Balanoposthitis in children: Clinical manifestations, diagnosis, and treatment
- Matthew Tews, DO
Matthew Tews, DO
- Associate Professor of Emergency Medicine
- Medical College of Wisconsin
- Jonathan I Singer, MD
Jonathan I Singer, MD
- Section Editor — Pediatric Surgical Emergencies
- Professor of Emergency Medicine and Pediatrics
- Wright State University Boonshoft School of Medicine
- Section Editors
- Gary R Fleisher, MD
Gary R Fleisher, MD
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Pediatric Signs and Symptoms
- Egan Family Foundation Professor
- Harvard Medical School
- Laurence S Baskin, MD, FAAP
Laurence S Baskin, MD, FAAP
- Section Editor — Pediatric Urology
- Frank Hinman, Jr., MD, Distinguished Professorship in Pediatric Urology
- Chief Pediatric Urology
- Professor of Urology and Pediatrics
- UCSF Benioff Children's Hospital
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will address the clinical manifestations, diagnosis, and treatment of balanoposthitis in children. Epidemiology and pathogenesis of this condition and normal development of the uncircumcised penis are discussed separately. (See "Balanoposthitis in children: Epidemiology and pathogenesis" and "Care of the uncircumcised penis".)
History — Common symptoms in patients with balanoposthitis include genital itching, genital irritation and pain, penile discharge, groin rash, and dysuria [1-3]. In infants, penile inflammation may be the cause of excessive crying.
In addition to the above, uncircumcised prepubertal boys with balanoposthitis may demonstrate relative phimosis, that is, inability to retract the foreskin to the extent possible prior to the illness.
The patient or parents may note scarring or changed appearance when balanoposthitis is longstanding.
- Schwartz RH, Rushton HG. Acute balanoposthitis in young boys. Pediatr Infect Dis J 1996; 15:176.
- 2001 National guideline on the management of balanitis. Edwards S. http://www.bashh.org/guidelines/2002/balanitis_0901b.pdf (Accessed on February 14, 2008).
- Escala JM, Rickwood AM. Balanitis. Br J Urol 1989; 63:196.
- Mallon E, Hawkins D, Dinneen M, et al. Circumcision and genital dermatoses. Arch Dermatol 2000; 136:350.
- Van Howe RS. Variability in penile appearance and penile findings: a prospective study. Br J Urol 1997; 80:776.
- Leslie JA, Cain MP. Pediatric urologic emergencies and urgencies. Pediatr Clin North Am 2006; 53:513.
- 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.
- Edwards S. Balanitis and balanoposthitis: a review. Genitourin Med 1996; 72:155.
- Thankappan TP, Zachariah J. Drug-specific clinical pattern in fixed drug eruptions. Int J Dermatol 1991; 30:867.
- Ozkaya-Bayazit E. Specific site involvement in fixed drug eruption. J Am Acad Dermatol 2003; 49:1003.
- Manian FA, Alford RH. Nosocomial infectious balanoposthitis in neutropenic patients. South Med J 1987; 80:909.
- Drivsholm T, de Fine Olivarius N, Nielsen AB, Siersma V. Symptoms, signs and complications in newly diagnosed type 2 diabetic patients, and their relationship to glycaemia, blood pressure and weight. Diabetologia 2005; 48:210.
- Wakatsuki A. [Clinical experience of streptococcal balanoposthitis in 47 healthy adult males]. Hinyokika Kiyo 2005; 51:737.
- Sakuma S, Komiya H. Balanitis caused by Streptococcus pyogenes: a report of two cases. Int J STD AIDS 2005; 16:644.
- Patrizi A, Costa AM, Fiorillo L, Neri I. Perianal streptococcal dermatitis associated with guttate psoriasis and/or balanoposthitis: a study of five cases. Pediatr Dermatol 1994; 11:168.
- Davidson F. Yeasts and circumcision in the male. Br J Vener Dis 1977; 53:121.
- Rodin P, Kolator B. Carriage of yeasts on the penis. Br Med J 1976; 1:1123.
- Cree GE, Willis AT, Phillips KD, Brazier JS. Anaerobic balanoposthitis. Br Med J (Clin Res Ed) 1982; 284:859.
