Balanitis is a topic covered in the Johns Hopkins Antibiotic (ABX) Guide.

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CLINICAL

  • Definition: inflamed glans penis +/- prepuce.
  • Causes/associations: infection, diabetes mellitus (check serum or urine glucose as may be initial presentation), poor hygiene (uncircumcised), chemical irritants (soap, petroleum jelly), anasarca, drugs, morbid obesity, penile CA.
  • Hx: tender glans, discharge, difficult to retract prepuce +/- impotence/difficult urination.
  • PE: penile erythema/edema/ulcers/plaques +/- discharge +/- phimosis.
  • Various types:
    • Candidal: KOH prep/cx.
    • Aerobic: cx for Strep/Staph/Gardnerella (r/o syphilis/trichomonas/HSV).
    • Anaerobic: foul-smelling d/c, edema + lymphadenopathy. Gram stain will show mixed flora, polymicrobial cx.
    • HPV: typical pathology with warts possible.
    • Circinate: manifestation of reactive arthritis (formerly Reiter’s syndrome). Bx - spongiform pustules, may be chlamydia probe positive.
    • Irritant/allergic: ? secondary to condoms, diaphragms, lubricants/spermicides, etc. Hx atopy common. Patch testing. Bx nonspecific.
    • Fixed drug eruptions: medication hx (tetracycline, sulfa, PCN, salicylates, phenacetin, phenolphthalein, some hypnotics), + oral/ocular mucosa lesions. Rechallenge to confirm dx.
    • Lichen sclerosus (balanitis xerotica obliterans): dx by bx. Associated with squamous call CA in 4-6% of patients. 1% risk of malignant transformation. Annual f/u needed.
    • Erythroplasia of Queyrat: bx shows squamous cell carcinoma in situ.
    • Zoon’s (plasma cell): pinpoint red spots "cayenne pepper spots" (typical appearance) or bright red or brown shiny patches with red specks. May resemble erythroplasia of Queyrat. Dx by biopsy.
  • Ddx: leukoplakia, lichen planus, psoriasis, seborrheic dermatitis, pemphigus, dermatitis artefacta, Bowen’s disease, Bowenoid papulosis.
  • If not responsive to initial therapy, involve dermatology or urology consultants. If resistant to rx, consider biopsy r/o penile CA.

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Last updated: April 23, 2014