Balanitis is inflammation of the glans penis, posthitis is inflammation of the prepuce, and balanoposthitis is inflammation of both.
Inflammation of the head of the penis most commonly occurs in people with poor hygiene. It has both infectious and noninfectious causes (see table Causes of Penile Inflammation). Often, no cause can be found.
Balanitis usually leads to posthitis except in circumcised patients.
The following conditions predispose to balanoposthitis:
Phimosis (tight, nonretractable prepuce)
Phimosis interferes with adequate hygiene. Subpreputial secretions may become infected with anaerobic bacteria, resulting in inflammation.
Chronic balanoposthitis increases the risk of
Symptoms and Signs of Balanitis, Posthitis, and Balanoposthitis
Pain, irritation, and a subpreputial discharge often occur 2 or 3 days after sexual intercourse. Phimosis, superficial ulcerations, and inguinal adenopathy may follow.
Diagnosis of Balanitis, Posthitis, and Balanoposthitis
Clinical evaluation and selective testing
History should include investigation of latex condom use. The skin should be examined for lesions that suggest a dermatosis capable of genital involvement. Patients should be tested for both infectious and noninfectious causes, especially candidiasis. Blood should be tested for fasting glucose and glycosylated hemoglobin (HbA1C).
Treatment of Balanitis, Posthitis, and Balanoposthitis
Hygiene and treatment of specific causes
Sometimes subpreputial irrigation
Sometimes circumcision
Hygiene measures should be instituted and specific causes treated. Subpreputial irrigation to remove secretions and detritus may be necessary. If phimosis persists after inflammation has resolved, circumcision should be considered. Circumcision reduces the risk of balanitis and appears to reduce the risk of HIV infection by about 50 to 60% in men who have sex with HIV-positive females (1).
Treatment reference
1. Auvert B, Taljaard D, Lagarde E, et al: Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 Trial. PLoS Med 2(11):e298, 2005. doi: 10.1371/journal.pmed.0020298
