Differential Diagnosis for Genital Pain in a 20-year-old Male

The patient presents with genital pain, inflammation to the superior aspect of his foreskin, and is uncircumcised but able to roll down past the head, with pain and edema present. Here is a differential diagnosis organized into categories:

• Single Most Likely Diagnosis
  • Balanitis: This is an inflammation of the glans penis and is common in uncircumcised males. The patient's symptoms of inflammation to the superior aspect of his foreskin, pain, and edema are consistent with balanitis. It can be caused by poor hygiene, infections (bacterial, fungal, or viral), or allergic reactions.
• Other Likely Diagnoses
  • Phimosis: Although the patient can roll down past the head, a partial phimosis could still cause inflammation and pain, especially if there is a degree of narrowing that leads to irritation or infection.
  • Urinary Tract Infection (UTI): While less common in young men, a UTI could cause genital pain and inflammation, especially if the infection has spread to involve the genital area.
  • Sexually Transmitted Infections (STIs): Various STIs, such as gonorrhea, chlamydia, or syphilis, can cause genital pain, inflammation, and edema.
• Do Not Miss Diagnoses
  • Paraphimosis: This is a condition where the foreskin is retracted behind the glans and cannot be returned to its original position, leading to swelling and pain. It's a medical emergency that requires prompt treatment to prevent complications like ischemia and necrosis of the glans.
  • Fournier's Gangrene: A severe and potentially life-threatening condition characterized by necrotizing fasciitis of the genitalia. Early recognition and treatment are crucial to prevent significant morbidity and mortality.
• Rare Diagnoses
  • Fixed Drug Eruption: A rare condition where certain medications cause a skin reaction that can lead to inflammation and pain in the genital area.
  • Lichen Sclerosus: A chronic inflammatory skin condition that can affect the genital area, leading to pain, inflammation, and scarring.

Each diagnosis has a brief justification based on the patient's symptoms and the common causes of genital pain and inflammation in young, uncircumcised males. The categorization helps prioritize the most likely and critical diagnoses for immediate consideration and treatment.