Balanitis in adults
- Glen W Barrisford, MD, MS
Glen W Barrisford, MD, MS
- Director of Urologic Oncology
- Santa Rosa Medical Center
- Kaiser Permanente
Balanitis is defined as inflammation of the glans penis . The word is derived from the Greek "balanos," which means "acorn."
When the prepuce (foreskin) also becomes involved, the condition is known as balanoposthitis. In common usage, "balanitis" and "balanoposthitis" are interchangeable, although balanoposthitis occurs only in uncircumcised males. For the remainder of this discussion, we will refer to both conditions using the term "balanitis."
The diagnosis and treatment of balanitis in adult males will be reviewed here. The disorder in children is discussed separately. (See "Balanoposthitis in children: Epidemiology and pathogenesis" and "Balanoposthitis in children: Clinical manifestations, diagnosis, and treatment".)
In the United States, balanitis accounts for approximately 11 percent of men seen in urology clinics. Approximately 3 percent of uncircumcised men are affected globally . Balanitis appears to be more common in men of African American and Hispanic descent, although this observation may be related to differences in circumcision rates .
Balanitis has a wide range of causes, but most cases are related to inadequate hygiene in uncircumcised men. When the foreskin is not routinely retracted and the glans is not cleansed in an appropriate fashion, buildup of sweat, debris, exfoliated skin, and bacteria or fungi can occur, resulting in inflammation. Predisposing factors include diabetes mellitus, trauma (eg, zipper injury), obesity, and edematous conditions (eg, congestive heart failure, cirrhosis, nephrotic syndrome).
- The American Heritage Stedman's Medical Dictionary. Available at: http://dictionary.reference.com/browse/balanitis (Accessed on April 04, 2008).
- Leber M. Balanitis. Available at: www.emedicine.com/emerg/topic51.htm (Accessed on April 04, 2008).
- Mayser P, Schütz M, Schuppe HC, et al. Frequency and spectrum of Malassezia yeasts in the area of the prepuce and glans penis. BJU Int 2001; 88:554.
- Cree GE, Willis AT, Phillips KD, Brazier JS. Anaerobic balanoposthitis. Br Med J (Clin Res Ed) 1982; 284:859.
- Wikström A, von Krogh G, Hedblad MA, Syrjänen S. Papillomavirus-associated balanoposthitis. Genitourin Med 1994; 70:175.
- Birley HD, Luzzi GA, Walker MM, et al. The association of human papillomavirus infection with balanoposthitis: a description of five cases with proposals for treatment. Int J STD AIDS 1994; 5:139.
- Peutherer JF, Smith IW, Robertson DH. Necrotising balanitis due to a generalised primary infection with herpes simplex virus type 2. Br J Vener Dis 1979; 55:48.
- Kinghorn GR, Jones BM, Chowdhury FH, Geary I. Balanoposthitis associated with Gardnerella vaginalis infection in men. Br J Vener Dis 1982; 58:127.
- Burdge DR, Bowie WR, Chow AW. Gardnerella vaginalis-associated balanoposthitis. Sex Transm Dis 1986; 13:159.
- Babu CS, Vitharana S, Higgins SP. Primary syphilis presenting as balanitis. Int J STD AIDS 2007; 18:497.
- Kishimoto M, Lee MJ, Mor A, et al. Syphilis mimicking Reiter's syndrome in an HIV-positive patient. Am J Med Sci 2006; 332:90.
- Michalowski R. [Trichomonal balano-posthitis. Report of 16 cases (author's transl)]. Ann Dermatol Venereol 1981; 108:731.
- Orden B, Manjavacas CG, Martinez R, Franco A. Streptococcal balanitis in a healthy adult male. Eur J Clin Microbiol Infect Dis 1995; 14:920.
- Kyriazi NC, Costenbader CL. Group A beta-hemolytic streptococcal balanitis: it may be more common than you think. Pediatrics 1991; 88:154.
- Lucks DA, Venezio FR, Lakin CM. Balanitis caused by group B streptococcus. J Urol 1986; 135:1015.
- Cruz-Rojo J, Martínez García MM, Fernández López MC. [Group A beta-hemolytic Streptococcus as a cause of perianal dermatitis, fissures and balanoposthitis]. An Pediatr (Barc) 2005; 62:483.
- Yusuke H, Yoshinori H, Kenichi M, Akio H. Granulomatous balanoposthitis after intravesical Bacillus-Calmette-Guerin instillation therapy. Int J Urol 2006; 13:1361.
