What are the causes of balanitis?

Causes of Balanitis

Balanitis is most commonly caused by fungal infections (particularly Candida albicans), bacterial infections (including Staphylococcus and Streptococcus species), and inflammatory conditions, with poor hygiene being a significant contributing factor in uncircumcised men. 1

Common Causes of Balanitis

Infectious Causes

1. Fungal Infections

   • Candida albicans (most common infectious cause) 1, 2
   • Other Candida species

2. Bacterial Infections

   • Staphylococcus species (including S. aureus and coagulase-negative staphylococci) 2, 3
   • Streptococcus species (groups B and D) 2
   • Anaerobic bacteria 4
   • Pasteurella species (associated with animal bites) 5

3. Viral Infections 4

   • Herpes simplex virus
   • Human papillomavirus

4. Parasitic Infestations 4, 6

Non-Infectious Causes

1. Inflammatory Dermatoses

   • Lichen sclerosus (balanitis xerotica obliterans) 1, 7
   • Lichen planus 4
   • Psoriasis 4
   • Plasma cell balanitis (Zoon's balanitis) 6

2. Contact Dermatitis

   • Irritant contact dermatitis (from soaps, detergents) 4
   • Allergic contact dermatitis (from topical medications, condoms) 4

3. Premalignant and Malignant Conditions

   • Erythroplasia of Queyrat
   • Bowen's disease
   • Squamous cell carcinoma (can develop from chronic balanitis, especially lichen sclerosus) 1, 7

Risk Factors

1. Anatomical Factors

   • Uncircumcised status (all patients in one study were uncircumcised) 2
   • Phimosis (tight foreskin) 1

2. Medical Conditions

   • Diabetes mellitus 1
   • Immunosuppression 1

3. Behavioral Factors

   • Poor hygiene 1
   • Tobacco use 1
   • Chronic inflammation 1

Clinical Presentation

Patients with balanitis typically present with:

• Pruritus (itching)
• Penile discharge
• Penile soreness or pain
• Burning sensation
• Erythema and edema of the glans penis 1

Diagnostic Approach

The clinical appearance of balanitis is often nonspecific and cannot reliably predict the causative agent 2. Therefore:

1. Clinical evaluation

   • Thorough history regarding hygiene practices, sexual behavior, and topical products used 4
   • Complete skin examination

2. Laboratory tests

   • Culture studies to identify infectious agents 1, 2
   • Biopsy for chronic, fixed, or suspicious lesions to rule out malignancy 1, 7

Prevention

• Good genital hygiene with gentle cleaning using warm water 1
• Complete drying after bathing 1
• Control of underlying conditions such as diabetes 1
• Avoidance of tight-fitting underwear 1
• Circumcision may be considered for recurrent cases in uncircumcised men 1, 3

It's important to note that balanitis can lead to complications including phimosis, urethral stricture, sexual dysfunction, and in cases of lichen sclerosus, malignant transformation (2-9% risk) 1. Therefore, proper diagnosis and management are essential, with lifelong follow-up recommended for certain conditions like lichen sclerosus due to the risk of malignancy.