Balanitis in Emergency Medicine Clinical Presentation

  • Author: Mark J Leber, MD, MPH, FACEP; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Feb 11, 2011
 

History

Patients with balanitis usually present with the following complaints:

  • Penile discharge
  • Pain or difficulty with retraction of foreskin
  • Impotence
  • Difficulty urinating or controlling urine stream (in very severe cases)
  • Inability to insert a Foley catheter
  • Tenderness and erythema of the glans penis
  • Itching
  • Systemic symptoms such as fever and nausea are uncommon
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Physical

Physical examination findings may include the following:

  • Erythema and edema of glans penis or foreskin
  • Discharge
  • Ulceration and/or plaques
  • Phimosis (uncommon)
  • Signs of urinary obstruction (rare)
    • Meatal stenosis
    • Bladder distension
    • Ballooning of the foreskin when voiding
  • Lymphadenopathy
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Causes

  • Diabetes is the most common underlying condition associated with adult balanitis.
  • Other causes include the following:
    • Poor personal hygiene
    • Chemical irritants (eg, soap, petroleum jelly)
    • Edematous conditions, such as congestive heart failure (right-sided), cirrhosis, and nephrosis
    • Drug allergies (eg, tetracycline, sulfonamide)
    • Morbid obesity
  • Several organisms and viruses cause balanitis, including the following:
    • Candidal species (most commonly associated with diabetes)
    • Group B and group A beta-hemolytic streptococci
    • Neisseria gonorrhoeae
    • Chlamydia species
    • Anaerobic infection
    • Human papilloma virus
    • Gardnerella vaginalis
    • Treponema pallidum (syphilis)
    • Trichomonal species
    • Borrelia vincentii and Borrelia burgdorferi
  • Penile cancer
  • Balanitis xerotica obliterans (lichen sclerosus): This is a chronic dermatosis identified by whitish plaques involving the glans and foreskin (shown in the image below). Balanitis xerotica obliterans (lichen sclerosus). Balanitis xerotica obliterans (lichen sclerosus). Courtesy of Wilford Hall Medical Center Slide collection.
  • Zoon balanitis - Reddish velvety lesion on the glans
  • Reiter disease - Circinate and eroding lesions on the glans
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Contributor Information and Disclosures
Author

Mark J Leber, MD, MPH, FACEP  Attending Physician and Faculty, Department of Emergency Medicine and Residency Program, Lincoln Medical and Mental Health Center

Mark J Leber, MD, MPH, FACEP is a member of the following medical societies: American College of Emergency Physicians and American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Anuritha Tirumani, MD  Research Coordinator, Department of Emergency Medicine, Brooklyn Hospital Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Edward Bessman, MD  Chairman, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine

Edward Bessman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Richard H Sinert, DO  Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

References

  1. Lisboa C, Ferreira A, Resende C, Rodrigues AG. Infectious balanoposthitis: management, clinical and laboratory features. Int J Dermatol. Feb 2009;48(2):121-4. [Medline].

  2. Georgala S, Gregoriou S, Georgala C, et al. Pimecrolimus 1% cream in non-specific inflammatory recurrent balanitis. Dermatology. 2007;215(3):209-12. [Medline].

  3. Zavras N, Christianakis E, Mpourikas D, Ereikat K. Conservative treatment of phimosis with fluticasone proprionate 0.05%: a clinical study in 1185 boys. J Pediatr Urol. Jun 2009;5(3):181-5. [Medline].

  4. Ashfield JE, Nickel KR, Siemens DR, MacNeily AE, Nickel JC. Treatment of phimosis with topical steroids in 194 children. J Urol. Mar 2003;169(3):1106-8. [Medline].

  5. Marques TC, Sampaio FJ, Favorito LA. Treatment of phimosis with topical steroids and foreskin anatomy. Int Braz J Urol. Jul-Aug 2005;31(4):370-4; discussion 374. [Medline].

  6. Steadman B, Ellsworth P. To circ or not to circ: indications, risks, and alternatives to circumcision in the pediatric population with phimosis. Urol Nurs. Jun 2006;26(3):181-94. [Medline].

  7. Van Howe RS. Neonatal circumcision and penile inflammation in young boys. Clin Pediatr (Phila). May 2007;46(4):329-33. [Medline].

  8. Buechner SA. Common skin disorders of the penis. BJU Int. Sep 2002;90(5):498-506. [Medline].

  9. Edwards S. Balanitis and balanoposthitis: a review. Genitourin Med. Jun 1996;72(3):155-9. [Medline].

  10. [Guideline] Edwards SK. European guideline for the management of balanoposthitis. Int J STD AIDS. Oct 2001;12 Suppl 3:68-72. [Medline].

  11. Harrison BP. Pediatric penile swelling. Acad Emerg Med. Apr 1996;3(4):384, 87, 88. [Medline].

  12. Huntley JS, Bourne MC, Munro FD, Wilson-Storey D. Troubles with the foreskin: one hundred consecutive referrals to paediatric surgeons. J R Soc Med. Sep 2003;96(9):449-51. [Medline].

  13. Kiss A, Király L, Kutasy B, Merksz M. High incidence of balanitis xerotica obliterans in boys with phimosis: prospective 10-year study. Pediatr Dermatol. Jul-Aug 2005;22(4):305-8. [Medline].

  14. Kizer WS, Prarie T, Morey AF. Balanitis xerotica obliterans: epidemiologic distribution in an equal access health care system. South Med J. Jan 2003;96(1):9-11. [Medline].

  15. McGregor TB, Pike JG, Leonard MP. Pathologic and physiologic phimosis: approach to the phimotic foreskin. Can Fam Physician. Mar 2007;53(3):445-8. [Medline].

  16. Muratov ID. [Bacteriological pattern of acute purulent balanoposthitis in children]. Zh Mikrobiol Epidemiol Immunobiol. Mar-Apr 2004;83-5. [Medline].

  17. O'Farrell N, Quigley M, Fox P. Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study. Int J STD AIDS. Aug 2005;16(8):556-9. [Medline].

  18. Pugliese JM, Morey AF, Peterson AC. Lichen sclerosus: review of the literature and current recommendations for management. J Urol. Dec 2007;178(6):2268-76. [Medline].

  19. Tanagho EA. Smith's General Urology. 14th ed. New York: McGraw-Hill; 1995:966.

 
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Balanitis xerotica obliterans (lichen sclerosus). Courtesy of Wilford Hall Medical Center Slide collection.
 
 
 
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