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Balanitis, Posthitis, and Balanoposthitis

by Patrick J. Shenot, MD

Balanitis is inflammation of the glans penis, posthitis is inflammation of the prepuce, and balanoposthitis is inflammation of both.

Inflammation of the head of the penis has both infectious and noninfectious causes (see Causes of Penile Inflammation). Often, no cause can be found. Balanoposthitis often occurs in patients with a tight prepuce (phimosis), which interferes with adequate hygiene. The subpreputial secretions may become infected with anaerobic bacteria, resulting in inflammation. Diabetes mellitus predisposes to balanoposthitis. Balanitis usually leads to posthitis except in circumcised patients. Chronic balanoposthitis increases the risk of balanitis xerotica obliterans, phimosis, paraphimosis, and cancer.

Causes of Penile Inflammation

Category

Examples

Infectious

Candidiasis

Chancroid

Chlamydial urethritis

Gonococcal urethritis

Herpes simplex virus infection

Molluscum contagiosum

Scabies

Syphilis, primary or secondary

Trichomoniasis

Noninfectious

Balanitis xerotica obliterans

Contact dermatitis

Fixed drug eruptions

Lichen planus

Lichen simplex chronicus

Psoriasis

Reactive arthritis*

Seborrheic dermatitis

*Reactive arthritis can cause shallow, painless ulcers of the glans (balanitis circinata).

Symptoms and Signs

Pain, irritation, and a subpreputial discharge often occur 2 or 3 days after sexual intercourse. Phimosis, superficial ulcerations, and inguinal adenopathy may follow.

Diagnosis

Patients should be tested for both infectious and noninfectious causes, especially candidiasis. Blood should be tested for glucose. The skin should be examined for lesions that suggest a dermatosis capable of genital involvement. History should include investigation of latex condom use.

Treatment

Hygiene measures should be instituted and specific causes treated. Subpreputial irrigation to remove secretions and detritus may be necessary. If phimosis persists after inflammation has resolved, circumcision should be considered.

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