Balanitis is the medical term used for inflammation of the glans penis (head of the penis). If the foreskin is also included the term is balano-phostitis. The most common presentation is where both the foreskin and glans are affected.
The most common cause is infection. This can include trichomonas, candidiasis, herpes simplex and syphilis.
Non-infectious causes include drug eruptions, contact dermatitis, psoriasis, lichen planus, and other skin diseases.
In some cases no cause can be found.
Who gets it and who is at risk?
Men with foreskins are at higher risk for certain infections. Good hygiene and safe sex lower the risk significantly.
Unsafe sex (sex with multiple partners without using a condom) increases risk for sexually transmitted diseases and thus also balanitis.
Men with poorly controlled diabetes mellitus are at increased risk for balanitis, particularly caused by candida (yeast infection).
Symptoms and signs
The main symptoms are soreness, irritation and a discharge, often two to three days after sexual intercourse.
The foreskin may be constricted due to inflammation and swelling of the glans and the foreskin itself. Both may have superficial ulceration present as a result of inflammation.
The lymph nodes in the groin area may be tender and enlarged.
The appearance of the condition is characteristic, and so diagnosis is made on examination. However, treatment depends on cause, so smears can be taken from the discharge to identify common sexually transmitted diseases. Blood tests can also identify the cause is some cases.
The urine should be tested for glucose in all cases and particularly in the case of candida balanitis in middle-aged men.
Balanitis is often associated with sexually transmitted diseases and as such can be prevented by using a condom during sexual intercourse and avoiding multiple sexual partners.
Candida balanitis in diabetic men can be prevented by strict attention to the control of blood glucose through correct diet and medication. Proper hygiene is also important.
Circumcision is recommended in diabetics who suffer from repeated balanitis.
Specific antibiotics are used for specific infections; an anti-fungal cream and/or tablet is used to treat candida.
If no cause can be found, saline washes several times a day can help symptoms and relieve the inflammation.
Circumcision is usually recommended in patients with persistent tightness of the foreskin, once the inflammation has resolved.
Skin conditions are sometimes difficult to identify. If a sore on the glans or foreskin persists, a biopsy is indicated to exclude premalignant or malignant conditions.
When to call the doctor
If you suffer from pain and irritation of the head of the penis with a discharge, particularly if you have recently engaged in risky sexual activity, you should see your doctor as soon as possible.
Revised by Dr Frans van Wijk, FCS (Urol), Pretoria Urology Hospital, January 2011