Differential Diagnosis for Uncircumcised Male with Penile Swelling and Discharge
Single Most Likely Diagnosis
- Balanitis: This is an inflammation of the glans penis, often caused by poor hygiene, infection, or an allergic reaction. It's more common in uncircumcised males due to the warm, moist environment under the foreskin, which can foster bacterial or fungal growth. The presence of swelling around the tip of the penis and discharge supports this diagnosis.
Other Likely Diagnoses
- Phimosis: This condition, where the foreskin cannot be fully retracted over the glans, can lead to swelling and discharge due to trapped secretions and potential infection.
- Urinary Tract Infection (UTI): While less common in men, UTIs can cause discharge and swelling, especially if the infection has spread to the prostate or epididymis.
- Sexually Transmitted Infections (STIs): Such as gonorrhea, chlamydia, or syphilis, which can cause penile discharge and swelling.
Do Not Miss Diagnoses
- Penile Cancer: Although rare, any unusual or persistent lesions, swelling, or discharge should prompt consideration of penile cancer, especially in uncircumcised men, as it can be deadly if not caught early.
- Necrotizing Fasciitis: A severe infection that can cause rapid progression of swelling, pain, and potentially life-threatening complications if not promptly treated.
Rare Diagnoses
- Lichen Sclerosus: A chronic inflammatory skin condition that can cause thinning and scarring of the skin on the penis, potentially leading to swelling and discharge.
- Psoriasis or Eczema: These skin conditions can cause inflammation and potentially lead to swelling and discharge if they affect the genital area.
Diagnostic Tests
To confirm the diagnosis, the following tests could be ordered:
- Urinalysis and urine culture to check for UTIs
- Swab tests for STIs
- Blood tests for STIs or to assess for signs of infection
- Ultrasound or other imaging tests if a more serious condition like testicular torsion or epididymitis is suspected
- Biopsy if penile cancer is a concern
Treatment Plan
The treatment plan will depend on the confirmed diagnosis:
- Balanitis: Treatment typically involves improving hygiene, topical antibiotics, or antifungals.
- Phimosis: May require topical steroids to loosen the foreskin or, in some cases, circumcision.
- UTIs or STIs: Appropriate antibiotics.
- Penile Cancer: Requires prompt surgical intervention and possibly additional treatments like chemotherapy or radiation.
- Necrotizing Fasciitis: Immediate surgical debridement and broad-spectrum antibiotics.
- Lichen Sclerosus, Psoriasis, or Eczema: Topical treatments aimed at reducing inflammation and preventing further irritation.