From the Guidelines
Treatment of balanitis should begin with improved hygiene and may involve topical antifungal or antibacterial creams, with the specific treatment depending on the underlying cause, as recommended by the most recent guidelines. When considering the treatment of balanitis, it's crucial to identify the underlying cause to provide effective management. The guidelines from 1 suggest that a minority of male sex partners may have balanitis, characterized by erythematous areas on the glans of the penis in conjunction with pruritus or irritation, and these men benefit from treatment with topical antifungal agents to relieve symptoms.
Key Considerations for Treatment
- For mild cases, improved hygiene is essential, including gently washing the penis with warm water daily, avoiding soap, and thoroughly drying the area.
- For fungal balanitis (candidal), topical antifungal creams like clotrimazole 1% or miconazole applied twice daily for 7-14 days are effective, as supported by the principle of treating symptomatic balanitis in sex partners 1.
- Bacterial balanitis typically requires antibacterial creams such as mupirocin 2% or fusidic acid cream applied 3-4 times daily for 7 days.
- For more severe or persistent cases, oral antifungals like fluconazole 150mg as a single dose or oral antibiotics such as cephalexin 500mg four times daily for 7 days may be necessary.
- Steroid creams like hydrocortisone 1% can help manage inflammatory balanitis, applied thinly twice daily for 5-7 days.
Additional Recommendations
- Uncircumcised men should retract the foreskin during treatment application and for cleaning.
- During treatment, sexual abstinence or condom use is recommended to prevent transmission to partners.
- If balanitis is recurrent or doesn't respond to treatment within two weeks, further evaluation is necessary as this may indicate an underlying condition like diabetes or a sexually transmitted infection requiring different management, aligning with the approach to consider treatment of sex partners who have symptomatic balanitis or penile dermatitis 1.
From the FDA Drug Label
A small amount of mupirocin ointment should be applied to the affected area three times daily. Adults and children 2 years of age and older: apply to the affected area no more than 3 to 4 times daily
The treatment guideline for balanitis involves applying a topical antibiotic ointment, such as mupirocin 2 or fusidic acid 3, to the affected area. The application frequency is:
From the Research
Treatment Guidelines for Balanitis
The treatment for balanitis depends on the underlying cause of the condition. Here are some treatment guidelines based on the available evidence:
- For candidal balanitis, a single oral 150-mg dose of fluconazole is comparable in efficacy and safety to clotrimazole cream applied topically for 7 days 4.
- In cases of fluconazole- and terbinafine-resistant Candida albicans, oral itraconazole may be an effective treatment option 5.
- For plasma cell balanitis, combined treatment with topical corticosteroids and 0.1% tacrolimus ointment may be effective in achieving clinical response and maintaining treatment efficacy 6.
- For Balanitis Xerotica Obliterans (BXO), surgical intervention may be necessary, with conservative surgical procedures such as circumcision often preferred in the first instance 7.
- In general, the treatment of balanitis should be tailored to the underlying cause and may involve a combination of medical and surgical approaches 8.
Treatment Options
Some treatment options for balanitis include:
- Topical antifungal agents such as clotrimazole for candidal balanitis 4
- Oral antifungal agents such as fluconazole and itraconazole for candidal balanitis 4, 5
- Topical corticosteroids for inflammatory balanitis 6
- Topical calcineurin inhibitors such as tacrolimus for plasma cell balanitis 6
- Surgical intervention such as circumcision for BXO 7
Considerations
When treating balanitis, it is essential to consider the following: