Balanitis

What is balanitis?

Infection or inflammation of the glans of the penis is called balanitis.  Around 3 to 11% of males are affected by this condition during their lifetime.  It is generally accompanied by another condition called posthitis, which is inflammation of the foreskin.

Balanoposthitis is the medical term used for inflammation of both the foreskin and the glans of the penis.  This condition generally occurs in men who are uncircumcised and it is estimated that around 6% of the uncircumcised male face this problem.  In the case of an uncircumcised male, the glans penis is covered by a flap of skin called the foreskin.

Different factors are responsible for the occurrence of balanitis such as tight foreskin, uncircumcised penis, as well as unhealthy hygiene.  Balanitis is not a sexually transmitted disease. The infection and inflammation are mainly associated with certain yeast, bacteria, or virus.

Types of balanitis

Zoon’s balanitis: This type of balanitis mainly affects middle-aged men who are not circumcised.  The head of the penis and the foreskin are involved causing inflammation.

Circinate balanitis:  This is caused because of reactive arthritis.  There are occurrences of circinate balanitis independently.  Ring-shaped dermatitis is formed around the glans penis causing discomfort.

Pseudoepitheliomatous keratotic and micaceous balanitis:  This is considered to be a rare condition with wart-like skin lesions on the head of the penis.

Causes

The first and foremost reason for the cause of balanitis is due to lack of hygiene.  If the area is not thoroughly cleaned, you have a higher chance of developing an infection.  It should be noted that this condition arises when there is the growth of bacteria or yeast.  It is recommended to use a mild soap to clean the area, but make sure to rinse off the soap thoroughly.  If the soap is not rinsed properly, it may lead to irritation of the skin leading to moisture accumulation and later lead to infection.

People suffering from diabetes are at higher risk of developing balanitis.  If your blood sugar is not under therapeutic levels, it can lead to the occurrence of infection. When sugar is excreted through urine, there is an increased number of sugar molecules present in the urine.  If the penis is not cleaned regularly, the urine that is retained underneath the foreskin becomes a breeding ground for bacteria and yeast. Over a period of time, there is increased growth of these organisms leading to balanitis. It is therefore advised that if you suffer from diabetes, you must get regular blood tests to check your levels of fasting blood sugar and post prandial blood sugar. These simple blood tests can be done at home.

Chlamydia which is the leading cause for balanitis is also responsible for a medical condition called reactive arthritis. This is an autoimmune disease that affects the joints and is also considered to cause circinate balanitis.  While anyone can be affected by balanitis, a man who is not circumcised has a higher chance of getting it. If the foreskin is tight and cannot be retracted, it can lead to balanitis and if it keeps returning, it is a clear indication that it is caused by a yeast infection that can be transmitted from one partner to another. The warm and moist condition underneath the foreskin is highly suitable for the yeast to breed and multiply.

When a man is born with an anatomical abnormality of the tight foreskin, it is important to understand that unless and until the area is thoroughly cleaned every day, there is always a chance of developing an infection.  Candida albicans is the most common cause of infection and surprisingly it is always present in our body.  When a suitable condition is available such as abnormal pH, there is excessive growth of these organisms causing the infection.

Skin conditions that cause balanitis

• Bacteria or yeast infections such as Candida that live on the skin. This is considered the most common cause.
• Herpes simplex virus can cause infections that are sexually transmitted.
• Irritation by foreign agents such as soap or detergents.
• Skin conditions such as psoriasis that is considered noncancerous can also cause balanitis.

Some of the infectious etiologies related to balanitis include candidal species (generally associated with diabetes), beta-hemolytic streptococci group A and B, Neisseria gonorrhea, Chlamydia species, anaerobic infection, human papillomavirus, Gardnerella vaginalis, syphilis, Trichomonas species, as well as Borrelia vincentii.

Non-infectious etiologies include unhealthy hygiene, chemical irritants (such as soaps, detergents, shower gels, conditioners), edematous conditions, including congestive heart failure, cirrhosis, nephrosis, drug allergies, morbid obesity, allergic reaction (related to condoms), plasma cell infiltration, trauma, neoplastic condition, as well as autodigestion by activated pancreatic transplant exocrine enzymes.

Other cause of balanitis include

Diabetes:  Diabetes may exacerbate the risk of infections.  This is generally caused when the blood sugar levels are not appropriately controlled.  Due to increased levels of urine glucose, some of the urine which is retained on the penis aids in the production of bacterial rapidly causing infection of the foreskin.

Phimosis:  This is a medical condition where the foreskin is not able to be retracted or pulled backward.  If this condition is ignored, sweat, dead skin tissue and cells, as well as oil from the genitals get accumulated under the foreskin causing irritation, as well as germs, multiply.  Phimosis generally occurs when the penis is uncircumcised.

Complications of balanitis

Getting a medical check-up at the earliest can reduce your chances of developing complications from balanitis.  Some of the possible complications include:

• Burning with urination as well as scarring at the opening of the penis.
• Foreskin retraction could become difficult due to the pain associated with it.
• Infection may lead to the inadequate blood supply to the penis.

Diagnosis

Diagnosing balanitis is not very difficult.  A single visit to the doctor can confirm the diagnosis.  A simple physical examination of the patient’s penis can determine if he has balanitis.  It is generally characterized by observing redness and inflammation of the glans penis.

Medical history is reviewed by the patient and possible causes are analyzed.  The patient is then advised regarding possible irritants as well as how to avoid them.  The patient will be advised to maintain healthy hygiene to avoid infections.  The doctor may also advise against the use of latex condoms, which has the potential to cause irritation to the glans.  Over-The-Counter treatment is prescribed to the patient.  This may include a topical cream, which needs to be applied to the genitals.

Generally, balanitis should be resolved within a week of over-the-counter medications.  If the symptoms of balanitis continue and there is increased inflammation and redness around the glans penis, the doctor may decide to do some diagnostic tests.  Some of the possible tests include a swab test of the glans, which is then tested in the lab for infection.  Secondly, a urine test may be advised in case of diabetes.  Finally, a blood test is drawn to determine glucose levels. (the diagnosis is not well-structured and organized)

Treatment

Once the diagnosis of balanitis is made, it is important to find the cause of the infection.  If the infection is caused due to bacteria, an antibacterial cream is prescribed, which needs to be applied over the glans penis and the inner portion of the foreskin after cleaning the area thoroughly with mild soap and water.  In the case of yeast infection, which is quite common, you will be provided with an antifungal cream, which needs to be applied after cleaning the area.

If the infection recurs, your doctor would recommend treatment with an antifungal agent in the form of a pill.  In some cases, the area may be inflamed but not infected.  In such an event, you will be advised to wash the area regularly after each time you use the washroom.  You may also be prescribed a steroid cream such as cortisone to aid in reducing the inflammation.  Practicing good hygiene along with medicated cream helps clear up any infection.  You can consult your doctor to find ways to improve your hygiene.

Prevention

Infections can be prevented by following some simple steps.  First and foremost, the head of the penis and the foreskin should be kept clean and dry.  Some of the hygiene tips are discussed below:

• Make a point to pull the foreskin backward, which exposes the glans.
• The area of the glans penis should be washed thoroughly with warm water. Try to avoid soap and other shower gels to prevent irritation.
• A non-soap based cleanser may be used to wash the area, but make sure to rinse the area thoroughly.
• Make sure to pat dry the glans penis completely before replacing the foreskin.

Finally, it is important to have protected sex with your partner if already experienced balanitis due to sexually transmitted infection previously. The head of the penis and the foreskin should be kept clean and dry. Daily washing, with particular attention to cleaning the penis, is essential.

References