Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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Balanitis (Adults)

Related Subjects: |Hypospadias |Phimosis |Balanitis (Children) |Balanitis (Adults)

🩺 Balanitis = inflammation of the glans penis. Often extends to the foreskin (balanoposthitis). Common in uncircumcised men and usually benign, but recurrent cases may signal diabetes or dermatological/STD-related causes.

📖 About

Swelling and inflammation of the glans ± foreskin.
More frequent in uncircumcised adults.
Often related to poor hygiene, infections (fungal, bacterial), or irritant dermatitis.

🧪 Aetiology

Difficult foreskin retraction trapping secretions.
Infections: Candida, Gardnerella, streptococci.
Dermatitis: allergic or irritant (e.g., soaps, latex, creams).
Underlying systemic disease: diabetes mellitus, immunosuppression.

⚡ Clinical Features

Redness, soreness, and swelling of the glans.
Itching or irritation.
Discharge beneath foreskin.
Dysuria (painful urination) or dyspareunia (painful sex).

🔀 Differential Diagnosis

Ulceration or induration → suspect penile carcinoma (urgent referral).
Inguinal lymphadenopathy or urethritis (consider STIs).
Specific balanitides (e.g., Zoon’s balanitis, lichen sclerosus).

🔎 Investigations

🧪 Urinary glucose: exclude diabetes mellitus.
🧫 Sub-preputial swab: if symptoms persist or diagnosis uncertain.

💊 Management (NICE)

🧼 General hygiene: Wash daily with lukewarm water only. Avoid soap/irritants. Consider emollient (e.g., emulsifying ointment) as soap substitute.
🌿 Non-specific dermatitis (± Candida): Hydrocortisone 1% OD + imidazole cream (clotrimazole, miconazole, econazole) for ≤14 days.
- If no improvement at 7 days → stop hydrocortisone + swab.
🧴 Irritant/allergic dermatitis: Stop suspected trigger (e.g., latex condoms). Hydrocortisone 1% OD until resolved (≤14 days).
🍄 Candidal balanitis: Topical imidazole cream (clotrimazole, econazole, ketoconazole, miconazole). Oral fluconazole 150 mg single dose (≥16 yrs).
- Add hydrocortisone 1% if painful inflammation (≤14 days).
- No response at 7 days → stop steroid + swab.
🦠 Gardnerella-associated: Oral metronidazole 400 mg BD × 7 days. + Hydrocortisone 1% if inflamed.
🧬 Streptococcal balanitis: Flucloxacillin 500 mg QDS × 7 days. If penicillin-allergic → erythromycin 500 mg QDS × 7 days or clarithromycin 250 mg BD × 7 days.
⚠️ Failure to improve or worsening symptoms: Reconsider diagnosis, take swabs, and refer to specialist if atypical or persistent.

🌟 Teaching Pearls

Recurrent balanitis → think diabetes mellitus → always dip urine.
Persistent or atypical lesions → rule out penile cancer.
In children, balanitis + ballooning of foreskin on urination → may indicate phimosis.

📚 Guidance

NICE CKS: Balanitis

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