Balanoposthitis

Background

• Balanitis = cellulitis of the glans
• Posthitis = cellulitis of the foreskin
• Recurrent balanoposthitis can be sole presenting sign of diabetes mellitus

Risk factors

• Poor hygiene
• Diabetes
• Phimosis

Etiology

• Irritant
• Bacterial
• Fungal

Clinical Features

Candidal balanoposthitis in a diabetic

• Glans, foreskin are swollen, tender, and edematous
• Erythematous papular rash with satellite lesions = fungal

Differential Diagnosis

Non-Traumatic penile diagnoses

• Phimosis
• Balanoposthitis
• Paraphimosis
• Priapism
• STDs

Penile trauma types

• Penile amputation
• Penile contusion
• Penile fracture
• Traumatic epididymitis
• Zipper injury to penis

Evaluation

• Typically a clinical diagnosis
• Consider blood glucose measurement to evaluate for diabetes

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 (no soap) should be sufficient

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

Paraphimosis Reduction

References

UpToDate, Tintinalli