Balanitis is inflammation of the glans penis, posthitis is inflammation of the prepuce (foreskin), and balanoposthitis is inflammation of both.
Inflammation of the head of the penis most commonly occurs in patients 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:
Causes of Penile Inflammation
Category | Examples |
|---|---|
Infectious | Herpes simplex virus infection |
Noninfectious | Fixed drug eruptions |
* Reactive arthritis can cause shallow, painless ulcers of the glans (balanitis circinata). | |
Symptoms and Signs of Balanitis, Posthitis, and Balanoposthitis
Pain, irritation, and a subpreputial discharge often occur 2 or 3 days after sexual activity. Phimosis, superficial ulcerations, and inguinal adenopathy may follow.
Diagnosis of Balanitis, Posthitis, and Balanoposthitis
History and physical examination
Selective testing (eg, microbiological testing for infectious causes)
History should include investigation of latex condom use. A comprehensive skin examination should be performed to identify any 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. Daily subpreputial irrigation with normal saline 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 (1) and appears to reduce the risk of HIV infection by about 50 to 60% in males who have sex with females who are HIV-positive (2).
Treatment references
1. Edwards SK, Bunker CB, van der Snoek EM, van der Meijden WI. 2022 European guideline for the management of balanoposthitis. J Eur Acad Dermatol Venereol. 2023;37(6):1104-1117. doi:10.1111/jdv.18954
2. 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 . 2005;2(11):e298. doi: 10.1371/journal.pmed.0020298
