What is balantitis and how is it treated?

Balanitis: Definition and Treatment

Balanitis is inflammation of the glans penis that requires targeted treatment based on the underlying cause, with fungal infections being the most common etiology requiring antifungal therapy. 1

What is Balanitis?

Balanitis is inflammation of the glans penis, while balanoposthitis involves both the glans penis and prepuce (foreskin) and occurs only in uncircumcised males 1, 2. Common symptoms include:

• Pruritus (itching sensation)
• Penile discharge
• Penile soreness
• Burning sensation 1

Causes and Risk Factors

Balanitis can be caused by various factors:

1. Infectious causes:

   • Fungal infections (most commonly Candida species)
   • Bacterial infections (Streptococci groups B and D, Staphylococci)
   • Viral infections
   • Parasites and other sexually transmitted infections 1, 2, 3

2. Non-infectious causes:

   • Inflammatory conditions (lichen planus, psoriasis)
   • Contact dermatitis
   • Pre-malignant lesions 1, 2, 4

3. Risk factors:

   • Uncircumcised status
   • Poor hygiene
   • Phimosis
   • Diabetes mellitus
   • Immunosuppression
   • Chronic inflammation
   • Tobacco use 1

Diagnosis

Diagnosis is primarily based on:

• Clinical presentation
• Patient history
• Laboratory tests when necessary
• Biopsy for chronic, fixed, or suspicious lesions to rule out malignancy 1

It's important to note that the clinical appearance is often non-specific and may not predict the infectious agent 3.

Treatment Approach

Treatment depends on the underlying cause:

1. Fungal Balanitis (Candidal)

• First-line treatment: Topical azole creams 1

  • Clotrimazole 1% cream: Apply 2-3 times daily for 7-14 days
  • Miconazole 2% cream: Apply 2-3 times daily for 7 days
  • Butoconazole 2% cream: Apply once daily for 3 days
  • Terbinafine 1% cream: Apply once or twice daily for 7 days

• For resistant cases: Oral fluconazole 150 mg as a single dose 1

2. Bacterial Balanitis

• Treatment based on culture and sensitivity testing
• For Staphylococcus or Streptococcus infections, appropriate antibiotics are needed 5, 3

3. Inflammatory Causes

• Topical corticosteroids: Potent topical corticosteroids (clobetasol propionate 0.05%) applied once or twice daily for 1-3 months for conditions like lichen sclerosus 1

4. Severe or Recurrent Cases

• Therapeutic circumcision may be considered for chronic, recurrent balanitis 2

Prevention Strategies

• Good hygiene: Gentle cleaning with warm water and complete drying after bathing
• Control of underlying conditions such as diabetes
• Avoidance of tight-fitting underwear
• Proper drying of the genital area after washing 1

Complications and Follow-up

• Potential complications include phimosis, urethral stricture, sexual dysfunction, and malignant transformation
• Patients with lichen sclerosus have a 2-9% risk of developing penile carcinoma 1, 6
• Follow-up within 1-2 weeks is recommended to assess treatment response
• Reevaluation is necessary if no improvement is seen after 72 hours of therapy
• Lifelong follow-up is recommended for patients with lichen sclerosus due to malignancy risk 1

Special Considerations

• Patients should avoid sexual intercourse until treatment is completed and symptoms have resolved (typically 7-14 days)
• Partners of patients with infectious balanitis, especially sexually transmitted infections, may need evaluation and treatment 1
• Any fixed, chronic, or suspicious lesion should be biopsied to rule out malignancy 1, 4