From the Guidelines
Balanoposthitis should be treated with improved hygiene and topical antifungal or antibacterial creams, and in recurrent cases, circumcision may be recommended as a definitive treatment option. Balanoposthitis is an inflammation of the glans penis (balanitis) and the foreskin (posthitis) that occurs simultaneously. Treatment depends on the cause but typically includes improved hygiene and topical antifungal creams like clotrimazole 1% applied twice daily for 7-14 days if a fungal infection is present, as suggested by the Centers for Disease Control and Prevention in their 2002 guidelines for treating sexually transmitted diseases 1. For bacterial infections, antibacterial creams such as mupirocin 2% applied three times daily for 7-10 days may be prescribed. During treatment, it is essential to keep the area clean and dry by gently washing with warm water (avoiding soap), retracting the foreskin if possible, and thoroughly drying afterward. Avoiding sexual activity until symptoms resolve is also recommended.
Some key considerations in managing balanoposthitis include:
- Identifying the underlying cause of the infection to guide treatment
- Maintaining good hygiene to prevent the growth of microorganisms
- Using appropriate topical treatments based on the cause of the infection
- Considering circumcision in cases of recurrent balanoposthitis, especially if phimosis is a contributing factor, as circumcision may have a role in managing conditions like lichen sclerosus, which can cause similar symptoms 1.
If symptoms persist beyond two weeks of treatment, recur frequently, or are accompanied by severe pain, fever, or discharge, a medical evaluation is necessary to reassess the treatment plan and consider other potential causes or complications. The warm, moist environment under the foreskin creates ideal conditions for microorganism growth, particularly when hygiene is inadequate, making preventive measures crucial in managing and preventing balanoposthitis.
From the Research
Definition and Causes of Balanoposthitis
- Balanoposthitis is defined as inflammation of the glans penis and/or prepuce, with a wide range of causes including infection, dermatoses, and premalignancy 2.
- Infection is the most frequent cause, with various microorganisms reported, including Candida albicans, Staphylococcus spp., and groups B and D Streptococci 3.
- The clinical aspect of balanoposthitis is often non-specific, making diagnosis and treatment a challenge 3, 4.
Diagnosis and Treatment of Balanoposthitis
- A targeted medical history and clinical examination are necessary for correct diagnosis and treatment of balanoposthitis 4.
- Laboratory tests, such as culture studies, can help confirm the diagnosis and identify the underlying cause 3.
- Treatment options vary depending on the cause, with antifungal agents commonly used for infectious balanitis, and antibiotic therapy used for non-candida balanitis 3.
- The 2022 European guideline for the management of balanoposthitis provides updated recommendations for diagnosis and treatment, including management of infective balanitis and premalignant conditions 2.
Epidemiology and Complications of Balanoposthitis
- Balanoposthitis is a common condition, affecting 53.9% of male STD clinic patients in one study 3.
- Recurrences are common, with 12.7% of patients experiencing recurrences in one study 3.
- Premalignant conditions, such as penile intraepithelial neoplasia (PeIN), are a potential complication of balanoposthitis 2.
- High-quality evidence specific to the management of penile disease is not available for all conditions described, highlighting the need for further research 2, 5, 6.