Is Group B Streptococcus (GBS) balanitis a common condition?

Group B Streptococcus (GBS) Balanitis: Prevalence and Clinical Significance

Group B Streptococcus (GBS) balanitis is uncommon but represents a significant proportion of infectious balanitis cases in uncircumcised men, with Staphylococcus species and Group B Streptococci being among the most frequently isolated bacteria in balanitis cases. 1

Epidemiology and Prevalence

• GBS balanitis is relatively uncommon compared to other causes of balanitis:

  • In a study of 219 men with balanitis (10.7% of all men attending an STD clinic), 118 (53.9%) had infectious balanitis 1
  • Of these infectious cases, Group B Streptococci were among the most frequently isolated bacteria, though Candida albicans was the single most common pathogen 1
  • All men with infectious balanitis in this study were uncircumcised, highlighting the role of the prepuce in disease development 1

• Subpreputial carriage of GBS:

  • Men attending genitourinary medicine clinics have shown higher prevalence of subpreputial infection with GBS than with Staphylococcus aureus or coliform bacilli 2
  • GBS carriage rates were higher in men with balanitis than those without, suggesting a causative relationship 2
  • Carriage rates were also higher in homosexual men compared to heterosexual men 2

Transmission and Risk Factors

• Sexual transmission appears to be a significant route:

  • Case reports have documented GBS balanitis in men whose female partners had vaginal colonization with GBS 3, 4
  • In one study, GBS was cultured from the vagina of an asymptomatic female partner of a man with severe recurrent GBS balanitis 3
  • However, the importance of sexual transmission varies:
    • More common among homosexual men 2
    • Less significant in heterosexual transmission despite potential for balanitis 2

• Other risk factors include:

  • Uncircumcised status (all cases in the major study were uncircumcised) 1
  • Possible traumatic abrasions during sexual intercourse providing entry points for bacteria 3

Clinical Presentation

• GBS balanitis can present with:

  • Inflammation of the glans penis, often involving the prepuce (balanoposthitis)
  • Purulent discharge and local pain (though these symptoms are more commonly associated with Group A Streptococcus infections) 5
  • Potential for severe and recurrent infections 3

• The clinical appearance is often nonspecific and has little value in predicting the specific infectious agent 1

Diagnosis and Management

• Diagnosis requires:

  • Swab culture from the affected lesion to identify the causative organism 1, 5
  • Consideration of partner testing in recurrent cases 3, 4

• Treatment:

  • Penicillin or erythromycin are the preferred antibiotics for GBS balanitis 3
  • Amoxicillin has also been shown to be effective 5, 4
  • Partner treatment may be necessary in recurrent cases, though long-term eradication of GBS from female carriers can be difficult 3

Prevention and Prognosis

• Recurrence is possible:

  • In one study, 7 out of 55 patients (12.7%) with infectious balanitis experienced recurrences during 3-12 months of follow-up 1
  • Prevention of additional episodes may be challenging due to difficulty eradicating the carrier state in sexual partners 3

• Circumcision may be considered in cases of recurrent balanitis, as all cases in the major study occurred in uncircumcised men 1

While GBS is a significant pathogen in neonatal and maternal infections, with colonization rates of 10-30% in pregnant women 6, 7, GBS balanitis represents a less common but clinically relevant manifestation of this organism in adult males.