What is Balanoposthitis?
Balanoposthitis is a condition seen in uncircumcised males where the glans penis and the prepuce are inflamed due to several infections related to the non-removal of the foreskin. This is frequently due to non retraction of the foreskin and very poor personal hygiene, which results in too much bacterial and fungal growth around the area.
The most affected groups are children 0-5 years old and adult males who actively engage in sexual intercourse. Other medical conditions may also precipitate to balanoposthitis, which can be more severe. This can signal the onset of bacteraemia and fever in men with very low levels of neutrophils.
Patients with diabetes mellitus are also susceptible to candidal balanitis. This can also lead to infections. Morbidity of this condition is limited to its associated symptoms. Death is only a possibility for those patients who are immunocompromised and those who develop balanoposthitis consequential to septicaemia caused by fungi.
Intermittent balanoposthitis caused by candida albicans results in mondor phlebitis. Severe balanoposthitis enhances the probability of balanitis xerotica obliterans, the tightening of the foreskin or phimosis, cancer and paraphimosis.
Balanoposthitis Signs and Symptoms
Upon physical examination, the following signs and symptoms can be noted:
- Red, damp non-elevated lesions on the glans and foreskin
- Redness of the penis
- Painful penis and prepuce
- Rashes around the penis
- Presence of discharge beneath the prepuce
- Tightening of the foreskin or phimosis
- Foul smelling discharge
- Apparent ulcerations
- Unusual enlargement of the lymph nodes over the groin area
- Low back pain
Causes of Balanoposthitis
In nearly all cases, balanoposthitis results from the existence of the foreskin or prepuce, which may be unnecessary and tightened, making it more susceptible to different infections. The foreskin, with peeling off of epithelial cells and secretions from the glands, provides an inviting warm, damp culture environment for organisms. Therefore, proper personal hygiene is very important for the prevention of balanoposthitis.
Other notable causes include:
- Usage of harsh soaps for genital washing
- Staphylococcus aureus infection
- Candida albicans infection
- Uncontrolled diabetes
- Improperly rinsing soap off during washing
- Diseases like lichen sclerosis and reactive arthritis
The diagnosis of this condition involves the physician doing a physical assessment, which reveals the symptoms most commonly associated with balanoposthitis. Aside from physical examination, the patient’s medical history is also taken. Other tests may include:
- Laboratory studies
- Potassium hydroxide test: This is done to check for the presence of candidial infections, and to know the specific antifungal medication to which the organism is sensitive.
- Serologic test: This test may be prescribed for candidial infections, especially in cases where the infection is unclear.
- Skin biopsy: This procedure is done if the recommended antifungal therapy does not produce a positive result and also to check for the malignancy of the affected area and to rule out other conditions.
The treatment for this condition concentrates on clearing the onset of infection and inhibiting the periodic irritation or infection by way of enhanced hygiene.
The exact treatment regime for balanoposthitis is also dependent on the cause. If the infection is caused by bacteria, then treatment will be based on antibiotics. Treatment may also include steroid based creams to reduce the inflammation.
Supportive Care: Proper personal hygiene, regular hand washing and exposure of the affected part to air helps stop growth of anaerobic micro-organisms.
Medical Care: Application of topical creams are widely used for this condition, to eradicate different microorganisms and stop inflammation.
Antifungal Therapy: These drugs act to slow down the conduits of substances essential for the production of the organisms’ cell membrane or change the capacity of cell membranes to let substance pass through the cell membrane of the fungal cells.
Cotrimazole (Lotrimin, Fomisol 7, Mycelex, Gyne-Lotrimin): These drugs have a broad spectrum of antifungal action against infections which result from different micro-organisms causing skin disorders and yeasts. They slow down the growth of yeasts by changing the capacity of the cell membrane to let substance pass through it, which results in the demise of the fungal cells. 1% cream is usually prescribed.
Antimicrobial Therapy: These drugs function by obliterating the microbes causing the infection, stopping their reproduction or development, or inhibiting their illness causing reactions.
Metronidazole (0.75% MetroGel Cream or lotion, 1% Noritate cream): This in conjunction with imidazole reduces the multiplication of anaerobic bacteris, protozoa, and fungi. It also provides an inflammatory effect, which involves the inflection of white blood cells.
Steroid Creams: These act by inhibiting the inflammation of the glans penis and the foreskin.
Surgery: In severe cases where the foreskin can no longer be retracted for cleaning, circumcision is probably the best choice for treating this condition.
Most patients who suffer from this condition have a good prognosis since, in most instances, the condition can be restricted with the use of specially medicated creams and with proper and improved personal hygiene. Circumcision is generally not needed especially if the balanoposthitis is severe and the foreskin is still retractable and smegma can still be removed.
Early detection and treatment is very important. Normally, balanoposthitis does not exhibit any kind of complications especially if the patient complies with the treatment prescribed. If the condition is left untreated or the inflammation or infection has been prolonged, it can lead to several complications such as:
- Scarring of the penis
- Narrowing of the penile orifice, a condition known as meatal stricture
- Phimosis or severe tightening of the prepuce making it hard to bare the head of the penis
- Paraphimosis or difficulty pushing the foreskin on top of the end of the penis
- Decreased blood supply to the end of the penis as a result of the narrowed penile orifice
The best prevention for Balanoposthitis is proper and good hygiene. Careful, regular washing will help reduce the possibility of balanoposthitis. By gently dragging back the foreskin, the end of the penis can be cleaned with soap and water. Rinse off the soap well and gently dry the area. Regular hand washing is also recommended to reduce the likelihood of infection. If you see changes around the scrotal and penile areas, consult a doctor and avoid self diagnosis and self medication.
Picture 1 – Observe unretractility of the foreskin
picture 2 – surgical procedure for Balanoposthitis
Proofreaded and updated by Jean on 23/8/2012 at 11.40pm