- Synder HM. Urologic emergencies. In: Textbook of Pediatric Emergencies, 5th, Fleisher GR, Ludwig S, Henretig FM. (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1679.
- 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.
- Kyriazi NC, Costenbader CL. Group A beta-hemolytic streptococcal balanitis: it may be more common than you think. Pediatrics 1991; 88:154.
- Orden B, Martin R, Franco A, et al. Balanitis caused by group A beta-hemolytic streptococci. Pediatr Infect Dis J 1996; 15:920.
- Naji H, Jawad E, Ahmed HA, Mustafa R. Histopathological examination of the prepuce after circumcision: Is it a waste of resources? Afr J Paediatr Surg 2013; 10:164.
- Gargollo PC, Kozakewich HP, Bauer SB, et al. Balanitis xerotica obliterans in boys. J Urol 2005; 174:1409.
- 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.
- David N, Tang A. Efficacy and safety of penile biopsy in a GUM clinic setting. Int J STD AIDS 2002; 13:573.
- Buechner SA. Common skin disorders of the penis. BJU Int 2002; 90:498.
- Keat A. Reiter's syndrome and reactive arthritis in perspective. N Engl J Med 1983; 309:1606.
- Das S, Tunuguntla HS. Balanitis xerotica obliterans--a review. World J Urol 2000; 18:382.
- Celis S, Reed F, Murphy F, et al. Balanitis xerotica obliterans in children and adolescents: a literature review and clinical series. J Pediatr Urol 2014; 10:34.
- Thiruchelvam N, Nayak P, Mostafid H. Emergency dorsal slit for balanitis with retention. J R Soc Med 2004; 97:205.
- The use of aqueous cream in children with atopic eczema. http://www.eczema.org/aqueous.htm (Accessed on February 15, 2008).
- Forster GE, Harris JRW. Double blind therapeutic trial in balanitis - miconazole and nystatin. Eur J Sex Transm Dis 1986; 3:81.
- Kinghorn GR, Woolley PD. Single-dose fluconazole in the treatment of Candida albicans balanoposthitis. Int J STD AIDS 1990; 1:366.
- Micali G, Nasca MR, Innocenzi D, Schwartz RA. Penile cancer. J Am Acad Dermatol 2006; 54:369.
- Amebiasis. In: Red Book: 2003 Report of the Committee of infectious diseases, 26th, Pickering LK. (Ed), American Academy of Pediatrics, Elk Grove Village 2003. p.193.
- 2008 UK National Guideline on the Management of Balanoposthitis. Clinical Effectiveness Group. British Association for Sexual Health and HIV. http://www.bashh.org/documents/2062.pdf. Accessed October 1, 2013
- Schoen EJ, Colby CJ, To TT. Cost analysis of neonatal circumcision in a large health maintenance organization. J Urol 2006; 175:1111.
- Fakjian N, Hunter S, Cole GW, Miller J. An argument for circumcision. Prevention of balanitis in the adult. Arch Dermatol 1990; 126:1046.
- Tobian AA, Serwadda D, Quinn TC, et al. Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. N Engl J Med 2009; 360:1298.
- Fergusson DM, Lawton JM, Shannon FT. Neonatal circumcision and penile problems: an 8-year longitudinal study. Pediatrics 1988; 81:537.
- Spilsbury K, Semmens JB, Wisniewski ZS, Holman CD. Circumcision for phimosis and other medical indications in Western Australian boys. Med J Aust 2003; 178:155.
- Wiswell TE, Tencer HL, Welch CA, Chamberlain JL. Circumcision in children beyond the neonatal period. Pediatrics 1993; 92:791.
- CLINICAL FEATURES
- Physical examination
- Laboratory testing
- Pathologic diagnosis
- DIFFERENTIAL DIAGNOSIS
- Relief of urinary obstruction
- General treatment
- Irritant nonspecific balanoposthitis
- Irritant contact balanoposthitis
- Fixed drug eruptions
- Infectious balanoposthitis
- - Candidal infection
- - Bacterial infection
- - Viral balanoposthitis
- - Protozoan balanoposthitis
- - Persistent infections
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS