Treatment

Investigations

Balanitis

Definitions:

· balanitis - inflammation of the glans penis

· posthitis - inflammation of the foreskin

· balanoposthitis - inflammation of the glans penis and foreskin

Balanitis is inflammation of the glans penis. If the foreskin is also inflamed, the correct term is balanoposthitis, although balanitis is commonly used to refer to both.

Inadequate hygiene is the most common cause of nonspecific acute balanoposthitis, which usually occurs in boys aged 2 to 5 years. Irritation from soaps, bubble baths, laundry detergent, and antistatic sheets have also been implicated. Balanitis in children usually arises from an infection of the smegma on the basis of a phimosis or non-retractile foreskin.

Other causes include trauma from masturbation and zip-fastener injuries.

Risk factors:

* The most important risk factor is diabetes mellitus.

* Use of oral antibiotics.

* Poor hygiene in uncircumcised males.

* Immunosuppression.

* Chemical or physical irritation of glans.

Balanitis is common in young boys with a non-retractile foreskin and in the elderly where there may be predisposing factors such as malignancy or diabetes. The organisms most commonly involved are faecal bacteria and candida. Streptococcus pyogenes, Staphylococcus aureus, Neisseria gonorrhoeae, Chlamydia trachomatis, and anaerobes are the usual bacterial pathogens in children in this country. Viral and protozoal infections are reported causes in third world countries.

Balanitis xerotica obliterans is a rare cause of acute balanoposthitis in children. This condition manifests as whitish plaques on the surface of glans and prepuce, usually around the corona and up to the external meatus; the foreskin is thickened, fibrous, and nonretractable.

Clinical features of nonspecific acute balanoposthitis include pain, erythema, and swelling of the glans penis and prepuce. In most cases, there is little or no discharge. True urethral discharge, suggestive of sexually transmitted disease, is seen after milking the length of the urethra starting from the base of the penis.

* Blood/urine testing for glucose if diabetes mellitus is possible.

* Swab of discharge for microscopy, Gram staining, culture and sensitivity.

* If syphilis or other sexually transmitted infections (STI) is suspected, refer to a Genitourinary Medicine Clinic.

Treatment depends on the underlying cause.

Treatment of nonspecific acute balanoposthitis usually includes:

· Local hygiene (keep area clean by bathing 2 to 3 times a day while symptoms persist)

- Warm bath with dilute saline (four tablespoons or so in a bath).

- Warm bath with potassium permanganate solution (1 in 10,000 dilution) is nearly always beneficial when used to wash the penis but causes temporary purple discolouration.

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· In most cases topical treatment is recommended.

- Topical hydrocortisone 1% cream (twice a day) or ointment may help in mild cases (steroid creams of mild to moderate strength are used in short-term courses for non-infective eczematous or inflammatory skin conditions).

- Topical antibiotics creams are sometimes used but are of unproven efficacy.

- If candidal infection is the suspected cause: clotrimazole cream 1% or miconazole cream 2%; apply twice daily until symptoms have settled.

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· Systemic therapy should be considered if there is severe inflammation affecting the penile shaft, or marked genital oedema.

- If there is significant bacterial infection of the whole of the foreskin or the skin of the penile shaft then bacterial infection is likely and antibiotics should be given. Most cases respond to oral antibiotics (e.g. flucloxacillin or erythromycin). Occasional cases require admission for parenteral antibiotics.

- If candidal infection is the suspected cause: fluconazole 150 mg stat orally if symptoms are severe.

- Anaerobic infection: metronidazole 400 mg twice-daily for one week.

· Analgesia is important, and sitting in a warm bath may ease dysuria.

· Surgical referral for consideration of circumcision if balanitis is recurrent or pathological phimosis is present.

· Balanitis xerotica obliterans (BXO)and rarer skin conditions require referral to an urologist or dermatologist.

In children, symptoms typically resolve 3 to 5 days after treatment is started.

Recurrent balanitis may cause a phimosis with disturbance of micturition.

Дата добавления: 2014-10-15