Makindo Medical Notes

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