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Balanitis Clinical Presentation

  • Author: Mark J Leber, MD, MPH; Chief Editor: Erik D Schraga, MD  more...
 
Updated: Sep 12, 2015
 

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. In a study of patients with type 2 diabetes mellitus, treatment with dapagliflozin (2.5 mg, 5 mg, or 10 mg once daily) was found to be associated with an increased risk of vulvovaginitis or balanitis, related to the induction of glucosuria. According to the authors, events were generally mild to moderate, were clinically manageable, and rarely led to discontinuation of treatment. For dapagliflozin 2.5 mg, 5 mg, and 10 mg, infections were reported in 4.1%, 5.7%, and 4.8% of patients, respectively, as compared to 0.9% in patients with type 2 diabetes who were given placebo.[5, 6]

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

Balanitis xerotica obliterans (lichen sclerosus) is a chronic dermatosis identified by whitish plaques involving the glans and foreskin (shown in the image below).[3, 4, 7]

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

Zoon balanitis is a reddish velvety lesion on the glans.[8, 9, 10]

Reiter disease consists of circinate and eroding lesions on the glans.

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Contributor Information and Disclosures
Author

Mark J Leber, MD, MPH Assistant Professor of Emergency Medicine in Clinical Medicine, Weill Cornell Medical College; Attending Physician, Lincoln Medical and Mental Health Center

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

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, 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.

Additional Contributors

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

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

Disclosure: Nothing to disclose.

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