Balanitis and balanoposthititis

Balanitis (inflammation of the glans) is a skin disorder that affects the glans of the penis and causes swelling, redness and discomfort.
Balanitis can be acute (usually heals fairly quickly) or chronic (lasts longer than a few weeks).

When an illness is described, the terms "acute" and "chronic" refer to the period over which it is suffered, not the severity of the illness.
You can also suffer from balanitis, which occurs again and again after treatment.

This is known as recurrent balanitis.
Balanitis does not cause impotence (erectile dysfunction) because it does not affect the circulation of the blood.
This disease affects both children and adults.

What are the signs and symptoms of balanitis?

Signs and symptoms of balanitis can include:

Red area on the glans (front part of the penis)
Inflammation of the glans
Acorn pain
There may be a crumbly and dense discharge under the foreskin
Itching around the glans area
Bad intimate smell
Painful urination
Enlarged inguinal lymph nodes

Usually, pain, irritation, and discharge under the foreskin appear a day or two after intercourse.

Some signs and symptoms of balanitis are similar to infections in sexually transmitted diseases or thrush.

What leads to balanitis?

The most common causes are:

irritants: neglected hygiene and tight foreskin (especially in adolescents) cause irritation from smegma (a creamy substance that is secreted by the foreskin).
Seborrheic dermatitis: an inflammatory eczema of uncertain origin, which is often found on the head, behind the ears and in the folds of skin.
Candida: although doctors and patients are likely to diagnose this infection too often.
contact dermatitis: Latex, additives in rubber manufacturing (e.g. condoms) and components of skin care products (used by the patient or his partner).
Balanitis xerotica obliterans (also called lichen sclerosus): this disease mainly affects the foreskin and causes fading of the skin color, scars and narrowing of the foreskin, as well as phimosis (inability to pull the foreskin back behind the glans).
A cortisone ointment can help relieve the irritation, but patients need regular check-ups to avoid relapses.
Surgery may be required to avoid narrowing the urethra.
Balanitis circinata: a manifestation of Reiter’s syndrome on the skin, in which patients also suffer from arthritis (often on the knee), urethritis (inflammation of the urethra in the penis) and conjunctivitis (red eyes).
Generalized skin disease: can also affect the penis and can be: lichen planus, psoriasis, erythema multiforme, medication erythema (mainly caused by antibiotics such as tetracyclines), erythroplasia de queyrat (a rare and precancerous skin disease).
virus: the herpes virus can cause balanitis herpetica.
diabetes.

Infectious balanitis can be transmitted to the partner during sexual intercourse. If it is not caused by an infection, there is no risk of infection.

Balanitis / vulvitis plasmacellularis

Plasma-cellular disorders usually appear as persistent red spots that are limited to the genitalsn.
The disease is called plasmacellularis in men and vulvitis plasmacellularis in women due to the large number of plasma cells (white blood cells) found in the skin during a biopsy.
Plasmacellularis (or zoon balanitis) affects the glans.

What are the signs and symptoms of plasmacellularis balanitis?
In men, plasmacellularis is a single bright orange-red plaque formation.
Patients do not have to have symptoms, but may experience pain and / or mild itching.

What is the cause of plasmacellularis balanitis?
The cause of plasmacellularis balanitis is unknown. The identification of plasma cells in a skin biopsy can be very unspecific and the response to infection, irritation or injury.
In the differential diagnosis, infection, allergic contact dermatitis, psoriasis, lichen planus or intraepithelial neoplasia of the penis must be excluded.

Balanitis from phimosis

In adolescent men, balanitis is usually associated with a narrowing of the foreskin, in which the foreskin cannot be pushed back over the glans (phimosis). The phimosis leads to poor hygiene and constant contact of urine and smegma with the glans skin. In such cases, antibiotic ointments usually help, but if there is recurrence, an urinary tract examination should be carried out to rule out infection. Sometimes the swelling and irritation of the glans can result from paraphimosis, which develops when the foreskin is too tight around the glans. The tightness around the penis body reduces the venous blood flow at the tip of the penis. The glans swells and continues to narrow the paraphimosis, making it impossible to push the foreskin back.

Finally, the restriction of blood supply can damage the glans and urgent medical intervention is required (circumcision).

Diagnosis of balanitis

The doctor asks about the symptoms and carries out an examination.
He can also ask about previous illnesses and operations.
The doctor may also have laboratory tests for communicable sexually transmitted diseases.
Because balanitis can sometimes be a sign of diabetes, the doctor could do blood tests to check for the presence of this condition.

The doctor can do one biopsy take a tissue sample from the tip of the penis and send it to a laboratory to check for the presence of an infection.
If balanitis recurs after therapy, the doctor may recommend a biopsy.

