Balanoposthitis
Background
- Balanitis = inflammation of the glans
- Posthitis = inflammation of the foreskin
- Balanoposthitis = inflammation of both glans and foreskin
- Recurrent balanoposthitis can be sole presenting sign of diabetes mellitus
Risk factors
Etiology
- Fungal (most common overall, candida most common species)[1]
- Irritant (soaps, lotions, lubricants)
- Bacterial, which includes common skin organisms (Staph, strep) and STIs.
- Trauma
Clinical Features
- Glans and foreskin may be swollen, erythematous, tender, or itchy
- Severe cases may involve difficulty voiding, foul smell, and penile discharge/purulence
- Erythematous papular rash with satellite lesions = fungal
Differential Diagnosis
Non-Traumatic penile diagnoses
Penile trauma types
Differential Diagnosis
Non-Traumatic penile diagnoses
Penile trauma types
Evaluation
- Typically a clinical diagnosis
- Consider blood glucose measurement to evaluate for diabetes
- Consider swabbing for Sexually transmitted diseases in the appropriate setting
Management
Reduce Irritation
- Sitz baths BID-TID while inflammation persists
- Hygiene
- Clean between foreskin and glans with Q-tip and irrigate with water until resolves
- Once resolved regular bathing of area in water is sufficient; soap may worsen irritation
Antimicrobial
Common organisms are Candida, anaerobes, and Group B Streptococcus
Antifungal
- Clotrimazole 1% applied topically to glans q12hrs until resolution
- Nystatin cream 100,000 units/gm if infection is recurrent after clotrimazole therapy
Antibacterial
- Topical triple antibiotic ointment QID or mupirocin cream BID
Disposition
- Discharge
See Also
References
- ↑ McCollough M, Rose E. Genitourinary and renal tract disorders. In: Walls RM, Hockberger RS, Gausche-Hill M, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Elsevier; 2018:(Ch) 173.