Balanitis

Balanitis is an infection that causes inflammation in the glans penis. The glans, or head, of the penis becomes swollen and painful, and if present the foreskin becomes inflamed. Balanitis commonly occurs in uncircumcised men because moisture can collect in the foreskin of the penis and provide an ample area for bacteria to grow. Balanitis can also occur following an injury to the tip of the penis or foreskin or because of irritation to the area. Balanitis can be a side effect of some medications, or a symptom of other health problems such as arthritis, diabetes, or sexually transmitted diseases. Apart from swelling and pain, balanitis may cause itchiness or penile discharge. Balanitis can be treated in several ways including with the use of an anti-itch cream or steroidal cream. Antibiotic or antifungal medications may also be necessary.

Background

Balanitis can be caused by several different strains of bacteria including candida species,

Streptococci, Neisseria gonorrhoeae, Chlamydia species, Human papilloma virus, Gardnerella vaginalis, Treponemapallidum (syphilis), Trichomonal species, Borrelia vincentii, and Borrelia burgdorferi. Certain types of fungi can also cause balanitis. Balanitis affects approximately 3 to 11 percent of men and can occur at any age. Uncircumcised men with poor hygiene habits are most at risk of experiencing balanitis. Dirt and germs that get trapped in skin folds around the penis lead to infection. Bacteria easily spread in warm, moist areas, which is why uncircumcised men are more likely to contract the infection than others. Men who are morbidly obese also have an increased risk of experiencing balanitis.

The infection is associated with several underlying conditions, primarily diabetes mellitus. It is also associated with conditions that cause edema such as congestive heart failure, cirrhosis, and nephrosis. A type of arthritis known as reactive arthritis has also been known to cause balanitis. Other causes of balanitis include irritation to the glans penis. Irritation can occur in a number of ways such as via injury, through friction with clothing fabric, or through the use of harsh soaps or cleansers on the genital area. Harsh chemicals in soaps, cleansers, and even lotions can lead to irritation of the genital area and cause infection. Certain drugs, such as tetracycline and sulfonamide, produce an allergic reaction that can lead to balanitis. Balanitis is also listed as a possible side effect of certain medications such as dapagliflozin, which is used to treat type II diabetes. This drug removes sugar from the body via urine, and since sugar is a breeding ground for yeast, use of the drug may cause a balanitis infection.

Several types of balanitis exist. Zoon’s balanitis, also known as balanitis circumscripta plasmacellularis involves lesions on the glans and most often occurs in older, uncircumcised men. Circinate balanitis is associated with reactive arthritis and also presents as red lesions on the glans. These lesions are usually painless and form a ring around the glans. Another type of balanitis is pseudoepitheliomatous, keratotic, and micaceous balanitis, a cutaneous form of the condition that primarily affects elderly men and presents as skin lesions characterized by whitish, crusty plague.

Overview

When balanitis occurs, the glans becomes swollen and red. It is often painful and sometimes may be itchy. Discharge may emit from the tip of the penis. Foul odor may also occur due to dead cells, discharge, and oils building up in the skin folds of the inflamed area. The debris that builds up in this area is called smegma. Balanitis may also impact a patient’s urethra and make it difficult to urinate. It may also impact the individual’s sex life as he may not be able to get an erection. Other symptoms include difficulty retracting the foreskin, ulceration or plaques, fever, or nausea.

Complications from untreated balanitis can lead to a condition called phimosis, an inability to retract the foreskin beyond the glans. Phimosis most commonly occurs in individuals suffering from chronic balanitis as opposed to acute. Other complications include scarring within the penis opening, painful foreskin retraction, and insufficient blood supply to the penis. Scar tissue within the penis opening can make urinating difficult or painful. Balanitis also increases a male’s risk of getting penile cancer.

Balanitis can usually be diagnosed with a simple physical exam by a doctor since most symptoms are highly visible. Doctors may take a sample of urine or discharge to test for the presence of bacteria or fungus. This helps the doctor determine the best course of treatment. If bacterial or fungal in nature, antibiotics or anti-fungal medication may be administered to treat balanitis. For balanitis that is caused by a skin condition, the doctor may remove a small piece of tissue from the penis for biopsy. A biopsy allows the physician to look for the presence of disease and examine treatment options based on biopsy results. Antifungal or antibiotic creams that relieve itching and swelling may also be prescribed. Doctors may prescribe a steroidal cream if inflammation is particularly bad.

Men can undertake a variety of preventative measures to ensure that they do not develop balanitis. Good personal hygiene is the most important preventative practice. In addition to showering daily, it is also important to shower after prolonged sweating or engaging in sexual intercourse. They should use a mild, unscented soap to avoid irritation or harsh chemicals. Men should also avoid using perfumed powders, lotions, and sprays. They should ensure that all the soap has been washed off the penis while showering and the penis is completely dried after showering.

Bibliography

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