What are the characteristics of balanitis?

Characteristics of Balanitis

Balanitis is an inflammatory condition of the glans penis characterized by erythema, pruritus, penile discharge, soreness or pain, and burning sensation during urination, which requires proper diagnosis to determine the underlying cause for effective treatment. 1

Clinical Presentation

Primary Symptoms

• Pruritus (itching sensation)
• Erythema and inflammation of the glans penis
• Penile discharge
• Soreness or pain
• Burning sensation, especially during urination 1

Physical Examination Findings

• Diffuse erythema and edema of the glans penis
• Possible purulent exudate in bacterial infections
• Erosive lesions in severe cases 2
• White plaques in candidal infections
• Possible fixed lesions in chronic cases that may require biopsy 3

Etiological Classification

Infectious Causes (Most Common)

1. Fungal infections:

   • Candida albicans (most common infectious cause) 4
   • Presents with white, curd-like discharge and erythema

2. Bacterial infections:

   • Staphylococcus species
   • Streptococci groups B and D 4
   • May present with more severe inflammation and purulent discharge

3. Sexually transmitted infections:

   • Various pathogens including Chlamydia trachomatis and Neisseria gonorrhoeae 1

Non-Infectious Causes

1. Irritant dermatitis:

   • Due to poor hygiene, chemical irritants, or allergic reactions 1

2. Lichen sclerosus (balanitis xerotica obliterans):

   • Porcelain-white papules and plaques
   • May lead to scarring and phimosis
   • Carries 2-9% risk of developing penile carcinoma 5

3. Inflammatory conditions:

   • Psoriasis, plasma cell balanitis, and other dermatoses 6

Risk Factors

• Uncircumcised status (most cases occur in uncircumcised men) 4
• Poor hygiene 1
• Phimosis (inability to retract the foreskin) 5
• Diabetes mellitus 1
• Immunosuppression 1
• Chronic inflammation 5
• Tobacco use 5

Complications

• Phimosis (inability to retract the foreskin)
• Urethral stenosis
• Sexual dysfunction 6
• Malignant transformation (particularly with lichen sclerosus) 5
• Recurrent infections 1

Important Clinical Considerations

• Balanitis affects approximately 10.7% of men attending STD clinics 4
• The clinical appearance alone is often insufficient to determine the specific causative agent 4
• Any fixed, chronic, or suspicious lesion should be biopsied to rule out malignancy 1, 3
• Recurrent balanoposthitis represents a strong indication for circumcision 1, 2
• Lichen sclerosus requires long-term follow-up due to the risk of developing penile carcinoma 1

Common Pitfalls and Caveats

1. Misdiagnosis based on appearance alone: The clinical aspect is often of little value in predicting the specific infectious agent 4

2. Failure to biopsy suspicious lesions: Any fixed, chronic, or suspicious lesion must be rapidly assessed by biopsy to rule out malignancy 3

3. Inadequate treatment of underlying conditions: Ignoring underlying conditions such as diabetes and immunosuppression can predispose to recurrent infections 1

4. Forceful retraction of the foreskin: This can cause trauma and worsen symptoms, especially in children 1

5. Mistaking normal variations for pathology: Normal aspects of the balanopreputial area may cause anxiety in some patients 3

By understanding these characteristics of balanitis, clinicians can better diagnose and manage this common condition, preventing complications and improving patient outcomes.