Balanitis

Balanitis is inflammation of the glans penis.[1] When the foreskin is also affected, it is termed balanoposthitis.[1]

Balanitis
Inflammation of the glans penis and the preputial mucosa of a circumcised penis
SpecialtyUrology

Balanitis on boys still in diapers must be distinguished from redness caused by ammoniacal dermatitis.[2] The word is from the Greek βάλανος balanos, literally "acorn", hence from similarity of shape "glans penis".[3]

Signs and symptoms

Symptoms can include:

  • First signs – small red erosions on the glans
  • Redness of the foreskin
  • Redness of the penis
  • Other rashes on the head of the penis
  • Foul smelling discharge
  • Painful foreskin and penis

Complications

Recurrent bouts of balanitis may cause scarring of the preputial orifice; the reduced elasticity may lead to pathologic phimosis.[4]

Cause

Inflammation has many possible causes, including irritation by environmental substances, physical trauma, and infection such as bacterial, viral, or fungal.[5][6] Some of these infections are sexually transmitted diseases.

It is less common among people who are circumcised, as in many cases, the foreskin contributes to the disease.[1] Both not enough cleaning and too much cleaning can cause problems.[1] Diabetes can make balanitis more likely, especially if the blood sugar is poorly controlled.[7]

It is important to exclude other causes of similar symptoms such as penile cancer.[1]

Diagnosis

Diagnosis may include careful identification of the cause with the aid of a good patient history, swabs and cultures, and pathological examination of a biopsy.[5]

Types
  • Zoon's balanitis also known as Balanitis Circumscripta Plasmacellularis or plasma cell balanitis (PCB) is an idiopathic, rare, benign penile dermatosis[8] for which circumcision is often the preferred treatment.[8][9][10] Zoon's balanitis has been successfully treated with the carbon dioxide laser[11] and more recently Albertini and colleagues report the avoidance of circumcision and successful treatment of Zoon's balanitis with an Er:YAG laser.[12] Another study, by Retamar and colleagues, found that 40 percent of those treated with CO2 laser relapsed.[13]
  • Circinate balanitis (also known as balanitis circinata) is a serpiginous annular dermatitis associated with reactive arthritis.
  • Pseudoepitheliomatous keratotic and micaceous balanitis

Treatment

Initial treatment in adults often involves simply pulling back the foreskin and cleaning the penis.[1]

Epidemiology

Balanitis "is a common condition affecting 11% of adult men seen in urology clinics and 3% of children" in the United States; globally, balanitis "may occur in up to 3% of uncircumcised males".[14]

Other animals
Prepuce of a dog affected by balanoposthitis

In dogs, balanoposthitis is caused by a disruption in the integumentary system, such as a wound or intrusion of a foreign body. A dog with this condition behaves normally, with the exception of excessive licking at the prepuce, and a yellow green, pus-like discharge is usually present. In sheep (rams/wethers), ulcerative enzootic balanoposthitis is caused by the Corynebacterium renale group (C. renale, C. pilosum & C. cystidis). For the condition in bulls, caused by a virus see Bovine herpesvirus 1. Balanoposthitis is believed to have contributed to the decline to near-extinction of Gilbert's potoroo.[15]

References
  1. Edwards, SK; Bunker, CB; Ziller, F; van der Meijden, WI (August 2014). "2013 European guideline for the management of balanoposthitis". International Journal of STD & AIDS. 25 (9): 615–26. doi:10.1177/0956462414533099. PMID 24828553. S2CID 127341.
  2. Simpson ET, Barraclough P (1998). "The management of the paediatric foreskin". Aust Fam Physician. 27 (5): 381–3. PMID 9613002.
  3. βάλανος. Liddell, Henry George; Scott, Robert; A Greek–English Lexicon at the Perseus Project.
  4. Phimosis at eMedicine
  5. Edwards S (1996). "Balanitis and balanoposthitis: a review". Genitourin Med. 72 (3): 155–9. doi:10.1136/sti.72.3.155. PMC 1195642. PMID 8707315.
  6. Cleveland Clinic: Penile Disorders
  7. Balanitis. Health Line. Retrieved 19 April 2016.
  8. Keogh G. Balanitis circumscripta plasmacellularis at eMedicine
  9. Pellicé i Vilalta C, Casalots i Casado J, Cosme i Jiménez MA (1999). "[Zoon's balanoposthitis. A preliminary note]". Arch. Esp. Urol. (in Spanish). 52 (1): 69–72. PMID 10101891.
  10. Buechner SA (2002). "Common skin disorders of the penis". BJU Int. 90 (5): 498–506. doi:10.1046/j.1464-410X.2002.02962.x. PMID 12175386. S2CID 45605100.
  11. Baldwin HE, Geronemus RG (1989). "The treatment of Zoon's balanitis with the carbon dioxide laser". J Dermatol Surg Oncol. 15 (5): 491–4. doi:10.1111/j.1524-4725.1989.tb03407.x. PMID 2497162.
  12. Albertini JG, Holck DE, Farley MF (2002). "Zoon's balanitis treated with Erbium:YAG laser ablation". Lasers Surg Med. 30 (2): 123–6. doi:10.1002/lsm.10037. PMID 11870791. S2CID 33098632.
  13. Retamar RA, Kien MC, Chouela EN (2003). "Zoon's balanitis: presentation of 15 patients, five treated with a carbon dioxide laser". Int. J. Dermatol. 42 (4): 305–7. doi:10.1046/j.1365-4362.2003.01304.x. PMID 12694501. S2CID 21305117.
  14. Balanitis at eMedicine
  15. Vaughan-Higgins, Rebecca; Buller, Nicky; Friend, J. Anthony; Robertson, Ian; Monaghan, Cree L.; Fenwick, Stan; Warren, Kristin (2011). "Balanoposthitis, Dyspareunia, and Treponema in the Critically Endangered Gilbert's Potoroo (Potorous gilbertii)". Journal of Wildlife Diseases. 47 (4): 1019–1025. doi:10.7589/0090-3558-47.4.1019. PMID 22102677. S2CID 7279808.

Further reading
Classification
External resources
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