Balanoposthitis - Symptoms, diagnosis and treatment | BMJ Best Practice

Last reviewed: May 2020

Last updated: October 2018

Summary

Balanoposthitis refers to inflammation of the glans penis and prepuce. It is a descriptive term and not a diagnosis.

There are numerous causes; these can be broadly divided into inflammatory, infective, and pre-cancerous.

The aim of diagnosis and management should be to exclude STI, minimise problems with sexual and urinary function, and reduce the risk of cancer of the penis.

A specific causative condition should be identified and treated aggressively. Non-specific balanoposthitis is a diagnosis of exclusion.

Patients will typically present in a primary care setting. Input from specialists, particularly dermatologists and urologists, may be very helpful in the management of poorly responsive or complex cases.

Definition

Balanoposthitis refers to inflammation of the glans penis and prepuce. It is a descriptive term rather than a diagnosis. It can be regarded as a special sort of dermatosis that occurs within a skin fold (i.e., an intertrigo). By definition, balanoposthitis cannot occur in a circumcised male, although balanitis (inflammation of the glans penis) might. There are many possible causes of balanoposthitis, and these can be broadly divided into inflammatory, infective, and pre-cancerous.[1]

History and exam

Key diagnostic factors

presence of risk factors
uncircumcised state

More key diagnostic factors

Other diagnostic factors

multiple sexual partners
high-risk sexual behaviours
post-inflammatory hypo- or hyper-pigmentation
pruritus
red scaly patches
erosions
personal/family history of atopy (eczema, hay fever, asthma, type I allergies)
personal/family history of psoriasis
urinary dribbling
hypo-pigmentation
purpura
red plaques
blisters
papules or micro-papules
pustules

Other diagnostic factors

Risk factors

congenital or acquired dysfunctional foreskin
uncircumcised state
poor hygiene; urinary dribbling or leakage
over-washing
human papillomavirus (HPV) infection
inflammatory skin diseases
Borrelia infection

More risk factors

Diagnostic investigations

1st investigations to order

swab for microbiology (Gram stain and culture) and PCR
swab for virology
dark-field microscopy

More 1st investigations to order

Investigations to consider

skin biopsy
patch testing

More investigations to consider

Treatment algorithm

ACUTE

atopic eczema

seborrhoeic dermatitis

irritant contact dermatitis

allergic contact dermatitis

psoriasis

reactive arthritis (Reiter's disease)

lichen sclerosus

gonorrhoea

candidosis

non-specific balanoposthitis

Zoon balanitis

carcinoma in situ/penile intraepithelial neoplasia (PeIN)

Contributors

AuthorsVIEW ALL

Ien Chan, MD, MRCP

Consultant Dermatologist

St Mary's Hospital

Imperial College Healthcare NHS Trust

London

UK

Disclosures

IC declares that he has no competing interests.

David Hawkins, FRCP

Consultant Genitourinary Physician

Chelsea and Westminster Hospital

London

UK

Disclosures

DH declares that he has no competing interests.

Christopher Bunker, MA, MD, FRCP

Consultant Dermatologist

Honorary Professor of Dermatology

University College London

Chelsea & Westminster Hospitals

London

UK

Disclosures

CB has received honoraria as European Society of Urology speaker. He is an author of a number of references cited in this topic.

Peer reviewersVIEW ALL

Colm O'Mahony, MD, FRCP, BSc, DIPVen

Consultant in Sexual Health

Department of Sexual Health

Countess of Chester Hospital NHS Foundation Trust

Chester

UK

Disclosures

CO declares that he has no competing interests.

Sarah Edwards, MD

Consultant

Department of GU Medicine

West Suffolk Hospital

Suffolk

UK

Disclosures

SE declares that she has no competing interests.

David Paige, MD

Consultant Dermatologist and Honorary Senior Lecturer

Dermatology Department

The Royal London Hospital

London

UK

Disclosures

DP declares that he has no competing interests.

Jashin Wu, MD

Chief Dermatology Resident

University of California

Irvine

CA

Disclosures

JW declares that he has no competing interests.

Christopher Huston, MD

Assistant Professor of Medicine

Division of Infectious Diseases

University of Vermont College of Medicine

Burlington

VT

Disclosures

CH declares that he has no competing interests.

Nanette Silverberg, MD

Clinical Professor of Dermatology

Columbia University College of Physicians and Surgeons

New York City

NY

Disclosures

NS declares that she has no competing interests.

Julian Trevino, MD

Associate Professor of Dermatology and Dermatology Residency Program Director

Boonshoft School of Medicine

Wright State University

Dayton

OH

Disclosures

Speaker's Bureau, Stiefel; Consultant, Abbott.

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