Balanitis

Balanitis is an inflammation of the glans penis. When the foreskin is also affected, the condition is termed balanoposthitis. This inflammation can arise from various causes, including infections, physical trauma, and environmental irritants. It is important for healthcare professionals, including dentists preparing for professional exams, to understand the clinical presentation, diagnosis, and treatment of balanitis.

Signs and Symptoms

Balanitis presents with several characteristic signs and symptoms that can help in its identification. The initial sign is often small, red erosions on the glans, accompanied by redness of the foreskin and penis. Patients may also experience other rashes on the head of the penis, foul-smelling discharge, and pain in the foreskin and penis.

Complications can arise from recurrent balanitis, leading to scarring of the preputial orifice and reduced elasticity, which may result in pathologic phimosis. Other potential complications include stricture of the urinary meatus, phimosis, and paraphimosis.

Causes

The inflammation associated with balanitis can be attributed to multiple causes. These include irritation from environmental substances, medications, physical trauma, and infections (bacterial, viral, or fungal). Some infections may be sexually transmitted. Balanitis is less common in circumcised individuals, as foreskin dysfunction often contributes to the condition. Both inadequate cleaning and excessive cleaning can lead to balanitis.

Diagnosis

Diagnosing balanitis involves a thorough identification of the underlying cause, which may require a detailed patient history, swabs and cultures, and pathological examination of a biopsy. Recognising the type of balanitis is also very important for appropriate management:

• Zoon's balanitis (plasma cell balanitis): A rare, benign penile dermatosis often treated with circumcision or laser therapy.
• Circinate balanitis: Associated with reactive arthritis, presenting as serpiginous annular dermatitis.
• Pseudoepitheliomatous keratotic and micaceous balanitis: A rare form with distinct clinical features.

Treatment

Initial treatment in adults generally involves retracting the foreskin and cleaning the penis. For mild cases, topical antibiotic and antifungal ointments may be effective. In more severe cases, hydrocortisone and other steroidal creams may be necessary. The choice of treatment should be guided by the underlying cause and severity of the condition.

Epidemiology

Balanitis is a common condition, affecting approximately 11% of adult men seen in urology clinics and 3% of children in the United States. Globally, it may occur in up to 3% of uncircumcised males, making it a significant health concern.

Balanitis in Other Animals

In dogs, balanoposthitis is often due to a disruption in the integumentary system, such as a wound or foreign body intrusion. Affected dogs exhibit excessive licking of the prepuce and may have a yellow-green, pus-like discharge. In sheep, ulcerative enzootic balanoposthitis is caused by the Corynebacterium renale group. In bulls, a similar condition is caused by Bovine herpesvirus 1. Balanoposthitis has also been implicated in the near-extinction of Gilbert's potoroo, highlighting its impact on various animal species.

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Self-assessment MCQs (single best answer)

What is balanitis?

What is the term for inflammation of both the glans penis and the foreskin?

Which of the following is NOT a common symptom of balanitis?

What is a potential complication of recurrent balanitis?

Which of the following is NOT a cause of balanitis?

How is Zoon's balanitis typically treated?

What is circinate balanitis associated with?

Which of the following treatments is NOT typically used for balanitis?

What percentage of adult men seen in urology clinics are affected by balanitis?

Which animal is NOT mentioned as being affected by balanoposthitis?