What is the diagnosis and treatment for balanitis (inflammation of the glans penis)?

From the Guidelines

Balanitis should be treated with topical antifungal agents to relieve symptoms, as recommended by the Centers for Disease Control and Prevention in 2002 1.

Causes and Symptoms

Balanitis is inflammation of the glans penis, characterized by redness, swelling, pain, and sometimes discharge. It's commonly caused by poor hygiene, fungal infections (particularly Candida), bacterial infections, or skin conditions.

Treatment

Treatment depends on the cause but typically includes:

• Improved hygiene with gentle washing using warm water only (avoiding soap)
• For fungal infections, antifungal creams like clotrimazole 1% or miconazole applied twice daily for 7-10 days are effective
• Bacterial infections may require antibiotics such as mupirocin ointment or oral antibiotics if severe
• Steroid creams like hydrocortisone 1% can help reduce inflammation if irritation is the primary cause During treatment, it's essential to:
• Keep the area dry
• Wear loose cotton underwear
• Avoid sexual activity until symptoms resolve

Special Considerations

If you have diabetes or recurrent episodes, seek medical attention as this may indicate underlying issues. Uncircumcised men are more susceptible to balanitis, and in cases of repeated infections, circumcision might be considered, as supported by the British Association of Dermatologists' guidelines for the management of lichen sclerosus in 2010 and 2018 1. Most cases resolve within 1-2 weeks with proper treatment.

From the Research

Definition and Causes of Balanitis

• Balanitis refers to a variety of unrelated conditions, resulting from infective, irritative, allergic, traumatic, or inflammatory causes, as well as pre-malignant lesions 2.
• It is classically defined as inflammation of the glans penis, often also encompassing the prepuce (balanoposthitis) 3.
• The causes of balanitis can be infectious, such as candidal balanitis, or non-infectious, such as irritant balanitis 4, 5.

Diagnosis and Treatment

• Accurate diagnosis is essential for management, and any fixed, chronic, or suspicious lesion must be rapidly assessed by a biopsy 2, 5.
• Treatment for balanitis depends on the underlying cause, and clotrimazole 1% cream has been shown to be effective in the treatment of candidal balanitis 4.
• A comprehensive review of the various etiologies, clinical workup, and treatments for balanitis is necessary to improve clinical outcomes 3.

Complications and Prognosis

• Balanitis can have numerous complications, including severe pain, urethral stenosis, phimosis, sexual dysfunction, and if untreated, malignancy 3.
• Pre-malignant lesions of the balanopreputial area, such as lichen sclerosus, may develop into squamous cell carcinoma and require lifelong follow-up 2.