causes and treatment of balanitis

What is Balanitis?

Balanitis is swelling of the foreskin or head of the penis. According to the National Health Service UK, balanitis is a common condition that affects an estimated one in 20 males. It also accounts for one in 10 cases of visits to a sexual health clinic or urology clinic by adult men (NSH).

Balanitis is a condition that largely occurs in uncircumcised men. Balanitis can be a painful condition, but it isn’t a serious one. It can usually be relieved using topical medication.

What Causes Balanitis to Develop?

The main cause of balanitis is poor hygiene. Poor hygiene causes harmful bacteria to overpopulate the area, which can lead to infection. The foreskin of the penis is an ideal place for bacteria to grow.

Injuries on the tip of the penis or foreskin can also cause swelling.

Irritation in the area can also cause balanitis. Irritation can arise from:

• not rinsing soap completely off of your penis after showering
• using scented soaps to clean the penis
• using bar soap that dries out the skin
• using scented lotions or sprays on the penis

Some medications like laxatives, sleeping pills, painkillers, and antibiotics can cause balanitis as a side effect. This is called a fixed drug eruption.

Less common causes of balanitis include:

• reactive arthritis
• uncontrolled diabetes
• sexually transmitted diseases like herpes and gonorrhea

Recognizing the Symptoms of Balanitis

The most apparent signs of balanitis are swelling and a red appearance to the foreskin. Aside from redness and swelling, these symptoms may also be present:

• tightened foreskin
• discharge
• itchy genitals
• pain in the genital area
• painful skin on the penis

If the tip of your penis is swollen, it can put pressure on your urethra. This can cause pain when urinating.

Diagnosing Balanitis

Since the majority of balanitis signs are visible, it can usually be diagnosed during a physical examination. If discharge is present, your doctor may take a sample of the discharge using a cotton swab. The sample is then checked for the presence of bacterial, viral, or fungal cells. The results will help determine what caused the balanitis.

In some cases, the cause isn’t immediately apparent, so you may need a more invasive test for diagnosis. One such test is a biopsy. Your doctor will remove a small piece of tissue from the penis for examination. The sample is checked for signs of a disease. You will be given local anesthesia before the doctor collects the sample.

Treating Balanitis

patient presenting with balanitis but without phimosis should receive the following recommendations and treatment:

• Gentle retraction of the foreskin daily and soak in warm water to clean penis and foreskin.
• In pediatric patients and patients with mild balanitis xerotica, a 2-month trial of antifungals may be attempted; the patient or mother should retract the foreskin gently and apply 0.05% betamethasone twice a day. This applies to children older than 3 years. Success is seen particularly in male children older than 10 years compared with those aged 3-10 years. Success ranges from 65-95%.
• Topical steroids have had only limited success in patients with moderate-to-severe balanitis xerotica obliterans. These patients are more likely to have distal scarring of the foreskin.
• In recurrent cases, 1% pimecrolimus cream was used instead of steroids, with a 64% success rate.^[11]
• Apply bacitracin (not Neosporin) for pediatric patients if bacterial infection is suspected.
• Apply topical clotrimazole for adult men with probable candidal balanitis.
• Obtain a culture of discharge in complicated cases such as those with associated cellulitis, then treat empirically with appropriate antibiotics (typically first-generation cephalosporin).
• A study of 1185 boys concluded that fluticasone proprionate 0.05% was effective and safe in treating associated phimosis, with successful results in 91.1% of patients.^[12]

Patients presenting to the ED with phimosis and severe urinary obstruction as a complication of balanitis should receive the following care (recommended that surgical intervention be performed by a urologist, if available):

• Steroid cream and gentle retraction of the foreskin, if the phimosis is not too tight, may be used before surgery is contemplated.^{[13, 14]}
• Without damaging the glans penis, dilate the foreskin using a clamp. If the glans penis is adherent to the foreskin, the procedure may be contraindicated. Local anesthesia, analgesia, and/or sedation may be required.
• Perform a dorsal slit incision by cutting the foreskin over the dorsal shaft of the penis to enlarge the foreskin opening. This procedure requires local anesthesia and, possibly, sedation.
• Perform a formal circumcision (preferably in the operating room).^{[15, 16]}
• Circumcision is not a preventive treatment of balanitis in those younger than 3 years.