Balanitis or inflammation of the Glans penis

Balanitis

Balanitis is inflammation of the Glans penis, which is the final part of the penis. The Glans is the final portion of the corpus spongiosum, which is the smallest of the three columns of erectile tissue in the penis (the other two are the corpora cavernosa, which are two parallel structures located at the top of this). When inflammation also affects the foreskin is known as balanopostitis.
Balanitis produces in almost all cases redness of the Glans and the foreskin, and can appear other injuries at that level as blisters, erosions, and whitish or greyish, markings depending on the cause that produces it. In the absence of inflammation, there is pain in the majority of cases, and can also associate itching and burning. The intensity of these symptoms is variable. In addition, it is not uncommon that appear other alterations as the emission of foul-smelling secretions.
This disease is relatively common, because it is about 10-11% of the Genitourinary effects in adult male. It also affects up to 3% of children.
Balanitis may be caused by a multitude of causes. Severity is variable, but most of the time it is a transitory and relatively banal process that evolves favorably with medical treatment, others may progress to invasive cancer, requiring surgery and subsequent follow-up. Therefore, it is important to make the diagnosis as soon as possible, especially if the balanitis is suspected to be a premalignant lesion.
In addition, in many cases you can a sexually transmitted infection associated have, being necessary to treat the affected couple. Lesions that appear on the Glans and the foreskin are very similar in some cases, so the anamnesis (interview physician to the patient to know your symptoms and history) and exploration are very important to make the correct diagnosis.
If there is doubt, testing other more invasive as cutaneous biopsy, allowing to confirm the diagnosis. The treatment depends on the cause that produces balanitis.

Causes of balanitis

Balanitis, inflammation of the Glans, can be caused by multiple causes, the most common being the lack of hygiene in uncircumcised patients and the use of soaps, perfumes or preservatives containing chemicals that irritate the glans. Although there are other reasons that may lead, ranging from trivial conditions to more serious premalignant lesions. The most important causes of occurrence of balanitis are:

Infections:

• Fungi (Candida albicans )).
• Bacteria of different types (G. Vaginalis, Group A Streptococcus, Staphylococcus aureus, T. vaginalis or syphilis).
• Virus: herpes virus, the human papillomavirus (HPV).

Dermatological diseases:

• Lichen Sclerosus.
• Circinate Balanitis.
• Psoriasis.
• Pemphigus.
• Zoon's Balanitis.
• Premalignant lesions, such as Erythroplasia of Queyrat, or Bowen's disease.

Other causes of balanitis:

• Irritants (soaps, perfumes, creams of intimate...).
• Lack of hygiene.
• Contact Dermatitis (irritation of the Glans to come into contact with different types of products).
• Drugs (fixed drug eruption erythema).
• Trauma.
• Stevens-Johnson Syndrome.

Symptoms and types of balanitis

The symptoms and signs of patients suffering from balanitis - inflammation of the Glans - are similar in many cases, however, there are some peculiarities depending on the cause producing it, which leads to talk about different types of balanitis:

Balanitis Candidomycetica

It is characterized by the appearance in the Glans of a red rash that is accompanied by pain or itching. The typical lesions are macules and papules, some of which may be eroded. The macules are spots not super-heating of small size (less than a centimeter), while papules also have a reduced size but, on the contrary, are elevated.
The diagnosis of balanitis by Candida albicans usually clinical, i.e., is performed through physical examination unless they are necessary diagnostic tests. However, sometimes there may be doubts. In these cases, is recommended to perform a test with potassium hydroxide or culture to check the growth of the fungus in the laboratory. When a male is candidiasis repeatedly be ruled out the existence of diabetes mellitus.

Balanitis by bacteria

It may be due to two types of germs:

• Balanitis by anaerobic bacteria (germs that do not use oxygen for their metabolism): produce foul-smelling drainage and swelling of the glans.
• Balanitis by aerobes (germs that used oxygen for their metabolism): the symptoms are highly variable depending on the causative agent, and can produce from a small reddening of the Glans until the appearance of fissures and edema in this.

In both cases a Gram stain or culture may be done to know the causative germ.

