteria.

Candidal Balanoposthitis: Candidal infection is a typical cause of balanoposthitis in young people, which can occur along with or as a result of diaper dermatitis. It is often described as an inflamed rash with satellite lesions that are painful to the touch. It can appear in adults with diabetes and immunosuppressive conditions. It can also appear in adults owing to the consumption of broad-spectrum antibiotics.

Fixed Drug Eruptions: Fixed drug eruptions are characterised by circular, erythematous patches that darken with or without oedema and vesicles. These occur with the use of pharmaceuticals such as tetracyclines, sulfa-drugs, phenolphthalein, phenacetin, NSAIDs, and barbiturates.

Irritant Balanoposthitis: Irritant balanoposthitis is often characterised by moderate erythema accompanied by or without pruritus. It is more frequent in people with atopic dermatitis. This problem might be caused by excessive or frequent washing with soap.

Nonspecific Balanoposthitis: Nonspecific balanoposthitis is the most prevalent cause of balanoposthitis in children. This condition is typically caused by improper hygiene. There shouldn't be any ulcers or lesions, and while one may detect some preputial discharge on a physical exam, no urethral drainage should be present.

Viral Balanoposthitis: Herpes simplex virus and human papillomavirus are examples of viral balanoposthitis. Herpes simplex is characterised by an erythematous base and overlaying vesicles, which may rupture.
 

Symptoms:

Symptoms of balanoposthitis are as follows:

Pain and irritation on the foreskin and head of the penis
Tenderness
Swelling (oedema)
Itching
Shiny or white areas on the penis
Foul-smelling discharge (smegma) under the foreskin
Pain during urination or ejaculation
Discolouration that may resemble a rash
 

Causes:

Infections: Yeast, bacterial, viral, and fungal infections can lead to balanoposthitis. Sexually transmitted infections (STIs) like chlamydia, gonorrhoea, herpes simplex, human papillomavirus (HPV), syphilis, trichomoniasis, and chancroid are also potential causes.
Noninfectious conditions: Chronic balanitis, eczema, psoriasis, reactive arthritis, and injuries can cause inflammation.
Other factors: Poor hygiene, a tight foreskin, irritation from chemicals or rubbing, and allergies to substances like latex may contribute to the condition.
If you or someone you know is experiencing these symptoms, it’s important to consult a healthcare provider for a proper diagnosis and treatment plan.

Risk factors:

The risk factors for developing balanoposthitis include:

Poor hygiene: Not cleaning the penis and foreskin properly can lead to infections.
Diabetes: Especially in males with uncontrolled diabetes, as glucose on the skin can encourage bacterial and fungal growth.
Obesity: This can contribute to the condition, likely due to the associated skin folds creating warm, moist environments.
Infections: STDs and STIs can cause balanoposthitis.
Allergies: Reactions to latex or certain chemicals can lead to inflammation.
Phimosis: Difficulty in retracting the foreskin can increase the risk.
Age: It’s more common in children, particularly those who wear diapers.

Maintaining good hygiene, managing health conditions like diabetes, and avoiding known allergens can help reduce the risk of balanoposthitis. If you have concerns about this condition, it’s best to consult a healthcare provider.

Possible Complications:

Patients experiencing recurrent or resistant symptoms to treatment beyond four weeks, as well as accompanying urinary blockage or pathologic phimosis, should be directed to a urologist. A biopsy can be deemed necessary to further explore the cause.

Cancerous or precancerous lesions, such as Balanitis Xerotica Obliterans or squamous cell carcinoma, may be present when the patient resists treatment. To achieve a pathologic diagnosis, a circumcision or even a 1 cm wedge biopsy of the affected region is necessary. Depending on the stage of infection, this may entail reconstructive surgery, radiation, or chemotherapy.

In immunocompromised individuals, balanoposthitis often manifests as a more serious ulcerating lesion. Only immunocompromised people who frequently have balanoposthitis due to fungal infection are at risk of death.

Prevention:

Preventing balanoposthitis involves maintaining good genital hygiene and being aware of potential irritants. Here are some key prevention strategies:

Maintain good hygiene: Regularly wash the penis with warm water and gently dry it, especially under the foreskin.
Avoid harsh soaps: Use mild or non-soap cleansers to avoid irritation.
Manage diabetes: If you have diabetes, keeping blood sugar levels under control can reduce the risk of infections.
Safe sexual practices: Use protection during sexual activity to prevent sexually transmitted infections (STIs) that can lead to balanoposthitis.
Treat skin conditions: Address underlying skin conditions like eczema or psoriasis that can contribute to inflammation.
Circumcision: In some cases, circumcision may be recommended to prevent recurrent episodes, especially if phimosis is present.
These measures can significantly reduce the risk of developing balanoposthitis. If you experience balanoposthitis symptoms, consult a healthcare provider for appropriate diagnosis and treatment.

When to Consult a Doctor?

Some of the warning signs that should ideally require a doctor’s visitation for the same include:

• Discolouration that resembles a rash. It might be red, purple, or a shade more profound than the natural skin tone.

• Irritation and pain on the foreskin as well as the glans or head of the penis.

• Itching

• Lesions or sores on the glans or the head of the penis

• Shiny or white patches on the skin of the penis

• Swelling or oedema

• Tenderness

• The appearance of smegma, a foul-smelling secretion under the foreskin

• The sensation of pain when urinating or ejaculating

• Foul smell

• Leathery skin

While balanoposthitis is not fatal or dangerous, it can cause immense pain and irritation. Hence, it is absolutely imperative to see a doctor for the condition. A general physician can help with the symptoms; they may refer you to a urologist in severe cases.

Diagnosis:

• Physical Examination: Balanoposthitis is not necessarily a diagnosis. It is a descriptive term used to explain the symptoms associated with another condition. The most basic procedure for detecting balanoposthitis is a visit to a general physician or a urologist. They usually ask questions about symptoms and inquire about the different health conditions the individual may have.

• Lab Tests: After an examination, a general physician may prescribe medication or suggest lab tests. These include skin tests, urethral discharge swabs, urinalysis, and blood tests.

• Imaging Tests: In extremely serious cases, doctors may order a biopsy of the infected area to determine the source of the infection.

Treatment:

• Home Care: Washing and drying the foreskin daily can help avoid balanoposthitis. However, doctors often advise against using soaps and other possible irritants, as one reason for its occurrence is an underlying allergy.

• Medication: The treatment for balanoposthitis typically depends on the underlying cause of the inflammation. Here are some examples of medications that may be prescribed:

Antifungal creams: These are used if the balanoposthitis is caused by a fungal infection. Examples include:
Clotrimazole, Miconazole, Econazole, Ketoconazole, or Sulconazole
Antibiotics: Antibiotics may be necessary if a bacterial infection is the cause. Some common antibiotics include:
Amoxicillin
Clarithromycin
Erythromycin
Corticosteroid creams: These may be prescribed to reduce inflammation and itching.
Oral antifungals: An oral medication like fluconazole may be used in severe cases.
It’s important to use these medications under the guidance of a healthcare provider, who can diagnose the specific cause of balanoposthitis and recommend the appropriate treatment.

• Surgical Treatment: If balanoposthitis is too severe, i.e., if it does not respond to medicines, doctors may suggest a circumcision. However, this is also a minor surgery with very high success rates and minimal underlying issues.