What is balanoposthitis?

It is defined as an inflammation of the glans and the foreskin seen in men without circumcision. Balanoposthitis may appear in men of various ages, and it may be caused by the multiple bacteria or fungi of the foreskin micro-environment, or it may be due to dermatitis.

Complex infections have been well documented, often from a poorly retractile foreskin and poor hygiene that leads to colonisation and overgrowth.

Treatment focuses on clearing the acute infection and preventing recurrent inflammation/infection through improved hygiene. Although not as necessary as in the past, circumcision may be considered for refractory or recurrent balanoposthitis.

Balanoposthitis should not be confused with balanitis, which is inflammation glans penis or the clitoris.

Pathophysiology

Although multiple organisms have been incriminated as causative agents, the patient is usually empirically treated without obtaining specific cultures.

Candida fungal infection seems to be the most common cause of the disease. Other aetiologies are often evident among older men, including intertrigo, contact dermatitis and other fungal infections. Among the species that have been identified, Bacteroides, Gardnerella, and non albicans Candida species are included, as well as beta-haemolytic Streptococcus.

Rare causes include Streptococcus pyogenes, Prevotella melaninogenica, Cordylobia anthropophaga, Providencia stuartii, and Pseudomonas.

Mortality / Morbidity

Apart from the relatively irritating symptoms, morbidity is limited. Mondor phlebitis of the penis following recurrent candidal balanoposthitis has been reported.

Mortality is only present in patients who are immunocompromised and often develop balanoposthitis secondary to fungal septicaemia.

Race

Analyses of race or ethnic background have not been performed, although balanoposthitis, because of its heterogenous aetiology, has been described in many races and ethnic backgrounds.

Gender

Balanoposthitis only occurs in males.

Age

Although identified over a wide age range, most studies have focused on the juvenile population, 0-5 years, or in sexually active adult males.