Balanitis Herpes:

Caused by the virus herpes simplex (HSV), mainly HSV-2, although the prevalence of genital herpes by HSV-1 is more and more because of changes in sexual practices. This type of balanitis symptoms vary depending on whether a primary infection, a non-primary first episode or recurrence:

• Primary infection: the infection or primary first episode is an infection seen in patients not exposed to HSV, and produce more severe symptoms. After an incubation period ranging between 2-14 days, appear papules which develop into vesicles, and these painful ulcers which become scabs. Takes to cure about 10 days, although it depends on each case. It is also often associated with painful inguinal lymph nodes (swollen glands).
• First episode non primary (primary infection asymptomatic): that there has been a prior exposure to HSV makes symptoms less intense and long-lasting. The affected area is more limited and the healing time is faster.
• Recurrent infections: dan symptoms less intense than the two previous shapes. The lesions appear on the same site as in the first episode, but with minor extension.

The diagnosis is usually done with the anamnesis (interview of the doctor to the patient) and the physical examination, although in cases in which there is ulceration of the lesions is advisable to culture for herpes simplex, in addition to serology (Studio that allows to check the existence of antibodies in the blood) to rule out syphilis.

Lichen Sclerosus

Possible inflammatory process causes autoimmune. The typical lesion are whitish plaques on the Glans that sometimes affect the foreskin. There may be hemorrhagic vesicles and, less often, blisters and ulcerations. Involvement of the skin causing Lichen Sclerosus can produce a narrowing of the foreskin, as well appearing phimosis. As it happens the Balanitis Candidomycetica, Lichen Sclerosus usually associated with diabetes mellitus.
Although physical examination is very important to guide the diagnosis of Lichen Sclerosus, biopsy of the lesions is the test that allows to achieve definitive diagnosis.

Circinate Balanitis

It consists of blanco-grisaceas lesions on the Glans, with well-defined whitish edges. It's an inflammatory process that may be associated with other pathologies such as Reiter syndrome reactive arthritis (a disease that is characterized by swelling of the joints, eyes, and urethra).
Although sometimes the diagnosis is reached only with physical examination, often a biopsy may be done to confirm it. In these patients it is recommended to perform a screening for sexually transmitted diseases.

Premalignant lesions (Erythroplasia of Queyrat and Bowen's disease)

The importance of diagnosing these lesions is that they have a fairly high risk of progression to invasive cancer (in lathe to 30% the Erythroplasia of Queyrat and 20% Bowen's disease). Erythroplasia of Queyrat lesions presents a reddish color with velvety appearance and well-defined edges. Whitish lesions may contain elevated, suggesting if they are induradas a squamous cell carcinoma. For its part, in Bowen's disease lesions tend to be reddened plaques.
In addition to physical examination, in these cases, biopsy is essential to rule out carcinoma of penis.

Zoon's Balanitis

More common in older men, uncircumcised, and associated with poor hygiene. It consists of the appearance in the Glans of bright rojo-anaranjadas lesions, with edges well demarcated and multiple pinpoint red spots.
Lesions very similar to the Erythroplasia of Queyrat (premalignant lesion), can be so it is advisable to perform a biopsy to confirm the diagnosis.

Balanitis by irritants (allergic)

The form of presentation is very variable, producing from a light redness of the Glans to great inflammation and swelling of this. It is almost always associated with frequent washing of the genitals, but only in a small percentage of cases the causative agent of injury find out is.
Sometimes performing a test of provocation may be useful to try to discover the cause. In these patients is often history of atopy, i.e. are immunologically speaking more sensitive than the rest of the population to such as asthma, eczema, atopic dermatitis or allergic rhinitis allergic disorders.

Drugs (fixed drug eruption erythema)

A rash appears on the skin 24-48 hours after having managed the responsible drug. The lesions are variable in appearance, although they tend to be one or more macules of well-defined edges and reddish or purplish coloration (the macules are less than a centimeter elevated lesions). Blisters or ulcerations may also appear.
Medical history performed by the physician is essential to make the diagnosis in these cases (has to be the antecedent of having used a drug in the previous days). Drugs that most commonly cause this type of injury include barbiturates, antibiotics (tetracycline or sulfa drugs), analgesics (paracetamol, aspirin, pyrazolones) and oral contraceptives. It is necessary to explore the oral and ocular mucosa to see if there are injuries. The appearance of lesions after the readministration of the drug confirms the diagnosis of fixed drug eruption erythema.