- Rodrigue RB. Amebic balanitis. JAMA 1978; 239:109.
- Davis P, Stein M. Human immunodeficiency virus-related connective tissue diseases: a Zimbabwean perspective. Rheum Dis Clin North Am 1991; 17:89.
- Edwards SK, Bunker CB, Ziller F, van der Meijden WI. 2013 European guideline for the management of balanoposthitis. Int J STD AIDS 2014; 25:615.
- Edwards S. Balanitis and balanoposthitis: a review. Genitourin Med 1996; 72:155.
- David LM, Walzman M, Rajamanoharan S. Genital colonisation and infection with candida in heterosexual and homosexual males. Genitourin Med 1997; 73:394.
- Mayser P. Mycotic infections of the penis. Andrologia 1999; 31 Suppl 1:13.
- Edwards SK, European Branch of the International Union against Sexually Transmitted Infection and the European Office of the World Health Organization. European guideline for the management of balanoposthitis. Int J STD AIDS 2001; 12 Suppl 3:68.
- Hershfield M, Dahlen CP. Phimosis with balanoposthitis in previously undiagnosed diabetes mellitus. GP 1968; 38:95.
- Buechner SA. Common skin disorders of the penis. BJU Int 2002; 90:498.
- Bernstein G, Forgaard DM, Miller JE. Carcinoma in situ of the glans penis and distal urethra. J Dermatol Surg Oncol 1986; 12:450.
- Pulido-Perez A, Suarez-Fernandez R. Circinate Balanitis. N Engl J Med 2017; 376:157.
- Sánchez-Pérez J, Córdoba S, Cortizas CF, García-Díez A. Allergic contact balanitis due to tetracaine (amethocaine) hydrochloride. Contact Dermatitis 1998; 39:268.
- Dodds PR, Chi TN. Balanitis as a fixed drug eruption to tetracycline. J Urol 1985; 133:1044.
- Csonka GW, Rosedale N, Walkden L. Balanitis due to fixed drug eruption associated with tetracycline therapy. Br J Vener Dis 1971; 47:42.
- Rodriguez A, Hill B, Gopolan R, Sklar GN. Cytomegalovirus balanitis in a renal transplant recipient. J Urol 1999; 162:2086.
- Palamaras I, Hamill M, Sethi G, et al. The usefulness of a diagnostic biopsy clinic in a genitourinary medicine setting: recent experience and a review of the literature. J Eur Acad Dermatol Venereol 2006; 20:905.
- Birley HD, Walker MM, Luzzi GA, et al. Clinical features and management of recurrent balanitis; association with atopy and genital washing. Genitourin Med 1993; 69:400.
- Stary A, Soeltz-Szoets J, Ziegler C, et al. Comparison of the efficacy and safety of oral fluconazole and topical clotrimazole in patients with candida balanitis. Genitourin Med 1996; 72:98.
- Hilton E, Isenberg HD, Alperstein P, et al. Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med 1992; 116:353.
- Shalev E, Battino S, Weiner E, et al. Ingestion of yogurt containing Lactobacillus acidophilus compared with pasteurized yogurt as prophylaxis for recurrent candidal vaginitis and bacterial vaginosis. Arch Fam Med 1996; 5:593.
- Dahlman-Ghozlan K, Hedblad MA, von Krogh G. Penile lichen sclerosus et atrophicus treated with clobetasol dipropionate 0.05% cream: a retrospective clinical and histopathological study. J Am Acad Dermatol 1999; 40:451.
- Ioannides D, Lazaridou E, Apalla Z, et al. Acitretin for severe lichen sclerosus of male genitalia: a randomized, placebo controlled study. J Urol 2010; 183:1395.
- Liatsikos EN, Perimenis P, Dandinis K, et al. Lichen sclerosus et atrophicus. Findings after complete circumcision. Scand J Urol Nephrol 1997; 31:453.
- Kumar B, Sharma R, Rajagopalan M, Radotra BD. Plasma cell balanitis: clinical and histopathological features--response to circumcision. Genitourin Med 1995; 71:32.
- Boon TA. Sapphire probe laser surgery for localized carcinoma of the penis. Eur J Surg Oncol 1988; 14:193.
- CLINICAL MANIFESTATIONS
- Candidal infection
- Less common etiologies
- - Bacterial and other infections
- - Dermatologic conditions
- - Premalignant conditions
- - Miscellaneous conditions
- DIAGNOSTIC EVALUATION
- Hygiene measures and empiric treatment
- Directed treatment for identifiable causes
- - Candidal infection
- - Less common etiologies
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS