From the Guidelines
Candidal balanitis should be treated with topical antifungal medications such as clotrimazole 1% cream applied twice daily for 7-14 days or miconazole 2% cream applied twice daily for 7-14 days, as recommended by the most recent guidelines 1.
Diagnosis and Treatment
Candidal balanitis is a fungal infection of the glans penis caused by Candida species, most commonly Candida albicans. The diagnosis is typically made clinically, with symptoms including redness, itching, burning sensation, and sometimes a white discharge under the foreskin.
Treatment Options
- Topical antifungal medications such as clotrimazole 1% cream or miconazole 2% cream applied twice daily for 7-14 days are effective for treating candidal balanitis 1.
- For more severe cases, oral fluconazole 150mg as a single dose may be prescribed 1.
- During treatment, patients should maintain good genital hygiene by gently washing the area with warm water and avoiding soap, keeping the area dry, and avoiding sexual contact until the infection resolves.
Prevention of Recurrent Infections
- For recurrent infections, addressing predisposing factors is essential, including controlling blood glucose in diabetic patients, avoiding unnecessary antibiotics, and ensuring proper hygiene 1.
- Uncircumcised men should retract the foreskin during washing and ensure the area is completely dry afterward.
- If symptoms persist despite treatment, patients should seek further medical evaluation to rule out other conditions or resistant infections.
Important Considerations
- Candidal balanitis is more common in men with diabetes, those taking antibiotics, individuals with compromised immune systems, and uncircumcised men 1.
- The treatment of candidal balanitis should be guided by the most recent clinical practice guidelines, which recommend topical antifungal medications as the first-line treatment 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Very moist lesions are best treated with the topical dusting powder. Adults and Pediatric Patients (Neonates and Older): Apply to candidal lesions two or three times daily until healing is complete. The diagnosis of candidal balanitis is not explicitly stated in the label, but the treatment for candidal lesions can be applied to the glans penis.
- The treatment is topical application of nystatin dusting powder.
- Apply the powder two or three times daily until healing is complete 2.
From the Research
Diagnosis of Candidal Balanitis
- Candidal balanitis is a type of balanitis caused by Candida infection, which is a descriptive diagnosis for a heterogeneous group of infectious or inflammatory dermatoses 3
- The diagnosis of candidal balanitis should consider other possible causes, including bacterial infections, viral infections, parasites, and other sexually transmitted infections (STI) 3
- A complete skin examination and a thorough patient history with respect to topically applied products and sexual behavior are essential for diagnosis 3
Treatment of Candidal Balanitis
- Treatment options for candidal balanitis include oral fluconazole and topical clotrimazole, with both treatments showing comparable efficacy and safety 4
- A single 150-mg dose of fluconazole was found to be effective in treating candidal balanitis, with 92% of patients showing clinical cure or improvement 4
- Topical clotrimazole applied twice daily for 7 days was also found to be effective, with 91% of patients showing clinical cure or improvement 4
- In cases of fluconazole- and terbinafine-resistant Candida albicans, oral itraconazole may be an effective treatment option 5
- Clotrimazole 1% cream has also been shown to be effective in treating candidal balanitis, with 91% of patients becoming asymptomatic after seven days of treatment 6
- Good genital hygiene and keeping the glans penis dry are also important in preventing and treating candidal balanitis 3