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

From the Guidelines

Balanitis treatment should primarily focus on addressing the underlying cause, with topical antifungal agents being a beneficial treatment option for relieving symptoms, as suggested by the Centers for Disease Control and Prevention 1. When considering treatment for balanitis, it's essential to identify the underlying cause, which can range from infections to irritations.

• For mild cases, improved hygiene practices are crucial, including gentle washing with warm water and avoiding the use of soaps, followed by thorough drying.
• In cases of fungal infections, applying an antifungal cream such as clotrimazole 1% or miconazole 2% twice daily for 7-14 days can be effective.
• If a bacterial infection is suspected, topical antibiotics like mupirocin 2% ointment applied three times daily for 7-10 days may be considered.
• For more severe or persistent cases, oral medications such as fluconazole 150mg for fungal infections or antibiotics like cephalexin 500mg four times daily for 7 days for bacterial infections might be necessary.
• Additionally, using mild emollients like petroleum jelly can provide relief for irritation-related balanitis, and retracting the foreskin during hygiene practices can help prevent recurrence in uncircumcised men.
• It's also important to manage underlying conditions such as diabetes, which can contribute to recurrent infections, emphasizing the need for blood sugar control 1.
• Treatment should be continued until symptoms resolve completely, typically within 1-2 weeks, and medical evaluation is necessary if symptoms persist or recur frequently to rule out underlying conditions.

From the FDA Drug Label

A small amount of mupirocin ointment should be applied to the affected area three times daily.

• Balanitis treatment with mupirocin ointment involves applying a small amount to the affected area three times daily 2.
• The area treated may be covered with a gauze dressing if desired.
• Patients not showing a clinical response within 3 to 5 days should be re-evaluated.
• Mupirocin is active against a wide range of gram-positive bacteria including methicillin-resistant Staphylococcus aureus (MRSA) and certain gram-negative bacteria 2.

From the Research

Balanitis Treatment Options

• Topical mupirocin ointment has been shown to be effective in treating Zoon's balanitis, also known as balanitis circumscripta plasmacellularis (BCP) 3
• Circumcision and topical calcineurin inhibitors are also treatment options for BCP 3
• For infectious balanitis, antifungal agents and antibiotic therapy may be used, depending on the causative microorganism 4
• Steroid creams are often the first-line treatment for Balanitis Xerotica Obliterans (BXO), but surgical intervention may be necessary in some cases 5

Management of Balanoposthitis

• The 2022 European guideline for the management of balanoposthitis provides updated recommendations for the diagnosis and treatment of penile skin conditions, including infective balanitis and Lichen sclerosus 6
• The guideline emphasizes the importance of recognizing the symptoms and signs of penile skin conditions and offers recommendations for diagnostic tests and treatment 6
• Management of balanoposthitis may involve a range of treatments, including topical creams, oral medications, and surgical intervention, depending on the underlying cause and severity of the condition 4, 5, 6

Complications and Prevention

• Balanitis can have several complications, including severe pain, urethral stenosis, phimosis, sexual dysfunction, and malignancy if left untreated 7
• Early referral to a specialist, such as a plastic surgeon or reconstructive urologist, may be necessary for patients with recurrent or severe balanitis 5
• Prevention of balanitis may involve good hygiene practices, safe sex, and regular check-ups with a healthcare provider 4, 7