Balanoposthitis in children: Epidemiology and pathogenesis
- Matthew Tews, DO
Matthew Tews, DO
- Professor of Emergency Medicine
- Medical College of Georgia
- 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 — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Balanoposthitis describes inflammation of the glans penis and the foreskin (prepuce) in uncircumcised males (picture 1). Although the etiology is multifactorial in children, balanoposthitis typically results from poor hygiene that is sometimes complicated by secondary infection. (See 'Irritant balanoposthitis' below.)
With general treatment, most patients with balanoposthitis have complete resolution of symptoms. In selected cases, topical or oral antibiotic therapy may be indicated. Pediatric urologic consultation is reserved for patients with acute urinary obstruction, prolonged and refractory disease course, recurrence, or development of true phimosis.
Balanitis, inflammation of the glans penis only, often occurs in conjunction with diaper dermatitis in young boys, both circumcised and uncircumcised. Local care and topical treatment aimed at the most likely etiology is rapidly curative and similar to balanoposthitis.
Balanitis and balanoposthitis must be differentiated from lesions that are sexually transmitted, indicative of systemic disease, or precancerous. These lesions are more common in adolescents and adults. However, vigilance is required to recognize sexually transmitted infection in prepubertal victims of child abuse. (See "Evaluation of sexual abuse in children and adolescents".)
This topic will address the epidemiology, pathogenesis, and clinical features of balanoposthitis. Specific diagnosis and treatment of balanoposthitis and routine care of the circumcised penis are discussed separately. (See "Balanoposthitis in children: Clinical manifestations, diagnosis, and treatment" and "Care of the uncircumcised penis".)
- Kayaba H, Tamura H, Kitajima S, et al. Analysis of shape and retractability of the prepuce in 603 Japanese boys. J Urol 1996; 156:1813.
- Fergusson DM, Lawton JM, Shannon FT. Neonatal circumcision and penile problems: an 8-year longitudinal study. Pediatrics 1988; 81:537.
- Cold CJ, Taylor JR. The prepuce. BJU Int 1999; 83 Suppl 1:34.
- 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.
- Imamura E. Phimosis of infants and young children in Japan. Acta Paediatr Jpn 1997; 39:403.
- Hsieh TF, Chang CH, Chang SS. Foreskin development before adolescence in 2149 schoolboys. Int J Urol 2006; 13:968.
- Edwards S. Balanitis and balanoposthitis: a review. Genitourin Med 1996; 72:155.
- 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.
- Abdullah AN, Drake SM, Wade AA, Walzman M. Balanitis (balanoposthitis) in patients attending a department of genitourinary medicine. Int J STD AIDS 1992; 3:128.
- Van Howe RS. Neonatal circumcision and penile inflammation in young boys. Clin Pediatr (Phila) 2007; 46:329.
- Herzog LW, Alvarez SR. The frequency of foreskin problems in uncircumcised children. Am J Dis Child 1986; 140:254.
- Fleiss PM, Hodges FM, Van Howe RS. Immunological functions of the human prepuce. Sex Transm Infect 1998; 74:364.
- Dockerty WG, Sonnex C. Candidal balano-posthitis: a study of diagnostic methods. Genitourin Med 1995; 71:407.
- 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.
- Lisboa C, Ferreira A, Resende C, Rodrigues AG. Infectious balanoposthitis: management, clinical and laboratory features. Int J Dermatol 2009; 48:121.
- Agartan CA, Kaya DA, Ozturk CE, Gulcan A. Is aerobic preputial flora age dependent? Jpn J Infect Dis 2005; 58:276.
- Porter WM, Bunker CB. The dysfunctional foreskin. Int J STD AIDS 2001; 12:216.
- Schwartz RH, Rushton HG. Acute balanoposthitis in young boys. Pediatr Infect Dis J 1996; 15:176.
- Kyriazi NC, Costenbader CL. Group A beta-hemolytic streptococcal balanitis: it may be more common than you think. Pediatrics 1991; 88:154.
- Guerrero-Vazquez J, Sebastian-Planes M, Olmedo-Sanlaureano S. Group A streptococcal proctitis and balanitis. Pediatr Infect Dis J 1990; 9:223.
- 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.
- Bhargava RK, Thin RN. Subpreputial carriage of aerobic micro-organisms and balanitis. Br J Vener Dis 1983; 59:131.
- Brook I. Balanitis caused by group B beta-hemolytic streptococci. Sex Transm Dis 1980; 7:195.
- Wahl NG, Castilla MA, Lewis-Abney K. Prevalence of Gardnerella vaginalis in prepubertal males. Arch Pediatr Adolesc Med 1998; 152:1095.
- Vohra S, Badlani G. Balanitis and balanoposthitis. Urol Clin North Am 1992; 19:143.
- Cree GE, Willis AT, Phillips KD, Brazier JS. Anaerobic balanoposthitis. Br Med J (Clin Res Ed) 1982; 284:859.
- Lincopan N, Neves P, Mamizuka EM, Levy CE. Balanoposthitis caused by Pseudomonas aeruginosa co-producing metallo-beta-lactamase and 16S rRNA methylase in children with hematological malignancies. Int J Infect Dis 2010; 14:e344.
- 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.
- Powers RD, Rein MF, Hayden FG. Necrotizing balanitis due to herpes simplex type 1. JAMA 1982; 248:215.
- Arumainayagam JT, Sumathipala AH, Smallman LA, Shahmanesh M. Flat condylomata of the penis presenting as patchy balanoposthitis. Genitourin Med 1990; 66:251.
- 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.
- COOKE RA, RODRIGUE RB. AMOEBIC BALANITIS. Med J Aust 1964; 1:114.
- Leslie JA, Cain MP. Pediatric urologic emergencies and urgencies. Pediatr Clin North Am 2006; 53:513.
- 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.
- Hoppa EC, Wiley JF 2nd. Bathing suit mesh entrapment: an unusual case of penile injury. Pediatr Emerg Care 2006; 22:813.
- Kanegaye JT, Schonfeld N. Penile zipper entrapment: a simple and less threatening approach using mineral oil. Pediatr Emerg Care 1993; 9:90.
- 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.