Diagnosis of balanitis

The anamnesis (interview specialist the patient to know your symptoms and State) and medical history are a very important pillar in the diagnosis of balanitis - inflammation of the Glans penis - and balanopostitis - inflammation of the foreskin. In some cases, as in produced by drugs (fixed drug eruption erythema) balanitis, an anamnesis directed towards the use of drugs in the days before is essential to make the diagnosis. The same occurs in balanitis by irritants or which is related to lack of hygiene.
The physical examination is also crucial, since although the clinical presentation is similar in many cases, there are some peculiarities depending on the cause, arising from balanitis. The appearance of the lesions and their characteristics allow the doctor a diagnosis.
Often the diagnosis of balanitis can be with the anamnesis and physical examination detailed, without the need for additional testing, but there are conditions in which carrying out other tests such as skin biopsy is required to rule out premalignant lesions. If there are doubts about the diagnosis a biopsy can be performed. Another frequently used test is the cultivation of a sample obtained from the lesions of the Glans or foreskin.
Carrying out other tests as an analysis of blood or urine, a chest x-ray or other more specific tests depends on the diagnosis. They will be only if the doctor considered necessary to rule out other diseases or complications associated.

Balanitis treatment

General measures to treat balanitis include wash the area with warm water or saline a couple of times a day and avoid soaps or other substances that can be irritating when there is inflammation of the Glans penis.
And it is that many cases of balanitis can be avoided with an proper hygiene of the penis . So, it is necessary to perform a complete wash of it, including the retraction of the foreskin to expose the Glans, and may as well clean it comfortably. This prevents the accumulation of dirt on the bridle and the glans. It will then dry the area as it is done with the rest of the body. It is not good to an excessive washing, because it favors the appearance of irritation.
If the cause of the balanitis is a sexually transmitted disease, they have to adopt the key recommendations indicated by the primary care physician or medical specialist for your specific case.
On the other hand, depending on which is the causative agent of balanitis, will begin a treatment specific or other:
Treatment of balanitis Candidomycetica: when it produces symptoms, being of choice antifungals such as clotrimazole or miconazole. Given that the rate of infection in the couple is quite high, it is advisable to also try this, especially if you develop symptoms. In cases of balanitis Candidomycetica recurrent, must rule out the presence of diseases such as diabetes mellitus or HIV.
Balanitis by aerobic and anaerobic treatment: the treatment of choice are antibiotics, which are selected depending on the causative germ suspected. The most commonly used are erythromycin for the aerobic (germs that used oxygen for their metabolism) and metronidazole or Amoxicillin-clavulanic acid to anaerobic bacteria (germs that do not use oxygen for their metabolism).
Balanitis Herpes treatment: medications antiherpetic as valacyclovir, acyclovir or famcicloviris used. If there are very serious or frequent recurrence, it can be maintain treatment suppressor maintenance for a year, since it decreases the risk of these.
Treatment of Lichen Sclerosus: treatment of choice are the topical corticosteroids to achieve remission of the lesion, to subsequently going reducing them gradually. Sometimes intermittent treatment is maintained for some time, for maintenance of remission. The realization of more aggressively as the circumcision or other surgical interventions depends on the degree of involvement of the Glans or foreskin, being something that must be assessed in each case in particular. It is usually to track patients, since a small percentage of cases can contain malignant transformation.
Circinate balanitis treatment: the treatment of choice are the topical corticosteroids, associating a specific treatment if associated infection is suspected. The treatment of the couple is necessary when suspected STD.
Treatment of Erythroplasia of Queyrat and Bowen's disease: surgical excision is the preferred treatment, although sometimes you can opt for alternative treatment. It is obligatory to follow, because there is a risk of recurrence.
Zoon's balanitis treatment: treatment includes general measures (hygiene), medical treatment (topical corticosteroids, antibiotics) and surgical measures (circumcision), rating depending on each case. You can be or not monitoring, on the basis of what it deems the specialist in each case.
Balanitis drug treatment: it is necessary to eliminate the causative drug and if involvement is extensive or severe, moisturizing creams and topical corticosteroids on the lesion may be given.
Treatment of balanitis by irritants (allergic): you must remove the agent precipitating and, depending on each case, add moisturizing creams or topical corticosteroids for several days if deemed appropriate. Thus is INCI

Article contributed for educational purposes