Complications and risks of balanitis

An untreated recurrent balanitis can lead to phimosis, i.e. the complete or partial inability of the foreskin to expose the glans.

Treatment of balanitis

Therapy of balanitis depends on the cause. In many men and adolescents, good hygiene also improves balanitis.
The patient can contact an andrologist, but a dermatologist is more appropriate in this case.

Natural remedies for balanitis

It is important that the foreskin is kept clean and dry. You should use warm water without soap and bath products.
The doctor may recommend the use of an emollient cream (e.g. an aqueous cream) to treat and soothe the area.
If balanitis is caused by an irritant such as a condom or soap, these products should be avoided.
Symptoms should go away when the skin no longer comes in contact with the substances that are causing the problem.

Baths with water and sodium bicarbonate can be useful for Candida fungal infections.
If irritation occurs, almond oil can be applied to the glans.

drugs
The doctor can prescribe a cortisone ointment that is applied directly to the skin.
This helps relieve the inflammation and symptoms.
If there is an infection, the doctor can prescribe an antifungal cream or ointment to apply to the skin.
Alternatively, a combination of cortisone and antifungal ointments can be recommended.
An antifungal (anti-fungal medication) is e.g. Clotrimazole (Canesten).

If the infection is bacterial or cream or ointment doesn’t work, the doctor may recommend antibiotic tablets.

A normal bacterial infection can usually be treated with flucloxacillin or amoxicillin (Zimox, Augmentin).
Erythromycin can be used in patients with an allergic reaction to penicillin.

Anaerobic infection

Recommended dose: 400 mg metronidazole twice a day for a week.
Alternative therapy: 375 mg Augmentin three times a day for a week; Apply clindamycin ointment twice a day until the infection is cured.

One of the side effects of antibiotics is the loss of the balance of the intestinal flora. Therefore, it is recommended to take probiotics to improve intestinal health.

If the balanitis has not improved after treatment or if it recurs, the doctor can recommend a visit to a dermatologist.

Surgical intervention

Circumcision is rarely used to treat serious balanitis. Circumcision is an operation in which the foreskin on the penis is removed. The doctor may advise circumcision if the balanitis keeps recurring or if complications arise.

How long does balanitis last? forecast

This infection has a short duration, usually a maximum of 7-10 days.
Prevention is important to avoid recurrence. You should avoid unprotected sexual intercourse with strangers, reduce stress and follow a healthy diet.

Balanoposthitis

In men, balanoposthitis (inflammation of the foreskin) is inflammation of the skin at the tip of the penis. Balanitis is an inflammatory disease in which only the glans is affected, posthitis is an inflammation of the inner foreskin of the penis.

Causes of balanoposthitis

Bacterial infections (from streptococci, staphylococci, Trichomonas, Escherichia, enterococci)
candidiasis
chlamydia
Gonorrhea
herpesvirus
trauma
Lack of hygiene
Irritation from soap
disinfectant

Balanoposthitis is more common in uncircumcised men due to the wetter and warmer microclimate of the skin.

Symptoms and signs of balanoposthitis

There are different forms of the disease:

Simple balanoposthitis
You see changes in the form of redness, swelling and secretion on the glans or skin and sometimes more or less large wounds are formed.
You may experience itching, burning or discomfort when urinating.
This type of balanoposthitis can be irritating (caused by chemical or mechanical irritation) or caused by a bacterial infection.

Balanoposthitis candidamycetica
Balanoposthitis candidamycetica (candidiasis) is characterized by red efflorescences and the appearance of white blisters, itching and burning due to the spread of the Candida fungus. It often occurs in diabetics, people with weakened immune systems and people who take medication.

Balanoposthitis erosiva circinata
The balanoposthitis erosiva circinata has a chronic course with irregular whitish, red and gray-white skin changes. It often occurs alone or in connection with Reiter’s syndrome.

Diagnosis of balanoposthitis

The diagnosis is made according to the clinical appearance. If necessary, additional examinations are carried out to find the exact cause of the disease. The partner should also be examined.

Therapy for balanoposthitis

The basic treatment approach is to remove the triggering factors. It is recommended to wash the affected skin areas with water and neutral soap and to rinse them with manganese.
A cream or lubricant can be applied to treat dryness of the skin, depending on the cause, the treatment may include an antibiotic or a local or systemic antifungal.
You can apply Gentalyn Beta, a combination of gentamicin and betamethasone.

Balanoposthitis must be taken seriously and treated with appropriate therapy because it can become chronic if the mucosa becomes shiny and smooth, regresses and loses its elasticity.
Possible complications of the disease are phimosis (the foreskin cannot be pulled back over the glans) and paraphimosis.

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